bluuebunny/crossref_metadata_2025 huggingface dataset:
Partnership in Education: An Example of Client and Educator Collaboration
Authors: Hutchings Deanna
Published: April 2021

ABSTRACT

This article describes one education strategy designed to assist nursing staff in the process of "learning to surrender" the service providers' need to direct client decision-making. Using the health promotion principle of "client as expert," a nurse educator and a client with advanced multiple sclerosis co-present an inservice class about the importance of personal empowerment and environmental mastery for maintaining physical and psychological well-being in the face of a chronic disorder.

This collaborative strategy provided the client a forum from which to share his personal experience and professional knowledge to influence attitudes and provide valuable information to nursing staff in a long-term care facility. Collaborating with the client to bring information to nursing staff is one means to foster a climate of client empowerment, influence staff perceptions and communicate the unique experiences of the client.
Computer Conferencing in Graduate Nursing Education: Perceptions of Students and Faculty
Authors: Andrusyszyn Mary-Anne , Iwasiw Carroll , Goldenberg Dolly
Published: April 2021

ABSTRACT

The authors report the perceptions of students and faculty who participated in a computer conferenced (CC) graduate course in nursing. Ten graduate students and three faculty members completed a course evaluation form, which included items about learning, interaction, environment, technical support, and satisfaction with CC. Responses indicated the CC medium offered a creative and flexible alternative for learning. Course participants perceived benefits such as enriched learning, meaningful interactions, opportunities for reflection, satisfaction with the technology, and the convenience of learning from a distance. These results have implications for facilitating continuing education.
Research Targets Earlier Diagnosis of Autism
Authors: Anonymous
Published: April 2021

IN OTHER NEWS
MALIGNANT HYPERTHERMIA: A COMPLICATION OF ORTHOPEDIC SURGERY
Authors: Wolfe John S , Bagenstose James E
Published: April 2021

ABSTRACT: Although malignant hyperthermia is seen most frequently as a complication of orthopedic surgery, most orthopedists have not encountered this commonly fatal problem. A case report and discussion of the inheritable metabolic detect is given. Immediate treatment concepts are discussed.
REOPERATION FOLLOWING PATELLECTOMY FOR CHONDROMALACIA
Authors: Ivey F Martin , Blazina Martin E , Fox James M , Del Pizzo Wilson
Published: April 2021

ABSTRACT: When primary patellectomy is performed for chondromalacia of the patella and subsequent surgery is required, this indicates failure of the initial procedure. A review of 51 patients having patellectomy for chondromalacia revealed a failure rate of 39% as evidenced by reoperation. Analysis of these cases showed continued extensor mechanism malalignment and/or continued degeneration of the distal femur or soft tissue as the reason for additional surgery. We believe that a careful preand intraoperative evaluation of the extensor mechanism kinematics and articular cartilage status of the distal femur is essential in lowering the failure rate of patellectomy for chondromalacia.
OSTEOPOIKILOSIS ASSOCIATED WITH PLANTAR FIBROMATOSIS: A CASE REPORT
Authors: Miki Takaaki , Oka Masanori , Tanaka Seisuku
Published: April 2021

ABSTRACT: A unique case of osteopoikilosis associated with plantar fibromatosis is reported herein, and we suggest that this hereditary osseocutaneous syndrome is caused by abnormal mesenchymal tissue.
SURGICAL TREATMENT OF TENNIS ELBOW
Authors: Routson G W , Gingras M
Published: April 2021

ABSTRACT: Nine patients with eleven cases of tennis elbow, recalcitrant to conservative therapy, underwent surgical reconstruction as described by Gardner in 1970. The average duration of symptoms preoperatively was 49 weeks. There were seven females and two males. Ages ranged from 30 to 54 years. Follow-up ranged from 1.3 to 4.25 years. Patients were evaluated regarding pain, activity, grip strength and satisfaction with the surgical result. Preoperatively, pain was described as moderate in eight, and severe in three. All patients described limitation of activity and decreased grip strength. Postoperatively, mild pain occurred in three, and none in eight. All patients reported no limitation of activity, normal grip strengths, and were satisfied with their surgical result. Lack of full elbow extension initially present in all cases resolved in three to twelve months. Surgical reconstruction of the elbow as described by Gardner is an effective means of treating unresponsive tennis elbow.
Update in the Treatment of Osteochondritis Dissecans
Authors: Guhl James F
Published: April 2021

ABSTRACT: During the early part of this century, various treatments for osteochondritis dissecans were recommended. A conservative program consisting of immobilization and non-weightbearing was advocated by many surgeons, particularly for children under 1 5 years of age. Later, fragments were pinned or removed in children's knees, while various methods of bone grafting were suggested for the adult.

With the development of arthroscopic surgery in the 1970s, these methods were reevaluated. Various treatments were suggested, including drilling, drilling and pinning, reconstruction of craters, replacement of lesions, and methods of grafting. Although conservative management is still indicated for some patients, arthrotomy may be necessary under certain conditions.

In the early 1980s scintigraphy has become helpful in following cases treated conservatively, as well as identifying those that require surgery. Also, methods of electrical stimulation are being applied and their results are being evaluated. The concept of early motion has gained more attention. Over a period of nine years, 1975 to 1984, arthroscopic surgery has been further modified. With this in mind, an update of all methods is here recorded and presented for consideration.
A False Aneurysm of the Ulnar Artery After a Forearm Compartment Syndrome
Authors: Vincent Kent , Blair William F
Published: April 2021

ABSTRACT: A case is presented of a forearm compartment syndrome following a low velocity gunshot wound, with a subsequent ulnar artery false aneurysm. The diagnosis of a traumatic false aneurysm was delayed, presenting as a pulsatile mass with confirmation by arteriography. Early exploration and surgical treatment of the arterial system is recommended when a compartment syndrome follows a low velocity gunshot wound of the extremities.
Irreducible Lateral Dislocation of the Patella: A Case Report
Authors: Benjamin James , Percy E C
Published: April 2021

ABSTRACT: Acute lateral dislocation of the patella is a common clinical entity. The dislocation often reduces spontaneously or with the assistance of the patient or someone in attendance at the time of the injury. Very occasionally the patient presents to an emergency room with the patella still dislocated, and it is usually easily reduced at that time without an anesthetic by a physician. It is extremely rare to find an irreducible lateral dislocation of the patella, which cannot be reduced by manipulation even with a general anesthetic. A case is herein reported of an irreducible lateral dislocation of the patella that required open reduction followed by soft tissue reconstruction.
An Evaluation of Cefoxitin in the Prevention of Postoperative Infections Following Orthopedic Surgical Procedures
Authors: Byrd H Joseph , Hughes James L , Sauer Barry
Published: April 2021

ABSTRACT: An open, nonrandomized study of 25 patients was conducted to evaluate the efficacy of cefoxitin in the prevention of postoperative infection following orthopedic surgical procedures. Cefoxitin was administered in a 2 g dose preoperatively and continued postoperatively at a dose of 2 g every six hours for 72 hours. The mean peak serum level achieved ten minutes after the preoperative dose was 153.7 mcg/ml. The mean bone level in samples taken during the procedure was 10.14 mcg/ml. All patients were monitored postoperatively and at intervals of six weeks, four months and six months for signs of early or late morbidity. No signs of major morbidity were observed in the study group. Indexing terms: cefoxitin; prophylactic antibiotics; arthroplasty; kinetics, bone penetration.
Subjective Evaluation of the UCBL Polycentric Knee Linkage by Active Above Knee Amputees: A Prospective Trial
Authors: Jergesen Harry E , Hoaglund Franklin T , Roberts Ruth A
Published: April 2021

ABSTRACT: In this study 20 active male above knee amputees were fitted with prostheses incorporating prototype UCBL four-bar polycentric knee units. The subjective responses of the amputees were evaluated in a prospective fashion. Additional information concerning the short-term durability and mechanical behavior of the device is presented. The average foilowup was 12.3 months. Sixteen of the 20 subjects felt that they benefited from the device, and seven of these stated that the research prosthesis was superior to all previous devices that they had used. Four subjects stated that they had received little or no benefit from the research limb. Previous levels of function and the ease of performance of specific activities were maintained or enhanced in almost all subjects. Most subjects felt that the ease of walking on inclines was improved, and found the increase in knee flexion afforded by the mechanism to be an advantage. Early in the study, problems were encountered, due to air leaks in the pneumatic swing-phase control units and to excessive wear of the aluminum linkage pins. These problems were corrected easily, and the devices were found to function well during the remainder of the study. Given the encouraging results from this preliminary clinical trial, we conclude that further study and clinical application of the UCBL four-bar polycentric knee are indicated.
Rights of the Risk Bearer
Authors: Goodman Richard S
Published: April 2021

LEGAL LIABILITY AND ORTHOPEDIC SURGERY
Preoperative (Neoadjuvant) Chemotherapy for Osteogenic Sarcoma: A Ten Year Experience
Authors: Rosen Gerald
Published: April 2021

ABSTRACT: During the past ten years, (November 1973 through November 1983) 208 patients with fully malignant primary osteogenic sarcoma of an extremity were treated with preoperative chemotherapy on four successive treatment protocols. Continuous improvements in the diseasefree survival of patients were attributed to refinements in the chemotherapy regimens. These refinements were made after direct observation of the response of the primary tumor to chemotherapy. At a minimum follow-up time of 36 months for 87 patients treated on the T-10 chemotherapy protocol, 67 (77%) have remained alive and continuously free of disease, and 71/87 (81.6%) are currently free of disease. Of the entire group of 208 patients receiving preoperative chemotherapy, 150 (72%) have remained continuously free of disease, and 1 58/208 (76%) are currently free of disease from three to 11 years (median five years). The overall complete response rate of the primary tumor to preoperative chemotherapy was 49%. Relapses in 19 patients with tumors about the knee were attributed to local recurrences following en bloc resection. Of the 58 patients undergoing amputation following preoperative chemotherapy, 46/58 (79.3%) have remained alive and continuously free of disease. 23/25 patients (92%) having undergone resection for proximal humerus lesions remain alive and free of disease at this time. There have been no local recurrences for patients having humeral resections. Preoperative chemotherapy has given rise to better chemotherapy regimens, higher cure rates, and the appropriate selection of the best postoperative therapy for patients with osteogenic sarcoma.
Congenital Spine Deformities: A Review of 47 Cases
Authors: Bernard Thomas N , Burke Stephen W , Johnston Charles E , Roberts John M
Published: April 2021

ABSTRACT: Forty-two cases of congenital scoliosis, four cases of congenital kyphosis and one case of congenital lordosis were reviewed retrospectively from 1975 through 1982, with an average follow-up of 5.09 years. Associated anomalies occurred in 62.5% of the cases, with Sprengel's deformity and Klippel-Feil syndrome being the most common musculoskeletal anomalies. The rate of abnormal intravenous pyelography was 21 .8%, and absent kidneys or duplication of collecting systems accounted for the majority of renal abnormalities. Myelographie abnormalities were noted in eight of twenty-five studies and included two cases of diastematomyelia and one tethered cord syndrome. Initial treatment was observation (11), bracing (11), and surgery in the remaining 25 cases. The surgical complication rate was 22.8%. Progressive deformities led to additional surgical procedures in six cases which had previous in situ fusions.
New Problems in Old Polio Patients: Results of a Survey of 539 Polio Survivors
Authors: Halstead Lauro S , Rossi C Donald
Published: April 2021

ABSTRACT: Presented are the results of a questionnaire survey on new health problems in 539 polio survivors. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from polio to the onset of these problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with developing these new health problems were: 1) being hospitalized, 2) being over 10 years old, 3) being on a ventilator, and 4) having paralytic involvement of all four limbs. The differential diagnoses of these new problems, implications for treatment and areas for future research are discussed.
Poliomyelitis: Late Respiratory Complications and Management
Authors: Fischer D Armin
Published: April 2021

ABSTRACT: One hundred forty-six respiratory polios have been reviewed for complications and current respiratory aids. One hundred thirty-eight of these people required respirator assistance at the onset of their poliomyelitis infection. Fifteen patients have kyphoscoliosis. Seventyfive percent of the total patients require some assisted ventilation. Fifty-two percent have tracheostomies. Most of these people have been followed at Rancho Los Amigos Medical Center for many years. The literature regarding late respiratory complications of polio is reviewed.
ANSWER PLEASE
Authors: Hayes Mark , Yngve David A
Published: April 2021

Extradural Lesion
Lateral Tibial Plateau Fracture as a Postoperative Complication of High Tibial Osteotomy
Authors: Ivey Marty , Cantrell Jeffrey S
Published: April 2021

ABSTRACT: Fractures associated with valgus producing high tibial osteotomy are generally reported as operative complications which involve the medial proximal segment. Factors associated with this fracture at the time of surgery include forceful closure of the osteotomy after an inadequately perforated medial cortex, a proximal segment being less than 1.5cm in thickness, and osteotomes entering the medial compartment due to excessive bone loss. Three patients are reported with postoperative fracture of the lateral tibial plateau after tibial osteotomy. One patient's fracture was clearly due to trauma and the other two occurred in patients with a thin proximal segment.
The Effect of Athletic Activity on the Bone Mass in Human Diaphyseal Bone
Authors: Dalén Niles , Laftman Peter , Ohlsén Hans , Strömberg Lennart
Published: April 2021

ABSTRACT: Both humeri of seven professional tennis players and seven controls were examined with x-ray spectrophotometry, and computed tomography. Both the bone mineral content and the cortical cross-sectional area were found to be larger in the dominant arm of the tennis players than in their non-dominant arm, and in comparison to both arms of the controls. The increase in cortical cross-sectional area was a result of an increased outer diameter of the diaphysis.
Diagnosis of Vertebral Osteomyelitis: Clinical, Radiological and Scintigraphic Features
Authors: Fernandez-Ulloa Mariano , Vasavada Prasan J , Hanslits Michael L , Volarich David T , Elgazzar Abdelhamid H
Published: April 2021

ABSTRACT: Incidence of non-tuberculous vertebral osteomyelitis has been increasing significantly over the past 15 years. Its prompt diagnosis remains difficult. Presented here are five cases of vertebral osteomyelitis studied clinically, with laboratory studies, radiographicaily, and with Tc-99m bone and ln-111 labeled white blood cells (ln-111 WBC) scintigrams. Three of the cases are described in detail. The ln-111 WBC studies were not found useful in detecting the infection in four out of the five patients. Reasons for these false negative results are discussed. Clinical, etiopathogenic and radiographic characteristics of vertebral osteomyelitis are also presented.
Modified Moberg Opponensplasty in Acquired Spastic Hemiplegia
Authors: Pinzur Michael S , Sherman Richard
Published: April 2021

ABSTRACT: Loss of the transverse arch of the hand and decreased thumb opposition has heretofore been an unreported deformity in the adult acquired spastic hémiplégie upper extremity. Based on Moberg's experience in quadriplegic patients, 11 patients underwent release of the annular ligament at the base of the thumb. This procedure allows the flexor pollicis longus tendon to bowstring and substitute for thumb opposition. All 11 had increased prehension capacity following the surgery. In carefully selected adult acquired spastic hémiplégie patients, release of the annular ligament at the base of the thumb can functionally restore the transverse arch of the hand, improve thumb opposition and improve prehensile capacity.
Autogenous Sural Nerve Grafts: A Harvesting Technique
Authors: Hankin Fred M , Jaeger Scott H , Beddings Alejandro
Published: April 2021

ABSTRACT: Sural nerve grafts have applicability in many facets of reconstructive surgery. A harvesting technique is described which utilizes a tendon stripper introduced through a single distal incision. This method provides adequate length of autogenous graft material without significant difficulty or morbidity.
Muscle Fiber Type Changes in Human Skeletal Muscle After Injuries and Immobilization
Authors: Häggmark Tom , Eriksson Ejnar , Jansson Eva
Published: April 2021

ABSTRACT: Eight athletes operated on for knee injuries were followed with muscle biopsies before and at various intervals after surgery and immobilization. A statistically significant change of the muscle fiber distribution was found. The percentage type I fibers dropped from an average of 54% to 43%.

One competitive cross-country skier showed a dramatic drop from 81% type I fibers at surgery to 58% type I fibers six weeks later. After beginning training he returned to 85% type I fibers. One athlete who had been operated and immobilized for long periods several times showed a drastic difference in fiber type distribution between his two thighs with 20% type I fibers in the injured leg and 69% type I fibers in his uninjured leg. After three years of training his fiber type composition in the injured leg returned toward the fiber type distribution of the uninjured thigh.

It is evident that muscle fiber type composition can change. The most probable reason for this is that the drastic change from hard sports training to nearly complete immobilization influences both the muscle itself and its innervation and causes this change of fiber types.
Postoperative TENS Pain Relief After Knee Surgery: Objective Evaluation
Authors: Arvidsson Inga , Eriksson Ejnar
Published: April 2021

ABSTRACT: A comparison was made between the pain-relieving effect of placebo-transcutaneous electrical nerve stimulation (TENS), high frequency TENS, and epidural analgesia with dilute local anesthetics in 15 patients with open knee surgery. Assessment of pain was compared with the patients' ability to contract their quadriceps muscle; the ability was measured with integrated EMG (IEMG) before and after the different treatments.

The results showed that placebo-TENS had no significant effect on either pain perception or on IEMG. High frequency TENS given for 15 min to 20 min decreased pain perception by 50% at rest and by 11% after quadriceps contraction. High frequency TENS increased muscle contraction ability by 305%, compared with the initial contraction before treatment. Epidural injection of a dilute local anesthetic decreased pain perception by 90% at rest and by 67% after contraction, and increased muscle contraction ability by 1,846%.

TENS undoubtedly has a place in the postoperative pain treatment, although its effect is not as strong as that of epidural analgesia with local anesthetics. TENS, however, is easy to administer, lacks side effects, and can be administered by the patients themselves.
Cost Effectiveness of Wrist Fluoroscopy and Arthrography in the Evaluation of Obscure Wrist Pain
Authors: Braunstein Ethan M , Vydareny Kay H , Louis Dean S , Hankin Fred M
Published: April 2021

ABSTRACT: The cost effectiveness of wrist fluoroscopy and arthrography was evaluated in patients with obscure wrist pain. Dynamic fluoroscopy was performed in 91 cases and was positive in 54 (59%). Radiocarpal arthrography was performed in 60 of these cases in which further information was desired. Arthrography increased the diagnostic yield to 62 of 91 cases (68%). Diagnoses included ligament and cartilage tears, and dynamic intercarpal instability.

The cost per positive examination for fluoroscopy, based on total cost for fluoroscopy in 91 patients divided by number of positive cases, is $126. The cost per positive examination by arthrography alone is $377. When arthrography is done only when fluoroscopy is equivocal or negative, the cost per positive examination (fluoroscopy plus arthrography) drops to $280. Wrist arthrography is only cost effective if done after dynamic fluoroscopy fails to answer the clinical questions. When done together in this setting, the two procedures are more cost effective than arthrography alone.

Based on current costs, conservative treatment of carpal instability costs about $1,500, and surgical therapy costs about $4,000. Thus, fluoroscopy and arthrography may further reduce the cost of management of obscure wrist pain by identifying those patients who would not benefit from surgical exploration.
A New Gait Analysis System for Clinical Use in a Rehabilitation Center
Authors: Hermens Hermie J , deWaal Cor A , Buurke Jaap , Zilvold Gerald
Published: April 2021

ABSTRACT: A semi-portable system based on a microcomputer has been developed to measure the vertical reaction forces on both feet during walking. Eight capacitive force transducers are attached to each sole of the patients' shoes. This allowed the forces to be measured for several consecutive steps during a walk of 20 sec. This article describes the principles of operation of the force transducers and the associated electronic system. It also shows data processing procedures and gives a review of the available methods of data presentation. Recordings of the walking pattern of three patients with different diagnostics are presented and discussed to demonstrate the usefulness of the new gait analysis system in a rehabilitation center.
Total Hip Replacement in Down's Syndrome
Authors: Skoff Hillel D , Keggi Kristaps
Published: April 2021

ABSTRACT: Hip subluxation occurs in 4% to 5% of Down's patients; adulthood coxarthrosis may result. Eight total hip replacements were performed in five Down's patients (ages 37 to 64 years) for painful coxarthrosis. The patients were followed for a mean of 4.3 years. The hip scores improved from an average of fair preoperative^ to excellent postoperatively, with a Harris hip score of 92. All of the patients demonstrated clinical improvement and were cared for more easily by virtue of the procedure. There were no major complications. Total hip replacement should be considered a useful surgical option for the treatment of hip osteoarthritis in patients with Down's syndrome.
Management of Severe Hand Trauma With a Mini External Fixateur
Authors: Seitz William H , Gomez Willim , Putnam Matthew D , Rosenwasser Melvin P
Published: April 2021

ABSTRACT: Maintenance of length, alignment, and mobility while affording ready access for wound care has traditionally been a problem in the management of severe hand trauma. However, miniaturization of existing components of external fixation has provided a significant step in the solution of this problem. Twenty-eight fractures in severely traumatized hands in 24 patients have been managed using a Hoffman mini external fixateur. The patients' mean age was 26.5 years. The dominant hand was involved 60% of the time, and 80% of the population was male. Most fractures (80%) were open injuries with marked comminution, often intraarticular, frequently the result of gunshot wounds (60%). Mini external fixation has afforded proper wound care and maintenance of desired alignment. Complications have been few, while improved results (alignment, range of motion, strength, fracture union), have been demonstrated. Our surgical technique, results, and some illustrative cases are presented.
Group C Streptococcal Arthritis: A Case Report of Equine Transmission
Authors: Gorman Paul W , Collins David N
Published: April 2021

ABSTRACT: Presented is the third known case of a group C streptococcal arthritis, this case documented in a healthy 42-year-old horse trainer, apparently transmitted by a mare. After a delayed diagnosis, the patient responded favorably to surgical drainage and parenteral penicillin G, but required a manipulation of his knee under general anesthesia. Although rare, group C streptococcal arthritis can occur in hosts with no apparent predisposing factors. Frequent exposure to farm animals may increase the risk.
Avascular Nonunion of a Subtrochanteric Femur Fracture With Formation of a Heterotopic Bone Strut: A Case Report
Authors: Schrader William C , Greenberg Barry J
Published: April 2021

ABSTRACT: Comminuted, subtrochanteric fractures of the femur are a complex and challenging form of skeletal injury. Reconstruction and fixation are technically demanding, and fracture nonunion is a known complication of both surgical and closed treatment.1-6 A case of an avascular nonunion in a subtrochanteric femur fracture with an interesting resolution is reported.
The Anatomy of Spinal Deformity: A Biomechanical Analysis
Authors: Deacon Philip , Archer Ian A , Dickson Robert A
Published: April 2021

ABSTRACT: The essential lesion in idiopathic scoliosis is a lordosis at the curve apex. For the rotational instability provided by a lordosis to progress, asymmetry must be present in another plane. A biomechanical analysis of spinal shape demonstrates a delicate balance between the median, transverse, and coronal planes. The normal cervical and lumbar lordoses which are Inherently rotationally unstable are protected by: a) prismatic shaped vertebral bodies with their bases anterior, b) considerable available intersegmental flexion, and c) powerful posterior soft tissue support. In contrast, the thoracic vertebral bodies are shaped as prisms with their apices anterior. This rotationally unstable configuration is protected by a kyphosis with the axis of spinal rotation situated anteriorly. The thoracic vertebral prisms are asymmetric, their apices lying to the right of the median plane. In the presence of a lordosis the apices of the prisms will be directed toward the right producing a right-sided scoliosis. Any significant degree of left-sided coronal asymmetry can override the influence of the transverse plane and therefore left-sided curves are not uncommon. Thoracic idiopathic scoliosis is located at T8/T9 and the lordosis here is often an upward continuation of the normal lumbar lordosis such that the asymmetric thoracic prisms are no longer protected.
Idiopathic Scoliosis: Characteristics and Epidemiology
Authors: Smyrnis Takis , Antoniou D , Valavanis J , Zachariou C
Published: April 2021

ABSTRACT: An epidemiological survey of idiopathic scoliosis derived by school screening in Greece has shown a three-fold rise in prevalence rate from 1% in 6-year-olds to more than 3% in 15-year-olds. Moderate curves (with a Cobb angle of 10° to 19°) are the most common curve magnitude encountered in both boys and girls. Typical curves (right thoracic, left lumbar, or right thoracic left lumbar double structural configurations) become relatively more prevalent with rising curve magnitude, while atypical curve patterns (left thoracic, right lumbar, or left thoracic right lumbar double structural configurations) reciprocally diminish. Growth is clearly an important environment in which curves progress and peak prevalence rates occur at the ages of 11 years and 13 years. Although it is not possible to prognosticate about the individual case, attention to these characteristics derived from epidemiological surveys is useful in assessing future curve behavior.
Shoulder Arthroscopy: Current Indications and Techniques
Authors: Ellman Harvard
Published: April 2021

ABSTRACT: The role of arthroscopy in the diagnosis and treatment of shoulder disorders is evolving. Arthroscopic subacromial decompression is an alternative to open anterior acromioplasty in the treatment of chronic stage II impingement syndromes prior to the development of full thickness rotator cuff tear. Patients with massive and otherwise unrepairable cuff tears have achieved significant pain relief from arthroscopic decompression and debridement of the floppy and irregular cuff margins. Routine repairable full thickness cuff tears are best treated by open reconstruction. The arthroscope is an adjunct in confirming the diagnosis and direction of shoulder instability. Arthroscopic stabilization is most feasible when the anterior glenohumeral ligament/labral complex is detached. The introduction of a metal staple is controversial, however, reported complications are diminishing with experience. Alternate methods of stabilization are being investigated. Effective arthroscopic techniques have been established for the removal of loose bodies, the treatment of calcific tendinitis, septic arthritis, and other disorders. Shoulder arthroscopy will undoubtedly achieve an appropriate place in the armamentarium of the orthopedic surgeon.
Salvage of Infected or Failed Below-Knee Amputations With Total Contact Casting and Continued Weight Bearing
Authors: Pinzur Michael S , Smith Douglas , Osterman Helen
Published: April 2021

ABSTRACT: Ten patients with infected or apparently failing below-knee amputations were treated with total contact casting and continued weight bearing ambulation with a commercially available temporary prosthesis. Amputation was performed for peripheral vascular insufficiency in all patients. Seven of the patients were diabetic, five being insulin dependent. All ten were treated as outpatients and proceeded to heal their wounds and continued to function as independent community ambulators during treatment. None of the patients required surgical revision and each was successfully fit with a permanent below-knee prosthesis.
Aneurysmal Bone Cyst of the Distal Thumb Phalanx: A Case Report and Review of the Literature
Authors: Leeson Mark C , Lowry Lisa , McCue R William
Published: April 2021

ABSTRACT: Although aneurysmal bone cysts are a well-known, well described clinical entity, their presence in small bones of the hand are not a common occurrence. Only 13 previous cases involving the bones of the hand have been reported in the English literature. Of these 13, only seven involved the phalanges and no previous case has been described involving the distal phalanx of the thumb. Because these lesions may demonstrate aggressive local biologic behavior, when the diagnosis of aneurysmal bone cyst of the small bones of the hand is considered, prompt diagnostic and therapeutic intervention should be performed. Early recognition and management of this lesion is essential to prevent amputation.
Radiographic and Histologic Study of Porous Coated Tibial Component Fixation in Cementless Total Knee Arthroplasty
Authors: Engh Gerard A , Bobyn J D , Petersen Tracy L
Published: April 2021

ABSTRACT: Radiographic changes occurring beneath three types of non-cemented, porous coated, cobalt-chrome tibial components were retrospectively reviewed a minimum of 1 year after arthroplasty. Radiolucent zones, radiodense lines, and loose sintered particles were commonly observed. These changes are consistent with non-rigid, fibrous tissue fixation. Histologic evaluation of two specimens retrieved at revision surgery revealed predominantly fibrous tissue within the porous surface under the tibial plateau. The long-term implication of fibrous tissue fixation of porous coated tibial implants in unknown.
A Case Report of Malignant Mesenchymoma With Discussion of Musculoskeletal Tumor Staging: The Enneking System
Authors: DePaolo Charles J , Foster W Stan , Dabezies Eugene J , D'Ambrosia Robert D
Published: April 2021

ABSTRACT: A 54-year-old black man presented with a soft-tissue sarcoma of the (eft anterior thigh. Surgical staging studies and initial biopsy results identified the lesion as a grade HB pleomorphic liposarcoma. After radical hip disarticulation, follow up pathologic studies of the disarticulated limb showed the tumor to be confined to the anterior compartment of the left thigh without extracompartmental extension. The post-excisional surgical pathology report identified at least four different malignant mesenchymal elements: liposarcoma, myosarcoma, chondrosarcoma, and extraosseous osteogenic sarcoma. The sarcoma was therefore reclassified as a malignant mesenchymoma. The fact that the tumor was found to be intracompartmental at the time of surgery changed the staging of the tumor to stage HA. A radical surgical margin, as recommended by Enneking, remained the treatment of choice. Three months postoperatively, the patient had chest pain and dyspnea. Chest films revealed multiple pulmonary nodules and the patient died of pneumonia 3 months later.
Spontaneous Fractures of the Hip in the Elderly
Authors: Horiuchi Tomio , Igarashi Mitsuo , Karube Shunji , Oda Hiromi , Tokuyama Hiroshi , Huang Tsun-jen , Inoue Shigeru
Published: April 2021

ABSTRACT: The authors found 41 patients with 42 fractures of the hip who had no distinct history of trauma in the total of 1,449 hip fractures treated. They were all women ranging in age from 64 to 91 years. Most of the fractures were of intracapsular type. Three extracapsular fractures, however, were found. Fractures were randomly selected with clear history of trauma, which were matched to the patients with no trauma for age, sex, and type of fracture as a control group. The grades of osteoporosis of the femoral neck, estimated with the Singh index, and of the spine, estimated with the spinal score, were noted statistically significantly higher in the patients than those in the control group. Most of spontaneous fractures of the hip in the elderly are considered similar phenomena to the compression fractures of the dorsolumbar spine.
Benign Osteoblastoma
Authors: Patnoe Thomas G , Pritchard Douglas J
Published: April 2021

ABSTRACT: A case of benign osteoblastoma is presented with a description of the typical clinical, radiographic, and pathologic features associated with osteoblastoma. The recommended treatment is tumor excision with avoidance of radiation therapy.
A Study of the Mechanisms Influencing Ligament Growth
Authors: Dahners Laurence E , Sykes K E , Muller P R
Published: April 2021

ABSTRACT This study investigated the effects of tension and/or exogenous growth hormone on the growth (elongation) of ligaments. In the first experiment, tension was applied to the lateral collateral ligaments of immature rabbits. In the second experiment, a group of skeletally mature rabbits was given exogenous growth hormone while tension was applied to their lateral collateral ligaments. The results revealed that immature rabbit ligaments elongated 140±1 8% when tension was applied, while "control" ligaments elongated 79 ±5% (P<.01). In mature rabbits receiving exogenous growth hormone, no significant change was found in the ligament's length with or without the application of tension when compared with controls.

Tension applied to ligaments in immature rabbits can increase ligament growth, indicating that physical forces (tension) may be important in the regulation of ligament growth. The same tension applied to mature rabbit ligaments in combination with exogenous growth hormone did not cause a resumption of growth, indicating that tension and the presence of growth hormone are not the only factors necessary for ligament growth.
THE USE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF ROTATOR CUFF TEARS
Authors: Morrison David S , Ofstein Richard
Published: April 2021

ABSTRACT

One hundred consecutive patients with symptoms of chronic subacromial impingement syndrome were evaluated by both arthrography and magnetic resonance imaging (MRI) techniques. By comparing intermediate and ?2 weighted images, the ability to identify the normal and abnormal anatomy of the rotator cuff with the MRI was excellent. All 51 patients with arthrogram-proven rotator cuff tears had abnormal MRI scans (100% sensitivity). However, six of the 49 patients with normal arthrograms had abnormal MRI scans (88% specificity). At arthroscopy, four of these patients were found to have moderate to severe partial thickness rotator cuff tears. These findings indicate that in patients with longstanding subacromial impingement syndrome the MRI has an exceptionally high sensitivity for damage to the rotator cuff.
ALTERNATIVES IN THE SELECTION OF ALLOGRAFT BONE
Authors: Skinner Harry B
Published: April 2021

ABSTRACT

Many orthopedic surgeons are unfamiliar with the various types of commercially available allograft bones, despite their frequent use in reconstructive and tumor surgery. This report summarizes the mechanical, osteoinduction, and safety data for sterile fresh-frozen, secondarily sterilized, and freeze-dried bone. The orthopedic surgeon can make informed choices about bone alternatives based on the risks and benefits of each type. Data have shown that fresh-frozen sterile-collection bone is the optimal substitute for autogenous bone in most applications.
TOTAL HIP ARTHROPLASTY FOR PROTRUSIO ACETABULI: A 3- TO 9-YEAR FOLLOW UP OF THE HEYWOOD TECHNIQUE
Authors: Ebert Frank R , Hussain Shabbar , Krackow Kenneth A
Published: April 2021

ABSTRACT

Thirty-five total joint arthroplasties (34 patients) were performed in patients who had protrusio acetabuli. Twenty-nine percent of the patients had acetabular protrusio of grade I, while 71% had grade II and grade III protrusio. The mean follow up was 4 years (range: 3 to 9). Cemented acetabular components were used in 11 hips; 24 hips received an uncemented porous coated acetabular component. The patient evaluations included preoperative and postoperative Harris Hip Ratings and standard radiographs. In all cases, the medial wall defect was reconstructed with the solid autogenous femoral head as described by Heywood. The mean preoperative Harris Hip Rating was 45 (range: 30 to 60 points), and the postoperative mean was 85 (range: 70 to 100 points). Radiographically, the preoperative protrusio measured a mean of 8.8 mm (range: 6 to 18 mm), and the mean postoperative placement of the femoral head was 10 mm lateral to Kohler's line (range: 6 to 13 mm). There were no acetabular component failures and no acetabular bone graft resorptions. All autogenous grafts were incorporated to the host radiographically by 1 year post-surgery. This study corroborates previous work which suggests that medial-placed bone grafting is not resorbed and consolidates with the host bone. We find this technique extremely useful in dealing with this technical problem.
The Role of Anterior Stabilization With Instrumentation in the Treatment of Thoracolumbar Burst Fractures
Authors: Harris Mitchel B
Published: April 2021

Abstract

Several areas of controversy still exist when discussing the treatment of burst fractures in the thoracolumbar and lumbar regions of the spine. This article addresses the role of anterior stabilization with instrumentation in these regions. Pertinent clinical and biomechanical data will be reviewed so that readers will be able to identify the relative indications and contraindications for this procedure.
THE RISK OF INJURY TO THE AXILLARY NERVE, ARTERY, AND VEIN FROM PROXIMAL LOCKING SCREWS OF HUMERAL INTRAMEDULLARY NAILS
Authors: Riemer Barry L , D'Ambrosia Robert
Published: April 2021

ABSTRACT

An elderly female cadaver fore-quarter amputation was dissected, and a custom straight intramedullary nail with a 55° oblique downward lateral to medial proximal screw was inserted with a trocar protruding beyond the medial cortex of the humeral surgical neck. The main trunk of the axillary nerve was found to be at risk with any penetration from anterior to posterior and any screw penetration beyond the medial cortex with internal rotation. The axillary artery and vein were at risk with penetration of over 3 cm by a drill point or screw tip whether a transverse or oblique downward screw was used. Transverse screws inserted through the humeral neck from lateral to medial have the potential for damaging a small branch of the axillary nerve laterally, and care must be taken of the lateral humerus while inserting these screws. Screws inserted in a downward direction near the greater tuberosity, if originating above the equator of the humeral head, may cause impingement.
AVASCULAR NECROSIS AFTER FRACTURE-SEPARATION OF THE DISTAL END OF THE HUMERUS IN CHILDREN
Authors: Yoo Chong Il , Suh Jeung Tak , Suh Kuen Tak , Kim Yong Jin , Kim Hui Taek , Kim Young Ho
Published: April 2021

ABSTRACT

Fracture-separation of the distal end of the humerus in children has been reported infrequently, and may be misdiagnosed as a fracture of the condyle or a traumatic dislocation of the elbow. We discuss eight cases of a seldom reported complication following fracture-separation of the distal end of the humerus. This complication consists of dissolution of the trochlea within three to six weeks postinjury and a defect of the medial or central part of the condyle that develops later. The fractures were severely displaced fracture-separation of the distal end of the humerus with large medial or lateral metaphyseal fragment, but initially misdiagnosed as a fracture of the medial, lateral condyle or a traumatic dislocation of the elbow in six of eight cases. We performed open reduction in six cases because of initial misdiagnosis or because of difficulty in satisfactory closed reduction. We speculated that this complication is due to avascular necrosis of the distal end of the humerus, and that fracture-separation of the distai end of the humerus is more common than reported.
TOTAL HIP REPLACEMENT IN PATIENTS WITH OSTEOARTHRITIS OF THE HIP: IMPROVEMENT IN PAIN AND FUNCTIONAL STATUS
Authors: Gogia Prem P , Christensen Cecil M , Schmidt Carol
Published: April 2021

ABSTRACT

A simple, self-rating questionnaire was developed to assess the clinical outcome related to pain and function after total hip replacement surgery followed by physical therapy. Twentytwo patients, 57 to 86 years of age, with osteoarthritis of the hip who underwent total hip replacement surgery and received physical therapy following surgery, participated in the study. A questionnaire consisting of 11 items was developed to ascertain the level of pain, functional ability and the assistive ambulatory device used to perform selected activities of daily living. A maximum cumulative score of 55 points was possible. The functional categories monitored included: sitting, standing, sleeping, functional walking, distance walking, stair climbing, sitting/ standing from a toilet seat, driving, and sexual activities. The questionnaires were completed preoperatively, and postoperatively at 3 and 6 months. The results showed an overall improvement of 56% at 3 months and 64% at 6 months after surgery. Twenty of 22 patients obtained "excellent" results with total hip replacement surgery and follow-up physical therapy. Results of this study indicated that total hip replacement followed by physical therapy decreases joint pain and improves function in patients with osteoarthritis of the hip.
VENOMOUS SNAKE BITE: CURRENT CONCEPTS OF TREATMENT
Authors: Seiler John Gray , Sagerman Scott D , Geller Robert J , Eldridge John C , Fleming Lamar L
Published: April 2021

ABSTRACT

The optimal treatment of venomous snakebites remains controversial. Because of the variables involved in treatment, an ideal, prospective clinical trial likely will never be done. The purpose of this article is to review the available treatment methods and outline the treatment methods preferred in our institution for crotalidae envenomation.
THE CLINICAL EFFECTS OF INTENSIVE, SPECIFIC EXERCISE ON CHRONIC LOW BACK PAIN: A CONTROLLED STUDY OF 895 CONSECUTIVE PATIENTS WITH 1-YEAR FOLLOW UP
Authors: Nelson Brian W , O'Reilly Elizabeth , Miller Mark , Hogan Mike , Wegner Joseph A , Kelly Charles
Published: April 2021

ABSTRACT

Eight hundred ninety-five consecutive chronic low back pain patients were evaluated. Six hundred twenty-seven completed the program. One hundred sixty-one began, but dropped out, and 107 were recommended for treatment but did not undergo treatment for various reasons. Average duration of symptoms prior to evaluation was 26 months. Forty-seven percent of patients were workers' compensation patients. The primary treatment was intensive, specific exercise using firm pelvic stabilization to isolate and rehabilitate the lumbar spine musculature. Patients were encouraged to work hard to achieve specific goals. Seventy-six percent of patients completing the program had excellent or good results. At 1-year follow up 94% of patients with good or excellent results reported maintaining their improvement. Results in the control group were significantly poorer in all areas surveyed except employment.
MODIFICATION OF TECHNIQUE AND RESULTS OF ATLANTOAXIAL TRANSFACET STABILIZATION
Authors: McGuire Robert A , Harkey H Louis
Published: April 2021

ABSTRACT

A modification of the C
1
C
2
transfacet stabilization is reported. This technique allows a smaller incision to be made and provides a method for easier screw insertion.
RADIOLOGIC CASE STUDY
Authors: Olson Paul N , Rud Paul , Griffiths Harry J
Published: April 2021

CYCLOPS LESION
Clinical Value of Radiologists' Interpretations of Perioperative Radiographs of Orthopedic Patients
Authors: Clark Ron , Anderson Michael B , Johnson Blaine H , Moore David E , Herbert F David
Published: April 2021

ABSTRACT

The content and accuracy of radiographic interpretations by radiologists was assessed to determine the reports' ability to provide sufficient information necessary to make clinical treatment decisions. A retrospective review was performed of 371 radiographic studies (21 1 consecutive patients) ana their reports which had been generated by three Board-certified radiologists. Data were collected regarding fracture assessment and description as well as the description and assessment of orthopedic implants. These descriptions were categorized by their ability to be used clinically (precise) or not (general). Fracture descriptions were considered complete for 85% of reports, while their assessment of alignment and displacement (necessary to determine fracture care) was complete on only 9%. Orthopedic implants were described precisely on 12% of reports with 7% of the descriptions in error. The effect and position of orthopedic implants were described precisely for only 27% and 25% of cases, respectively, while implant stability was assessed precisely in only 4% of cases. For 61 % of preoperative studies, the radiologist's report was not available until after the surgical procedure had already been performed. For all variables considered, an average of 3% of descriptions contained an error. Radiologists' reports of radiographs of these patients undergoing orthopedic procedures did not contain sufficient descriptive information to be used clinically, were not promptly available, and contained an error for 3% of variables studied. The attending orthopedic surgeon has traditionally interpreted such radiographs and should continue to do so to provide patients with more immediate and complete clinical evaluation and management
Management of Unilateral Facet Dislocations: A Review of the Literature
Authors: Andreshak John L , Dekutoski Mark W
Published: April 2021

Spinal Trauma