bluuebunny/crossref_metadata_2025 huggingface dataset:
Cement Dam: A Simple Device to Prevent Cement Extrusion
Authors: Callahan Dennis J , Safley Charles K
Published: April 2021

ABSTRACT: Cement extrusion through cortical defects during total hip arthroplasty can be prevented by a simple technique utilizing one or more Penrose drains.

Bone-cement fixation in total joint arthroplasty depends upon interdigitation between the cement and the bony trabeculae.1-3 It has been shown that deeper penetration results in more secure fixation in total hip arthroplasty.4-7 Various methods have been developed to increase the intramedullary pressure, and thus obtain deeper penetration into the trabeculae;5-7 however, once the cortex has been violated by fracture, screws or reaming devices, it is difficult to obtain the necessary intramedullary pressure for secure fixation. If there is only a small hole, it can be blocked by digital pressure. However, when there is a fracture with comminution or loss of fragments, pressurization becomes more difficult, especially if one is simultaneously attempting to maintain the fracture reduction.

The authors have developed a simple, inexpensive, readily available method to contain the cement under pressurization when the cortex has been violated. One or more Penrose drains are wrapped around the femur, pulled tightly over the defect, and clamped with a large clamp (Fig. 1, 2). If there is a fracture, plates can be temporarily wired over these Penrose drains or the drains may be placed over the plates holding the reduction . Once the prosthesis is placed, the cement pressurized and the curing process begun, the Penrose drains may be removed.

A device similar to our cement dam is described in the product literature from the Richards Company. 8 That device consists of a silastic membrane and curved plastic plate, which can be wired over a single large defect. Although the concept of this device is similar to the device we describe, it requires special equipment. It also is more limited in its usefulness, being mainly applicable for a single large gutter-type defect. The cement dam that we describe can be adapted to circumferential defects, múltiple small defects, or single large defects.
Muscle Fiber Types
Authors: Arendt Elizabeth A
Published: April 2021

ABSTRACT; Muscle fiber can be typed according to histologic, biochemical, neurophysiology, and ultrastructural differences. The relationship between muscle fiber typing and clinical areas of investigation is summarized. Genetic factors are largely responsible for the distribution of main muscle fiber types. Strength training produces relatively slight alterations in muscle properties, as defined by present analytic techniques. The functional adaptation of skeletal muscle are dependent on a multitude of factors, which at the present time are not completely understood. Key indexing terms: Muscle fiber; Red fiber; White fiber.
Acute and Latent Effect of Poliomyelitis on the Motor Unit as Revealed by Electromyography
Authors: Wiechers David O
Published: April 2021

ABSTRACT: When polio virus attacks the motor neuron H may be completely destroyed, damaged, or unaffected. Muscle fibers of a destroyed motor neuron are orphaned or reinnervated. Nearby functioning motor units will then send terminal axon sprouts to reinnervate the orphaned muscle fibers. If there are too many orphaned muscle fibers and not enough surviving motor units to reinnervate them, the orphaned muscle fibers will continue to fibrillate until they atrophy and the. The resultant effect of poliomyelitis upon the affected muscle is an overall loss of motor units with the remaining units innervating many more muscle fibers than they originally did.

There appears to be a late effect of polio upon these larger reinnervated motor units. After approximately 20 to 30 years, impulse transmission to the muscle fibers of the large reinnervated motor unit begins to fail. These transmission difficulties increase with age and time from recovery. These late onset transmission abnormalities may be factors in patient complaints of fatigue and progressive weakness.
Polio Residuals Clinic: Conditioning Exercise Program
Authors: Owen Richard R , Jones David
Published: April 2021

ABSTRACT: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.
The Embedded Ring: Case Report and Review of the Literature
Authors: Fleeter Thomas B , Gunther Stephen F
Published: April 2021

ABSTRACT: A tight ring can become embedded in the finger of a chronically ill patient. A case is presented with discussion of the literature on this subject.
Congenital Carpal Tunnel Syndrome: A Case Report
Authors: Leslie Bruce M , Ruby Leonard K
Published: April 2021

ABSTRACT: A boy with bilateral idiopathic congenital carpal tunnel syndrome was first seen at the age 4 years 6 months. He presented with triggering of the finger flexors at the wrist, abnormal posturing of the fingers and inability to pinch on one side. The triggering was relieved by transection of the transverse retinaculum. Pinch was restored by a tendon transfer. There have been no previous reports of idiopathic carpal tunnel syndrome present since birth. The literature and case are reviewed.
Prevention of Quadriceps Wasting After Immobilization: An Evaluation of the Effect of Electrical Stimulation
Authors: Arvidsson Inga , Arvidsson Håkan , Eriksson Ejnar , Jansson Eva
Published: April 2021

ABSTRACT: Eighteen male and 20 female patients who underwent reconstruction of their anterior cruciate ligament (ACL) with a flap from the patellar tendon were randomly assigned into either closed cast, isometric muscle training and electric stimulation (ES group), or closed cast and isometric training alone (control group).

The degree of quadriceps wasting was determined from computerized tomographic scans (CT) before and 6 weeks after surgery. Electrical stimulation was given with a battery operated stimulator that produced a rectangular asymmetric balanced biphasic pulse shape. The pulse rate was 40 Hz and the pulse width 300 µ5. Patients received 30 min of stimulation three times daily during 5.5 weeks. Female control patients showed a larger decrease in quadriceps area on CT than male control patients (P<.001). No significant difference was found between male electrically stimulated patients and control patients. In female patients, there was on the contrary, a highly significant difference in favor of electrical stimulation (P<.001)

When the different parts of the quadriceps were studied, a significantly lower degree of atrophy of the vastus medialis was found after electrical stimulation, vastus lateralis did not show any difference.

Measurements of CT attenuation, pre- and postoperatively, showed a decrease in attenuation of 17% for the vastus medialis and lateralis of the operated leg after immobilization, indicating an increase in fat content. In the rectus femoris, however, there was an increase in attenuation of 14.6%.

Percutaneous muscfe biopsies from the vastus lateralis obtained before, one week after, and 6 weeks after surgery revealed that the cross-sectional area of the individual muscle fibers decreased less in the electrically stimulated than in controls, but the difference was not significant. There were no differences between the two groups in the activity of an oxidative enzyme, citrate synthase, or a glycolytic enzyme, phosphorructokinase (PFK).

We conclude that females reacted more favorably than males to electrical stimulation of quadriceps during an immobilization period after knee surgery.
Use of Polydioxanone Absorbable Monofilament Sutures in Orthopedic Surgery
Authors: Miles James S
Published: April 2021

ABSTRACT: The safety and efficacy of polydioxanone absorbable monofilament sutures was documented in 57 orthopedic surgery patients (32, dyed sutures; 25, undyed sutures), 55 of whom were followed for at least 42 days postoperatively. The other two patients were lost to follow up prior to 42 days. The final clinical outcome was excellent in all completed study subjects. No suture-related adverse effects were reported. Both dyed and undyed sutures were consistently better than surgical gut with respect to pliability, strength, ease of passage, ease of tying, fraying, knot security, and overall handling. Intraoperative visibility of dyed polydioxanone sutures was consistently superior to that of surgical gut. The visibility of undyed sutures was rated better than surgical gut in 16 cases, equal in 8, and worse in 1. Both the overall handling of the polydioxanone monofilament sutures and performance as it affected wound healing were significantly superior to those of surgical gut.
Bilateral Patellar Ligament Rupture: A Case Report
Authors: Olen Richard N , Chmell Samuel
Published: April 2021

ABSTRACT: Patellar ligament ruptures are uncommon injuries; bilateral ruptures are rarely seen. When they do occur they are associated with chronic disease states. A case of a bilateral patellar ligament rupture secondary to trauma in a healthy man is presented. Appropriate management with aggressive surgical repair and rehabilitation are discussed.
Postoperative Laminectomy Pain Control Using Bupivacaine and Epidural Morphine
Authors: Rechtine Glenn R , Love Lucy C
Published: April 2021

ABSTRACT: In a prospective double blind study, 26 patients were evaluated for postoperative pain relief with use of epidural morphine. The variable in this study was the addition of paravertebral bupivacaine used in 14 patients. The addition of the bupivacaine did not have a statistically significant effect on lowering the analgesic requirement during the first 36 hours after surgery, the total dose of medication required during hospitalization, nor the time to the onset of supplemental pain medicine requirement. There were no problems with late respiratory depression. We conclude that the addition of paravertebral bupivacaine is not effective in decreasing the amount of pain medication that is required in lumbar lammectomy patients and adds very little to patients already receiving epidural narcotics.
Calcaneus Fractures: Rationale for the Medial Approach Technique of Reduction
Authors: Bunleaux Billie D
Published: April 2021

ABSTRACT: The fractured calcaneus is an enigma to many orthopedic surgeons. Because of this they are often not reduced as well as they might be. The majority of these fractures can be adequately reduced by the medial approach. This approach is based on the fact that a definite pattern of fracture occurs on the medial side of the calcaneus, whereas there is no pattern on the lateral side. If one restores the medial wall of the calcaneus, which is most accurately done from the medial side, the height, length, and much of the width is restored. Strong pressure over the lateral bulge is necessary to completely restore normal width. Generally, the tongue or joint depression-type fragments can be reduced from the medial side. If not, a separate, lateral incision is used to insure their reduction.

The neurovascular bundle is no longer dissected out, removing a psychological barrier to the medial approach. A strong recommendation is made to use the longitudinal pin method of fixation. It is simple, and extremely strong. A classification of calcaneus fractures is presented, which can help in preoperative planning for reduction of these fractures.
The Use of CT Scan in the Evaluation of Non-Popliteal Synovial Cysts About the Knee
Authors: Eady John L , Yaszemski Michael J
Published: April 2021

ABSTRACT: We investigated the diagnostic approach to non-popliteal synovial cysts about the knee. Included were all cases that occurred at the Wilford Hall USAF Medical Center in the past 5 years. The five patients all presented with a mass about the knee. The history and physical exam placed synovial cyst high on all five differential lists. All patients had a CT scan, and the CT failed to identify the cystic nature of the mass in any of them. We conclude that the CT scan is not useful in the evaluation of suspected nonpopliteal synovial cysts about the knee.
Wrist Arthroplasty: A Retrospective Study
Authors: Cimino Peter M , Riordan Daniel , Edmunds J Ollie , Brunet Michael E , Haddad Ray J , Davis Michael J
Published: April 2021

ABSTRACT: A retrospective study was conducted to evaluate the long-term effectiveness of wrist arthroplasties in patients with various arthritic conditions. A total of 39 wrist arthroplasties were performed in 29 patients (average age, 52.5 years) by the orthopedic staff at Tulane University School of Medicine. Rheumatoid arthritis was the major presenting diagnosis in 84.6% of these operative cases and pain was the most common indication for surgery (79.5%).

Postoperative relief of pain was reported in all of the cases reviewed, with an average follow up period of 51.2 months (range, 12 to 118 months). A group of 15 patients who were examined clinically had an average grip strength of 19.2 lb (range, 6 Ib to 45 Ib). Pinch measurements averaged 1.9 Ib and arc of motion averaged 59.5° (range, 20° to 100°) for these patients. Postoperative complications included dislocation (3 cases), fracture of the prosthesis (2 cases), and infection (2 cases). No complications were observed in 32 (82.1%) of the 39 cases reviewed.

This retrospective study revealed that at an average follow up period of 51.2 months, pain relief was excellent and patient acceptance was good, with 94.9% of the wrists having been improved by the procedure. The majority (82.1%) of the cases were free of complication. It is concluded from this study that wrist arthroplasty is a viable alternative to wrist arthrodesis.
Failure Analysis of PCA Revision Total Knee Replacement Tibial Component: A Preliminary Study Using the Finite Element Method
Authors: Skinner Harry B , Mabey Monique F , Paganelli Jude V , Meagher James M
Published: April 2021

ABSTRACT: This report documents the results of a finite element method (FEM) "worst-case" failure analysis of a stemmed, porous-coated tibial revision component that was designed with "slots" to aid in removal. A three-dimensional FEM model of a metal-backed tibia! component was subjected to expected peak loads while being restrained at the stem and unsupported under the plateaus. Stresses in the prosthesis plateau adjacent to the stem were found to exceed yield stress in many areas, and to exceed the expected endurance limit in large areas. We conclude that a stemmed prosthesis with slots is flawed and may be expected to fail if implanted without adequate support for the prosthesis plateau. The long-term effects of bone remodeling may further jeopardize the integrity of this prosthesis. We recommend that this prosthesis not be used in its present design.
Spontaneous Bilateral Rupture of the Extensor Mechanism of the Knee in Two Patients on Chronic Ambulatory Peritoneal Dialysis
Authors: Lauerman William C , Smith Brian G , Kenmore Peter I
Published: April 2021

ABSTRACT: Two cases of patients on Chronic Ambulatory Peritoneal Dialysis (CAPD) who suffered bilateral, spontaneous rupture of the extensor mechanism of the knee are presented. In neither case was the diagnosis readily apparent. Both patients did well with standard surgical treatment. A review of the literature and consideration of the mechanism of tendon rupture is presented.
Osteoid Osteoma of the Femoral Neck: Excision Through Medial Approach
Authors: Price Charles T
Published: April 2021

ABSTRACT: An 11-year-old girl with osteoid osteoma of the medial femoral neck underwent excision of the lesion through a medial adductor approach. A satisfactory result was achieved without unsightly scarring or internal fixation. The medial adductor approach should be considered when osteoid osteoma of the femoral neck is encountered.
Computed Tomography in the Postoperative Lumbar Spine
Authors: Kornberg Markus
Published: April 2021

ABSTRACT: A retrospective review of computed tomograms (CT) was performed in eight patients who underwent surgery for presumed reherniation of a lumbar disc. The CT scan in the three patients with surgically proven extradural scarring and no disc herniation, demonstrated distinct characteristics of perineural fibrosis which differed markedly from the uniform changes seen on the scans of the five patients with proven herniation.
Adhesive Capsulitis of the Shoulder: Current Concepts and Treatment
Authors: Murnaghan J Patrick
Published: April 2021

ABSTRACT: Primary adhesive capsulitis of the shoulder is a common cause of a painful shoulder in clinical practice. The pathogenesis remains unclear. Many patients continue to have significant long-term restrictions in their range of motion although few are functionally restricted.

Prevention is the ideal treatment. Patients respond to treatment plans directed at pain relief and improving the range of motion, however, ongoing controlled therapeutic trials are necessary to better refine the selection of treatment for individual patients.
Archer's Shoulder: Recurrent Posterior Subluxation and Dislocation of the Shoulder in Two Archers
Authors: Fukuda Hiroaki , Neer Charles S
Published: April 2021

ABSTRACT: Two right-handed archers presented with posterior instability of the shoulder. A 19-year-old Japanese and a 26-year-old white male archer developed pain and instability of the shoulder of 6 months' duration. Both had engaged in archery for several years. Both exhibited a positive apprehension test and recurrent posterior subluxation and dislocation by flexing the arm to 80° with internal rotation. Both could reduce the instability with a snap by extending the arm. For the subluxation, Neer's inferior capsular shift procedure via a posterior approach was performed. For the dislocation, a posterior bone bfock was added to the inferior capsular shift. The posterior capsular redundancy was marked in both cases. At 5 and 9years follow up respectively, both were doing archery and full activities without pain. These cases are thought to be examples of how a repetitive force can cause shoulder instability.
Neuropathic Arthropathy of the Shoulder: A Case Report
Authors: Drvaric David M , Rooks Michael D , Bishop Andrew , Jacobs Louis H
Published: April 2021

ABSTRACT: A case of neuropathic arthropathy of the shoulder secondary to syringomyelia is presented. The classic clinical and radiographic features of the entity are illustrated. Emphasis is made on the use of magnetic resonance Imaging in evaluation. Neuropathic arthropathy should be considered in the evaluation of shoulder pain or instability.
The Treatment of a Phalangeal Delayed Union Using Electrical Stimulation
Authors: Ohl Matthew D , Smith William S
Published: April 2021

ABSTRACT: The use of electrical stimulation to heal ununited fractures or nonunions of phalanges has not been previously reported. A case is reported using pulsed electromagnetic fields (PEMF) in the treatment of a phalangeal delayed union.
Post-Traumatic Fracture of Polymethylmethacrylate Surrounding a Harrington Hook Site: A Radiolucent Cause of Instability and Pain
Authors: Grogan Dennis P , Ogden John A
Published: April 2021

ABSTRACT: As polymethylmethacrylate (PM MA) is used more often in spine surgery, problems associated with its use are likely to be encountered. A case is presented of a young patient with myelomeningocele and scoliosis. The patient presented with instability and pain associated with fractured PMMA surrounding the lower Harrington hook site. Since the PMMA was radiolucent, the fractures were not visible on radiographs. The patient required surgical exploration and revision. The stability achieved with PMMA may present future liabilities, therefore, its use should be limited to those unusual cases with specific indications.
Slipped Capital Femoral Epiphysis Results of Treatment With a Single Cannulated Screw
Authors: Mann David , Weddington Joel
Published: April 2021

ABSTRACT: Thirty patients with 36 slipped capital femoral epiphysis underwent pinning with a single cannulated screw. All patients were pinned in situ, allowed immediate weight bearing as tolerated, discontinued crutches at 6 weeks, and had a minimum of 1 year follow up (average 21 months). One patient had avascular necrosis, one patient had bilateral chondrolysis, and two patients required repinning.
Osteomyelitis Associated with Crohn's Disease: A Case Report and Literature Review
Authors: Chandler James T , Riddle C Dayton
Published: April 2021

ABSTRACT: The case of a patient with pelvic osteomyelitis in association with Crohn's disease is presented. A review of the literature is discussed. The location most frequently affected is the right ileum, but other sites may be involved. The osteomyelitis usually develops as a result of direct extention of internal fistulae, with enteric flora being the infecting organisms. The importance of resecting the diseased segment of bowel is discussed. Many patients do not require bony resection. The possibility of pelvic osteomyelitis must be considered in patients with Crohn's disease who present with suggestive symptoms and radiographic evidence of osteomyelitis. Patients who initially present with pelvic osteomyelitis should be suspected of having intraabdominal pathology.
The Compared Effect of a Four-Coiled System in Pulsed Electromagnetic Field Stimulation
Authors: Cakirgil G S , Saplakoglu A , Yazar T
Published: April 2021

ABSTRACT: A clinical trial of 21 cases was conducted to evaluate the effects of a pulsed magnetic field on pseudoarthroses. Nineteen out of 21 cases had successful results; the remaining 2 failed to respond. Two-coiled and four-coiled systems were used in this study. It was concluded that the four coiled system is more effective in spite of its practical disadvantages and larger size.
Calcium Pyrophosphate Dihydrate Crystal Deposition Patterns in the Triangular Fibrocartilage Complex
Authors: Berger Richard A , Buckwalter Joseph A
Published: April 2021

ABSTRACT: To define the patterns of calcium pyrophosphate dihydrate (CPPD) crystal deposition in the triangular fibrocartilage complex (TFCC), we examined the wrists of five adult, fresh-frozen cadavers using light and scanning electron microscopy and the wrist radiographs of 10 patients with a clinical diagnosis of CPPD disease. The radiographs consistently showed mineral deposits near or on the proximal and distal surfaces of the radial half of the TFCC. Light and electron microscopy showed that CPPD crystals formed distinct clusters sharply demarcated from uninvolved fibrocartilage. The density of crystal packing within clusters varied with the sharpness of demarcation of the clusters from the surrounding tissue. TFCC defects were consistently found in the vicinity of CPPD crystals, and degeneration of the articular cartilage on the ulnar half of the proximal surface of the lunate was associated with CPPD crystal deposition in the radial half of the TFCC. These observations suggest that degenerative tears of the TFCC and degeneration of the articular cartilage of the lunate are associated with CPPD crystal deposits in the TFCC.
Pulsed High Frequency (27MHz) Electromagnetic Therapy for Persistent Neck Pain: A Double Blind, Placebo-Controlled Study of 20 Patients
Authors: Foley-Nolan Darragh , Barry Ciaran , Coughlan Robert J , O'Connor Peter , Roden Dermot
Published: April 2021

ABSTRACT: In the majority of patients with neck pain, symptoms will resolve spontaneously or quite quickly in response to therapy. However, some patients' symptoms persist for a long period, irrespective of therapy. In this study, 20 patients with persistent (greater than 8 weeks) neck pain were enrolled in a double blind, placebo-controlled trial of low energy, pulsed electromagnetic therapy (PEMT)-a treatment previously shown to be effective in soft tissue injuries. For the first 3-week period, group A (10 patients) received active PEMT units while group B (10 patients) received facsimile placebo units. After 3 weeks, both pain (visual analogue scale (P<.023) and range of movement (P<.002) had improved in the group on active treatment compared to the controls. After the second 3 weeks, during which both groups used active units, there were significant improvements in observed scores for pain and range of movement in both groups. PEMT, in the form described, can be used at home easily in the treatment of patients with neck pain. It is frequently successful and without side effects.
PROXIMAL METATARSAL SEGMENTAL RESECTION: A TREATMENT FOR INTRACTABLE PLANTAR KERATOSES
Authors: Spence Kenneth F , O'Connell Stephen J , Kenzora John E
Published: April 2021

ABSTRACT

For the past 15 years, a procedure the authors have termed proximal metatarsal segmental resection has been used for the treatment of intractable, painful, submetatarsal plantar keratoses which have failed nonoperative treatments. This simple procedure basically is the resection of a cylindrical segment of proximal metatarsal bone approximately 0.5 cm long. Fifty-four patients (70 metatarsals) underwent the procedure and were followed a mean of 6 years. Good to excellent results were reported in 89% of these patients. Transfer lesions occurred in 18% of feet and were responsible for all fair and poor results. When the procedure was carried out in association with a bunion correction, transfer lesions occurred in 23%; whereas when performed as an isolated metatarsal procedure, transfer lesions followed in 12%. Recurrent keratoses developed in 7%. This technically simple procedure is associated with minimal patient morbidity and should be considered an option in the surgical management of metatarsalgia.
RESULTS OF AKIN TYPE PROXIMAL PHALANGEAL OSTEOTOMY FOR CORRECTION OF HALLUX VALGUS DEFORMITY
Authors: Plattner Paul F , Van Manen John W
Published: April 2021

ABSTRACT

The results of 26 Akin proximal phalangeal osteotomies in 22 patients for hallux valgus deformities are reported. The average follow up was 53 months (range, 12 to 97 months). Subjectively, 16 feet had a satisfactory result (61.5%). Objectively, 14 feet met the criteria for a satisfactory result (53.8%). The authors found that the Akin osteotomy was unpredictable as an isolated procedure, and not indicated in a hallux valgus deformity with an incongruent joint.
CUSTOM-MOLDED ORTHOTICS IN POSTOPERATIVE HALLUX VALGUS IMMOBILIZATION
Authors: Donatto Keith C , Rightor Nicholas , D'Ambrosia Robert
Published: April 2021

ABSTRACT

Bunion surgery is one of the most frequently performed operations on the foot. The majority of established procedures use some form of soft tissue manipulation with or without an osteotomy as the means of achieving correction. Long-term success depends on operative technique and adequate postoperative immobilization. The authors describe a custommolded thermoplast splint that effectively maintains hallux position in the healing phase of hallux valgus surgery. It is easy to construct, comfortable to wear, and has several advantages over other forms of immobilization.
ORTHOPEDIC EXPERIENCE IN A MASH UNIT IN POSTWAR IRAQ
Authors: Johnson William L , O'Hearn Charles J , Dobner Joseph J
Published: April 2021

ABSTRACT

The orthopedic experience of a U.S. Army MASH unit deployed in southern Iraq is discussed. Seventy major casualties were surgically treated in a short time span. A high percentage of extremity trauma was observed (69%). Many patients had multiple extremity involvement. The emergency wartime surgical treatment of four specific types of trauma is explored. A new algorithm is presented for the rapid evaluation of penetrating joint injuries. We summarize the current concepts of war surgery as they apply to orthopedic injuries, and add specific observations from this experience.
PATHOLOGIC FRACTURES OF THE HUMERUS
Authors: Pritchard Douglas J
Published: April 2021

ABSTRACT

Pathologic fractures of the humerus create serious management problems. Impending fractures often can be anticipated. Fixation of impending or established fractures may provide significant benefits: comfort, improved functional ability, and facilitation of nursing care.
PRINCIPLES OF RADIATION THERAPY IN THE TREATMENT OF BONE METASTASES
Authors: Frassica Deborah A , Gunderson Leonard L
Published: April 2021

ABSTRACT

The radiation oncologist is an important member of the multidisciplinary team involved in the management of patients with metastatic bone disease. Radiation therapy provides local tumor control of the metastatic deposit and effective pain relief in the majority of patients. If there is a risk of fracture, prophylactic fixation is done before radiation therapy.
THE INFLUENCE OF AGE, SEX, AND INITIAL FIT ON BONY INGROWTH STABILIZATION WITH THE AML FEMORAL COMPONENT IN PRIMARY THA
Authors: Shaw James A , Bruno Anthony , Paul Emmanual M
Published: April 2021

ABSTRACT

A radiographic review of 178 consecutive primary total hip arthroplasties using the AML femoral component with a mean follow up of 40.1 months identified 92.3% to be stabilized by bony ingrowth and 7.7% by fibrous tissue. None were classified as loose. The quality of fit in the isthmus and calcar regions was identified as an important factor in achieving bony ingrowth stabilization. Bony ingrowth was achieved in all age groups with equal frequency. No relationship between sex and the type of stabilization was identified. A clinical correlation utilizing a subset of patients with identical prosthetic components identified equivalent clinical results across all age groups. Thirty-four percent of patients experienced some residual thigh pain. No statistically significant relationship between the presence of thigh pain and the type of femoral component stabilization (bony vs fibrous) could be identified. Ninety-eight percent of patients expressed unconditional satisfaction with their hip replacements.
POSTTRAUMATIC STIFFNESS: DISTRACTION ARTHROPLASTY
Authors: Morrey Bernard F
Published: April 2021

ABSTRACT

Loss of motion after elbow trauma is a common complication. At times, the limitation of motion may significantly impair function. Options to improve posttraumatic motion by surgery depend on whether the joint surface has been severely involved (intrinsic vs extrinsic contracture). Increasing experience with the surgical release of the posttraumatic stiff elbow has been enhanced by the use of distraction with or without interposition arthroplasty. Current experience suggests that approximately 85% of patients will be satisfactorily treated with surgical intervention.
IMMEDIATE PLATE FIXATION OF HIGHLY COMMINUTED FEMORAL DIAPHYSEAL FRACTURES IN BLUNT POLYTRAUMA PATIENTS
Authors: Riemer Barry L , Butterfield Spencer L , Burke Charles J , Mathews David
Published: April 2021

Abstract

From January 1982 through December 1988, 150 patients with 153 Winquist Class ITI and IY comminuted diaphyseal femur fractures due to high energy blunt trauma were treated with immediate plate fixation. A total of 260 major gênerai surgical systems were injured in 150 patients. Forty-nine patients did not have adequate preoperative spine radiographs due to positioning or time factors. Nineteen patient« had spine fractures; nine were diagnosed post-femoral fixation. The average injury severity score (ISS) was 22.7. Three patients died (2%). Our institution predicted mortality with this ISS for patients without pelvic or femur fractures at 15% (P= .0003).

Six patients moved to other states and three were lost to follow up due to noncompliance. One of us reviewed 141 fractures in 138 patients at a minimum of 12 months follow up and completion of treatment. Forty-nine fractures were open; 8 grade 1, 25 grade ?, 10 grade ???, 4 ???, 2 HIC. A total of 153 pelvic or ipsilateral major orthopedic injuries were present in 141 fractures. An additional 188 major associated orthopedic injuries were noted.

The average time to union was 17.2 weeks. One plate was applied in 11° of varus. Five plates failed from fatigue and five from repeat traumas. Seven plate failures were rodded and healed within 8 weeks. There was one persistent nonunion. One fracture, open IIIC, became infected after uniting. One patient has 110° of knee motion and 140 fractures have greater than 130° of knee motion.

Plate fixation is a safe technique for immediate femoral stabilization in the face of high energy blunt trauma. Failures occur late and are easy to reconstruct Intramedullary nails are the preferred method of reconstruction. Ultimate knee function is excellent. Infection rates (1/49) in open fractures are acceptably low.
SURGICAL RESULTS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION USING A COUNTERSUNK INTERLOCKING AUTOGENOUS ILIAC BONE GRAFT
Authors: Bosacco David N , Berman Arnold T , Levenberg Richard J , Bosacco Stephen J
Published: April 2021

ABSTRACT

The purpose of this study was to evaluate the surgical results of anterior cervical discectomy and fusion using a countersunk interlocking autogenous iliac bone graft. Two hundred thirty-two patients were followed for an average of 6.8 years. All patients suffered neck and arm pain. Two hundred twenty patients received conservative treatment for at least six months. Overall results were satisfactory in 202 patients (87%) and unsatisfactory in 30 patients (13%). The pseudoarthrosis rate was 6.5% which is significantly lower than previous reports. The premise of this technique is that the interlocking graft prevents migration, promotes fusion by providing immobilization, and restores the height of the interspace. Anterior cervical discectomy and fusion, using a countersunk interlocking autogenous iliac bone graft, is a satisfactory surgical procedure in which successful pain relief is to be expected.
SCAPHOID FRACTURES: ASSESSMENT AND TREATMENT
Authors: Calandra Joseph J , Goldner Richard D , Hardaker William T
Published: April 2021

ABSTRACT

The scaphoid is the most commonly fractured carpal bone. The fracture pattern and its relationship to the blood supply have significant implications regarding treatment and prognosis. Prompt recognition and treatment are fundamental to successful management.
ANSWER PLEASE
Authors: Avolio Armando , Berman Arnold T
Published: April 2021

FEMORAL HEAD AND ACETABULUM FRACTURES ASSOCIATED WITH A POSTERIOR HIP DISLOCATION - PIPKEN 4
PAIN INHIBITION OF SHOULDER STRENGTH IN PATIENTS WITH IMPINGEMENT SYNDROME
Authors: Ben-Yishay Ari , Zuckerman Joseph D , Gallagher Maureen , Cuomo Frances
Published: April 2021

ABSTRACT

Fourteen patients with Stage II or III impingement syndrome (average age 58 years) were studied. Nine patients had full-thickness rotator cuff tears documented by arthrograms. Patients initially underwent a thorough shoulder examination followed by baseline isokinetic strength testing. Abduction/ adduction testing was performed utilizing a Biodex dynamometer. Maximum concentric contractions were performed, and values for peak torque (PT), total work (W), and power (P) were obtained. All patients received a subacromial injection of 5 cc 1% lidocaine plus 5 cc 0.5% bupivacaine (Marcarne). After 5 minutes the testing sequence was repeated. Clinically, patients demonstrated marked improvement following injection. Eighty-six percent reported complete pain relief; the remaining two patients reported only mild discomfort at the extremes of motion. Improvement in functional activity of the affected shoulder was noted by all subjects. On manual muscle testing, 13 of 14 patients (93%) demonstrated increased abduction strength; 11 of 14 (79%) had improvement in external rotation. Mean increases in active forward elevation and external rotation were 36° and 11°, respectively (P<.01). Postinjection isokinetic changes in PT, W, and P for abduction/adduction were dramatic. For abduction, all patients showed significant increases in P (mean 82%), W (mean 90%), and PT (mean 48%) (all P<.05). No significant differences in range of motion testing or strength parameters were noted based on the presence or absence of a rotator cuff tear. For adduction, all patients showed significant increases in P (mean 208%), W (mean 183%), and PT (mean 41%) (all P<-05). Our findings indicate that pain is an important factor in the etiology of shoulder weakness documented by both clinical examination and isokinetic testing. Isokinetic muscle testing provides a method of quantitating the effect of pain on muscle function as measured by PT, W, and P. This information may be important in assessing the improvement in strength following acromioplasty with or without rotator cuff repair.
SURVIVORSHIP ANALYSIS OF ACETABULAR REVISION IN MEDIAL, LATERAL, AND GLOBAL PRIMARY OSTEOARTHRITIS
Authors: Bissacotti Joao Flavio , Cates Hal E , Keating E Michael , Faris M , Ritter Merrill A
Published: April 2021

ABSTRACT

Acetabular revision rates after cemented total hip arthroplasty vary from series to series in the literature. Little attention has been paid to the type of primary osteoarthritis in these previous series. We studied 782 cemented total hips in 671 patients with an average follow up of 73 years. Acetabular revision rates were analyzed in medial, lateral, and global primary osteoarthritis using survivorship analysis. Medial osteoarthritis was associated with a higher acetabular revision rate when compared to lateral osteoarthritis (P=.015). No differences were noted in acetabular revision rates when the preoperative diagnosis was medial vs global or lateral vs global primary osteoarthritis (P=.18 and P=.45, respectively). According to this study, a preoperative diagnosis of medial primary osteoarthritis should be added to a list of several factors associated with increased cemented acetabular failure, especially in the Charnley prosthesis.
'Clearing' Cervical Spine Injuries in Polytrauma Patients: Is It Really Safe to Remove the Collar?
Authors: Harris Mitchel B , Waguespack Alexis M , Kronlage Steve
Published: April 2021

ABSTRACT

Polytrauma patients are at increased risk for occult cervical spine injuries. Those unable to provide clinical dues to injury either remain in hard collars until they are able to cooperate with the physical examination or are deemed "clear of cervical injury" if the emergency room screening radiographs are without obvious bony abnormality. Cervical immobilization for a lengthy period of time is not without morbidity. Missed ligamentous injuries can lead to cervical instability, which in turn can result in permanent neurologic sequelae. This article reviews the current methodologies to "clear the cervical spine" and highlights the inadequacies.
Nonoperative Treatment of Thoracolumbar Fractures
Authors: Vanichkachorn Jed S , Vaccaro Alexander R
Published: April 2021

Spinal Trauma
The Clinical Utility of Duplicate Readings for Musculoskeletal Radiographs
Authors: Anglen Jeffrey , Marberry Kevin , Gehrke Jon
Published: April 2021

ABSTRACT

It is a common practice in many hospitals to have all skeletal radiographs read by a second physician, usually a radiologist, as well as by the treating physician. A two-part study was performed in order to examine the cost and clinical benefit of this practice for plain films ordered by orthopedists. In the first part of this study, the attending orthopedic surgeons were surveyed about the clinical usefulness and effect on patient care of 1000 radiologic reports from plain films ordered on orthopedic patients. In the second part, the charts of 272 patients who had 704 radiographs were reviewed with the goal of identifying any discrepancies between the orthopedic interpretation and the radiologic reading.

Thirty-eight reports were discarded because they were not reports of plain skeletal films. One hundred twenty-nine of the remaining 962 radiologic reports were never read by the attending orthopedist. The average time between the taking of the film and an orthopedic attending reading the printed report was 6.1 days. Three radiology reports contained findings that were incorrect. Only one report contained findings that the orthopedist was unaware, and one report may have led to an alteration in treatment. No reports resulted in an unplanned trip to the operating room or a patient being called back to the clinic.

Of the 272 chart reviews (704 reports), 70 had no orthopedic interpretation recorded and 94 had no radiologic report in the chart. Twelve discrepancies were noted in the cases that had both reports. Four fracture displacements were identified by orthopedists, but not on the written radiology report; three of these required a return to the operating room. Four instances of hardware displacement or breakage were noted by orthopedists, but not commented on by the radiologists. Three incidental injuries (two fractures and an acromioclavicular injury) were noted on printed reports of films taken for other reasons, but not commented on by the orthopedist, and not treated. A dorsal bunion was noted on one film by the orthopedist, but not by the radiologist.

From this study, one can conclude that the benefit of routine duplicate radiograph interpretation by a second physician does not justify its cost.
Ganglion Cysts of the Lower Extremity: An Analysis of 54 Cases and Review of the Literature
Authors: Rozbruch S Robert , Chang Vivian , Bohne Walther H O , Deland Jonathan T
Published: April 2021

ABSTRACT

This article reviews 54 consecutive patients with lower extremity ganglion cysts that were surgically removed and histologically confirmed at the Hospital for Special Surgery from 1981 to 1993. Lower extremity ganglia were more common among women. Patients' ages ranged from 13 to 80 years, with the fifth and sixth decades being the most common. Size of the cysts ranged from 3 cm to 10 cm (average: 2.9 cm). Thirty-six (67%) patients had ganglion cysts of the foot and ankle, and 18 (33%) patients had ganglion cysts of the knee area. Four (7%) patients had intraosseous ganglia located in the proximal tibia, patella, and the first metatarsal head.

Follow-up data of 40 (74%) patients at an average of 5.9 years (range: 1 to 12.5 years) were obtained. Satisfaction was reported by 83% of patients. Recurrence was seen in 10% of patients, and a report of no or mild pain was given by 86% of the group. Patients who underwent revision ganglion excision had inferior results. Only 25% reported satisfaction and 50% reported no or mild pain. Patients who underwent curettage of an intraosseous ganglion appeared to have superior results. All patients reported satisfaction and no or mild pain. The performance of a concomitant surgical procedure, the anatomic region of the ganglion, or type of postoperative immobilization did not appear to affect the outcome.
The Effects of Pulsed Electromagnetism on Fresh Fracture Healing: Osteochondral Repair in the Rat Femoral Groove
Authors: Grace Katie L R , Revell William J , Brookes Murray
Published: April 2021

ABSTRACT

Some clinical studies have claimed significant reductions in the healing time of fresh fractures with the use of pulsed electromagnetic fields (PEMFs). Animal models, however, have produced more equivocal results. This investigation examined the effects of PEMF treatment on an osteochondral defect placed in the patellofemoral groove of the rat. The results indicated that PEMF enhances early vascular reaction and suppresses initial pannus proliferation. Early chondrogenesis and bone formation were consistently stimulated, and the restoration of normal bone trabeculae advanced. Pulsed electromagnetic field treatment therefore may be useful in advancing repair during the early proliferative stage. Later results were variable and suggest that prolonged use may have deleterious effects, enhancing chondrogenesis beyond a point observed in normal repair and thus delaying normal subsurface trabeculation.
Quadriceps Atrophy After Partial Resection of the Patellar Tendon: An Experimental Study in a Rat Model
Authors: Irie Kazunori , Inoue Kazuhiko , Kawai Mika
Published: April 2021

ABSTRACT

Quadriceps muscle atrophy of rats was examined after resection of the central third (group 1) or the lateral two thirds (group 2) of the patellar tendon, the tensor fascia lata (group 3), or the medial hamstring (group 4). The quadriceps atrophied in groups 1 and 2, and more so in group 2, but there was no atrophy in groups 3 or 4. Thus, after an anterior cruciate ligament reconstruction procedure using the patellar tendon, resection of the patellar tendon itself leads to quadriceps atrophy and the extent of atrophy is related to the resected width.
Functional Outcome of Arthrodesis for Failed Total Knee Arthroplasty
Authors: Benson Eric R , Resine Susan T , Lewis Courtland G
Published: April 2021

ABSTRACT

To establish the ability of a salvage procedure to restore an independent lifestyle, the SF-36 functional outcome instrument and the pain, mobility, and physical activity subscales of the Arthritis Impact Measurement Scale (AIMS) was used to assess patient function. Nine patients (10 knees) who had undergone arthrodesis for failed total knee arthroplasty were compared with a control group of successful primary total knee arthroplasty patients. Average clinical follow-up was 42 months (minimum: 24 months).

For six of the eight SF-36 categories, the average scores for the arthrodesis and arthroplasty groups were similar. The average global scores for the two groups were nearly identical. The arthroplasty patients scored better on the AIMS physical activity and mobility subscales than the arthrodesis group, although the latter group fared better on the pain subscale. Overall, global scores favored the arthroplasty patients. The only subscales to show a statistically significant difference between the arthrodesis and arthroplasty groups were the SF-36 physical functioning and the AIMS physical activity subscales.

This pilot study demonstrated the ability of a salvage procedure to allow for an independent lifestyle with minimal complications. Furthermore, despite its popularity, the SF-36 does not appear as sensitive as the AIMS to differences in functional status or health outcomes between total knee arthroplasty and arthrodesis patients.
Wrist Arthrodesis: An Alternative Technique
Authors: Shayfer Shawn S , Toledano Baruch , Ruby Leonard K
Published: April 2021

ABSTRACT

An alternative form of fixation was used for arthrodesis of 10 wrists in 10 nonrheumatoid patients. Fusion took place in all patients at an average of 7 weeks. There were 5 complications in 10 wrists after an average follow-up of 4 years. All patients had pain relief after the procedure, and 9 patients were able to return to their previous occupation.
Computed Tomographic Evaluation of the Internal Structure of the Lateral Mass of the Lower Cervical Spine
Authors: Ebraheim Nabil A , Xu Rongming , Reader Doug , Stanescu Stephan , Yeasting Richard A
Published: April 2021

ABSTRACT

Axial computed tomography scans with a slice thickness of 2 mm taken from 12 cervical spines were used to study the internal structure of the lateral mass. Images representing the middle of zone I (Heller's classification) and the top of zone III were analyzed. The measurement of zone I involved anterior cortex thickness (ACT) while measurements of zone III included ACT, lateral cortex thickness (LCT), posterior cortex thickness (PCT), lateral mass thickness (LMT), and lateral mass width (LM W). The percentage of the ACT and PCT with respect to the LMT (ACT/LMT and PCT/LMT) were calculated.

Results showed the average ACT in zone I ranged from 1 .6 to 1 .8 mm. In zone III, the average LMT and LMW ranged from 8 to 9 mm and 1 3 to 1 5 mm, respectively. The smallest LMT was found at C7. The average ACT and PCT for all levels ranged from 1 .8 to 2 mm. The ACT with respect to the LMT (ACT/LMT) was approximately 1 7% to 1 9% for C3 to C5 and C7, and 1 5% for C6 separately. The PCT with respect to the LMT (PCT/LMT) was approximately 16% to 18% for C3 to C6, and 20% for C7. These results show the ventral cortex of the lateral mass is relatively thicker and support the concept of bicortical screw purchase.