bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Two Methods for Teaching Advanced Arrhythmias to Nurses
Authors: Lamb Mary J , Henderson Melinda C
Published: April 2021

ABSTRACT

An experimental study to compare the effectiveness of assisted self-directed learning (ASD) and traditional lecture methods (TLM) in acquiring competency for electrocardiogram interpretation was conducted within a conceptual framework of developmental and adult learning theory (Erickson, Tomlin & Swain, 1983; Knowles, 1980). After two teaching units were designed and an EKG posttest was constructed (r=.75) from actual patient records, registered nurse volunteers (N= 19) were randomly assigned to groups for simultaneous instruction. Because of the small sample size, statistical procedures were used to determine the effectiveness of randomization and to justify statistical procedures. EKG post-test scores for the experimental group (ASD, M= 81) and the control group (TLM, M= 71) were significantly different (one-tailed t = 1.79; p = .045); however, participants' prior knowledge of basic arrhythmias was not independent of method (ANCOVA, f[l, 16] = 21.373, p = .0003, covariate; F[1.16] = 2.312, p =.1479, main effects). EKG post-test scores were not related to critical care experience, cardiac monitoring experience, education level, or course satisfaction. While both methods are effective, ASD had higher mean scores and is more cost- and time-efficient.
Enhancing Clinical Nursing Research: A Vital Role for Staff Development Educators
Authors: Tuohig Gail M , Oleson Kathy J
Published: April 2021

ABSTRACT

Staff development educators can play a vital role in clinical nursing research. To accomplish this, they must first broaden their role concept to include research facilitation. Second, they must utilize resourceful means to facilitate the research learning process. This article outlines essential steps to guide the staff development educator in enhancing research efforts of staff nurses.
A Rite of Passage to Certification
Authors: Galarowicz LeaRae
Published: April 2021

ABSTRACT

Becoming certified through examination involves much more than correctly answering test questions. Before some of us are able to take the risk and apply to write the exam, a confrontation with personal issues may be necessary. This article describes one nurse's experience as she seeks the source of her fear, then moves through the examination encounter and finally uncovers serendipitous outcomes.
Searching for Oz: The Canadian Nursing Doctorate
Authors: Kopinak Janice Katherine
Published: April 2021

ABSTRACT

The pathway leading to a doctorate, for the Canadian nurse, is still a very difficult one to traverse. After completion of a master's degree, many nurses wish to embark on doctoral study. However, for many Canadian, graduate-prepared nurses, finding a doctoral program that will meet the requirement of supplying advanced nursing knowledge is not an easy task. The author describes these difficulties and in drawing on an analogy from the "Wizard of Oz," suggests solutions that can be used to eliminate some of the current roadblocks.
Living Environments, Geriatric Wheelchairs and Older Persons' Rehabilitation
Authors: Snyder Lorraine Hiatt
Published: April 2021

Reprinted from Human Ecology Forum, Vol. 3, No. 2, Autumn, 1972,
MEET YOUR LEADERS
Authors: Anonymous
Published: April 2021

JGN welcomes new editorial board members...
KNEE SYNOVECTOMY IN HEMOPHILIA
Authors: Clark Mary Williams
Published: April 2021

ABSTRACT: We sent questionnaires to 268 hemophilia clinics in the United States, asking about their experiences with knee synovectomy in hemophilic patients, and 86 clinics responded. Of those responding, 22 clinics reported a total of 65 synovectomies, one to seven cases per clinic, in patients ranging from 4 to 56 years of age. Follow-up periods ranged from six months to eight years. The indication for synovectomy was failure of medical management to control recurrent bleeding into the joint; preoperative frequency of bleeding ranged from 1 to 20 hemarthroses per month. Factor replacement for the surgery and postoperative period provided factor levels of 20 to 100%, for five days to three weeks. All but three surgeons routinely used a drain. Physical therapy was begun an average of ten days after surgery (median, 5 days) and consisted of isometric, active-assisted or active range-of-motion exercises. Some clinics used manipulation from 7 to 14 days after surgery; one manipulation was done three months after surgery with an improvement in range of motion. Most patients lost range of flexion postoperatively (from 10 to 50° lost). Four cases of postoperative ankylosis were reported. After synovectomy the frequency of hemarthrosis decreased in ail patients (0-1 /mo). We believe synovectomy can be useful for carefully selected patients in whom nonsurgical management has been ineffective, when done in centers with full laboratory and physical therapy support.
CLASSIFICATION AND TREATMENT OF ANKLE FRACTURES
Authors: Dabezies Eugene , D'Ambrosia Robert D , Shoji Hiromu
Published: April 2021

ABSTRACT: Treatment of ankle fractures should restore normal ankle joint anatomy. The systematic approach in analysis based on understanding of the anatomy, the roentgenograms and the mechanism of injury allow one to determine the elements of the lesion. The Lauge-Hansen classification is most helpful because it takes into account the ligamentous damage that may have occurred, therefore, giving one a better appreciation of the extent of the injury. Open reduction that accurately restores the joint anatomy produces the best and most enduring end-results. Early mobilization of the ankle is possible when internal fixation has produced stability that withstands the dynamic activity of controlled use. A "cook book" approach should not be used; rather, the fundamental principles should be understood, and then the methods of treatment will be self-evident.
SKELETAL CHANGES IN COPPER DEFICIENCY FOLLOWING PROLONGED TOTAL PARENTERAL NUTRITION
Authors: Wiss Donald A , Ledesma-Medina Jocyline
Published: April 2021

ABSTRACT: Two cases of human copper deficiency following total parenteral nutrition are reported. The clinical, biochemical, and roentgenographic features of the syndrome are discussed and the histologic changes in bone are reviewed. Replacement therapy with copper sulfate rapidly corrects the diverse spectrum of abnormalities in this nutritional disorder.
HEMANGIOMA OF THE FINGERTIP
Authors: Frazier Calvin H
Published: April 2021

ABSTRACT: This article describes a case of hemangioma of the fingertip that the patient said had been treated previously without success. A satisfactory result was achieved after using a V-Y pedicle flap.
IRREDUCIBLE DISLOCATION OF THE DISTAL INTERPHALANGEAL JOINT CAUSED BY LONG FLEXOR TENDON ENTRAPMENT
Authors: Rayan Ghazi M , Elias Louis S
Published: April 2021

ABSTRACT: Two cases of open irreducible dislocation of the distal interphalangeal joint are reported. One case involved the ring finger, and the other involved the thumb. The cause of irreducibility in both cases was an entrapment of the flexor digitorum profundus tendon behind the ulnar condyle of the adjacent phalanx.
MULTIPLE EPIPHYSEAL DYSPLASIA: A LONGITUDINAL FAMILY STUDY
Authors: Lehman William L , Murray Douglas M
Published: April 2021

ABSTRACT: The natural history of multiple epiphyseal dysplasia in a 74-member kindred was monitored for 17 years. Genetic transmission was clearly autosomal dominant, with variable expressivity. Onset of symptoms, joint involvement, and severity of deformity in 24 definitely affected individuals were somewhat variable, though short stature and hip involvement were characteristic. In several cases patients displayed the clinical and radiographic course of such diverse diseases as Blount's, Perthes, and osteochondritis dissecans, suggesting a common developmental etiology. Longitudinal study suggests that non-weightbearing in the prepubertal patient may limit evolving hip deformity. Experience with surgical interventions is discussed.
THE NATURAL HISTORY OF "BOW LEGS" AND "KNOCK KNEES" IN CHILDHOOD
Authors: Weiner Dennis S
Published: April 2021

ABSTRACT: Since it is still quite prevalent in many communities to see cases of bow legs and knock knees treated with a variety of different shoes and contraptions, the author was prompted to do a retrospective review of patients primarily complaining of either bow legs or knock knees in childhood. The data generated was then compared with a large number of consecutive operations done at Akron Children's Hospital Medical Center, and with data on 600 control normal males and females who did not complain about their knees. Based on a review of 265 children with bow legs and 336 with knock knees, this comparison allowed for the definition of the natural history of these conditions. It was found that treatment was superfluous, unnecessary, and did not alter the natural history. It was found that, in children under two years of age, there is a distinct "varoid" phase that is subsequently followed by a "valgoid" phase to age ten. By skeletal maturity, only minor degrees of bow legs or knock knees were present, and no case necessitated any further attention.
PROLONGED SURVIVAL FOLLOWING REPEATED PULMONARY RESECTIONS FOR METASTATIC OSTEOGENIC SARCOMA
Authors: Light Terry R , May Carl , Fenn John E
Published: April 2021

ABSTRACT: This case report discusses the clinical course of a gentleman who is alive today without evidence of tumor 14 years following above knee amputation for osteogenic sarcoma of the distal femur. Twice during the two years following his initial ablative surgery, metastatic pulmonary foci were identified and resected. The latter procedure required partial chest wall and pneumonectomy resection.

Survival beyond ten years occasionally occurs following initial ablative surgery for osteogenic sarcoma. Prolonged survival has only rarely been reported following repeated pulmonary resection procedures. The extent of his second resection procedure is noteworthy, in light of the early evidence of recurrent or residual disease a few months after initial thoracotomy.

The potential for long-term survival exists in a substantial fraction of patients with osteosarcoma metastatic to the lung.
PATHOLOGICAL FRACTURE IN HYPERTHYROIDISM
Authors: Chmell Samuel
Published: April 2021

ABSTRACT: A unique case of a young woman with severe osteopenia secondary to thyrotoxicosis who developed a pathological humeral fracture is presented. Osteoclastic resorption is apparently directly stimulated by thyroid hormones. Antithyroid therapy corrects the derangement.
Abductor Paralysis and the Role of the External Oblique Transfer
Authors: Hammesfahr Rick , Topple S , Yoo K , Whitesides T , Paulin A M
Published: April 2021

ABSTRACT: Hip abductor paralysis leads to gait abnormalities and to hip instability. Correction of abductor paralysis was first done by Mustard in patients with poliomyelitis and later adapted by Sharrard for patients with a myelomeningocele. The Mustard-Sharrard procedure is technically difficult, with strict indications for patient selection. By contrast, the external oblique transfer of Thompson has broad applicability and is a relatively simple operative procedure. This is a preliminary report of 37 external oblique transfers performed on poliomyelitic patients. The patient satisfaction rate is 89% and none of the patients who wore a pelvic band preoperatively required one postoperatively. While average followup is only nine months, this report supports the earlier work by Thompson. The procedure is successful in poliomyelitic patients and may also be appropriate for myelodysplastic patients.
Traction in the Treatment of Spinal Deformity
Authors: Lawhon S Michael , Crawford Alvin H
Published: April 2021

ABSTRACT: An independent study was undertaken whereby all members of the Scoliosis Research Society as well as orthopedic surgeons known by the authors to be involved in the treatment of spinal deformities were queried to determine 1) the role of various forms of traction, 2) methods and timing ot application, 3) the indications for use with respect to type of spinal deformity and angle of curvature, and 4) the complications encountered during use. Our results indicated a majority of spinal surgeons, 85%, used preoperative traction when curves were greater than 80° . Cotrel's traction was considered ineffective by the majority of respondents. Halofemoral traction was considered to be indicated in rigid curves greater than 80° and/or associated with pelvic obliquity, and paralytic/neuromuscular curves. Halo-pelvic traction has very limited use in "collapsing spines." Halo-gravity techniques (wheelchair, circoelectric bed) have become increasingly popular and their use issate and effective. Halo-cast is widely accepted as an effective method in the treatment of cervical spine fracture/dislocations and cervicothoracic curves.
Pitfalls in the Diagnosis of the Simple Wrist Ganglion
Authors: Fogel Guy R , Younge Derek A , Dobyns James H
Published: April 2021

ABSTRACT; A wrist mass, often found to be a ganglion, is a common clinical problem. Any mass is difficult to diagnose by physical examination alone. Reported entities appearing to be wrist ganglions areanomalous extensor muscle bellies, lipomas, neuromas of the posterior interosseous nerve, synovial cysts of rheumatoid arthritis, aneurysm of the radial artery, and others. In addition, the authors are aware of entities not previously reported. This retrospective review of four malignancies and a plexiform neuroma that appeared to be simple wrist masses serves to increase the clinician's awareness of the pitfalls to be avoided in the diagnosis of the wrist mass.
Salah Eddin External Fixation System: A Bone Slider and Compressor
Authors: Habboushe Mudhaffar P
Published: April 2021

ABSTRACT: This study involves 65 patients with severe war injuries to the extremities where all conventional and available lines of treatment have failed or a decision of amputation has been made. Twelve humeri, 45 tibiae and eight femura were studied. The sliding system was used on 39 patients and the compressor system on 26 patients. In the sliding system, gaps ranged from 2 cm to 12 cm. In the compressor system established nonunion, failed bone graft operations, infected pseudarthrosis and gaps less than 2 cm were studied.

Salah Eddin external fixation systems, both sliding and compressor, were found to be efficient, biomechanicaliy adequate, easy to apply and remove and able to replace considerable gaps with no risks of open surgery.
ANSWER PLEASE
Authors: Harris William A , Yngve A , Herndon W A
Published: April 2021

Whistling Face Syndrome
Life-Threatening Clavicular Osteomyelitis in Two Debilitated Patients
Authors: Baratz Mark , Appleby David , Fu Freddie H
Published: April 2021

ABSTRACT: Two cases are presented of immunologically compromised patients who developed acute pyogenic clavicular osteomyelitis from direct spread of a contiguous focus. Each patient's condition declined despite antibiotic therapy drainage procedures until survival was in doubt. Both showed striking reversal of their conditions and recovery when an aggressive surgical debridement (total claviculectomy) was performed.

Acute pyogenic osteomyelitis of the clavicle is uncommon and rarely reported. The special implications in our patients of this disease of the adapted therapy are discussed.
Ankle Arthroscopy: Anatomical Features
Authors: Harty Michael
Published: April 2021

The following contribution to Arthroscopic Advances is the first of a two part series on arthroscopy of the ankle. Part rwo will appear in the February 1985 issue.

ABSTRACT: The site and functional significance of the anatomical structures surrounding the ankle joint plays a major role in the selection of arthroscopic portals.
Vascularized Fibular Grafting for the Treatment of Congenital Pseudarthrosis of the Tibia
Authors: Gordon Leonard , Weulker Nicholas , Jergesen Harry
Published: April 2021

ABSTRACT: Six patients with congenital pseudarthrosis of the tibia were treated with vascularized fibula transplantation after the abnormal pseudarthrosis site had been radically debrided. At the time of surgery, the patients' ages ranged from 18 months to 5.5 years, and follow up was from 9 months to 4.5 years. All the fibular transplants healed and the patients were all fully weight bearing in a brace 6-months postoperatively. Age at fracture or surgery, site of the fracture, or radiographic appearance were not contraindications to the use of this technique. Although three of the patients required one further operation, the short- and long-term problems have been relatively minor. This technique has proven successful in managing many resistant patients with this difficult orthopedic problem.
Bilateral Fracture of the Upper Third of the Fibula Caused by Indirect Trauma
Authors: Walker A Paul
Published: April 2021

ABSTRACT: A case of bilateral fractures of the upper third of the fibula caused by indirect trauma is reported. There was no associated ankle or knee injury. A probable mechanism of injury is discussed.
Compression Induced Damage on In-Situ Severed and Intact Nerves
Authors: De Luca Carlo J , Bloom L Jack , Gilmore L Donald
Published: April 2021

ABSTRACT: The effect of rapid as well as sustained compressive forces applied to the surface of intact and severed peroneal nerves of rabbits was studied. Considerable effort was taken to ensure a quantitative and consistent experimental paradigm. Stimuli were delivered to the sciatic nerve, and the compound action potential was recorded in the peroneal nerve, with compressive forces applied more proximally on the peroneal nerve. It was found that the conduction of action potentials on the larger nerve fibers was more sensitive to compressive force than that of the smaller nerve fibers, although all nerve fibers stopped conducting when sufficient compression was applied to the nerve. The effect on the conduction of action potentials on the nerve fibers appeared to be determined both by Laplace's law (as previously reported by others) and the viscoelastic properties of the entire nerve. Relatively low compressive forces (20 gm applied over approximately 7 sq mm) were found to decrease the neutral conduction of the larger nerve fibers for at least two hours, whereas stagnation of blood circulation was not found to affect measurably the neural conduction of all the nerve fibers for up to two hours.
Treatment of Solitary Bone Cysts with Intramedullary Nailing
Authors: Santori Francesco , Ghera Stefano , Castelli Vincenzo
Published: April 2021

ABSTRACT: The article describes the treatment of solitary bone cysts of the upper and lower limbs by means of elastic intramedullary nailing. In the 11 cases treated, bone rehabilitation was complete, probably due to the defection of the intracystic fluid by means of the drainage caused by the nails.
Osteolysis of the Pubic Bone Simulating Malignancy: A Case Report and Review of Literature
Authors: An Howard S , Jackson W Thomas , Hawthorne Kenneth B
Published: April 2021

ABSTRACT: A 78-year-old white female presented with groin pain of 3 months' duration. Radiographs revealed an osteolytic lesion in the pubic bone, simulating a malignancy or infection. A closed needle biopsy was performed and pathological findings were consistent with posttraumatic osteolysis, showing avascular necrotic tissues. A review of the literature found 16 previous cases presenting with groin pain and a radiographic lesion in the pubic bone that appeared malignant. All of the patients reported in the literature were postmenopausal women most with a recent history of trauma or increased physical activity. All of the lesions were benign and, when treated conservatively, usually resolved within 6 months.
A New Semirigid Method for Interpedicular Fixation of the Spine
Authors: Luque Eduardo R , Rapp George F
Published: April 2021

ABSTRACT: A new, semirigid method for interpedicular fixation of the spine is described. The system has safety factors, flexibility, and other advantages over some systems now in use. Details in technique are given. Eighty cases have been followed for an average of 18 months. Results of the series are presented, and indications and contraindications for use of this system in spinal surgery are outlined.
Use of the Herbert Bone Screw for Scaphoid Nonunions
Authors: Manske Paul R , McCarthy Jack A , Strecker William B
Published: April 2021

ABSTRACT: The Herbert bone screw was used to treat 22 selected patients with established scaphoid nonunions. The indications for its use included evidence of avascular necrosis, proximal third fracture fragment, previous bone graft, fracture angulation or displacement, and a bipartite scaphoid. Treatment resulted in radiographic and clinical evidence of healing in 16 patients; 4 patients were symptom-free, but had incomplete healing as evidenced by radiograph; and 2 patients had persistent symptoms with radiographic evidence of nonunion.
The Use of Anesthesia for Surgical Treatment of Achilles Tendon Rupture
Authors: Keller Johnny , Bak Bue
Published: April 2021

ABSTRACT: The influence of the type of anesthesia on the treatment and final results of Achilles tendon surgery was investigated. Open repair of Achilles tendon rupture was performed using general or spinal anesthesia in 80 patients and local anesthesia in 42 patients. Surgery using local anesthesia was very acceptable to the patients and was less resource-demanding than surgery using general anesthesia. The functional result was good in both groups and only minor differences in the functional results between the two groups were found.
Femoral Endoprosthesis Fixation With a Soft, Flexible Low Modulus Stem Coating Four to Six Year Clinical Results
Authors: Runne Wouter C , van Sambeek Karel J M , Stierum Jan L , van Tongerloo Robert B
Published: April 2021

ABSTRACT: Fifty-nine patients received 62 femoral endoprostheses exhibiting a 2 mm thick, low modulus (soft), porous stem coating in a total hip arthroplasty. Follow up ranged from 36 to 69 months (average 60 months). There were 26 male and 33 female patients whose ages ranged from 29 to 75 and 39 to 72 years, respectively (average 57 years). All patients were operated on without trochanteric osteotomy. Initial stabilization was obtained by uniform press-fit and collar/neck osteotomy contact at implantation; secondary stabilization derived from soft tissue ingrowth into the stem coating. Four implants in four patients were deleted from the scored population because of unrelated deaths or loss to follow up. By the Harris scoring system, 48 of the 58 implants (82.7%) were rated excellent or good, 58.6% and 24.1% respectively. Seven were rated poor (12.1 %), of which six (10.3%) have been revised. Other revisions included one hip for secondary sepsis (1.7%), one post-traumatic fracture (1.7%), and one intraoperative technical error (1.7%).
SOMETHING NEW
Authors: Anonymous
Published: April 2021

Appearance of a product in this section in no way implies endorsement by Orthopedics* including its publisher and editorial board. This section is presented solely as a service to our readers.
The Study of Giant Cell Tumors in Bone
Authors: Fan Quingyu , Lu Yu-pu
Published: April 2021

ABSTRACT: Twelve samples of giant cell tumor of bone were incubated in the authors' laboratory. The activity of the cells was documented by means of time lapse cinemicrography. The multinuclear giant cells (MGCs) with undegenerating nuclei migrating from the expiants had active ameboid movement and continuously changed their shapes. The majority of them kept splitting themselves into smaller MGCs until mononuclear cells formed, which were indistinguishable from the original stromal cells in morphology and could take up tritiated thymidine as shown by autoradiography. This splitting process of MGCs is mainly responsible for their vanishing in culture. The authors believe that an MGC is one of the true neoplastic elements. MGCs are present merely in the form of a syncytium derived from neoplastic stromal cells. In culture, the factors maintaining the syncytium are lost and the process opposite to cell fusion appears. Therefore, from a morphological view, MGCs and neoplastic stromal cells are homologous.
Angulation of Fixation Screw in Knee Ligament Procedures
Authors: Acker James H , Drez David
Published: April 2021

ABSTRACT: In knee ligament reconstruction procedures, soft tissue grafts are often secured to bone with sutures tied around screws used as tie-down posts. The technique of utilizing screw angulation to preserve the tension in the graft is demonstrated. Angulation of the fixation screw can enhance the attachment of the graft to bone by maintaining or increasing the tension applied to the graft as the screw is advanced to its final position in the bone.
Lower Extremity Telescopic Orthosis for Immediate Fitting in Paraplegia
Authors: Limbird Thomas J , Stills Mel , Elliott Deby , Wharton George
Published: April 2021

ABSTRACT: For initial gait training with the paraplegic patient, a lower extremity telescoping orthosis has been developed. This brace eliminates the time-consuming fabrication, considerable weight, and cumbersome use of conventional knee-ankle-foot orthoses and is easily adjustable to a wide range of patients. Particularly during the early phase of rehabilitation, this brace offers significant advantages to the patient with lower extremity disabilities.
The Effect of Prenatal Protein-Energy Malnutrition on Collagen Metabolism in Fetal Bones
Authors: Miwa Takashi , Shoji Hiromu , Solomonow Moshe , Yazdani Malektaj , Nakamoto Tetsuo
Published: April 2021

ABSTRACT: We analyzed various biochemical variables of the bones in fetal rats whose dams were protein-energy malnourished. Dams were randomly divided into two groups and fed either a 6% protein diet as a malnourished group or a 20% protein diet as a control, from day 13 of gestation to day 22, when fetuses were removed. Hexosamine and hydroxyproline contents of the calvaría and hexosamine contents of long bones were greater In the malnourished group than in the controls. Sequential extractability of collagen differed among various bones in the malnourished group and controls. The ratio of α:β obtained from SDS-polyacrylamide gel of neutral salt-soluble collagen tended to increase in the long bones and mandible, and decrease in the calvaria and ribs in the malnourished group. Also, the ratio of α
1
:α
2
tended to be lower in the malnourished group than in the control group in all bones. Protein-energy malnutrition during pregnancy has shown to affect biochemical composition of various fetal bones.
Sporotrichosis
Authors: Rowe John G , Amadio Peter C , Edson Randall S
Published: April 2021

ABSTRACT: Forty-nine patients with cultureproven sporotrichosis were treated between 1 957 and 1986. Infections were lymphocutaneous in 36 patients, pulmonary in two, intraarticular in four, and involved multiple deep tissues in seven. Thirty-six infections involved an upper extremity. Five patients with deep infection had some evidence of being immunocompromised. Delay in diagnosis after presentation averaged 4 months overall and 25 months for those with deep infection. Ten of 12 joint infections resulted in significant functional impairment. Treatment with saturated potassium iodide solution was effective for lymphocutaneous infection. Four patients with infection of deeper tissues remain infected despite multiple operations and systemic courses of antifungal medication.
Radical Resection of the Shoulder Girdle for a Malignant Tumor: Four Case Reports
Authors: Xunyuan Di , Minsin Jin , Yuanpei Xin
Published: April 2021

ABSTRACT: Four cases of malignant tumor of the shoulder were treated by radical resection of the shoulder girdle, saving the upper extremity. During follow up, all patients were able to use their upper extremities with satisfactory function and stability. This article presents the indications, operative technique, and follow up.
CLS Femoral Component
Authors: Giacometti Roberto Ceroni , Pace Antonio
Published: April 2021

ABSTRACT: Between 1984 and 1988, we performed 540 total hip replacements, using the CLS device as an uncemented femoral component. The reasons that led to this type of prosthesis and our surgical technique are illustrated. In the whole series of treated patients, we found a smaller number of complications and in 128 cases with a minimum 2year follow up, we had very good results. The evaluation of radiologic findings show that the subsidence of the device occurred in three cases only.
Early Clinical Results of the TTAP Acetabular Cup
Authors: Keating E Michael , Ritter Merrill A , Faris Philip M , Czarkowski Robert A
Published: April 2021

ABSTRACT: One hundred seventy-five threaded titanium alloy prostheses (TTAP) acetabular cups and 125 cemented cups were evaluated clinically and radiographically at 1 to 3 years postoperatively. The series was statistically different in that there were more women in the cemented group than in the noncemented group (P <.001). The cemented group was also older than the threaded group (P <.001). Pain, ambulation, function, range of motion, and roentgenograms were evaluated in all patients. There were no significant differences in the clinical function of the two groups, but there were fewer radiolucencies in the radiographic analysis of the TTAP group. This may be an artificial difference, since two TTAP acetabular cups were removed for loosening, but none of the cemented cups were removed.
Experimental and Clinical Experience With Hydroxyapatite-Coated Hip Implants
Authors: Geesink R G T
Published: April 2021

ABSTRACT: Published experimental studies have founded the principles of implant fixation using hydroxyapatite coatings. Clinical results are given on the first 100 consecutive cases of hydroxyapatite-coated total hip replacement performed since 1986. The Harris hip score rating at 1 year and longer is 98 and the specific radiologic characteristics are discussed.
Closed Intramedullary Pinning of Metacarpal and Phalanx Fractures
Authors: Varela Charles D , Carr James B
Published: April 2021

ABSTRACT: The surgical technique for closed intramedullary pinning of metacarpal and phalanx fractures is described. Commonly available 0.045 K-wires are used in a manner similar to Ender or Rush nailing of long bone fractures. This technique avoids impaling soft tissue structures-a drawback to more commonly used percutaneous K-wire techniques-and provides sufficient stability to allow early, protected motion.
THE EFFECTS OF PRENATAL PROTEIN-ENERGY MALNUTRITION ON OSSIFICATION OF FETAL RAT BONES: A BIOCHEMICAL STUDY
Authors: Miwa Takashi , Shoji Hiromu , Solomonow Moshe , Nakamoto Tetsuo
Published: April 2021

ABSTRACT

In fetal rats whose dams were fed a low-protein diet, 35S sulfate uptake into the growth plate of the long bone and rib was higher than in the control group. The el ut ion pattern of guanidine-HCI extract in gel chromatography revealed that the malnourished group had more high molecular weight proteoglycans in the dissociative condition and a larger aggregated portion in the associative condition than did the control group; however, the same chondroitinsulfate chain size existed. Calcium content did not differ in both groups. Aggregated proteoglycan or a high molecular *weight proteoglycan that existed in the malnourished group probably played an inhibitory role in calcification. Prenatal protein-energy malnutrition may delay the change of proteoglycan character, which could affect mineralization of fetal bones.
TREATMENT OF KYPHOTIC DEFORMITY IN ANKYLOSING SPONDYLITIS
Authors: Gerscovich Eugenio O , Greenspan Adam , Montesano Pasquale X
Published: April 2021

ABSTRACT

This article reviews the available literature on the surgical options for the correction of kyphosis in ankylosing spondylitis and presents the radiologie appearance of the postoperative spine. In the postsurgical evaluation of the spine, the focus is on appreciation of the patterns of correction, early and late determination of angular correction, recognition of various complications (infection, nonunion, improper location, or breakage of hardware), and alertness to the possibility of complications at all levels of the spine.
A MISSING LINK IN THE EVOLUTION OF THR: "DISCOVERY" OF THE LATERAL FEMUR
Authors: Fetto Joseph F , Austin Kenneth S
Published: April 2021

ABSTRACT

Using cadaveric studies and mathematical models that include consideration of the iliotibial band (ITB) as a "tension band/9 the authors have demonstrated that compression loading occurs throughout the entire lateral femoral cortex from the apophyseal line of the greater trochanter to the lateral femoral epicondyle at the knee* This model suggests that the magnitude of this load on the medial and lateral cortices is proportional to the medial displacement of these cortices from the ITB. The authors have further demonstrated that the "tension band" model is more consistent with actual bone morphology and function than existing models and is a strong argument for the incorporation of design concepts such as lateral extensions into total hip arthroplasty femoral components. Such extensions would permit use of lateral femoral cortical bone as an additional base of prosthesis support, distributing loads over a greater area of the proximal femur. This model, therefore, would theoretically reduce the areas of stress concentration in diaphyseal bone and stress shielding of the proximal femur, both of which appear to be deficiencies of present femoral stem designs.
USE OF ANTIBIOTIC-PMMA BEADS IN THE ISCHEMIC FOOT
Authors: Calhoun Jason H , Klemm Klaus , Anger Diane M , Mader Jon T
Published: April 2021

ABSTRACT

Thirty-six patients with 44 ischemic foot infections were managed with antibiotic-polymethylmethacrylate (PMMA) beads. Most of these patients received gentamicin-impregnated PMMA beads but tobramycin and vancomycin-impregnated PMMA beads were used on three patients. Angiopathy occurred in 35 patients secondary to diabetes and secondary to renal disease in 2; 1 patient had both diabetes and renal disease. The most common bacteria was Staphylococcus aureus (82%), although other organisms and multiple bacteria were present. In spite of the variability of the bacteria, PMMA beads were helpful in managing foot infections in this difficult patient population.
SPINAL EPIDURAL ABSCESSES IN CHILDREN
Authors: Jacobsen F Stig , Sullivan Bradley
Published: April 2021

ABSTRACT

Spinal epidural abscess (SEA) is rare, especially in children, in which fewer than 90 cases have been reported. We present three case examples illustrating the complex course before diagnosis and treatment. All patients had back pain, but two had pain of the abdomen or extremity dominating the clinical picture. Magnetic resonance imaging (MRI) was found to be the best diagnostic test. All had surgery with full recovery. A literature review of 58 cases since 1945 was done and showed that 76% of children had neurological compromise before surgery, and the overall mortality rate in children was 12%.
REVISION TOTAL JOINT ARTHROPLASTY: DOES MEDICARE REIMBURSEMENT JUSTIFY TIME SPENT?
Authors: Ritter Merrill A , Carr Kimberly D , Keating E Michael , Faris Philip N , Bankoff David L , Ireland Philip M
Published: April 2021

ABSTRACT

In 1991, five different total joint replacement surgeons performed 337 primary total knee replacements and 250 primary total hip replacements. They revised 25 total knee replacements and 73 total hip replacements. The average length of stay was 6.6 days for the primary total knee arthroplasty and 7.5 days for knee revisions. For total hip replacement, average stay was 5.9 days for primary surgery and 6 days for revisions. The operative time required for each of the five surgeons to complete a total knee replacement increased 55%, 3%, 38%, 72% and 38%; whereas for the total hip replacement, time increased 87%, 77%, 84% and 58%. Overall, there was a 41% increase in operating time for revision total knee replacements and a 77% increase for revision total hip replacement. Allowable charges by Medicare in 1993 for a primary knee and hip replacement were $1,298 and $1,363, respectively. Revision total knee replacement increased 24.3% ($1,613) and revision total hip replacement increased 30.8% ($1,782) in the state of Indiana. These figures do not encourage those surgeons who are capable of doing total joint replacements to revise other surgeons' problems.
RADIOLOGIC CASE STUDY
Authors: Gilbert Thomas J , Bullis Brent R , Griffiths Harry J
Published: April 2021

TENNIS CALF OR TENNIS LEG
MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF HEEL PAIN
Authors: Hall Reginald L , Erickson Scott J , Shereff Michael J , Johnson Jeffrey E , Kneeland J Bruce
Published: April 2021

ABSTRACT

This study demonstrates magnetic resonance findings in 16 patients (25 heels) with heel pain. Sixteen of 25 (64%) studies demonstrated abnormalities which could be related to the etiology of their heel pain. Eleven of 16 abnormal scans demonstrated thickening of the plantar aponeurosis with associated fibrosis (7 of 11), and a tear of the flexor digitorum brevis (1 of 11). One study demonstrated changes in the heel pad consistent with fluid. The other four abnormal studies demonstrated changes thought to be consistent with bilateral fibrous calcaneonavicular coalitions, subtalar arthrosis and tenosynovitis of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons.
THE POTENTIAL USE OF HUMAN RECOMBINANT ERYTHROPOIETIN IN ORTHOPEDIC SURGERY
Authors: Bose William J
Published: April 2021

ABSTRACT

Human recombinant erythropoietin has been approved by the Food and Drug Administration for treatment of anemia due to chronic renal failure or malignancy and in zidovudine-treated patients with the human immunodeficiency virus. It is highly effective in reducing the anemia commonly seen in these patients, with minimal adverse effects. Approximately 20% of patients undergoing elective orthopedic procedures are not able to donate adequate amounts of autologous blood prior to surgery. Additionally, patients who cannot donate 3 or more units of blood prior to large procedures are at increased risk for receiving a homologous transfusion despite the use of intraoperative and postoperative blood conservation techniques. Investigational use of this drug as an adjuvant to autologous blood donation has been shown to increase the amount of blood donated by patients prior to surgery and, therefore, will decrease homologous blood transfusions after surgery. Perioperative use of this drug, dosage, route of administration, and clinical indications are currently being evaluated in multicenter clinical trials.
ACTIVITY RELATIONSHIPS OF TOTAL HIP ARTHROPLASTY IN PATIENTS WITH OSTEONECROSIS AND OSTEOARTHRITIS
Authors: Letson G D , D'Ambrosia R D , Aguilar E A , Wagespack A
Published: April 2021

ABSTRACT

We compared the age adjusted results of all primary Osteonics total hip arthroplasties with osteonecrosis and osteoarthritis. The Harris index hip score was used for the analysis. Twenty-eight patients had osteoarthritis and 26 patients had osteonecrosis. The Harris hip score was used to compare the osteoarthritis and osteonecrosis gross. Patients with osteoarthritis gradually increased in Harris hip score, whereas osteonecrosis patients gradually decreased in Harris hip score over 60 months. However, after the patients were adjusted for age above and below 50 years, the trend for each group was similar despite the diagnosis. All patients below 50 years of age, regardless of diagnosis, gradually decreased in hip score over time. On the other hand, all patients over 50 had a gradual increase in hip score with time. The poor results seen in patients with osteonecrosis may be related more to age and activity level than to the primary diagnosis. We do not believe that the diagnosis of osteonecrosis plays as significant a role in the final outcome of a total hip arthroplasty as does the patient's age and, more importantly, activity level following hip arthroplasty.
Blood Management Experience: Relationship Between Autologous Blood Donation and Transfusion in Orthopedic Surgery
Authors: Sculco Thomas P , Gallina Jessica
Published: April 2021

ABSTRACT

Preoperative autologous donation (PAD) is commonly used for patients undergoing elective total joint arthroplasty; however, PAD is associated with increased overall transfusion rates and may not be cost-effective for all patients. A retrospective analysis was conducted on a series of 1405 patients undergoing unilateral or bilateral total hip or total knee arthroplasty at The Hospital for Special Surgery to determine the effect of PAD on transfusion outcomes. Eighty-three percent of patients predonated blood (1 unit to 3 units). Transfusions occurred in 82% of PAD participants and in only 50% of nondonors. The allogeneic transfusion rates were 8% for PAD participants and 50% for nondonors. Thirty-four percent to 45% of donated autologous units were discarded. Hemoglobin concentrations measured prior to surgery were inversely related to frequency of allogeneic transfusion. These data underscore the importance of hemoglobin levels in blood management planning. This information can be useful for formulating rational, cost-effective blood management guidelines.
In Vitro Comparison of Elongation of the Anterior Cruciate Ligament and Single- and Dual-Tunnel Anterior Cruciate Ligament Reconstructions
Authors: Edwards T Bradley , Guanche Carlos A , Petrie Scott G , Thomas Kevin A
Published: April 2021

ABSTRACT

This study evaluated strain in the normal anterior cruciate ligament (ACL) and compared it to four different doubte-strand hamstring tendon reconstructive techniques. Seventeen fresh-frozen knees from 11 cadavers were tested. The strain in the anteromedial and posterolateral bands of the native ACL and their equivalents in four autograft techniques were measured using differential variable reluctance transducers.

The anteromedial band of the intact ACL shortened from 0°-30° of flexion, then lengthened to 120°; the posterolateral band of the intact ACL shortened from 0°-120° of flexion. Following ACL excision, these knees underwent reconstruction with double-strand hamstring tendons with either single tibial and femoral tunnels, single tibial and dual femoral tunnels, dual tibial and single femoral tunnels, or dual tibial and dual femoral tunnels. With the exception of the dual-band, dual-tunnel technique, all of the procedures placed greater strain on the reconstructive tissues than was observed on the native ACL, after approximately 30° of flexion.

These results indicate that dual-band hamstring tendon reconstructions placed with single tibial and femoral tunnels do not address the complexity of the entire ACL. Rather, these procedures appear to only duplicate the effect of the anteromedial band, while perhaps overconstraining the joint as a result of its inability to reproduce the function of the posterolateral band. During rehabilitation following ACL reconstruction, therefore, only from 0°-30° of the graft tissues are not significantly strained. Dual tibial and femoral tunnel techniques should be evaluated further to more closely recreate knee kinematics following ACL reconstruction.
Elbow Ligament Strain Under Valgus Load: A Biomechanical Study
Authors: Pribyl Charles R , Wascher Daniel C , Firoozbakhsh Keikhosrow , Hurley Davis K , McNally Thomas P , Weiser Martin W
Published: April 2021

ABSTRACT

This study assessed the importance of the anterior and posterior bundles of the medial collateral ligament in the elbow by measuring in situ strain in response to valgus loads at three positions of forearm rotation throughout a full arc of motion. Strain in the anterior bundle was significantly greater than in the posterior bundle and increased with more flexion. The anterior bundle developed strain at a lower flexion angle (30°) than the posterior bundle (60°). Strain ratio increased with load increase for all flexion angles. Forearm position minimally affected strain. These results indicate that the anterior bundle is important in resisting a valgus load, particularly in mid-flexion, while the importance of the posterior bundle increases as the elbow approaches full flexion.
Treatment of Large Skeletal Defects in the Lower Extremities Using Double-Strut, Free Vascularized Fibular Bone Grafting
Authors: Chang Ming-Chau , Lo Wai-Hee , Chen Chuan-Mu , Chen Tain-Hsiung
Published: April 2021

ABSTRACT

This article reports on the use of double-strut, free vascularized fibular grafts to treat six patients with infected nonunion or traumatic bone loss in the femur or tibia after prolonged treatment and multiple operations. The defects were 6-13 cm long. Five patients achieved solid union within 6 months, and one patient required additional cancellous grafting to achieve union at the distal end of the fibula. One patient experienced a stress fracture due to strenuous exercise, and union was achieved 3 months after reapplying an external fixator. Although three patients had some restricted knee motion, all patients had a satisfactory outcome in regard to walking, and no limb-length discrepancies were noted in any patient.
In Vitro Analysis of Periprosthetic Strains Following Total Knee Arthroplasty
Authors: Parry Bryan R , Ganley Theodore J , Bortel David T , Englund Richard , Cooney Timothy E
Published: April 2021

ABSTRACT

Clinical case studies have disclosed certain risk factors associated with periprosthetic fracture in elderly patients. How the mechanical strength of the distal femur is changed by total knee arthroplasty (TKA) has not been elucidated. Using elderly cadaveric femora, this study evaluated both periprosthetic strains and associated fracture patterns arising from an in vitro simulation of a fall onto the distal femur. The data showed a significant Increase in anterior and posterior mechanical strain following TKA. Neither stemless nor stemmed versions of two cemented Howmedica prostheses (Rutherford, NJ) reduced distal femur strains to baseline values. However, neither produced a disproportionate frequency of periprosthetic fractures. Although not formally evaluated herein, bone geometry/density may contribute more profoundly to the occurrence of periprosthetic fracture than the implants tested.
Functional Outcome Following Surgical Treatment of Metastatic Tumors Involving the Femur
Authors: Lee Sang Hoon , Kim Han-Soo , Kim Sang Rim , Park Yong-Bum , Yoo Kwang Hyun , Lee Han Koo
Published: April 2021

ABSTRACT

Thirty-eight patients treated surgically for metastatic tumors of the femur were reviewed to evaluate the effects of surgical treatment on quality of life. Average age at surgery was 59 years. The most common origin site of metastatic tumors was the lung. The intertrochanteric area was involved in 14 patients, followed by the subtrochanteric area in 1 1 , femoral neck in 7, and shaft in 6 patients. Surgery was based on the principles that tumor excision should be maximal, and to permit early postoperative ambulation, internal fixation should be rigid with cement augmentation. Types of internal fixation were applied according to lesion site to allow early ambulation and included intramedullary nailing (1 1 ), compression hip screw (9), and Rowe plates (7). Prosthetic replacement was performed in 9 patients.

Average performance scores improved from 3.8 preoperatively to 2 postoperatively, based on the Functional Classification of the New York Heart Association. In 31 patients (82%), the degree of pain relief was more than a lot according to the criteria of Kaiko. Thirty-five patients survived >5 months postoperatively. In patients with a single metastatic lesion, survival was 21 months, and in patients with multiple lesions, survival was 10 months. Surgical stabilization of a pathologic lesion involving the femur resulted in improvement in the quality of life, including pain relief and early ambulation. In selected patients with a single metastatic lesion and a low-grade primary tumor, prolonged postoperative survival may be expected.