Anterior Subconjunctival Anesthesia for Manual Small Incision Cataract Surgery: A Randomized Controlled Trial.

Purpose: To compare the effectiveness of anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for manual small incision cataract surgery (MSICS), regarding pain, akinesia, surgeon comfort, and complications.

Methods: This trial randomized 164 patients into two groups. Group 1 received ASCA, and Group 2 received STA.

Impact of accreditation on documentation and staff perception in the ophthalmology department of an Indian medical college.

Purpose: National Accreditation Board for Hospitals and Healthcare Providers operates the health-care accreditation program in India. Research on impact of accreditation on eye-care centers is scarce. This article was conceptualized to scientifically evaluate the changes in documentation brought about by accreditation and its effects on staff in the Ophthalmology Department of an Indian Medical College.

Osteomyoplastic Transtibial Amputation: The Ertl Technique.

Amputation may be required for management of lower extremity trauma and medical conditions, such as neoplasm, infection, and vascular compromise. The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing.

Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes.

Background: Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures.

Questions/purposes: We evaluated our results in patients with acetabulum fractures with the modified Stoppa approach in terms of (1) hip function as measured by the Merle d'Aubigne hip score; (2) complications; and (3) quality of fracture reduction and percentage of fractures that united.

Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis--a feasibility study.

Background: Specialized treatment of plantar fasciitis that can reduce inflammation and promote healing may be a possible alternative prior to surgical intervention. We report the results of a randomized clinical trial examining the efficacy of micronized dehydrated human amniotic/chorionic membrane (mDHACM) injection as a treatment for chronic refractory plantar fasciitis.

Methods: An institutional review board-approved, prospective, randomized, single-center clinical trial was performed.

Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques.

Introduction: The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.

Step 1 Preoperative Planning: As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.

Step 2 Flap Design: Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.

Gritti-stokes amputations in the trauma patient: clinical comparisons and subjective outcomes.

Background: The Gritti-Stokes amputation procedure is a modification of the traditional transfemoral amputation, with resection of the bone at a supracondylar femoral level and fixation of the patella to the distal part of the femur as an end-cap. Although well-established in patients with vascular compromise, no evidence exists on its use in the trauma setting.

Methods: Fourteen consecutive patients who underwent Gritti-Stokes amputation and fifteen consecutive patients who underwent traditional transfemoral amputation by fellowship-trained orthopaedic traumatologists at a level-I trauma center were evaluated at more than fourteen months postoperatively.

Induced membrane technique for reconstruction to manage bone loss.

Multiple surgeries are often required to manage segmental bone loss because of the complex mechanics and biology involved in reconstruction. These procedures can lead to prolonged recovery times, poor patient outcomes, and even delayed amputation. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge.

Definitive treatment of bilateral acetabular and pelvic ring injuries using external fixation.

Bilateral pelvic ring and acetabular fractures are rare injuries. The optimal treatment of these patients and their outcomes remain largely unknown. We present a three year follow up of a case of bilateral posterior pelvic ring injuries and acetabular fractures treated successfully with limited internal fixation and external fixation.

Adolescents' perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention.

Purpose: This study examined African American adolescents' perceptions of a mobile cell phone (MCP)-enhanced intervention and development of an MCP-based HIV prevention intervention.

Design And Methods: One focus group was conducted with 11 adolescents who participated in the Becoming a Responsible Teen Text Messaging project.

Results: Adolescents said they benefited from the MCP-enhanced approach and were receptive to the idea of developing an MCP-based intervention.

Osteomyoplastic transtibial amputation: technique and tips.

Treatment of severe lower extremity trauma, diabetic complications, infections, dysvascular limbs, neoplasia, developmental pathology, or other conditions often involves amputation of the involved extremity. However, techniques of lower extremity amputation have largely remained stagnant over decades. This article reports a reproducible technique for transtibial osteomyoplastic amputation.

Osteomyoplastic and traditional transtibial amputations in the trauma patient: perioperative comparisons and outcomes.

We hypothesized that patients undergoing transtibial amputation osteomyoplasty would have better functional outcomes than patients undergoing traditional transtibial amputation. We conducted a retrospective review of the medical and radiographic records to evaluate and compare 26 patients who underwent transtibial amputation osteomyoplasty and 10 patients who underwent traditional transtibial amputation, with specific attention to perioperative complications and functional outcomes. At >1 year follow-up, patients who underwent amputation osteomyoplasty had significantly improved rates of return to work and decreased rates of revision than patients who underwent traditional transtibial amputation.

Traumatic abdominal hernia and lateral compression type 1 pelvic fracture: a case report.

Pelvic fractures often are associated with concomitant injuries. In general, the more severe the pelvic fracture, the more likely other, potentially life-threatening injuries exist. We present a case of a typical type 1 lateral compression pelvic fracture with the less common associated injury of abdominal wall muscle disruption and large-bowel herniation.

Perioperative management of foot and ankle trauma.

This review covers the perioperative management of trauma to the foot and ankle. The goal when treating these injuries is to return the patient to a sensate, plantigrade, painless, and functioning foot and ankle. Depending on the nature of the trauma, realistic outcomes should be established for the patient, family, and surgeon.

Prospective comparison of retrograde and antegrade femoral intramedullary nailing.

Objective: To prospectively compare the results, function, and complications of antegrade and retrograde femoral nailing for femoral shaft fractures.

Design: Prospective, randomized.

Setting: Urban Level 1 trauma center.

Effects of retrograde femoral intramedullary nailing on the patellofemoral articulation.

Objective: To determine the patellofemoral contact areas as well as mean and maximal pressures after retrograde intramedullary nailing in a cadaveric model.

Study Design: Pressure-sensitive film was used to analyze patellofemoral joint pressures after insertion of a retrograde femoral nail in a cadaveric specimen.

Methods: A retrograde femoral nail was inserted into seven cadaveric knees.

Retrograde intramedullary nailing of femoral diaphyseal fractures.

Objectives: To prospectively evaluate the results of retrograde intramedullary nailing of femoral shaft fractures.

Design: Prospective, consecutive series.

Patients And Setting: All patients with a femoral shaft fracture admitted at an urban Level 1 trauma center from December 1995 to December 1996 were treated with a retrograde femoral intramedullary nail.

Indications and techniques for external fixation of the pelvis.

Pelvic ring disruption is often accompanied by severe, multiple injuries to the organs, vessels, and nerves within the true pelvis. Mortality in the acute resuscitative period is usually due to hemorrhage and hemodynamic instability. Establishing rapid, provisional pelvic stability with external fixation is of immediate importance in the hemodynamically unstable patient, because fixation contributes to hemostasis.

Intramedullary nailing of femoral shaft fractures. Part III: Long-term effects of static interlocking fixation.

The results of treatment of fractures of the femoral shaft with static interlocking nailing were reviewed retrospectively to determine the clinical importance of any stress-riser or stress-shielding properties of the nail. These properties, if relevant, would have been manifested by refracture of the femur, either through a hole used for a locking screw or through the original site of fracture after extraction of the device. Two hundred and fourteen fractures that had been treated with static interlocking nailing and that had healed without conversion to dynamic intramedullary fixation were divided into two groups.

Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur.

A review of the data on 684 fractures of the femur that had been treated with intramedullary nailing led to the identification of twenty-three patients who had had a fracture of the shaft of the femur with an accompanying ipsilateral supracondylar fracture (twelve patients, group I) or a concomitant ipsilateral intercondylar fracture (eleven patients, group II). The group-I fractures had been treated with interlocking nailing without supplemental fixation. In group II, ten fractures were stabilized with interlocking nailing and supplemental screw fixation and one, with interlocking nailing and a supplemental plate and screws.

Complications of reamed intramedullary nailing of the tibia.

A retrospective review of 60 acute fractures of the tibia treated with reamed intramedullary nailing was undertaken to document the spectrum of complications associated with this procedure. Forty-five tibial fractures were followed to radiographic union; follow-up averaged 25 months (range, 10-63 months). Complications were categorized into intraoperative, early postoperative, and late postoperative groups.

Heterotopic ossification about the hip after intramedullary nailing for fractures of the femur.

A prospective study of 100 consecutive unilateral fractures of the shaft of the femur was performed to delineate the incidence of, and the factors predisposing to, heterotopic ossification about the hip after intramedullary nailing. Bone debris from reaming of the endosteal canal is deposited in the soft tissues surrounding the site of insertion of the nail, and we postulated that this debris may stimulate the formation of heterotopic bone and that decreasing the amount of debris left in the tissues after nailing may decrease the amount of heterotopic ossification. To test this theory, the patients were treated with routine intramedullary nailing and were randomly divided into two groups.

Pelvic ring disruptions: effective classification system and treatment protocols.

From January 1, 1985, to September 10, 1988, 210 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to a statewide referral center for adult multiple trauma. They were treated by one of four attending orthopaedic traumatologists per protocol as determined by their injury classification and hemodynamic status; the injury classification system was based on the vector of force involved and the quantification of disruption from that force, i.e.