bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraosseous Ganglion Cysts
Authors: Daly Peter J , Sim Franklin H , Beabout John W , Unni K Krishnan
Published: April 2021

ABSTRACT: An illustrative case report of intraosseous ganglion cyst is presented. Intraosseous ganglion cysts are uncommon, juxtaarticular, and benign. They are thought to arise from an intramedullary metaplastic event. Intraosseous ganglia are most common in middleaged patients. They usually involve the tibia but also are located in other skeletal sites. The lesion is typically epiphyseal and appears benign. It is successfully treated with curettage and bone graft if it is symptomatic or progressively increasing in size. It is important to avoid extensive surgical procedures. Recurrence is unlikely.
The Biomechanics and Biology of Internal Fixation Using Plates and Nails
Authors: Perren Stephan M
Published: April 2021

ABSTRACT: In fracture healing, the mechanical environment and bone biology are closely related. Furthermore, the mechanics of the medullary nail fixation are, In many aspects, different from those of compression fixation using screws and plates. A few general items will be discussed to review the basic principles of the mechanics and biology involved and to clarify the terminology. This article outlines the basic ideas of mechanical and biological interaction.
Metallurgical Evaluation of Retrieved Implants and Correlation of Failures to Patient Record Data
Authors: Zardiackas Lyle D , Black R John , Hughes James L , Reeves R Bradley , Jun Jiang Ning
Published: April 2021

ABSTRACT: This study sought to establish an orthopedic implant retrieval program according to ASTM F561-87 (the American Society for Testing and Materials) and to describe the results of evaluation of failed implants. A total of 275 fracture fixation and prosthetic devices have been retrieved to date. Results of metallurgical evaluation showed no deviations in ASTM specifications among the failed implants evaluated. The cause of failure in most cases was fatigue following nonunion or delay in healing.
The Use of Nickel-Titanium Alloy in Orthopedic Surgery in China
Authors: Kuo Paul Pang-Fu , Yang Pei-Jun , Zhang Yan-Feng , Yang Hai-Bo , Yu Yu-Fei , Dai Ke-Rong , Hong Wei-Qing , Ke Mao-Zhi , Cai Ti-Dong , Tao Jin-Chen
Published: April 2021

ABSTRACT: A new biomaterial made of nickel and titanium with its shape-memory characteristics has been manufactured, investigated, and used in Shanghai, China. Since 1981, this biomaterial has been used in 265 cases clinically, among which 71 involved orthopedic surgery. Results are satisfactory without failure in our short-term follow up. This preliminary report of the use of this new biomaterial with the unique characteristic of being able to recover to its original shape with particular transformation temperatures indicates its potential for opening a new field for investigation in surgery. Research to discover appropriate ratios of nickel and titanium for specific usage is underway. The Interest and cooperation between the medical and engineering professions may eventually solve the problems through mutual efforts and result in improved shape-memory biomaterials.
Tire Explosion Injuries
Authors: Teasdall Robert D , Aiken Marc A , Freeland Alan E , Hughes James L
Published: April 2021

ABSTRACT: Twenty-five patients hospitalized with injuries sustained from tire explosions from 1980 to 1987 were reviewed. Injuries occurred directly from the tire rim or parts of Its assembly, from the patient being thrown against adjacent unyielding structures, or a combination of these. Lethal or life-threatening injuries do occur, so these patients initially must be triaged as polytrauma patients. Resuscitation and expeditious attention to life-threatening injuries must be provided when necessary. Serious head, facial, eye, and upper extremity injuries occurred frequently. Pelvic and long-bone fractures, particularly those of the femur, are stabilized primarily as part of the overall treatment of the polytraumatized patient. Open fractures and fractures with arterial injuries and/or compartment syndromes are primarily decompressed, debrided, and appropriately stabilized. After lifethreatening and limb-threatening injuries are attended, eye injuries that threaten sight should be addressed. While hand, wrist, and other upper extremity injuries that do not fall in the above categories may not require immediate or primary treamtent, they are often critical in determining the patient's final outcome. This Is particularly true since most patients are manual workers, often mechanics. Therefore, hand, wrist, and upper extremity injuries should be treated as early as possible and in parallel with other injuries to achieve optimal results and minimize impairment, disability, and time and economic loss from work. Strong emphasis should be placed on education and safety training in preventing this severe form of civilian trauma.
The Use of the Manuflex Disposable Mini External Fixator
Authors: Cziffer Endre
Published: April 2021

ABSTRACT: The Manuflex® mini external fixator is an original device which is suitable for either provisional or definitive fixation of hand or foot fractures. The system is simple, disposable, relatively radiolucent, and inexpensive. It has been tested in an animal laboratory and has been used successfully in 27 human cases.
Hip Fractures in Children: A Long-Term Follow Up of 17 Cases
Authors: Ovesen Ole , Arreskov Jørgen , Bellstrøm Torben
Published: April 2021

ABSTRACT: Late results (average 18 years posttrauma) after hip fractures in 17 children are reported. The average age at the time of fractures was 8.5 years (range 2 to 15 years). The treatment was conservative for undisplaced or slightly displaced transcervical and cervicotrochanteric fractures (Delbet's Type Il and III) as well as for intertrochanteric fractures (Delbet's Type IV). The overall complication rate was 25%. Avascular necrosis of the femoral head was seen in two hips, premature epiphyseal closure with leg shortening in two cases, and a coxa vara in one hip. These complications only had resulted in few symptoms at follow up.
Early Radiolucencies Following Cemented Total Hip Replacement: Influence of Postoperative Treatment with Indomethacin
Authors: Kjærsgaard-Andersen Per , Schmidt Steen Asmus , Pedersen Niels Wisbech , Kristensen Søren Skydt , Pedersen Poul
Published: April 2021

ABSTRACT: The influence of treatment with indomethacin in the first 6 postoperative weeks on the incidence of early loosening and radiolucencies following cemented total hip replacement were studied in 102 hips. Ninety-nine hips in 99 patients without postoperative antiinflammatory treatment served as control group. One year after surgery, two patients in the indomethacin group and five patients in the control group were suspected of having loosening of one or both prosthetic components. However, no patients had a revision. The lateral acetabular cement-bone interface most frequently showed a radiolucent line. Concerning the incidence of radiolucent lines in any acetabular or femoral cement-bone interface zone, no difference could be shown between the two groups. When evaluated 1 year after surgery, postoperative treatment with indomethacin does not increase the incidence of aseptic loosening or cementbone interface radiolucencies in cemented total hip replacement.
Infected Tibial Pseudarthrosis: A 2-Year Follow Up on Patients Treated by the Ilizarov Technique
Authors: Morandi Massimo , Zembo Michele M , Ciotti Mauro
Published: April 2021

ABSTRACT: The Ilizarov technique with a circular external fixator was used in the treatment of infected tibial nonunions. This is a report on 13 patients with a 2-year follow up after removal of the external fixation. There was no debridement of the site of nonunion performed. Union was obtained in all cases. There was no recurrence of infection at follow up. The Ilizarov technique provides the orthopedic surgeon with another alternative in the treatment of complicated tibial nonunions and their associated problems.
The Application of Advanced CT Imaging and Computer Graphics Methods to Reconstructive Surgery of the Hip
Authors: Robertson D D , Walker P S , Fishman E K , Mintzer C M , Poss R , Magid D , Granholm J W , Brooker A F , Essinger J R
Published: April 2021

ABSTRACT: Advanced computed tomographic and computer graphic techniques enhance diagnostic accuracy and offer the means by which three-dimensional operative planning can be achieved. These techniques have been used to diagnose hip pathology, rehearse and evaluate surgical plans, assess postoperative results, and design individualized prostheses.
Quantitative Computed Tomography Reflects Vertebral Fracture Morbidity in Osteopenic Patients
Authors: Kaplan Frederick S , Dalinka Murray , Karp Joel S , Fallon Michael D , Katz Michael , Boden Scott , Simpson Emma , Attie Maurice , Haddad John G
Published: April 2021

ABSTRACT: We studied the relationship between spontaneous vertebral compression fractures and lumbar vertebral trabecular bone density in 69 consecutive patients with suspected osteopenia. Seven had biopsy-confirmed osteomalacia. The remaining 62 were divided into three groups: group 1 - asymptomatic patients suspected of having osteopenia on plain films, but with no vertebral compression fractures (N =24); group Il - those with one to five vertebral compression fractures (N =16); and group III - those with six or more vertebral compression fractures (N =22). A quantitative computed tomographic (QCT) scan of the lumbar spine was performed on all patients. Patients in group I had QCT values of 94 ± 23 mg/cm3 (mean ± SE); those in group Il had QCT values of 66 ± 28 mg/cm3; and those in group III had values of 34 ± 28 mg/cm3. There were significant differences among all groups (P<.001), although there was considerable overlap of individuals among the groups. There was no significant difference between the mean QCT value of patients with one compression fracture and the value of those with between two and five compression fractures. Patients with biopsy-proven osteomalacia had higher vertebral trabecular bone density than patients with osteoporosis and compression fractures. Our study provides evidence suggesting a strong inverse relationship between QCT-measured vertebral bone density and the presence of vertebral compression fractures in a group of osteopenic patients.
Diagnosis and Treatment of Obscure Ulnar-Sided Wrist Pain
Authors: Bottke Craig A , Louis Dean S , Braunstein Ethan M
Published: April 2021

ABSTRACT: Thirty-seven patients were followed for symptoms of chronic ulnar-sided wrist pain in which specific physical examination and standard radiographs were unrevealing. Initial conservative treatment did not relieve the pain. The patients underwent further diagnostic studies including dynamic cineroentgenographic evaluation and radiocarpal arthrography. Nineteen of the 37 patients were demonstrated to have a triangular fibrocartilage complex (TFCC) tear on arthrography; 18 had a normal examination. The average follow up was 23 months. Seven of the 19 patients with TFCC tears have undergone operative treatment, and 5 (71%) remain symptomatic. Of the remaining 12 patients with TFCC tears treated nonoperattvely, eight (67%) have persistent symptoms. Of the 18 patients whose arthrograms were normal, five eventually underwent surgical exploration, four of which remain symptomatic. Of the 13 patients without TFCC tears treated nonoperatively, seven (54%) continue to have symptoms. In our experience, both surgical exploration and nonoperative treatment have been less than satisfying. In addition, treatment results could not be correlated with arthrographic findings.
The Temporomandibular Joint: The Forgotten Articulation
Authors: Lestrange Nile R
Published: April 2021

ABSTRACT: Fifty-seven patients (79 temporomandibular joints) whose symptoms did not respond to conservative treatment subsequently underwent surgery to correct the internal derangement and obtain relief. This 8-year study emphasizes etiology, the diverse nature of the symptoms, clinical diagnosis, radiographic diagnostic features, surgical findings and technique, postoperative treatment, complications, and long-term results. Special attention is given to a heretofore undescribed bilaminar posterior ligament repair technique which appears to provide greater strength of repair and more natural joint function.
A New Technique for Harvesting the Patella Tendon in Patients Undergoing Anterior Cruciate Ligament Reconstruction
Authors: Jackson Douglas W , Cohn Bruce T , Morrison David S
Published: April 2021

ABSTRACT: A new technique for harvesting the patella tendon for anterior cruciate ligament reconstruction is described. A circular oscillating saw is used to harvest the bone plugs. We feel that this technique offers reproducibility that is difficult to obtain with more conventional methods of graft harvesting.
Early Clinical Experience With Orthofix External Fixation of Complex Distal Radius Fractures
Authors: Gainor Barry J , Groh Gordon I
Published: April 2021

ABSTRACT: Twelve patients with complex fractures of the distal radius were treated with the Orthofix external fixation system (EBI Medical Systems, Fairfield, NJ). On follow up physical examination, the average wrist dorsiflexion was 46 degrees, and the average volar flexion was 55 degrees. The average grip strength in the involved hand was 38 lb force. The average final radial angle was 18 degrees, and the average residual radial height was 12 mm. Average volar tilt was 3 degrees. The complication rate was 42%. Very rigid axial stability is afforded by the fixator, but the large 3.5 mm tapered bone screw diameter precludes redrilling for screw adjustment. The apparatus needs frequent monitoring to reconfirm the security of the locking nuts and cam mechanisms, and the Orthofix system can be reused only four times.
MONTEGGIA LESIONS IN CHILDREN AND ADULTS: AN ANALYSIS OF ETIOLOGY AND LONG-TERM RESULTS OF TREATMENT
Authors: Ovesen Ole , Brok Karl Erik , Arreskøv Jorgen , Bellstrøm Torben
Published: April 2021

ABSTRACT

The mechanism of trauma and late results of treatment were analyzed in 1 7 pediatrie and 16 aduit Monteggia lesions. Pediatrie Monteggia lesions were almost entirely tbund to be the result of low energy trauma leading to a closed, noncommi nut ed fracture in an otherwise noninjured child. In the adult cases, however, these lesions were most often found to be the result of high energy trauma leading to open and comminuted fractures. Furthermore, 62% of the adults had other, and often more serious, injuries. Results at follow up (average 7 years) were excellent in the pediatrie cases, whereas all adults had sequelae, especially regarding range of motion.

The results of this study clearly suggest that a Monteggia lesion represents a more severe injury in the adult.
ARTHROSCOPIC TREATMENT OF POSTTRAUMATIC CHONDROMALACIA PATELLAE
Authors: Zorman D , Prezerowitz L , Pasteels J L , Burny F
Published: April 2021

ABSTRACT

An arthroscopic procedure of excision of damaged cartilage and drilling the subchondral bone plate for treatment of chondromalacia patellae is described. Satisfactory results and absence of major complications are reported in a preliminary, short-term series of 24 cases of symptomatic posttraumatic chondromalacia patellae, with a mean follow up of 12 months.
COMPONENT MOTION IN BIPOLAR HIP ARTHROPLASTY: AN EVALUATION OF REAMED AND NON-REAMED ACETABULA
Authors: Burton Paul , Prieskorn David , Smith Richard , Page Billy Joe , Swienckowski John
Published: April 2021

ABSTRACT

Sixty-four patients with 67 bipolar arthroplasties of the Mp were reviewed for a mean follow up of 3.1 years. The study group consisted of 46 hemiarthroplasties secondary to primary osteoarthritis of the hip and 21 hemiarthroplasties secondary to displaced subcapitai hip fractures. Reaming of the acetabulum was performed in 47 of the hips studied. The Harris hip scores were not significantly affected by acetabular reaming. Total motion decreased when hips were loaded in the standing position. Reaming of the acetabulum resulted in a decrease in percent outer component motion and an increase in percent inner component motion. The nonreamed acetábala had the largest percent inner motion decrease when taken from the supine to the standing position* The reamed acetabula had significantly higher average percentage of inner component motion in both standing and supine positions. There was no patient with postoperative acetabular protrusion.
THE USE OF MRI IN THE DIAGNOSIS OF OCCULT HIP FRACTURES IN THE ELDERLY: A PRELIMINARY REVIEW
Authors: Guanche Carlos A , Kozin Scott H , Levy Andrew S , Brody Leonard A
Published: April 2021

ABSTRACT

Establishing the diagnosis of a non-displaced hip fracture in an elderly patient can be a prolonged and costly procedure, involving hospital admission, several days of bed rest, and a bone scan 3 to 5 days later. The authors evaluated 10 hips in 10 patients with a questionable diagnosis of non-displaced hip fracture. Magnetic resonance imaging (MRI) soon after admission revealed four patients with acute hip fractures who were subsequently treated. The other six patients, whose scans were negative for either femoral neck or intertrochanteric fractures, were mobilized. The authors show that, through the use of an immediate MRI study of a questionable hip fracture, the prolonged recumbency and inherent costs associated with awaiting a positive bone scan can be avoided.
PIN TRACT INFECTIONS: SILVER VS UNCOATED PINS
Authors: Collinge Cory A , Goll Günter , Seligson David , Easley K Jack
Published: April 2021

ABSTRACT

To test the hypothesis that coating external fixation pins with a silver-containing compound (Spi-Argent, Spire Corp, Bedford, Mass) will reduce bacterial colonization and/ or pin tract infection, 36 silver-coated and 12 conventional stainless steel pins were placed in the iliac crest of six sheep and inoculated with Staphylococcus aureus. After 2 ½ weeks the pin sites were examined for motion and inflammation, and the pin tips were quantitatively cultured and examined with scanning electron microscopy (SEM). We found that 84% of the uncoated pins were infected, while 62% of the silver-coated pins were infected. Silver-coated pins were less frequently infected than uncoated pins (confidence interval [CI] >85%). Also, silver-coated pins were loose less frequently than uncoated pins. Pin motion was closely correlated with infection: 28 of 32 infected pins (88%) had motion, while only 9 of 16 uninfected pins (56%) had motion (CI >80%). SEM study of the pin tips showed a decreased level of glycocalyx-protected colonization on the surface of the silver-coated pins. Clinically, these results suggest that silver-coated pins will result in less infection and motion at the pin site, the most significant problems in external fixation.
REMOVAL OF BROKEN SYNDESMOTIC SCREWS: A TECHNICAL TIP
Authors: Henley M Bradford , Law Melvin D , Henry Stephen L
Published: April 2021

ABSTRACT

A simple method of extracting broken distal tibial-fibular syndesmotic or cross-locking screws for intramedullary nails is illustrated. After extraction of the head portion of the broken screw, a blunt impactor is introduced through the vacant screw hole and abutted to the remaining portion of the screw tip. The screw can usually be impacted through the far cortex. A small incision should be made over the protruding portion, and the screw extracted with pliers.
BONE MINERAL CONTENT OF THE SPINE AND PROXIMAL FEMUR IN FEMALE PATIENTS WITH HIP FRACTURE
Authors: Soghikian G W , Boden S A , Labropoulos P A
Published: April 2021

ABSTRACT

Measurement of bone density in the spine and hip by quantitative computed tomography (QCT) and dual photon absorptiometry (DPA) was performed in 36 women with hip fracture. Hip density by DPA was determined at three anatomic subregions of the hip. Comparison to normals revealed an average decrease in hip bone density by 15% below controls. Spine density measurements were not significantly different from that of controls. Correlations of hip and spine densities varied by hip subregion. This study demonstrated that bone density measurement methods and measurement at one axial site may not accurately reflect bone density at appendicular subregions.
A NEW RADIOGRAPHIC EVALUATION OF PRIMARY OSTEOARTHRITIS
Authors: Bissacotti Joao Flávio , Ritter Merrill A , Faris Philip M , Keating E Michael , Gate Hal E
Published: April 2021

ABSTRACT

Two thousand five hip radiographs, both AP and lateral, were evaluated for osteoarthritis. We excluded all cases of traumatic osteoarthritis, rheumatoid arthritis, avascular necrosis, and congenital deformities. This left 1578 hips in 1309 patients, which were sub-divided into three categories: medial osteoarthritis (405 hips, 20% of which were bilateral, 68% women, 32% men); superior lateral osteoarthritis (934 hips, 19% of which were bilateral, 49% men, 51% women); and global osteoarthritis (239 hips, 23% bilateral, 53% men, 47% women). These categories may have significance in operative technique and survival of acetabular cups after total hip arthroplasty.
POSTOPERATIVE AUTOTRANSFUSION AFTER TOTAL KNEE ARTHROPLASTY
Authors: Berman Arnold T , Levenberg Richard J , Tropiano Marianne T , Parks Brent , Bosacco Stephen J
Published: April 2021

ABSTRACT

To evaluate the quality of shed blood postoperatively after total knee arthroplasty (TKA), the safety of autotransfusion, and to minimize homologous transfusion, the Autovac system was used for reinfusion of whole blood following cemented TKA. The system was used in SO consecutive patients who were reinfused an average of 420 cc of whole blood. Twenty-five patients had a calcium binding resin anticoagulant within the collection canister. A second group of 25 patients had 40 cc of acid citrate dextrose anticoagulate (ACD-A) in the collection canister as an anticoagulant. Fifteen hematologic parameters were measured during five time periods. Each study group was compared to a control group of 25 TKAs with a standard drain. The clinical safety of auto-transfusion with ACD-A was proven. Blood collected in the calcium binding resin had a statistically significant higher hemoglobin (P<.05), plasma-free hemoglobin (P<.05), fibrin split products (P<.05), and a different white blood cell differential.
TIBIAL DIAPHYSEAL NONUNIONS AFTER EXTERNAL FIXATION TREATED WITH NONREAMED SOLID CORE NAILS
Authors: Riemer Barry L , Sagiv Shaul , Butterfield Spencer L , Burke Charles J
Published: April 2021

ABSTRACT

Twenty-nine patients with tibial diaphyseal fractures had external fixators applied to treat their initial fractures and underwent nonreamed solid core nailing for nonunion (>22 weeks). Fifteen Alta, 11 Lottes, and 3 Rush nails were used. The original fracture grades were: 1 closed, 1 grade I, 7 grade II, 3 grade IIIA, and 17 grade IIIB. The duration of nonunion was 51 weeks (average: 22 to 173). The average duration of external fixation was 19 weeks (range: 9 to 47). The average interval from fixator removal to nail was 32 weeks (range: 0 to 156). Twenty-eight patients were seen at >12 months' follow up (average: 35; range: 10 to 58) and completion of treatment. Twenty-seven patients' fractures united at an average of 14 weeks (range: 6 to 40). One patient required a reamed exchange nailing at 39 weeks and united 58 weeks post-exchange nailing. One patient had a persistent asymptomatic nonunion. One patient developed a stress fracture 49 months post nail requiring an exchange nailing. Eleven fractures had a prenail deformity of 10° or more; 9 were corrected. Eight patients had pre-nail wound and five had pre-nail pin tract infections. Except for two cases, all of these infections were treated successfully with surgical debridement and/or antibiotics prior to nail insertion. Two patients had their nail inserted through active infections that could not be controlled with an unstable fracture. One patient healed uneventfully in 6 weeks. One required two subsequent debridements. There were no other infections. The authors conclude that nonreamed solid core nailing is an acceptable treatment for tibial diaphyseal nonunions following external fixation.
HIP FUSION IN YOUNG ADULTS
Authors: Barnhardt Todd , Stiel James B
Published: April 2021

ABSTRACT

Hip arthrodesis remains an option for treatment of severe arthritis in young persons resulting primarily from osteonecrosis, congenital dysplasia, and joint sepsis. The authors reviewed six patients who underwent fusions as young adults (average age: 30.8 years) with an average follow-up period of 11.7 years. Solid arthrodesis without infection was noted in all cases. Patients who worked returned to prior employment without limitation. All patients complained of symptomatic low back pain and felt ambulation was limited by ipsilateral knee pain. Five of six noted impaired sexual function; although childbearing was not affected in one case. Four of six were satisfied with the operation, but only three of six would undergo it again given the alternative of total joint arthroplasty.
COMPARISON OF TENDO-ACHILLES LENGTHENING ALONE AND COMBINED WITH NEURECTOMY OF THE GASTROCNEMIUS MUSCLE IN THE TREATMENT OF EQUINUS DEFORMITY OF THE FOOT ASSOCIATED WITH CLONUS IN CHILDREN WITH CEREBRAL PALSY
Authors: Camacho Francisco J , Isunza Agustin , Coutino Betty
Published: April 2021

ABSTRACT

In a prospective study of 12 children with spastic cerebral palsy and equinos deformity (21 extremities) complicated by clonus, the results of two surgical techniques were compared. Six children had tendo-Achilles lengthening (TAL) alone and six had TAL combined with neurectomy of the gastrocnemius muscle. The equinus deformity was corrected in all children, but of those with neurectomy clonus subsided in 50%, compared to only 27% in those with TAL alone.
LONG-TERM RESULTS OF FOREFOOT ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Patsalis T , Georgousis H , Göpfert S
Published: April 2021

ABSTRACT

Disabling forefoot deformity of rheumatoid origin frequently requires surgical intervention. Twenty-three patients (36 feet) who underwent excision of the metatarsal heads in our unit between 1980 and 1987 were assessed clinically and radiologically (n=12) and by questionnaire (n=11) at an average 10.5 years (range: 4 to 15) following surgery. Although the procedure was initially successful at the time of review, the result was classified as unsatisfactory because of restriction of walking ability due to pain in the forefoot area in 56% of patients. Recurrence of the deformity-more frequently involving the great toe-had occurred in 72% of patients, and painful callosities were present in 61%. In the patients examined clinically and radiologically, unsatisfactory results were due mainly to mal-alignment of the great toe and extensor tendon tightness. Hindfoot deformity also significantly contributed to pain in the forefoot area. Diminished arthroplasty space, irregular resection cascade, and development of bony spikes were frequently associated with recurrence and callosities. The result of forefoot arthroplasty deteriorates with time. Failure to maintain a plantigrade great toe, intrinsic weakness, and hindfoot deformity were the main factors contributing to an unsatisfactory result.
Hip Fracture in the Elderly: The Effect of Anesthetic Technique
Authors: Koval Kenneth J , Aharonoff Gina B , Rosenberg Andrew D , Schmigelski Carl , Bernstein Ralph L , Zuckerman Joseph D
Published: April 2021

ABSTRACT

Seven hundred forty-nine community-dwelling, previously ambulatory, elderly patients who sustained a femoral neck or intertrochanteric fracture underwent prospective follow-up to determine whether anesthetic technique (spinal or general) had an effect on inpatient morbidity and mortality, or 1-year mortality. One hundred seven patients were excluded from the study as the anesthetic technique was "predetermined" based on a underlying medical condition. Of the remaining 642 patients, 362 (56.4%) received general and 280 (43.6%) received spinal anesthesia. Twenty (3.1%) patients died during hospitalization; 73 (1 1 .4%) patients developed one or more postoperative medical complications. The T -year mortality rate was 12.1%. There was no difference in inpatient morbidity and mortality, or 1-year mortality rates between patients receiving general or spinal anesthesia.
Tensile Force in Limb Lengthening: Histogenesis or Only Mechanical Elongation
Authors: Matsushita Takashi , Nakamura Kozo , Kurokawa Takahide
Published: April 2021

ABSTRACT

Although bone response can be evaluated by radiography, there have been no reports in human confirming formation of new soft tissue in limb lengthening. This study evaluated the tensile force between pin clamps in 14 lower limb lengthenings. Legs were lengthened 0.5 mm every 1 2 hours and the tensile was measured continuously. The tensile force increased simultaneously with each lengthening and decreased gradually. However, the reduction rate of tensile force during the nighttime (120±22%) was significantly higher than that during the daytime (72±10%). This differed from the stress relaxation phenomenon shown by viscoelastic material and suggested the presence of other phenomena such as histogenesis.
Migration of the Uncemented CLS Femoral Component
Authors: Davies M S , Parker B C , Ward D A , Hua J , Walker P S
Published: April 2021

ABSTRACT

The migration of uncemented CLS (Cementless Total Hip Replacement System) femoral stems was measured retrospectively from standard anteroposterior pelvic radiographs using a digitizer and software specifically designed for this study. The study population was comprised of 117 patients with 126 uncemented CLS femoral stems. All radiographs were reviewed and the incidence of thigh pain obtained by means of a questionnaire. The mean clinical follow-up was 3 years and the mean follow-up for radiographic review was 2.77 years.

The mean femoral stem migration was 2 mm at 2 years and 3.66 mm at 7 years. Radiographic features varied little with no specific predictive features in patients with excessive early migration or those who complained of thigh pain. There was no statistical relationship between the presence of thigh pain and femoral stem migration.
The Microvascular Anatomy of the Physis as Revealed by Osteomedullography and Correlated Histology
Authors: Oni Olusola O A
Published: April 2021

ABSTRACT

The microvascular anatomy of the physis has been demonstrated by perfusing the epiphysis with an aqueous suspension of barium sulfate. Plain radiographs taken immediately after perfusion reveal escape of dye into the metaphysis and into the system veins. Mieroradiographs reveal a labyrinthine network of channels on either side of the physis. The density of these channels is much greater than the density of vessels observed in histologic sections.
Magnetic Resonance Imaging Evaluation of Thecal Sac Diameters Following Laminectomy in the Lumbar Spine
Authors: Ebraheim Nabil A , Farooq Amjad , Xu Rongming
Published: April 2021

ABSTRACT

Sagittal magnetic resonance images (MRIs) from 20 patients who had postoperative persistent or recurrent low back pain were reviewed to study the thecal sac diameter at laminectomy sites. The thecal sac anteroposterior diameter was measured in three sites: the maximum AP diameter at the laminectomy site, and the proximal and distal levels to the laminectomy site. A comparison between the thecal sac AP diameter at laminectomy sites and the average diameter of both the proximal and distal levels was then made.

Based on the measurements, the diameters of the thecal sac were divided into three groups. Patients in group A (5 cases) had a constriction (the thecal sac AP diameter at the laminectomy site was less than the average diameter of both the proximal and distal levels) of the thecal sac at the laminectomy site. Patients in group B (12 cases) had an expansion (the thecal sac AP diameter at the laminectomy site was more than the average diameter of both the proximal and distal levels) of the thecal sac. Patients in group C (3 cases) demonstrated no change. This study suggests that there was no correlation between the thecal sac AP diameter at laminectomy site and postoperative low back pain.
High Tibial Osteotomy Without Internal Fixation for Medial Unicompartmental Osteoarthrosis
Authors: Khan Muhammad Tahir , Matthews J G
Published: April 2021

ABSTRACT

Between 1982 and 1993, a total of 35 patients underwent high tibial osteotomy for medial unicompartmental osteoarthrosis. The osteotomy was performed high in the tibia without the use of jigs, and internal fixation devices were avoided. Patients were assessed using the British Association for Surgery of the Knee score, and satisfactory results with minimal complications were obtained. Our results indicate that in a select group of patients, high tibial osteotomy preserves bone stock and is performed near the deformity so that excellent correction is achieved and recurrence of varus deformity is avoided.
Monitoring of Somatosensory and Motor Evoked Potentials During Open Reduction and Internal Fixation of Pelvis and Acetabular Fractures
Authors: Arrington Edward D , Hochschild David P , Steinagle Timothy J , Mongan Paul D , Martin Steven L
Published: April 2021

ABSTRACT

Monitoring of motor and somatosensory evoked potentials provides instantaneous intraoperative assessment of a patient's neurologic status. Monitoring of the sciatic nerve through motor and somatosensory evoked potentials can be used during open reduction and internal fixation of pelvic and acetabular fractures. A review of 12 pelvic and acetabular fractures treated with open reduction and internal fixation was conducted and assessed with a combination of intraoperative motor and somatosensory evoked potential monitoring.

Results revealed intraoperative motor evoked potential monitoring was 1 00% sensitive and 1 00% specific in predicting postoperative sciatic nerve deficits, whereas somatosensory evoked potentials were not accurate in predicting postoperative sciatic nerve deficits. Combined monitoring of the sciatic nerve with motor and somatosensory evoked potentials is beneficial at predicting postoperative sciatic nerve deficits during open reduction and internal fixation of pelvic and acetabular fractures.
Effect of Intermittent Administration of Parathyroid Hormone on Fracture Healing in Ovariectomized Rats
Authors: Jahng Jun Seop , Kim Hyun Woo
Published: April 2021

ABSTRACT

The effects of intermittent administration of parathyroid hormone on fracture healing in ovariectomized rats were examined to evaluate its potential use as a therapeutic agent for osteoporotic fractures. Three months postovariectomy, bilateral tibial shaft fractures were induced and stabilized by intramedullary nailing with Kirschner wires. Saline, 1 7ß-estradiol (Sigma Chemical Corp, St Louis, Mo), or recombinant human parathyroid hormone (1-84) (Korean Green-Cross Pharm Corp, Seoul, Korea) was given once a day for 30 consecutive days during fracture healing. Fracture healing was assessed by morphometric and mechanical analysis of fracture callus. Intermittent parathyroid hormone administration increased the morphometric and mechanical parameters in a dose-dependent manner. A bone-resorption inhibiting agent, 1 7β-estradiol did not offer advantage in terms of fracture healing in ovariectomized rats. Findings suggest intermittent parathyroid hormone administration may benefit osteoporosis and fracture.
Endoscopic Harvesting of the Sural Nerve Graft: A Cadaveric Investigation
Authors: Oliveira M T , Marttos A C C , Fallopa F
Published: April 2021

ABSTRACT

This study investigated an endoscopic technique of harvesting the sural nerve graft. Using endoscopic instrumentation, the sural nerve was harvested from six cadaveric legs. A 2-cm longitudinal incision was made immediately posterior to the lateral malleolus, and a 5mm endoscope was introduced. The path of the nerve was followed to the popliteal space, and nerve dissection was performed from proximal to distal. Air inflation of a balloon was used to enlarge the endoscopic cavity. The cavity created around the nerve was insufflated with carbon dioxide gas, allowing complete nerve isolation. Using a 0.5-cm transverse incision, the nerve was cut and removed. This endoscopic sural nerve grafting approach offers potential advantages such as less injury to soft tissues, decreased pain, nerve integrity preservation, and good aesthetic results.
Comparison of Migration in Modular Sockets With Ceramic and Polyethylene Inlays
Authors: Böhler M , Schachinger W , Wölfl G , Krismer M , Mayr G , Salzer M
Published: April 2021

ABSTRACT

This study compared migration in 73 cementless total hip arthroplasties (THAs) with either alumina ceramic (n=23) or polyethylene (n=50) inlays; prosthesis sockets and stems were identical except for the inlays. After 7 years of follow-up, 5 sockets (4 with ceramic and 1 with polyethylene inlays) had been revised an average of 63.3 months (range: 49-81 months) after implantation, and survival analysis showed a significantly higher revision rate for sockets with ceramic inlays (89±6%) versus polyethylene inlays (98.2±1.7%) (P=.032). Migration analysis of the first three postoperative years revealed significantly higher vertical migration in sockets with ceramic inlays (P=.047), in patients aged <60 years (P=.02), and in osteoporotic type C bone (A versus C, P=.0071 and B versus C, P=.0004).
The Pain and Function of the Hip (PFH) Scale: Patient-Based Instrument for Measuring Outcome After Total Hip Replacement
Authors: Alonso Jordi , Lamarca Rosa , Martí-Valls Josep
Published: April 2021

ABSTRACT

The Pain and Function of the Hip (PFH) scale was developed following the recommendations of the Société International de Chirurgie Orthopédique et Traumatologie to assess the outcomes of total hip replacement (THR). This study evaluated metric properties of the PFH scale and its ability to measure clinical change (responsiveness) in consecutive patients undergoing THR. Patients were evaluated preoperatively and at 3 and at 12 months postoperatively. The PFH scale and the Nottingham Health Profile (NHP) were administered.

Complete data were collected for 79 patients. Mean overall preoperative PFH score was 26.5 and mean overall PFH score 1 2 months postoperatively was 69.8 (P<.01). Correlation with the NHP was high (r=-0.64), and the magnitude of improvement (effect size) as assessed by the PFH scale was large (3.6 compared with 1 .7 for the NHP). The PFH scale is simple and valid, and may complement routine clinical evaluation of hip replacement. Residual pain after hip replacement may have been previously underestimated.
The Effects of Severe Femoral Bone Loss on the Flexion Extension Joint Space in Revision Total Knee Arthroplasty: A Cadaveric Analysis and Clinical Consequences
Authors: Krackow Kenneth A , Mihalko William M
Published: April 2021

ABSTRACT

Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1 994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femora! bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibia! position.

To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45° and 90° of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2±8.9 mm of joint space is created in 90° of flexion, whereas the joint space in full extension is conserved (1.5±1.7 mm). With additional loss of the posterior capsule, the joint space at 90° of flexion increased to 26.2±6.1 mm, with minimal changes in the extension gap (3.4±0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.
Long-Term Results After Operative Treatment of Femoral Neck Fractures With Ceramic Head Prostheses
Authors: Degreif J , Müller L P , Runkel M , Blum J , Willmann G
Published: April 2021

ABSTRACT

From 1 985-1 990, a total of 277 elderly patients underwent hemiarthroplasty using a ceramic head prosthesis. Average patient age was 81.7 years. Of these, 77 patients were available for follow-up examination in 1993. A standardized score was calculated assessing activity, gait, and hip pain; the average score was 58 out of 78 possible points. Three patients had hip pain, and in 4 patients, radiographic examination revealed protrusio acetabuli. Two of 4 patients underwent revision surgery for replacement of the cup, leaving the stem in situ.

Because of the small number of prosthetic-related complications, hemiarthroplasty using a ceramic head prosthesis is the recommended surgical treatment for femoral neck fractures in elderly patients. In the rare patient with protrusio acetabuli, revision surgery can be performed to replace the cup, leaving the stem in situ.
Comparison of Metal Versus Absorbable Implants in Tension-Band Wiring: A Preliminary Study
Authors: Morgan William J , Slowman Lisa A Schulz , Wotton Harold M , Nairus James
Published: April 2021

ABSTRACT

The strength of tension-band wiring using bioabsorbable materials versus metal implants was assessed with a rabbit knee fusion model. Ten rabbit knees were osteotomized and rigidly fixed using a tension-band technique: five with metal implants (2 pins and 24-gauge wire) and five with absorbable implants (2-mm pins [Bionx, Blue Bell, Pa] and 1 Maxon [Davis and Geck, Danbury, Conn]). Biomechanical testing of the fixation strength was completed using a servohydraulic mechanical testing machine and a specifically designed four-point bending jig. The parameters assessed were maximal load, relative stiffness, displacement, and bending moment of the constructs. Results of the biomechanical testing showed no statistical difference between the constructs on any of the parameters assessed.
Sacroiliac Joint Dysfunction: A Long-Term Follow-Up Study
Authors: Sasso Rick C , Ahmad Rick I , Butler James E , Reimers Deborah L
Published: April 2021

ABSTRACT

Sixty-nine patients with sacroiliac joint dysfunction were prospectively evaluated and treated with a structured physical therapy program. Follow-up clinical outcome was obtained from a patient questionnaire administered by an independent reviewer a minimum of 2 years after treatment. Average patient age was 40 years, and 80% were women. Ninety-five percent rated their result as good or excellent, while 5% believed their outcome was fair or poor.

A structured physical therapy program can produce good long-term results in most patients; however, 5% continue to be symptomatic. This small subset may be candidates for more invasive evaluation.
Exchange Nailing for Failure of Initially Rodded Tibial Shaft Fractures
Authors: Mercado Edwin M , Lim Edward V A , Stern Peter J , Aquino Neal J
Published: April 2021

ABSTRACT

This retrospective study evaluated 32 patients who underwent exchange nailing for initially rodded nonunited tibial shaft fractures during a 5-year period. High-energy trauma accounted for 22 fractures; 19 fractures were open. An unreamed nail was initially used to stabilize all but 2 fractures. Implant failure occurred in 31% of fractures, mostly in distal-third fractures, with a failure rate of 34%. Average time from injury to exchange nailing was 36 weeks (range: 6-148 weeks) and consisted of closed reamed nailing and fibulectomy in 27 cases.

Healing occurred an average of 20 weeks (range: 6-47 weeks) after postexchange nailing in 27 (84%) fractures. Four (12.5%) fractures healed after additional procedures. There was 1 persistent nonunion. Factors leading to delay in union time included comminution, healed fibula, and proximal location. Multiple regression analysis using survival data at P<.05 showed a significant correlation between fracture configuration and fixation method (locked, dynamic, and unlocked) on time to union.

Exchange nailing with closed reaming and fibulectomy is a viable option for treating failures of primarily nailed tibial fractures. Increased stability and stimulation of arrested bone healing may account for the good outcome. The advantages of repeat reamed nailings should be weighed against the possible adverse effect of reaming on bone vascularity.
Athletic Activity After Total Joint Replacement
Authors: Nicholls Mathew A , Selby Jeffrey B , Hartford James M
Published: April 2021

Total hip and knee replacement surgery is a successful treatment for the arthritic hip and knee ensuring proven pain relief and return of function. Younger, more active patients who have greater expectations and higher demands are receiving hip and knee replacements. With current surgical techniques and implant designs, athletic participation should be limited to low impact, low demand, and low duration activity. Future advances in bearing surfaces may allow for higher demand activities.
The Economic Impact of Medical Complications in Geriatric Patients With Hip Fracture
Authors: Khasraghi Fardin A , Lee Eu Jin , Christmas Colleen , Wenz James F
Published: April 2021

Abstract

The records of 510 elderly patients with hip fractures admitted to our institution between January 1995 and December 2000 were retrospectively reviewed to determine the incidence and type of developed medical complications and their economic implications. Of those 510 patients, 217 (43%) developed at least 1 medical complication, most frequently electrolyte imbalance (11%), urinary tract infection (10%), respiratory failure (10%), and delirium (9%). Patients who developed medical complications had significantly longer mean hospital stays (10 days) and higher mean hospital costs ($16,203) than patients without such complications (5 days and $10,284, respectively) (P<.001).
Thromboprophylaxis and Neuraxial Anesthesia
Authors: Horlocker Terese T
Published: April 2021

Abstract

Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. Generally, a patient's coagulation status should be optimized at the time of spinal or epidural needle/catheter placement, and the level of anticoagulation should be monitored during epidural catheterization. Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographie evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia.