Posterior Hip Precautions Do Not Impact Early Recovery in Total Hip Arthroplasty: A Multicenter, Randomized, Controlled Study.

BACKGROUND: Posterior hip precautions have been routinely prescribed to decrease dislocation rates. The purpose of this study was to determine whether the absence of hip precautions improved early recovery after total hip arthroplasty via the posterolateral approach. METHODS: Patients undergoing total hip arthroplasty via the posterolateral approach at 3 centers were enrolled. Patients meeting the selection criteria were randomized to standard hip precautions (SHP) or no hip precautions (NHP) for 6 weeks following surgery. HOOS Jr, Health State visual analog score, and rate of pain scores were recorded preoperatively and in subsequent postoperative visits; dislocation episodes were also noted. Standard statistical analysis was performed. RESULTS: From 2016 to 2017, 159 patients were randomized to SHP and 154 patients were randomized to NHP. Controlling for the center at which the surgery was performed, the only difference in outcome scores between the 2 groups was at 2 weeks; the NHP group had a lower HOOS Jr score when compared to the SHP group (P = .03). There was no difference in outcome scores at any other time points when compared to preoperative assessments. In the SHP group, there were 2 recorded dislocations (1.3%) and 1 in the NHP group (0.7%; P = .62). CONCLUSION: In this multicenter, randomized, controlled study, the absence of hip precautions in the postoperative period did not improve subjective outcomes which may be explained by the self-limiting behavior of NHP patients. Furthermore, with the numbers available for the study, there was no difference in the rate of dislocation between the 2 groups.

Safety and Complications Associated With MRI-Conditional External Fixators in Patients With Tibial Plateau Fractures: A Case Series.

OBJECTIVES: To address the safety of obtaining magnetic resonance imaging (MRI) in patients with temporary knee-spanning external fixators placed for tibial plateau fractures. DESIGN: Institutional Review Board-approved retrospective review. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Records were reviewed on patients with knee-spanning external fixators applied during staged management of tibial plateau fractures from 2009 to 2015 and who also had an MRI performed. MAIN OUTCOME MEASUREMENTS: Complications associated with the MRI; secondary outcomes were pain scores, narcotic requirements, and fracture healing. RESULTS: A total of 56 patients with 57 fractures were included, and 55 scans (96.5%) were completed without complication. Two scans (3.5%) were stopped prematurely for patient-reported pain and subjective warmth of the external fixator. For all 57 studies, pain scores and narcotic usage were unchanged, and all fractures healed without complication. CONCLUSIONS: Knee-spanning external fixator placement does not preclude MRI for patients with tibial plateau fractures. MRIs can be safely performed on patients with external fixators if patients are educated before imaging. Even in the small percentage of patients who experienced discomfort, there were no long-term complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Acute Carpal Tunnel Syndrome: A Review of Current Literature.

Acute carpal tunnel syndrome is a progressive median nerve compression leading to loss of two-point discrimination. Most cases encountered are in the emergency department following wrist trauma and distal radius fractures. Although rare, atraumatic etiologies have been reported and diligent evaluation of these patients should be performed. If missed or neglected, irreversible damage to the median nerve may result. Once diagnosed, emergent carpal tunnel release should be performed. If performed in a timely manner outcomes are excellent, often with complete recovery.

Reliability of school surveys in estimating geographic variation in malaria transmission in the western Kenyan highlands.

BACKGROUND: School surveys provide an operational approach to assess malaria transmission through parasite prevalence. There is limited evidence on the comparability of prevalence estimates obtained from school and community surveys carried out at the same locality. METHODS: Concurrent school and community cross-sectional surveys were conducted in 46 school/community clusters in the western Kenyan highlands and households of school children were geolocated. Malaria was assessed by rapid diagnostic test (RDT) and combined seroprevalence of antibodies to bloodstage Plasmodium falciparum antigens. RESULTS: RDT prevalence in school and community populations was 25.7% (95% CI: 24.4-26.8) and 15.5% (95% CI: 14.4-16.7), respectively. Seroprevalence in the school and community populations was 51.9% (95% CI: 50.5-53.3) and 51.5% (95% CI: 49.5-52.9), respectively. RDT prevalence in schools could differentiate between low (<7%, 95% CI: 0-19%) and high (>39%, 95% CI: 25-49%) transmission areas in the community and, after a simple adjustment, were concordant with the community estimates. CONCLUSIONS: Estimates of malaria prevalence from school surveys were consistently higher than those from community surveys and were strongly correlated. School-based estimates can be used as a reliable indicator of malaria transmission intensity in the wider community and may provide a basis for identifying priority areas for malaria control.