bluuebunny/crossref_metadata_2025 huggingface dataset:
SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN
Authors: Skolnick Matthew D , Hall John E , Micheli Lyle J
Published: April 2021

ABSTRACT: Supracondylar fractures of the humerus were treated in 50 children over a six-year period. Patient age ranged from 2 to 15 years; 58% of the children were between 5 and 8 years of age. Our data agreed with the literature regarding left-sided predominance, usual age at injury, greater incidence in boys, and the infrequency of open and anteriorly displaced fractures. Our data differed from the literature, however, in that we encountered nerve injury more frequently and in different patterns of distribution. The article reviews the different types of supracondylar fractures and the pitfalls that can be encountered in their care and treatment.
FRACTURES THROUGH THE DISTAL WEIGHT-BEARING SURFACE OF THE TIBIA
Authors: Maale Gerhard , Seligson David
Published: April 2021

ABSTRACT: Fractures of the distal tibial plafond have been associated with an usually high incidence of morbidity and both early and late complications. Fractures through the distal tibial plafond can be divided into three basic groups: (1) distal tibial compression fractures; (2) external rotatory trimalleolar fractures with large posterior fragments; and (3) spiral extension fractures. Loss of length and alignment at the ankle joints, with concomitant loss of congruity of the articular surface, requires innovative intervention to prevent disability. The prognosis for these fractures depends not only on the amount of articular involvement of the ankle joint, but also on the accuracy of the reduction and the details of postoperative care.
Biomechanical Studies on Framework and Insertion of Pins of External Fixation
Authors: Oonishi Hironobu , Tatsumi Masanori , Hasegawa Tatsuhiko
Published: April 2021

ABSTRACT: Compression, moment, and shear forces were loaded onto models of a long tubular bone with comminuted fracture fixed with external fixation using several pins and frameworks. Stabilities were compared by finite element method. For the unstable fracture, stability in all directions is necessary. The selection of pins and framework methods, as well as selection of pin insertion site, should take into account anatomical conditions, conditions of fracture part, muscle power, and direction of muscular actions. To obtain better stability, it is also good to add half pins to piercing pins and to make triangular frameworks. For the stable tibia fractures, Judet's method is simple and excellent. Adherence to a single method is not necessary. Pins, insertion method, and fixation apparatus should be selected after understanding all conditions.
The Use of External Fixators in the Treatment and Rehabilitation of Compound Limb Injuries
Authors: Stein H , Hörer D , Horesh Z
Published: April 2021

ABSTRACT: Application of the Wagner leg lengthening apparatus, the A-O tubular system, and the Avmedica-Shiba external fixator in the treatment of severe compound limb fractures is reported. The application of the fixation frame at the time of patient arrival, together with aggressive surgical debridement of lacerated tissues and early skin grafting, followed five days later by patient and joint mobilization, has significantly improved the results of treatment. The time of hospitalization was shortened, and the complication rate was low with no deep infection, in the face of a nonunion rate of 10%. In the lower limb, with the appearance of callus formation the transfixing pins were removed, and cast brace immobilization substituted. In the upper limb, external fixation was continued until complete bony healing was achieved.
RADIOLOGIC CASE STUDY
Authors: Wopperer Daniel B , Griffiths Harry J
Published: April 2021

Postirradiation Changes in the Skeleton
Complications of Ipsilateral Femur and Tibia Fractures
Authors: Grana William A , Gruel John , Wedro Benjamin , Hollingsworth Susan
Published: April 2021

ABSTRACT: The purpose of this paper is to document the frequency and serious nature of complications associated with ipsilateral femur and tibia fractures. This study is based on 23 consecutive cases reviewed during a five-year period. The emphasis is on the severity of the associated injury in other body systems, the relationship of the tibial fracture to the complications observed, and the high incidence of unrecognized knee ligament injuries.
Bilateral Spontaneous Avulsion Fractures of the Calcaneus in a Diabetic Patient: A Case Report
Authors: Harper Marion C
Published: April 2021

ABSTRACT: A 29-year-old woman with a diabetic peripheral neuropathy sustained bilateral spontaneous avulsion fractures of the calcaneus. Although overlooked on the initial radiographs, both fractures healed with a brief period of casting. This lesion should be distinguished from osteomyelitis involving the calcaneus.
RADIOLOGIC CASE STUDY
Authors: Agee Jeffrey H , Sundaram Murali
Published: April 2021

Chondrodysplasia Punctata
TRAUMA
Authors: Ross Steven D K , Wiss Donald A
Published: April 2021

The Open Femoral Neck Fracture
Sternoclavicular Osteomyelitis and Pyoarthrosis as a Complication of Subclavian Vein Catheterization: A Case Report and Review of the Literature
Authors: Lindsey Ronald W , Leach John A
Published: April 2021

ABSTRACT: Numerous complications have been attributed to subclavian vein catheterization. Osteomyelitis and/or sternoclavicular pyoarthrosis is a rarely mentioned complication, previously reported only four times. Soft tissue infections occur frequently and respond well to topical and antibiotic treatment. If symptoms should persist for several weeks, osteomyelitis and/or sternoclavicular pyoarthrosis should be considered. We advocate management with early surgical intervention. Bone and gallium scans are helpful diagnostically, but CT scans offer the best assessment of the sternoclavicular joint itself. Surgery has produced excellent results, without functional compromise.
RADIOLOGIC CASE STUDY
Authors: Ray Marilyn J , Bassett Robert L
Published: April 2021

Paget's Disease
TRAUMA
Authors: Matta Joel M , Wiss Donald A
Published: April 2021

Malgaigne Fracture
ANSWER PLEASE
Authors: Yates Carlan , Yngve David A , Herndon William A
Published: April 2021

Gangrene of the Newborn
Direct Evidence of a Link Between Burning Phantom Limb Pain and Stump Blood Circulation: A Case Report
Authors: Sherman Richard A
Published: April 2021

ABSTRACT: A soldier began experiencing burning phantom limb pain after his left index finger was amputated following an accident. Videothermograms of both hands demonstrated that the stump and associated palmar region were 3°C to 5°C cooler when he was experiencing burning phantom pain than when no pain was present. The intensity of reported pain correlated well with changes in stump temperature, and could be controlled to some extent through learned self-regulation of hand blood flow.
The Brachioradialis for Restoration of Abduction and Extension of Spastic Thumb in Children
Authors: Lee Bong S , Horstmann Helen
Published: April 2021

ABSTRACT: The surgical technique is described for transfer of the brachioradialis for restoration of abduction and extension of the thumb in spastic children's hands. Long-term followup studies (average: 6.5 years) for 14 children demonstrate satisfactory functional and cosmetic results for patients carefully selected on the basis of Goldner's criteria.
Topical Therapy in Orthopedic Infection
Authors: Kawashima Mahito , Tamura Hiroaki
Published: April 2021

ABSTRACT: An improved method of closed irrigation-suction treatment of bone and joint infections is described. The method utilizes a new irrigation suction system that prevents obstruction of the tube. A series of 232 patients with acute and chronic bone and joint infections was treated with closed irrigation in 256 closed irrigation-suction procedures. Of these, 226 (88.3%) were treated successfully, seven (2.7%) were improved, and 23 (9.0%) were failures. Blood concentration levels of antibiotics were examined during closed irrigation. Absorption of antibiotics from the wound was insignificant. Culture and sensitivity tests of drainage during closed irrigation were used to monitor the cleansing of the wound. Serum hepatitis was seen in four cases within the hematogenous group and in three cases within the traumatic group. Postoperative bleeding during irrigation was an important complication.
Antimicrobial Prophylaxis for Arthroplasty: A Comparative Study of Cefonicid and Cefazolin
Authors: Davis William A , Kane James G
Published: April 2021

ABSTRACT: A double-blind, multicenter trial compared cefonicid and cefazolin for prophylaxis against postoperative infection in 117 patients undergoing joint replacement. Cefonicid, which has an extended serum half-life, was administered once daily, while cefazolin was given every eight hours. The drug was administered one half to one hour before surgery and continued for up to 72 hours. Patients were observed throughout their hospitalization period and followed for 30 days after discharge. No evidence of wound or joint infection was observed in any of the patients who met the criteria for evaluation. Adverse reactions consisted mainly of infrequent gastrointestinal symptoms and laboratory abnormalities. Three patients died from causes unrelated to study medication. No differences between the two regimens were found with respect to safety or efficacy in the prevention of postoperative infection after arthroplasty. The effectiveness of once-daily administration should make cefonicid a highly cost-effective alternative to many of the more expensive first- and second-generation cephalosporin antibiotics currently used in hospital practice.
Total Hip Arthroplasty: Can the Patient Play Sports Again?
Authors: Ritter Merrill A , Meding John B
Published: April 2021

ABSTRACT: To analyze the effect of athletic involvement on total hip replacements, a questionnaire was sent to all of our total hip patients with at least a 3-year follow up. Patients were asked to list the type, degree, and frequency of sports participation before and after surgery, along with any problems they encountered upon returning to active sports. The patients who responded were then placed in one of two groups, participant or non-participant, for each sport we encountered, and were statistically compared with respect to clinical analysis.

The population showed a significant decrease in all forms of activity after surgery, except bicycling; yet more returned to an active sport than did not. No correlation existed between involvement in a sport and the variables we tested. We concluded that intelligent participation in activities such as walking, golf, or bowling where no excess load was placed on the total hip, had no influence on the outcome of a total hip replacement.
SEPTIC BURSITIS: EXPERIENCE IN A COMMUNITY PRACTICE
Authors: Pien Francis D , Ching Diane , Kim Emery
Published: April 2021

ABSTRACT

We reviewed 47 episodes of septic bursitis occurring in a private community medical practice. Most patients were male (85%), and roughly half (49%) the cases were related to recreational or occupational trauma. About 72% of cases were located in the olecranon bursa, while the remaining cases were prepatellar. Prepatellar bursitis patients were more likely to be hospitalized. Staphylococcus aureus was isolated from 70% of bursal fluid aspirations; other etiologic organisms included gram negative bacteria and Mycobacterium marinum. The majority of patients were able to be treated as outpatients with oral antibiotics. All patients were eventually cured without serious complications.
THE IMMUNOLOGY OF BONE AND CARTILAGE TRANSPLANTATION
Authors: Bolano Luis , Kopta Joseph A
Published: April 2021

ABSTRACT

Bone tissue was one of the earliest human transplanted tissues, yet little is known about its transplant biology. For many years, bone and cartilage tissues were thought to be immunoprivileged tissues because of the absence of acute rejection phenomenon. Advances in the understanding of transplant immunology of vascularized tissue grafts (kidney, heart, liver, etc) have led to a renewed interest in the immunobiology of bone and cartilage allograft transplantation. Since prosthetic materials used in orthopedic reconstructive surgery have a limited lifespan, there is great interest in the transplantation of bone and cartilage tissue. The first half of the article discusses transplant terminology, basic principles of immunology, and experimental studies on the immunogenicity of bone and cartilage tissue. The second half of the article discusses how allotransplanted bone and cartilage behaves in human transplants, storage and preservation techniques, and future directions in bone and cartilage transplantation.
MORPHOLOGIC AND BIOMECHANICAL STUDY OF AVASCULAR NECROSIS OF THE FEMORAL HEAD
Authors: Kim Young Min , Lee Sang Hoon , Lee Francis Young-In , Koo Kyung Hoi , Cho Kook Hyung
Published: April 2021

ABSTRACT

Radiologic review and uniaxial compression tests of 1 cm
p 3
cubes of avascular and subjacent portions of 64 femoral heads of 51 patients with idiopathic avascular necrosis of the femoral head were performed to determine the morphologic and biomechanical changes with progression of the disease. Cases were divided into three groups according to the simple radiographic findings: group I (precollapse), group II (collapse), and group III (advanced collapse with secondary degenerative arthritis). Fourteen group I, 36 group II, and 14 group III specimens were identified. In addition to the simple radiographs, 16 magnetic resonance images were reviewed. In group I, there was no significant difference of yield and maximum stress, and modulus of elasticity between avascular and subjacent portions below the reactive rim. In group ?, the above parameters showed lower values in the avascular portion than in the subjacent portion (P<.05). In group III, maximum stress of the avascular portion showed significantly higher value than that of the subjacent region (P<.05). In groups II and III, a major crack was observed in the subchondral area in 14 specimens and in the deep avascular and reactive junction in 36 specimens. Bone densitometry data suggested higher mineral content indicative of more sclerosis in the deep crack group. These findings might suggest that different biomechanical properties in the subchondral crack group and interface crack group might contribute to varieties in clinical manifestations. Later sclerotic changes and aspherical collapse of the femoral head might play a large role in the development of secondary degenerative arthritis of the hip joint.
THE PSYCHOLOGY OF POLIO AS PRELUDE TO POST-POLIO SEQUELAE: BEHAVIOR MODIFICATION AND PSYCHOTHERAPY
Authors: Bruno Richard L , Frick Nancy M
Published: April 2021

ABSTRACT

Even as the physical causes and treatments for post-polio sequelae (PPS) are being identified, psychological symptoms - chronic stress, anxiety, depression, and compulsive, Type A behavior - are becoming evident in polio survivors. Importantly, these symptoms are not only causing marked distress but are preventing patients from making the lifestyle changes necessary to treat their PPS. Neither clinicians nor polio survivors have paid sufficient attention to the acute polio experience, its conditioning of life-long patterns of behavior, its relationship to the development of PPS, and its effect on the ability of individuals to cope with and treat then* new symptoms. We describe the acute polio and postpolio experiences on the basis of patient histories, relate the experience of polio to the development of compulsive, Type A behavior, link these behaviors to the physical and psychological symptoms reported in the National Post-Polio Surveys, and present a multimodal behavioral approach to treatment.
ACTIVITY AND POST-POLIO FATIGUE
Authors: Packer Tanya L , Martins Isabel , Krefling Laura , Brouwer Brenda
Published: April 2021

ABSTRACT

Fatigue was studied in 12 subjects with postpolio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 ± 1.6 (non-disabled scores = 2.3 ± 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.
ENERGY CONSERVATION, OCCUPATIONAL THERAPY, AND THE TREATMENT OF POST-POLIO SEQUELAE
Authors: Young Grace R
Published: April 2021

ABSTRACT

Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.
THE EFFECTS OF LONG-TERM NON-FATIGUING RESISTANCE EXERCISE IN SUBJECTS WITH POST-POLIO SYNDROME
Authors: Fillyaw Michael J , Badger Gary J , Goodwin Gregory D , Bradley Walter G , Fries Timothy J , Shukla Amitah
Published: April 2021

ABSTRACT

Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.
POST-POLIO FATIGUE: Ap 31P MAGNETIC RESONANCE SPECTROSCOPY INVESTIGATION
Authors: Thompson R Terry , Barton Pamela M , Marsh Gregory D , Cameron M G Peter , Gravelle Denis G , Hsieh Jane T C , Hayes Keith C , Driedger Albert A
Published: April 2021

ABSTRACT

Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls usingp 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.
RESULTS OF THE MULTICENTRIC ITALIAN EXPERIENCE ON THE GAMMA™ NAIL: A REPORT ON 648 CASES
Authors: Boriani S , Bettelli G , Zmerly H , Specchia L , Bungaro P , Montanari G , Capelli A , Canella P , Regnoli R , Rispoli R , Trabucchi L , Simonini D , Bonicoli F , D'Imporzano M , Rava M , Ghera S , Giacomelli M , Dorigotti P , Ragazzi E , Montella S , Renier F , Parduzzi S , Torelli L , Spagnolo R
Published: April 2021

ABSTRACT

In a multicentric study, the data of 628 trochanteric fractures, two non-unions, and 18 pathologic or impending fractures treated by Gamma nail in 13 Italian traumatology services were collected and analyzed. In 70% of the patients weight bearing was allowed in the first postoperative week and 78% of the controlled patients returned to their pretrauma walking ability. Complications included intraoperative (1.4%) and postoperative (1.2%) shaft fractures, "cut out" of the lag screw (2.6%), and nail failure (0.5%). There were no cases of infection. An analysis of complications showed that most of them were due to technical mistakes. The safest procedure is 2 mm diaphyseal overreaming, introduction of the nail without hammering, and distal locking; the lag screw should be placed in the lower part of the head of the femur.
NEUROMUSCULAR FUNCTION IN POLIO SURVIVORS
Authors: Agre James C , Rodriquez Arthur A
Published: April 2021

ABSTRACT

Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.
CURRENT STATUS OF ALLOGRAFTING FOR BONE TUMORS
Authors: Mankin Henry J , Springfield Dempsey S , Gebhardt Mark C , Tomford William W
Published: April 2021

ABSTRACT

Over the past 20 years the Orthopaedic Oncology Unit of the Massachusetts General Hospital has performed over 660 massive cadaveric allograft transplantations, mostly for patients with bone tumors. The overall success rate for such procedures is around 80%, with most of the failures occurring in the first 3 years as a result of fracture (19%), nonunion (14%), and infection (10%). With longer follow up, late occurring osteoarthritis has been noted in approximately 17% of those patients at risk, suggesting that the articular surface begins to "wear" at 5 years. Some problems remain with the procedure, and more study of such aspects as the immune mechanism, cryopreservation of cartilage, maintaining the status and safety of the bone banking system, and improving the techniques of surgery ultimately may lead to a more uniform and predictable success rate.
THE LONG-TERM SUCCESS OF FRESH, SMALL FRAGMENT OSTEOCHONDRAL ALLOGRAFTS USED FOR INTRAARTICULAR POST-TRAUMATIC DEFECTS IN THE KNEE JOINT
Authors: Mahomed M N , Beaver R J , Gross A E
Published: April 2021

ABSTRACT

Ninety-two fresh osteochondral allografts were implanted in 91 patients with posttraumatic osteoarticular defects of the knee joint. These patients have been prospectively followed since 1972. An analysis of long-term survival of these grafts has been performed to determine their success rates: 75% at 5 years, 64% at 10 years, and 63% at 14 years. An evaluation was made between unipolar grafts, which involve only one surface of the compartment, and bipolar grafts, which involve both surfaces. The unipolar grafts had a lower failure rate at all time periods compared to bipolar grafts, with 76% survival at 5 years, 69% at 10 years, and 67% at 14 years. While investigating other factors that might affect the survival of the fresh osteochondral allografts, we calculated the influence of the anatomical location of the graft, patient sex, and patient age. There was no meaningful impact on allograft survival by either the location of the allograft or the sex of the patient. However, there was a significant effect on allograft longevity in terms of patient age, with patients under age 60 doing better. The best indication for the use of unipolar fresh osteochondral allografts is for posttraumatic defects in relatively young, active patients. Joint malalignment should be corrected to achieve best results.
CLINICAL USE OF FRESH, FROZEN SOFT TISSUE ALLOGRAFTS
Authors: Olson Eric J , Harner Christopher D , Fu Freddie H , Silbey Mark B
Published: April 2021

Abstract

Fresh frozen allograft tissue provides a good alternative to autogenous tissue for the treatment of patients with symptomatic ligamentous deficiency. While transmission of AIDS and other infectious diseases remains a small possibility, allografts provide the advantages of shorter operative time, small incisions, no damage to a patient's own tissues, and superior usefulness in multiple reconstructions, as well as revision of failed autogenous reconstructions. An independent, critical evaluation of the 4-year results of patients with allograft ACL reconstructions is presented. Issues important in allograft tissue recovery, banking, and intraoperative preparation are reviewed.
CONCOMITANT INJURIES OF THE HIP JOINT AND ABDOMEN RESULTING FROM GUNSHOT WOUNDS
Authors: Brien Earl W , Brien William W , Long William T , Kuschner Stuart H
Published: April 2021

ABSTRACT

Septic arthritis is a devastating complication of transabdominal gunshot wounds to tne hip. Five patients sustained gunshot wounds to the hip which violated the alimentary tract. Diagnosis was established with plain radiographs in three patients, arthrogram in one patient, and a gastrointestinal series in one patient Three patients had an exploratory laparotomy with diverting colostomy followed by immediate hip arthrotomy within 24 hours and no joint infections occurred. In the other two patients, hip involvement was identified late after septic arthritis occurred. Early diagnosis, diverting colostomy, and immediate arthrotomy are recommended for gunshot wounds to the hip which involve the alimentary tract.
POSTRADIATION SARCOMA OF BONE
Authors: Frassica Frank J , Frassica Deborah A , Wold Lester E , Beabout John W , Sim Franklin H
Published: April 2021

A 58-year-old woman was examined because of increasing low back and left buttock pain of 2 months' duration. Her discomfort occurred at night and was progressive. The pain was not responsive to anti-inflammatory medications and was not related to activity.

The patient's medical history was significant for successful treatment of an adenocarcinoma of the colon 17 years previously. In addition to surgical treatment, she had received a course of adjuvant external beam radiation. The radiation was delivered over a 5 ½-week period through parallel opposed fields. The estimated midline dose was 40 Gy centered over the left iliac fossa. The source of radiation was cobalt 60.

A plain radiograph of the pelvis suggested an area of bone destruction in the ileum near the left sacroiliac joint (Fig 1A). A computed tomography (CT) scan demonstrated cortical destruction of the left iliac wing and an associated soft tissue mass (Fig 1B). A staging evaluation revealed lung metastasis, indicating that the patient had Stage III disease.1 A diagnosis of high-grade fibroblastic osteosarcoma was made after biopsy of the lesion in the left iliac wing (Fig 2). The patient died of the lesion 1 month after presentation.
FRACTURES OF THE FEMORAL SHAFT ADJACENT TO LONG STEM FEMORAL COMPONENTS OF TOTAL HIP ARTHROPLASTY: REPORT OF SEVEN CASES
Authors: Missakia Maylene L , Rand James A
Published: April 2021

ABSTRACT

Seven femoral shaft fractures adjacent to the distal aspect of long stem revision femoral components of total hip arthroplasty were evaluated at a mean of 6 years (range: 2 to 12) after fracture. Nonoperative treatment with a spica cast was used in four patients. Complications were delayed union in two patients and malunion in two. Operative treatment included revision and bone grafting in one patient and open reduction and internal fixation in two. Plate fracture and delayed union occurred in one patient. Operative treatment resulted in no malunions and earlier recovery of function than with nonoperative management. Femoral shaft fractures adjacent to long stem total hip arthroplasties are difficult to manage; the complication rate is 71%.
MECHANICAL PROPERTIES OF BONE AFTER GRAFTING WITH CORALLINE HYDROXYAPATITE: AN EXPERIMENTAL STUDY
Authors: Szabó G , Schmidt B
Published: April 2021

Abstract

Based on animal experiments, mechanical properties of rabbit radii after grafting artificial gaps with a coralline hydroxyapatite (CH) material are discussed. Healing velocity of complete and partial gaps after the same kind of grafting is also analyzed. Based on the results obtained from 48 gaps of 24 animals it is stated that fused grafts in both types of gaps showed bending strength of the radii similar to that of normal bone. The incidence of nonunions and infections are also discussed. It is concluded that CH is suitable in the treatment of incomplete bone defects.
LASER THERAPY: SCIENTIFIC BASIS AND CLINICAL ROLE
Authors: Basford Jeffrey R
Published: April 2021

ABSTRACT

The ability of laser irradiation to destroy tissue is well known. Less well known is the fact that the same radiation, at much lower intensities, can non-destructively alter cellular function. This latter phenomenon, which occurs in the absence of significant heating, is now a basis for the conservative treatment of a variety of musculoskeletal, neurological, and soft tissue conditions in many parts of the world. This review first examines the 25-year history and scientific basis of "láser therapy." Clinical applications are discussed and the reasons for its relative lack of acceptance in the US are examined. The article concludes with an overview of current research and the impact it will have on laser therapy's role in US clinical practice.
INTERNAL FIXATION OF THE THORACIC AND LUMBAR SPINE USING ROY-CAMILLE PLATES
Authors: Simpson J Michael , Ebraheim Nabil A , Jackson W Thomas , Chung Stanley
Published: April 2021

ABSTRACT

Thirty patients underwent fixation of the thoracic and lumbar spine from 1986 to 1990 using the Roy-Camille pedicular screw fixation system. The spine was stabilized for a variety of pathologic entities including fracture, tumor, spondylolisthesis, postlaminectomy Instability, and pseudarthrosis. All but one patient obtained solid fusion based on radiographic and clinical criteria with an average foflow up of 19.5 months. All patients reported subjective Improvement in preoperative pain levels. There were no neurologic complications associated with the surgical procedure. Roy-Camille plate fixation appears to offer a stable surgical construct in the treatment of thoracic and lumbar spine instability.
SIMULTANEOUS HIGH TIBIAL OSTEOTOMY AND ACL RECONSTRUCTION FOR COMBINED GENU VARUM AND SYMPTOMATIC ACL TEAR
Authors: Neuschwander David C , Drez David , Paine Russell M
Published: April 2021

ABSTRACT

This article reviews the subjective, objective, functional, and radiographic results of five patients with symptomatic anterior cruciate instability, genu varum, and varus rotational instability treated by sequential high tibial osteotomy and anterior cruciate ligament reconstruction at one operative procedure. The average patient age was 27 years (range: 21 to 35), and the average follow up was 2.5 years (range: 2 to 3). AU patients had symptomatic instability with anterior tibia subluxation, which was documented by KT- 1000 testing. All patients also had a varus alignment clinically and radiographically with medial compartment pain. Postoperatively, the medial compartment pain was improved, and instability episodes were eliminated. Side to side differences (KT-1000 - manual maximum) were reduced to 3.1 mm. There were no complications. The instability episodes were eliminated, and functional levels were improved in all patients. We concluded that, for this select group of patients, simultaneous extremity realignment and ligament stabilization will effectively manage both conditions without compromising the results of either procedure.
RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT WITH ACHILLES TENDON AUTOGRAFT
Authors: Seo Jai-Gon , Cho Duck-Yun , Kim Key-Yong
Published: April 2021

ABSTRACT

The increasingly serious complications of artificial ligaments and allografts have brought them into disrepute. Recently, autografts have drawn more attention. A new type of autograft, the Achilles tendon autograft, has been developed and applied to anterior cruciate ligament reconstructions. This report describes the advantages of the Achilles tendon autograft used and presents the results of a prospective study of 21 patients with minimum 2 year follow up. Of the 21 cases, 16 patients (75%) had a rating of excellent; 2 (10%) good, 2 (10%) fair, and 1 (5%) poor. Preoperative knee scores of 56.7 were improved to 89.5 postoperatively. The authors removed less than half of the Achilles tendon with the calcaneal bone incorporated. Through magnetic resonance imaging we confirmed that the remaining Achilles tendon of the donor site regained its volume and strength within a year without significant complication. Achilles tendon autograft offers the advantages of length, elastic strain modulus, reproducibility in technique, and consistency of the result without significant complications.
CURRENT CONCEPTS IN MENISCAL REPAIR
Authors: Diment Michael T , DeHaven Kenneth E , Sebastianelli Wayne J
Published: April 2021

ABSTRACT

As the importance of meniscal preservation has become recognized, meniscal repair has become a more commonly practiced procedure. We briefly review the current, commonly accepted indications, techniques, and our rehabilitation protocol for meniscal repair. Both open and arthroscopic repairs are reviewed, including the arthroscopic techniques classified as inside-out, outside-in, and all inside. We conclude with a review of the results of meniscal repair and some thoughts on future directions.
ARTHROSCOPIC MANAGEMENT OF INSTABILITY OF THE SHOULDER
Authors: Snyder Stephen J , Strafford Brereton B
Published: April 2021

ABSTRACT

Anterior shoulder dislocation in the young athlete may be difficult to treat and, without proper care, usually results in recurrent episodes of instability. By permitting direct visualization of all intraarticular pathology, the arthroscope assists in the diagnosis and helps to determine appropriate therapeutic interventions. Numerous techniques have been developed for arthroscopic reconstruction of unstable shoulders. These can be classified according to the type of fixation employed. The categories include metal devices such as staples or screws, absorbable devices, and suture-based methods, both anterior and transglenoid. An anterior suture anchor method using a new suture passing device known as a Shuttle Relay (Linvatec Corp, Largo, Fla), which allows the surgeon to incorporate non-absorbable mattress sutures in the repair, is described in detail.
EFFECTS OF EPIDURAL ANESTHESIA ON INCIDENCE OF VENOUS THROMBOEMBOLISM FOLLOWING JOINT REPLACEMENT
Authors: Haas Steven B
Published: April 2021

ABSTRACT

Deep vein thrombosis (DVT) and pulmonary embolism are serious complications following Mp and knee replacement surgery. Both surgical procedures have significantly high postoperative rates of DVT. In total hip replacement, the rate of proximal thrombi tends to be higher. However, total knee replacement produces a high rate of calf thrombi and a higher overall rate of thrombosis.

In a search for innovative ways to reduce the risk of thrombosis, three types of anesthesia were examined: general anesthesia, epidural anesthesia, and hypotensive epidural anesthesia in which a controlled hypotension is provided. The hypotension commonly exists with epidural anesthesia also, unless blood pressure is maintained with an agent such as ephedrine. When blood pressure is allowed to drop in a controlled fashion, hypotensive anesthesia is effected.
PROPHYLAXIS OF DEEP VEIN THROMBOSIS IN TRAUMA PATIENTS
Authors: Vrahas Mark S
Published: April 2021

ABSTRACT

Orthopedists who use prophylaxis for deep vein thrombosis (DVT) in total joint arthroplasty are often called on to care for trauma patients. Much less is known or published about the effects of such prophylaxis in the trauma patient than in the arthroplasty patient The questions to ask are: what is the incidence of DVT in trauma patients; what are the benefits of DVT prophylaxis; and what are the risks of DVT prophylaxis, and do the risks outweigh the benefits?
A PROSPECTIVE, RANDOMIZED COMPARISON OF OPEN VS ARTHROSCOPICALLY ASSISTED ACL RECONSTRUCTION
Authors: Cameron Scott E , Wilson William , St Pierre Patrick
Published: April 2021

ABSTRACT

A prospective, randomized study comparing arthroscopic and open anterior cruciate ligament (ACL) reconstructions was undertaken. Neither the patients nor the physical therapists were made aware of which technique was used. The central one third of the patellar tendon with proximal and distal bone plugs was utilized as the graft material to reconstruct the ACL in all cases. Rehabilitation was identical for each group. The following variables were compared: postoperative pain score, operating time, estimated blood loss (EBL), quantity of analgesics used, complications, range of motion at 1, 3, and 6 months, a 6-month evaluation consisting of Lachman's, anterior drawer, and pivot shift tests, amount of thigh atrophy, and Cybex II tests. Statistical significance was achieved (P<.05) in only three parameters. The 1month postoperative range of motion, the 6-month postoperative thigh atrophy, and the Cybex II test (knee extension at 607sec) were statistically different favoring the arthroscopic method.
DIAPHYSEAL HUMERUS FRACTURES: NATURAL HISTORY AND OCCURRENCE OF NONUNION
Authors: Foulk Douglas A , Szabo Robert M
Published: April 2021

ABSTRACT

We reviewed 38 fractures of the humeral shaft which had been treated non-operatively to identify factors prognostic of nonunion. Of these, 23 healed uneventfully and 15 progressed to nonunion. Factors prognostic of nonunion included long oblique fracture pattern, alcohol abuse, and obesity. In patients with these risk factors, lack of clinical and radiographic evidence of healing 8 to 10 weeks post-injury suggests an impending nonunion, and operative intervention should be considered.
RESULTS OF LUMBAR DISK SURGERY IN A CITY COMPENSATION POPULATION
Authors: Bosacco Stephen J , Berman Arnold T , Bosacco David N , Levenberg Richard J
Published: April 2021

ABSTRACT

This is a retrospective analysis of 118 patients who underwent 132 operations in a city compensation setting for the treatment of lumbar disk disease from January 1976 to December 1987. Each of these patients had a work-related injury. There was a minimum 2-year follow up with an average follow up of 6.9 years. No patients were lost to follow up. The purpose was to determine what percentage of patients treated in a work-related setting could be expected to return to a sustained, pre-injury employment state following a carefully executed lumbar spine surgical procedure. Satisfactory surgical results were considered achieved only by those patients who returned to full-duty work status. Only 31 of the 118 patients (26%) returned to full duty and were considered satisfactory. Regarding the number of surgical procedures, 31 of 132 operations (23%) were successful. Sixteen reoperations in 13 patients all resulted in failure. Only 16 of the 64 patients (25%) treated with laminectomy and diskectomy alone had a satisfactory result. When a two-level, posterior lateral spinal fusion was added the success rate was increased to 44%, with 12 of 27 patients returning to work. Six patients with spinal stenosis underwent decompression laminectomy and entry level foraminotomies, and all had unsatisfactory results. Five patients with isthmic spondylisthesis underwent a Gill procedure and fusion. Only one of these patients (25%) returned to work. For a 2-year period chymopapain injection was given to 14 patients. Only two returned to work, with a 14% success rate. Overall, the surgical treatment of lumbar disk disease in this group of city compensation patients resulted in a 74% rate of permanent disability.
THE EFFECTS OF THE INTEROSSEOUS MEMBRANE AND PARTIAL FIBULECTOMY ON LOADING OF THE TIBIA: A BIOMECHANICAL STUDY
Authors: Thomas Kevin A , Harris Mitchel B , Willis Michael C , Lu Yun , MacEwen C Dean
Published: April 2021

ABSTRACT

The biomechanical basis for the treatment of delayed union of tibial fractures by partial fibulectomy has yet to be fully evaluated. To gain further insight into this problem, nine intact cadaveric lower extremities were instrumented with strain gauges on the surfaces of the tibia and fibula. The limbs were then subjected to axial loading with the ankle and subtalar joints placed in multiple positions. The specimens were loaded either through the distal femur or by direct loading of the tibial plateau. All specimens were first tested intact then after sectioning of the interosseous membrane and finally after partial fibulectomy.

It was shown that during loading of the leg, the primary effects of the interosseous membrane were to stabilize the fibula and constrain its posterolateral bending. The fibular strains were not reduced to zero following sectioning of the interosseous membrane. Tibial strains measured on the anteromedial and anterolateral surfaces were consistently in relative tension, indicating a posterior bending force (anterior bowing) of the tibia. After partial fibulectomy, strains on these surfaces became relatively more compressive. With the ankle and subtalar joints in neutral position (0° flexion, 0° inversion/eversion) the strains on the anterior surface averaged approximately 10% more compressive relative to the intact condition. Tibial strains were observed to vary with the position of the ankle and subtalar joints. The fact that the anteromedial and anterolateral tibia surfaces were always in tension may explain why partial fibulectomy has not proved to be a uniformly successful treatment method for delayed union of the tibia. Furthermore, it points to the important role of "fracture personality" in the selection of treatment.
A TRIGONOMETRIC ANALYSIS OF DISTAL PATELLOFEMORAL REALIGNMENT
Authors: Gibson Wilford K , Dugdale Thomas W
Published: April 2021

ABSTRACT

Patellofemoral malalignment is often treated successfully with realignment procedures. Although distal patellar realignment has been used widely with excellent results, there is no published equation to predict degrees of change in the Q angle with millimeters of medialization. The purpose of this study was to quantify this relationship. In 20 fresh cadaver knees, threaded Kirschner (K) wires were placed in the anterior superior iliac spine, center of patella, and tibial tubercle. Q angles and measurements from the center of the patella to tibial tubercle were obtained. After using Fulkerson's technique of anteromedialization, Q angles were measured with 5 mm and 10 mm of medialization in a plane parallel to the floor and perpendicular to the threaded K-wires. The triangle formed by the center of the patella, tibial tubercle (initial), and tibial tubercle (medialized) was in one plane and could be studied by trigonometric analysis. A formula derived from the Law of Cosines to predict the change in the Q angle with medialization was found to be highly accurate. The authors present an equation that can be used to ensure adequate correction of the Q angle in distal patellar realignment.
A CUSTOM DISTAL FEMORAL PROSTHESIS FOR RECONSTRUCTION OF LARGE DEFECTS FOLLOWING WIDE EXCISION FOR SARCOMA: RESULTS AND PROGNOSTIC FACTORS
Authors: Muschler George F , Ihara Koichiro , Lane Joseph M , Healey John H , Levine Marc J , Otis James C , Burstein Albert H
Published: April 2021

ABSTRACT

Between 1979 and 1986, 37 patients with sarcoma of the distal femur underwent limb salvage using a custom prosthetic knee replacement. Thirteen (35%) had early complications. Fourteen (38%) had late complications, which consisted of 6 aseptic femoral loosenings, 1 aseptic tibial loosening, 2 tibial fractures, 2 contractures, 1 femoral fracture, 1 prosthetic fracture, and 1 septic loosening. By 1988, nine patients died. Thirteen prostheses failed in 12 patients, resulting in 9 revisions, 2 above-knee amputations, and 2 Van Nes rotationplasties. The 2- and 5-year prosthetic survival rates were 82% and 57%, respectively. Twenty-two of the 26 survivors (85%) had successful limb salvage. Preventable factors were implicated in the loosening of six femoral components and in one femoral fracture. The mean Hospital for Special Surgery Knee Score was 69 (range: 62 to 86).
CLINICAL EFFICACY OF ELECTRONEUROMETER SCREENING IN CARPAL TUNNEL SYNDROME
Authors: Beckenbaugh Robert D , Simonian Peter T
Published: April 2021

ABSTRACT

The authors evaluated the motor latency values of 72 median nerves assessed with the compact, hand-held, battery-powered NervePace Electroneurometer. Results of this test were compared to those of clinical examination, standard electrodiagnostic tests, and median nerve findings of compression at the time of surgery in 23 patients. The motor latency values obtained with an electroneurometer correlated positively with those from routine electromyography (EMG): sensitivity and specificity were calculated for the ability to diagnose carpal tunnel syndrome (CTS) (>3.9 ms considered abnormal). This study identified a sensitivity of 85.7% and a specificity of 87.5% in predicting CTS, as confirmed by complete EMG and electroconduction studies.
SPINAL OSTEOMYELITIS: A REVIEW OF 10 YEARS' EXPERIENCE
Authors: Bateman Judith L , Pevzner Martin M
Published: April 2021

ABSTRACT

Spinal osteomyelitis is an infrequent cause of back pain, but it can cause severe neurologic compromise or death if not treated effectively. We report 71 cases of spinal osteomyelitis. Ninety-three percent of patients complained of back pain that had been present for several weeks (average: 59 days) at the time of hospitalization. Localized tenderness and an elevated erythrocyte sedimentation rate were often the only abnormal signs. Plain radiographs were abnormal in 39 of 56 cases. At our institution, computed tomography-guided biopsy was safe and effective, yielding a pathogenic organism in 19 of 30 procedures vs 24 of 32 cultures of open surgical specimens.