- N Engl J Med 2022; 387:e14
A 74-year-old woman with psoriatic arthritis presented with swelling of the fifth finger. On examination, there were nontender, subcutaneous nodules in the hypothenar region and over the fifth finger.
- N Engl J Med 2022; 387:368-370
An estimated one third or more of U.S. adults 60 years of age or older take vitamin D supplements, not including those who take multivitamins or other compounds containing vitamin D.1 Yet controversy continues about its overall benefits. In this issue of the Journal, LeBoff and...
- N Engl J Med 2022; 387:299-309
A study ancillary to a large trial showed that supplemental vitamin D3 did not lower the risk of fractures among generally healthy midlife and older adults not selected for vitamin D deficiency, low bone mass, or osteoporosis.
- N Engl J Med 2022; 386:e65
Hip pain is common, and the hip joint is complex. Obtaining a relevant patient history and conducting a proper physical examination can be challenging. This video demonstrates how to assess a patient with hip pain.
- N Engl J Med 2022; 386:2316-2326
A 29-year-old woman presented with recurrent bone fractures and hypophosphatemia. The patient had been well until 19 months before admission, when pain in the right foot developed. During the next 19 months, multiple fractures of the metatarsal bones of the right foot occurred. On admission, the blood phosphorus level was...
- N Engl J Med 2022; 386:2213-2220
Cold injury is a combination of direct cellular damage from freezing and cellular ischemia from vasospasm and small-vessel thrombosis. The severity is related to the degree to which frozen tissues are reperfused on thawing.
- N Engl J Med 2022; 386:e55
A 61-year-old man presented with a 2-day history of left upper back pain. Computed tomographic angiography revealed aneurysmal dilatation of the ascending aorta, aortic arch, and descending thoracic aorta.
- N Engl J Med 2022; 386:1742-1749
An 82-year-old woman presented to the emergency department with a 3-week history of severe low back pain, rigors, anorexia, difficulty ambulating, and a sensation of incomplete urination. She had no numbness, tingling, weakness, saddle anesthesia, or fecal incontinence.
- N Engl J Med 2022; 386:1409-1420
In this multicenter trial involving patients with acute Achilles’ tendon rupture, surgery (open repair or minimally invasive surgery) did not result in better outcomes than nonoperative treatment at 12 months.
- N Engl J Med 2022; 386:1465-1466
Acute rupture of the Achilles’ tendon can be a life-changing event, since it leaves many patients with permanent deficits. One year after injury, 4 in 10 patients with Achilles’ tendon rupture have returned to their preinjury sport activities, and 1 in 2 patients considers their level of symptoms to be...
- N Engl J Med 2022; 386:594-595
A majority of persons in whom a femoral neck fracture occurs have physical impairment, cognitive impairment, or both. For these patients, a hemiarthroplasty is considered to be the most suitable treatment; bone cement may or may not be used for fixation of the prosthesis. Using an uncemented stem reduces both...
- N Engl J Med 2022; 386:521-530
In this multicenter, randomized trial comparing cemented with modern uncemented hemiarthroplasty in persons 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty.
- N Engl J Med 2022; 386:300-302
To reduce the harm associated with improper financial relationships between manufacturers and physicians, practitioners could be required to disclose such relationships directly to patients.
- N Engl J Med 2022; 386:e4
A 34-year-old man presented with sudden onset of pain in his right foot after landing a jump in a handball game. Imaging showed a severe Lisfranc injury, or injury to the tarsometatarsal joint complex. He underwent immediate surgical repair and recovered well.
- N Engl J Med 2021; 385:2161-2172
A phase 2 trial compared various doses of milvexian with standard enoxaparin for thromboprophylaxis after total knee replacement. Venous thromboembolism occurred in 7 to 8% of patients who received 200 mg of milvexian once or twice daily and in 21% of those who received enoxaparin. The risk of bleeding was...
- N Engl J Med 2021; 385:2179-2179
A 36-year-old man presented with a large mass on his back after he slipped on the stairs and slid down on his back. Magnetic resonance imaging showed a large, encapsulated, subcutaneous, suprafascial lesion consistent with a Morel–Lavallée lesion.
- N Engl J Med 2021; 385:2173-2178
Spontaneous cerebrospinal fluid leakage causes orthostatic headache, and mental dullness, diplopia, and coma may occur. Most cases are due to a tear in the spinal CSF membranes. MRI shows enhancement of the dura, and special imaging, such as digital-subtraction myelography (shown in videos), may be required to show the leakage...