CONTEXT For patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of op...

Osteoarthritis (OA) of the knee, one of the most common causes of disability, continues to increase in prevalence as the older adult and obese populations grow. Often, the general practitioner is the first to evaluate a patient with a painful knee that has arthritis. Evidence-based evaluation and treatment guidelines recommend the use of nonoperative treatments before surgical treatment options...

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately control...

Clavicle fractures are among the most common skeletal injuries accounting for 2-5% of all adult fractures. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Furthermore, nonoperative treatment has been challenged by an increasing popularity and rate of surgical fixations in recent years despite a lack of clear evidence in the current...

Recurrent pyogenic cholangitis (RPC) is characterized by repeated infections of the biliary system with the formation of stones and strictures. The management aims are to treat acute cholangitis, clear the biliary ductal debris and calculi, and eliminate predisposing factors of bile stasis. Operative options include hepatectomy and biliary drainage procedures or a combination of both; nonoperat...

STUDY DESIGN Concurrent, prospective, randomized, and observational cohort study. OBJECTIVE To assess the 4-year outcomes of surgery versus nonoperative care. SUMMARY OF BACKGROUND DATA Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to nonoperative treatment remain controversial. METHODS Surgical candida...

Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union, and the functional outcomes are good after nonoperative treatment. Nonoperative treatment of displaced shaft fractures may be associated with a higher rate of nonunion and functional deficits than previously reported. However, it remains difficult to predict which patients will have these ...

OBJECTIVES To compare clinical and functional outcomes after operative and nonoperative treatment of undisplaced, unstable, isolated fibula fractures. DESIGN Randomized multicenter clinical trial. SETTING Six level 1 trauma centers. PATIENTS/PARTICIPANTS Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demons...

INTRODUCTION The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up. AIM Update knowledge about the spleen injury. METHOD Was performed review of the literature on the nonoperativ...

Exercise and athletic competition for the young individual has become increasingly more important in society. Scoliosis and Scheurmann kyphosis are spinal deformities prevalent in up to 2% to 3% and 7% of the population respectively, requiring nonoperative and occasionally operative treatment. Curve progression and patient physiologic age dictate treatment regimens. Bracing and physical therapy...