bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of the Juvenile Bunion by Mitchell Osteotomy
Authors: Ball John , Sullivan J Andy
Published: April 2021

ABSTRACT: Twelve patients who had a total of 18 Mitchell bunionectomies were reviewed to assess the long-term results of the procedure. Although metatarsus varus correction was maintained in all cases, hallux valgus recurred in 11 of the 18 cases. Sixty-seven percent reported complete relief or improvement of preoperative pain. Although lateral metatarsalgia did occur, the most common area of persistent pain remained the first metatarsal. Six of 18 procedures had marked loss of active joint motion, associated with pain and an unsatisfactory result. Of 18 procedures, 11 (61%) were satisfied with the results of their osteotomy.

Although the Mitchell osteotomy corrected the metatarsus primus varus in each case, the current series shows a discouraging incidence of later recurrence of hallux valgus and restriction of metatarsophalangeal motion causing the abandonment of this procedure for the management of juvenile bunion.
RADIOLOGIC CASE STUDY
Authors: Kerr Roger
Published: April 2021

Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Double Osteotomy Operation in the Surgical Treatment of Coxa Plana Disease
Authors: Chakirgil Gungor Sami , Isitman Ali Tan , Ceten Ilker
Published: April 2021

ABSTRACT: During the years 1975 to 1982, what was named the double osteotomy-which is a combination of pelvic osteotomy together with subtrochanteric varus, extension and denotation osteotomy- was applied to 26 cases suffering from coxa plana (Perthes-Calvé-Legg disease). The postoperative follow up averages a period of three years and five months and was undertaken at the Department of Orthopedics and Traumatology of the Faculty of Medicine, University of Ankara, Turkey.
Free Vascularized Flaps for Lower Extremity Reconstruction
Authors: Frykman Gary K , Leung Vincent C L
Published: April 2021

ABSTRACT: Large wounds of the lower extremity, particularly distal to the knee, have been difficult to cover by traditional means such as skin grafts, local flaps, cross-leg flaps and jump flaps. These wounds, particularly when associated with fractures and osteomyelitis, have frequently resulted in amputation of the lower extremity. Microvascular surgical techniques have allowed the transfer of large flaps of skin and/or muscle from a remote site of the body to the defect in the leg for soft tissue coverage and additional blood supply to the defect. Although these techniques are more tedious and require longer operating times, they usually shorten the patient's hospital stay, heal the wounds faster and shorten disability time.

With wider experience, improved techniques and greater microsurgical skill, lower limbs with large defects due to trauma or tumor resection can be salvaged and reconstructed with acceptable risks and minimal donor site morbidity.
Total Hip Replacement and Sciatic Nerve Trauma
Authors: McLean Michael
Published: April 2021

ABSTRACT: Intraoperative injury to the sciatic nerve is a known risk during total hip replacement. Postoperative injury by an implant is rare. A case of sciatic nerve laceration possibly caused by a protrusio ring is presented. The presentation of the patient, the mechanism of injury, and the means to avoid it are discussed.
Intramedullary Reaming and Nailing: Its Early Effects on Cortical Bone Vascularization
Authors: Olerud Sven , Strömberg Lennert
Published: April 2021

ABSTRACT: The early effect of reaming the medullary cavity prior to intramedullary nailing using Küntscher's method, on human cortical bone vascularization in the femur is discussed.

In sections of the femur where the medullary tissue had been totally reamed, the inner two-thirds of the cortical bone tube was completely avascularized one week after the reaming. In the outer third of the cortex the vascularization was only moderately decreased. In the parts of the femur where the medullary tissue was not totally destroyed there was a marginal effect on the amount of intact cortical vessels. The observation is thus in accordance with corresponding results from experimental studies on animals. Microcracks, and cracks in the cortical wall, caused by the reaming and procedure are also described in the article.
Radical Reduction Operation in the Treatment of Congenital Dislocation of the Hip: An Analysis of 2,789 Cases
Authors: Chakirgil Gungor Sami
Published: April 2021

ABSTRACT: During the period 1960 to 1983, 2,789 operations were performed in patients with congenital dislocation of the hip. Of these, 784 patients were between V/z and 4 years of age, 1,646 patients were between 4 and 8 years of age, and 359 patients were between 8 and 14 years, with an average age of 10 years. The procedure is performed in a single operation by sectioning all contracted muscles, opening and debriding the joint, and reducing the femoral head into the acetabulum after removal of a 2 cm to 3 cm bone segment from the subtrochanteric region of the femur. Fixation of the femoral shaft in a derotation, varus position is done with a bone plate. Finally, a transiliac acetabuloplasty is performed. The bone segment removed from the subtrochanteric region is used to support the acetabular roof. The results, graded according to Severin's classification, were 83.3% successful and 16.7% unsuccessful.
Tibial Plateau Fractures: A Review of Operative Treatment Using AO Technique
Authors: Savoie Felix H , Griend Robert A Vander , Ward E Frazier , Hughes James L
Published: April 2021

ABSTRACT: In a retrospective review of 80 tibial plateau fractures, 28 fractures were treated nonoperatively with a variety of closed methods and 52 were treated with open reduction and internal fixation using AO technique. At an average follow up of 24 months, a satisfactory result was obtained in 87% of the operatively treated patients and in 66% of those treated nonoperatively. It appears that stable, minimally displaced fractures do equally well with closed or open treatment. Patients with depressed, displaced, or unstable fractures did better with operative treatment. When operative treatment is planned the principles and techniques of internal fixation should be carefully followed.
Mechanical Performance of the Standard Orthofix External Fixator
Authors: Chao Edmund Y S , Hein Todd J
Published: April 2021

ABSTRACT: Static and fatigue tests of the standard Orthofix® unilateral external fixator (Orthofix SRL®, Verona, Italy) were performed. Under similar fixation configurations, the Orthofix device offered higher bending stiffness in both directions, equal torsional stiffness, and lower axial stiffness when compared to the Hoffmann-Vidal quadrilateral frame with full pins. The bending resistance of the Orthofix ball joint was found to be proportional to its locking cam tightening torque. After applying 2 million loading cycles to the bone ends fixed by the device, the overall stiffness characteristics of the frame dio not change significantly. Repetitive manual tightening and loosening of the ball joint caused abrasive wear on the cam and bushing surfaces. The locking position of the cam migrated for a mean of 45°. After 50 cycles of tightening and bending to failure, the ball joint locking strength was reduced by 20% to 25%, but the stiffness did not change. Wear and stripping of the seat of the fixator body locking screw and the pin fixation screw threads were also noted. Based on the test results, the standard Orthofix device could be re-used, but certain fixator components must be inspected and replaced. The ball joint locking cam and fixation screws required periodic tightening during clinical application to prevent loss of frame stiffness under repetitive loading. Modifications of the fixator design are recommended to improve its mechanical performance.
Zielke Instrumentation
Authors: Hammerberg Kim W , Rodts Mary F , DeWald Ronald L
Published: April 2021

ABSTRACT: Ziefke modified Dwyer's anterior spinal Instrumentation to produce the Ventral Derotational Spondylodesis (VDS) System. The primary indication for VDS instrumentation is the treatment of progressive, single, major lumbar or thoracolumbar curves in idiopathic scoliosis. The surgical technique, including selection of appropriate curvatures and levels of instrumentation, is described.

A group of 25 consecutive patients undergoing VDS instrumentation for lumbar or thoracolumbar curvatures was reviewed. The average correction of the major curve was 76%. The minor curvature was corrected with an average of 47%. A significant complication was a 20% incidence of pseudarthrosis and rod breakage. The implications of these problems are discussed. Zielke instrumentation is a powerful technique for the correction of selected curves. The system provides greater correction of the major curve, improved frontal and sagittal alignment, and preservation of distal motion segments.
Intramedullary Osteosclerosis: A Report of the Clinicopathologic Features of Five Cases
Authors: Abdul-Karim Fadi W , Carter John R , Makley John T , Morrison Stuart C , Helper Stephen D , Joyce Michael J , Linke Thomas F
Published: April 2021

ABSTRACT: The clinicopathologic features of five patients with intramedullary osteosclerosis are presented. The patients, ranging in age from 8 to 52 years (mean 31 years), all presented with pain referred to the lower extremity. The sclerotic lesions involved the entire lower extremity in 1 patient, mid-tibial shaft in 2, distal tibia in 1 , and distal fibula in 1 patient. The histopathologic features of intramedullary osteosclerosis overlap with those of melorheostosis. The differential diagnosis also includes a spectrum of entities, each characterized by osteosclerosis and each of which is compared and contrasted to the cases presented.
Intramedullary Stabilization of Neoplastic Destructive Disease Involving the Subtrochanteric Region of the Femur
Authors: Fasano Frank J , Olysav David J , Stauffer E Shannon
Published: April 2021

ABSTRACT: Neoplastic destructive disease involving the subtrochanteric region of the femur is a difficult condition to treat. This is a retrospective study of 11 femurs in 10 patients with subtrochanteric destructive lesions or pathologic fractures that were stabilized with the Zickel intramedullary device. The study investigated underlying disease process, ambulatory status, operative parameters, time to death, and associated metastasis. The average survival time of the patients who died was 4.7 months. All of the patients involved in this study could be mobilized, but only 3 out of 10 were ambulatory. This study concludes that the intramedullary fixation of pathologic fractures or lesions of the subtrochanteric region does not necessarilly allow ambulation, but does allow mobilization of debilitated patients.
Ninety-Ninety Intraosseous Wiring for Internal Fixation of the Digital Skeleton
Authors: Zimmerman Neal B , Weiland Andrew J
Published: April 2021

ABSTRACT: Ninety-ninety intraosseous wiring has been used in more than 150 cases over the last 4 years to obtain skeletal stability. This technique has been effective for the internal fixation of replanted parts, arthrodeses, transverse fractures, and elective free-tissue transfers. All osteotomies and fractures healed promptly, usually within 6 weeks. There have been no instances of nonunion, malunion, or implant failure. Only one wire had to be removed due to its prominence. Ninety-ninety intraosseous wiring is an expeditious, straightforward, and very stable method to secure rigid internal fixation and allow early active motion of the digital skeleton.
Interlocked Intramedullary Nailing of the Humerus
Authors: Ward E Frazier , White James L
Published: April 2021

ABSTRACT: Indications for use of the intramedullary interlocked humeral nail are: pathologic fractures, including those with severe osteopenia alone; nonunions, especially those with bone atrophy and/or marked osteopenia; and humeral shaft fractures with comminution, bone loss, or other causes of instability not controlled by conventional treatment methods. In this series, eight patients were treated by intramedullary interlocked humeral nail. Follow up ranged up to 30 months, with an average of 12 months. Five of six patients in this series who had the potential to unite their fractures did so. The remaining patient had a painless fibrous union. While the two patients with pathologic fractures of the humeral shaft caused by malignant tumors did not unite their fractures, the pain relief, functional recovery, and lack of postoperative morbidity justified the operative procedure.
Recurrent Anterior Dislocation of the Shoulder: A Comparison of the Results after the Bankart and the Putti-Platt Procedures
Authors: Varmarken Jens-Erik , Jensen Claus Hjorth
Published: April 2021

ABSTRACT: A retrospective comparison of the results after the Bankart and the Putti-PIatt procedures in the treatment of recurrent anterior dislocation of the shoulder showed no significant differences in the rate of redislocation or in the limitation of outward rotation. The dislocation recurrence rate after surgery was 13% for the Bankart procedure and 22% for the Putti-PIatt procedure. Only 67% of the patients were satisfied with the operation. The poor results seem to be due to the fact that the operations were performed by 16 different surgeons who had varying approaches to the operations.
Total Knee Arthroplasty Using the Kinematic Rotating Hinge Prosthesis
Authors: Shaw James A , Balcom William , Greer Robert B
Published: April 2021

ABSTRACT: Patients receiving a Kinematic Rotating Hinge total knee prosthesis with a 25month minimum follow up were reviewed. A total of 46 patients and 54 knees were included in the study. A detailed clinical assessment was available on 38 knees. Twenty of these knees had primary arthroplasties performed with the Kinematic Rotating Hinge prosthesis and 18 knees had revision arthroplasty. Ninety-five percent of primary knees and 83% of revision knees caused no or mild pain postoperatively. Using the Brigham and Women's Hospital and Harvard Medical School knee rating system, 80% of primary knees and 61% of revision knees were rated as good to excellent. Using the criteria defined in this article, 90% of primary knees and 83% of revision knees were labeled as having a satisfactory result. Forty-five percent of primary components and 52% of revision components demonstrated lucent lines on radiographie review. Seven percent of primary knees and 20% of revision knees showed evidence of aseptic lucency progression in one or more zones. No radiographie evidence of aseptic loosening was noted in this review. Documented sepsis occurred in one primary knee and two revision knees. Patellar instability occurred in 21% of primary knees and 36% of revision knees, representing the major complication. The Kinematic Rotating Hinge prosthesis is intended for use in arthroplasty cases where there is functional absence of collateral ligament stability. This review suggests that a high percentage of satisfactory clinical results can be achieved with this prosthesis with long-term radiographie stability.
Compartment Syndrome: A Complication of Intravenous Regional Anesthesia in the Reduction of Lower Leg Shaft Fractures
Authors: Maletis Greg B , Watson R C , Scott Steve
Published: April 2021

ABSTRACT: Forty-one consecutive patients who had closed reduction of closed lower leg shaft fractures under an intravenous regional anesthetic are reviewed for the complication of compartment syndrome. Four patients were graded as having mild compartment syndrome, two as moderate, and five as severe, giving an overall rate of 27%. This was compared with a control group of 39 consecutive patients who also underwent closed reduction of closed lower leg shaft fractures, but under general anesthesia or intravenous analgesia alone rather than an intravenous regional anesthetic. In the control group, three patients were graded as having mild compartment syndrome, and two as severe, giving an overall complication rate of 13%. The authors feel that the use of the thigh tourniquet with the intravenous regional anesthetic technique increases the frequency of compartment syndrome as a complication in lower leg fractures.
Resolving Solitary Osteochondromas: A Report of Two Cases and Literature Review
Authors: Montgomery David M , LaMont Richard L
Published: April 2021

ABSTRACT: Resolving osteochondromas were previously thought to be uncommon. Two cases are presented, including the first report of a resolving solitary osteochondroma of the proximal tibia. These cases, along with previous reports, suggest resolution may occur, especially in boys under age 12 years. Surgical excision should be delayed in this group of patients provided malignant transformation or neurovascular compromise is not a concern.
Fracture of the Femur After Total Hip Arthroplasty
Authors: Roffman Moshe , Mendes David G
Published: April 2021

ABSTRACT: The classification and treatment of ipsilateral femur fractures after total hip arthroplasty are described on the basis of the predicted stability of the implant after the fracture. Conservative treatment was successful in most cases.
Completely Displaced Distal Radius Fractures With Intact Ulnas in Children
Authors: Roy Dennis R
Published: April 2021

ABSTRACT: Completely displaced distal radius fractures with intact ulnas are uncommon, ditticult-toreduce fractures in children. Ten of these fractures were retrospectively reviewed from a series of more than 600 forearm fractures. Eight of ten patients were available for follow up clinically and radiologically at an average of 21 months. Considerable remodeling was noted including two fractures that were left in an overriding position of 10 mm. If angulation does not exceed 16° of radial deviation and 20° of dorsal angulation, repeat manipulations need not be performed. Stimulation of growth by the fracture restored radial length. Thus, reduction of the overriding is unnecessary.
Anterior Knee Dislocation: Case Report and Discussion
Authors: Pearsall Albert W , Schueller Dean
Published: April 2021

Case Report

A 34-year-old man presented to the emergency room with a complaint of left knee pain and deformity. The patient recalled that while fleeing several armed assailants, he struck his left foot on a curb with his knee in full extension. He immediately fell to the ground and was unable to bear weight on his left leg.

Upon examination he had a left knee hyperextension deformity with no evidence of gross varus/valgus malalignment. He was neuro vase ularly intact bilaterally. Radiographs of the patient's left knee were obtained (Fig 1). Diagnosis: Anterior knee dislocation.
The Effects of Contrast Dye on Bacterial Growth: An In Vitro Model
Authors: Lee Wayne A , MacEwen G Dean
Published: April 2021

ABSTRACT: We devised an in vitro model to examine the effects of Conray 60 contrast dye on microorganisms commonly found in septic arthritis. Using 42 culture plates in aerobic and anaerobic environments, we found no adverse effect on bacterial growth using 30, 7.5, 3.75, and 1.875% concentrations of Conray 60 contrast dye on cultures of Staphylococcus aureus, Hemophilus influenza, and Streptococcus pneumonia.
Evaluation of Hip Pain Following Cemented Total Hip Arthroplasty
Authors: Horne Geoffrey , Rutherford A , Schemitsch E
Published: April 2021

ABSTRACT: The occurrence of pain following a technically satisfactory cemented total hip arthroplasty is of concern for both the orthopedic surgeon and the patient. In order that the source of the pain be accurately located, a scientific approach is required. We present an algorithm for the evaluation of pain following an apparently satisfactory hip arthroplasty which, if followed, results in the correct diagnosis.
VANCOMYCIN VS TOBRAMYCIN ELUTION FROM POLYMETHYLMETHACRYLATE: AN IN VITRO STUDY
Authors: Lawson Kevin Jon , Marks Kenneth E , Brems John , Rehm Susan
Published: April 2021

ABSTRACT

We fabricated batches of cement containing 0.5 gm, I. O gm* and 2.0 gm vancomycin and one with 1.0 gm tobramycin and shaped them into cylinders. They were immersed into 0.5 L of normal saline and the fluid volume was changed daily. Samples of fluid were obtained on days 1 , 2, 3, 5, 7, 14, and 28. All fluid samples had antibiotic assays performed to quantitate the amount of elution for vancomycin or tobramycin. \ancomycin elution from PMMA occurred under our study conditions in similar quantities to that measured for tobramycin controls, \bncomycin-loaded PMMA cement may have a clinical role in the treatment of musculoskeletal sepsis caused by gram-positive bacteria, particularly if organisms resistant to the usual antibiotic agents are identified.
VASCULARIZED BONE GRAFTS
Authors: Pirela-Cruz M A , DeCoster T A
Published: April 2021

ABSTRACT

Free vascularized bone grafts allow living bone tissue to be transplanted to replace a bone defect. The use of vascularized bone grafts requires microvascular dissection and attachment to a recipient site artery and vein, whereas rotational or pedicle grafts are moved, while still attached to their blood supply, to a new site. Conventional nonvascularized bone grafts heal by resorption and creeping substitution. The major benefits of vascularized bone grafts are more rapid and complete incorporation of the graft which provides immediate structural support, the ability of the transplanted (living) bone to form new bone, and the addition of new blood supply to the recipient area. The technique of the free vascularized fibula transplantation is described.
GUNSHOT FRACTURES: A MEDICAL, SOCIAL, AND ECONOMIC ANALYSIS
Authors: Hakanson Robyn , Nussman Donna , Gorman Richard A , Kellam James F , Hanley Edward N
Published: April 2021

ABSTRACT

One hundred ten fractures due to gunshots were reviewed to examine the medical, social, and financial impacts of such injuries. The population was predominantly male (91%), unemployed (56%), and uninsured (79%). Sixty-eight percent were documented substance abusers, and 65% of the injuries appeared to be related to illicit drug activities. There were 94 long bone fractures and 16 intraarticular fractures. Early operative treatment was employed in 64 patients (58%) with formal internal fixation in 31. There was no difference between type of treatment, associated injury variables, and outcome, and no increase in complications with acute operative management employing internal fixation. Medical charges averaged $13 108 per patient, a 1200% increase over injuries treated at this institution in 1972 and a rise far in excess of the medical care inflation rate (334%) during the same period.
RISK FACTORS FOR RESTRICTED MOTION AFTER ANTERIOR CRUCIATE RECONSTRUCTION
Authors: Graf Ben K , Ott Judson W , Lange Richard H , Keene James S
Published: April 2021

Ben K. Graf, MD

Judson W. Ott, MD

Richard H. Lange, MD

James S. Keene, MD

ABSTRACT

A retrospective review of 373 patients who had undergone anterior cruciate ligament (ACL) reconstruction utilizing the central third of the patellar tendon was undertaken to identify those factors that placed a patient at risk for restricted postoperative motion (flexion ≤ 125° or flexion contracture ≥ 10°). Stepwise logistic regression analysis determined that the variables most strongly correlated with restricted final range of motion (ROM) were open surgery (P =.0008) and reconstruction performed ^ 7 days after the initial injury (P =.004). Age, associated meniscal repair, or associated collateral ligament injuries did not significantly affect the ROM. A subgroup of 204 patients arthroscopically reconstructed more than 7 days post-injury were significantly less likely to have limited motion when ROM exercises were begun within 2 days of surgery (P= .008). These data support delayed, arthroscopic ACL reconstruction followed by early ROM exercises as useful techniques for avoiding postoperative motion problems.
PAIN DYSFUNCTION SYNDROME OF THE KNEE
Authors: Neuschwander David , Drez David , Heck Suzy
Published: April 2021

ABSTRACT

Pain dysfunction syndrome is a descriptive term recommended by Amadio1 to describe patients whose pain is excessive, nonanatomic, and out of proportion to their injury. This retrospective review reports the effectiveness of a differential epidural block in the evaluation of these patients. Four patterns of response were identified with the block: 1) reflex sympathetic dystrophy (RSD) (14%), 2) somatic (9%), 3) mixed sympathetic and somatic (27%), and 4) central (50%). The inciting injury in 70% of the patients was a minor strain, sprain, or contusion. Despite accurate diagnosis, the results in compensation cases with pain dysfunction syndrome are exceedingly poor.
LONG-TERM RESULTS OF 56 REVISION TOTAL KNEE REPLACEMENTS
Authors: Gustilo Tara , Comadoll James L , Gustilo Ramon B
Published: April 2021

ABSTRACT

Fifty-six consecutive revised total knee arthroplasties (TKA) were followed for an average of 8.3 years (range: 3 to 15 years). The purpose of this study was to evaluate the results of revision TKA to determine any trend's in either the good outcomes or the failures. We found that the success rate for revision TKA was comparable to that for primary TKA. Eighty-nine percent of the knees rated at least fair, with 73% of these rating good or excellent, and 4% poor result. Moreover, the findings suggest that if prostheses are aligned correctly at implantation, there is only slight deterioration in their performance over time. Outcome was not affected by the type of prosthesis used in either the previous surgery or the revision. There is a correlation between the number of revisions and the functional knee rating; the more revisions, the less chance for success. There was also a direct correlation between varus knee alignment and significant increased incidence of failure. No appreciable difference was found between degenerative arthritis patients and rheumatoid patients, except that the rheumatoid patients had a higher incidence of delayed infections.
BONE GRAFT IN HINDFOOT ARTHRODESIS: ALLOGRAFT VS AUTOGRAFT
Authors: McGarvey William C , Braly W Grant
Published: April 2021

ABSTRACT

From 1990 to 1992, all arthrodeses of the socalled triple joints, combined or isolated and performed by one surgeon, were reviewed to allow a minimum follow up of 18 months from the time of the index procedure. Type of bone graft was selected based on the patients' decision after the risks of each were explained by the surgeon. There were 37 patients undergoing 41 procedures (4 bilateral) including double and triple arthrodesis, as well as isolated subtalar fusions. Twenty-nine of these were performed for either degenerative or posttraumatic arthritis. Ten others were performed for joint incongruity resulting from posterior tibial tendon insufficiency, and the rest for hemiparesis or residual clubfoot. All patients were placed into a routine postoperative regimen of casting, bracing, weight bearing, and therapy. They were evaluated based on subjective complaints, physical examination, and postoperative radiographs. Any patient suspected of having a nonunion underwent a computed tomography scan for confirmation. Overall, 24 patients received allografts and 17 iliac crest grafts. There were four nonunions, three of which utilized banked bone graft, with the only nonunion in the autograft group occurring in a patient following open calcaneus fracture. Of the four nonunions, three opted for revision surgery and the only one to choose allograft again incurred the only recurrent nonunion. There were two infections, one in each group, resulting in prolonged intravenous antibiotic therapy.
TRUE EPINEURAL NEUROLYSIS IN MORTON'S NEUROMA: A 5-YEAR FOLLOW UP
Authors: Diebold P F , Daum B , Dang-Vu V , Litchinko M
Published: April 2021

ABSTRACT

Morton's neuroma is a frequent cause of metatarsalgia. Neuroma resection was the usual recommended surgical treatment. Failure rate of neurectomy can be as high as 14% to 21%, and treatment of recurrences is difficult. The authors have treated Morton's neuroma by neurolysis since 1985. They present their results in a group of 40 patients with 5 years follow up. Thirty-seven of 40 patients had an excellent result after neurolysis and 35 patients had normal toe sensitivity at the date of examination. Thirty-nine patients stated they would undergo the operation again if necessary.
CHRONIC LAXITY OF THE SUBTALAR JOINT
Authors: Pisani G
Published: April 2021

ABSTRACT

Chronic laxity of the subtalar joint derives from the functional significance of the joint with the talo-calcaneal interosseous ligament as the articular "pivot." The laxity of the subtalar joint is usually associated with traumatic or degenerative pathology of the interosseus ligament. The characteristic pain is present along the sinus tarsi and at times also more proximally along the posterior subtalar joint. Radiographic examination is not significant; however, with arthrography, the normal synovial recess of the posterior subtalar joint corresponding to the sinus tarsi is not visualized. With magnetic resonance imaging it has been possible to document structural alterations of ligament. Reconstruction of the interosseus talo-calcaneal ligament has a reasonable expectation of success. The author presents the results of this treatment in 47 operations (44 patients, 3 bilateral) between January 1982 and June 1992.
LONG-TERM RESULTS OF THE MODIFIED EVANS REPAIR FOR CHRONIC ANKLE INSTABILITY
Authors: Rosenbaum Dieter , Becker Horst-Peter , Sterk Jürgen , Gerngross Heinz , Claes Lutz
Published: April 2021

ABSTRACT

We treated 19 patients for chronic ankle instability with a modified Evans procedure. All patients were evaluated after an average follow up of 128 months with detailed questionnaire, clinical examination, and stress radiographs. Although the subjective results were reported as 8 excellent, 7 good, and 4 fair, residual pain was reported by 11 patients. There was a significantly increased number of osteophytes in the treated ankle joint Stress radiographs demonstrated significantly improved stability in the operated ankle joint. Range of motion was significantly reduced in hindfoot inversion. The results showed that the modified Evans procedure achieved sufficient joint stability at the expense of inversion range of motion. This reconstruction method apparently did not prevent the development of arthrosis.
HELAL METATARSAL OSTEOTOMY FOR THE TREATMENT OF METATARSALGIA: A CRITICAL ANALYSIS OF RESULTS
Authors: Trnka H-J , Kabon B , Zettl R , Kaider A , Salzer M , Ritschl P
Published: April 2021

ABSTRACT

We reviewed the results of treatment of 114 feet in 96 patients with pressure metatarsalgia treated with a metatarsal osteotomy performed according to the technique of Helal. Clinical examination was performed according to a standardized evaluation questionnaire using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale. The results were correlated with number of metatarsal osteotomies, the length of the follow up, the age of the patient, and type of additional procedures performed. Sixty-one percent of the patients rated the operation as excellent or good. Patient age and number of osteotomies did not influence the results; however, the length of time following surgery and associated Keller-Brandes resection arthroplasty influenced the outcome negatively. There was a high incidence of increased transfer of weight to adjacent metatarsals. We concluded that the Helal type metatarsal osteotomy is unlikely to predictably achieve symptom relief over a long period.
PLANTAR FOREFOOT ULCERATION WITH EQUINUS DEFORMITY OF THE ANKLE IN DIABETIC PATIENTS: THE EFFECT OF TENDO-ACHILLES LENGTHENING AND TOTAL CONTACT CASTING
Authors: Lin Sheldon S , Lee Thomas H , Wapner Keith L
Published: April 2021

ABSTRACT

Between 1993 and 1995, 93 neuropathic diabetes mellitus patients with foot ulcers underwent a total contact cast (TCC) protocol. A randomly chosen group of 21 patients (Group I) demonstrated ulcer healing in a mean time of 43.5 days. Despite 9 weeks of TCC, 15 patients (Group II) with forefoot ulcers failed to heal. Physical examination of Group I revealed plantarflexion/dorsiflexion range of motion of the ankle of 33.871.9° compared to 32.3°/-10.5° of Group II, demonstrating an ankle equinus deformity and limited joint motion. Group II patients underwent a correction of the equinus deformity with percutaneous tendo-Achilles lengthening (TAL), followed by a TCC. All but one ulcer (93.3%) healed within 39.4 days. Four (19.0%) ulcers recurred (at the same site) in Group I, compared to none in Group II at the latest follow up of 17.3 months. Surgical correction with percutaneous TAL and TCC results in healing of forefoot ulcer and helps prevent ulcer recurrence.
CARPECTOMY AND FUSION IN ADULT-ACQUIRED HAND SPASTICITY
Authors: Pinzur Michael S
Published: April 2021

ABSTRACT

Five adult patients with voluntary hand control, complicated by severe flexion contracture and spasticity secondary to brain injury, underwent subtotal carpectomy and radio-carpal or radiometacarpal fusion. None of the patients were capable of functional prehension before surgery, and all had difficulty with hygiene due to their deformity. The deformities were beyond the scope of correction with soft tissue release. Two of the patients had previously undergone flexor- prona tor origin release, musculo-tendinous lengthening of the wrist and finger flexors, or a combination of both. AU five patients progressed to union without complication. Four achieved meaningful gains in functional grasp-release of the hand following the surgery.
Thawing the Frozen Shoulder: The "Patient" Patient
Authors: Miller Mark D , Wirth Michael A , Rockwood Charles A
Published: April 2021

ABSTRACT

Many different modalities have been advocated for the treatment of frozen shoulder (adhesive capsulitis), some of which can be associated with complications and morbidity. We retrospectively reviewed 50 patients with adhesive capsulitis treated by the senior author over a 10-year period. Treatment consisted of closely monitored home therapy using moist heat and antiinflammatory medication, and a physiciandirected rehabilitation program. Without exception, every patient regained a significant amount of motion and returned to activities of daily living without pain.
Assessing the Expected Outcomes of Orthopedic Surgical Care for Children
Authors: Lewis Charles E , Shaperman Julie
Published: April 2021

ABSTRACT

A sample of 175 parents of children treated operatively for orthopedic problems were interviewed before surgery to ascertain their expectations with regard to specific functional changes postoperatively. They were interviewed about changes from 6 to 12 months after surgery. Medical records of a sample of this group were reviewed for any notes about functional status. Of this group, 54% said a specific function named preoperatively was "much better."' Only a third of the parents from Mexico understood the nature of the procedure performed 6 to 12 months postoperatively, and only 40% of medical records contained notes about functional status pre- or postoperatively.
Femoral Head Size: Variation Among Manufacturers
Authors: Ritter Merrill A , Meding John B , Faris Philip M , Keating E Michael
Published: April 2021

ABSTRACT

Nine manufacturers were contacted for their specific femoral head diameters of the 22 mm, 28 mm, and 32 mm femoral components. The 22 mm heads averaged .869 in. (±.005) and 100% were within 1 standard deviation; however, the standard deviation was large. The 28 mm heads averaged 1.101 in. (± .002), and 89% were within 1 standard deviation. The 32 mm heads averaged 1.258 in. (± .002), and 78% were within 1 standard deviation. It seems that when a 28 mm or 32 mm femoral head is used, different femoral and acetabular components by different manufacturers can be intermixed. However, when changing a 22 mm femoral head, the manufacturer should possibly be notified and an attempt to use the same manufacturer is preferable.
Integrated Analysis of Thrombotic/Vascular Event Occurrence in Epoetin alfa-Treated Patients Undergoing Major, Elective Orthopedic Surgery
Authors: de Andrade J Robin , Frei Dieter , Guilfoyle Mary
Published: April 2021

ABSTRACT

Data from four prospective, multicenter, randomized studies involving 869 major, elective orthopedic surgery patients were examined by means of a retrospective integrated analysis to evaluate whether perioperative Epoetin alfa use was associated with the occurrence of thrombotic/vascular events. The incidence of thrombotic/vascular events was similar between 619 patients treated with Epoetin alfa and 250 patients receiving placebo (7.4% versus 8.0%, respectively). Regression analyses identified age, cardiac history, hypertension, and cardiac medications, but not Epoetin alfa, as risk factors for thrombotic/vascular events. The analysis did not implicate an increase in the rate of rise in hematocrit or maximum hematocrit obtained prior to surgery as contributors to thrombotic events. Thus, Epoetin alfa, which enhances preoperative erythro poiesis and increases hematocrit, did not affect the probability of thrombotic/vascular events.
Comparison of the Hospital Cost of Primary and Revision Total Hip Arthroplasty After Cost Containment
Authors: Iorio Richard , Healy William L , Richards Julie A
Published: April 2021

ABSTRACT

This study compared the hospital cost of primary and revision total hip arthroplasty (THA) after the introduction of cost-containment programs (clinical pathway, hip implant standardization, and competitive bid purchasing of hip implants). Hospital financial records for 290 primary and 85 revision THAs performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined.

Average hospital length of stay was 4.9 days for primary THA and 5.9 days for revision THA. Average hospital cost was $11,104 for primary THA and $14,935 for revision THA. Average net income (hospital revenue - hospital expense) for primary THA was $2486. Average loss from revision THA was $401 . The payer mix included commercial insurance. Blue Cross/Blue Shield, managed care. Medicare, Medicaid, and workmen's compensation. For primary THA, all payers were profitable except Medicaid and selected managed care contracts. For revision THA, profit was achieved with payment from commercial insurance only. Despite the introduction of cost-containment programs, revision THA did not achieve profitability at our institution.
General Short-Term Indomethacin Prophylaxis to Prevent Heterotopic Ossification in Total Hip Arthroplasty
Authors: Hofmann S , Trnka H-J , Metzenroth H , Frank E , Ritschl P , Salzer M
Published: April 2021

ABSTRACT

This prospective study evaluated heterotopic ossification prophylaxis with indomethacin for 14 days in 201 consecutive patients undergoing total hip arthroplasty. Ranitidine was administered concurrently to alleviate gastrointestinal side effects. None of the patients with mild gastrointestinal side effects (1 2%) had to suspend the prophylaxis, and no major postoperative bleeding or gastrointestinal ulcers were observed. After 12 months of follow-up, 67% of patients had no evidence of heterotopic ossification, 32% percent had grades I and 1% had grade III without clinical significance, and 0% had grade IV ossification according to BrookeKs classification. These results indicate that short-term indomethacin prophylaxis is an effective, inexpensive, and easily administrated alternative to single-dose radiotherapy for nearly all patients undergoing THA.
AO Tension-Band Osteosynthesis of Displaced Olecranon Fractures
Authors: Finsen Vilhjalmur , Lingaas Per Snorre , Storrø Sturla
Published: April 2021

ABSTRACT

This study reviewed 31 patients who underwent AO tension-band osteosynthesis of displaced olecranon fractures. Thirteen fractures were comminuted. Postoperative immobilization was short, and the median hospital stay was 3 days. In 2 patients, the stainless steel wire broke and required replacement. In 13 patients, the osteosynthesis material was removed after healing because of pain at the tip of the elbow; this did not influence the final result. Median time out of work was 12 weeks. There was no significant loss of elbow power. There was satisfactory mobility, function, and absence of pain. There were 29 good and 2 fair clinical results. Anatomic reduction was achieved in 24 elbows. Possible arthrosis was detected at follow-up in 5 elbows but these patients had a good clinical result. AO tension-band osteosynthesis of displaced olecranon fractures yields good clinical medium-term results with few serious complications.
The Figure-of-Four View to Evaluate ACL Injury
Authors: Tejwani Samir G , Marx Robert G , Warren Russell F
Published: April 2021

Standard arthroscopic assessment of the anterior cruciate iigament (ACL) injury through an anterior view can be suboptimal for evaluation of the femoral origin, particularly the posterior component. The figure-of-four view provides increased exposure to the posterolateral aspect of the intercondylar notch, thereby facilitating diagnosis of proximal ACL injury and avulsions of the ACL origin.
Distal Biceps Repair: A Consistent and Safe Approach to the Radial Tuberosity
Authors: Miller Suzanne L , Hausman Michael
Published: April 2021

Surgical treatment of distal biceps avulsion requires a precise anatomical approach and landmark to avoid such complications as radioulnar synostosis and heterotopic ossification.
Joint Synovial Osteochondromatosis Following High-Voltage Electrical Injury to the Extremities
Authors: Freeland Alan E , Sud Vipul
Published: April 2021

Synovial osteochondromatosis is a rare, benign, self-limiting condition characterized by formation of one or more cartilaginous or osteocartilaginous bodies by a synovial membrane in a joint This month's Trauma Update describes synovial osteochondromatosis that occurred in two patients following a high-voltage electrical injury.
The Effect of AlloMatrix Injectable Putty on the Outcome of Long Bone Applications
Authors: Wilkins Ross M , Kelly Cynthia M
Published: April 2021

Abstract

Long bone defects due to nonunion or surgical excision of benign bone tumors result in areas that require rapid regeneration of local bone. This clinical and radiographic article details the results of a commercially prepared allograft demineralized bone matrix in patients with long bone voids or gaps. Of the 76 patients included for study, 41 (54%) patients were undergoing surgical intervention for removal of benign tumors or space-occupying lesions and 35 (46%) patients had long bone nonunions. AlloMatrix Injectable Putty (Wright Medical Technology, Inc, Arlington, Tenn) was used alone in 74 (97%) patients and in combination with bone marrow aspirate in two (3%) patients with tibial nonunion. Adjunctive strut allografts were used in three patients with humeral nonunion. The average time to follow-up for the combined population was 7 months (nonunion group 6 months; benign tumor group 7 months). At the most recent follow-up, radiographic evidence of the average percent of bone healing was 85.1% for the nonunion patient group and 93% for the benign tumor patient group. From this study, AlloMatrix Injectable Putty used as a bone void filler in long bone nonunions and benign tumors shows results equal to those historically reported for autograft and other materials.
Osseous Healing Using Injectable Calcium Sulfate-Based Putty for the Delivery of Demineralized Bone Matrix and Cancellous Bone Chips
Authors: Turner Thomas M , Urban Robert M , Hall Deborah J , Infanger Susan , Gitelis Steven , Petersen Donald W , Haggard Warren O
Published: April 2021

Abstract

Three formulations of injectable calcium sulfate-based putties containing demineralized bone matrix (DBM), 50% DBM/50% cancellous bone (CB) chips, and 30% DBM/70% CB were studied in canines. Four humeral defects per dog were implanted with one of each of the putty formulations while the fourth defect was left untreated. After 6 weeks, the dogs were euthanized. Radiographs and histology showed that the area fraction of new bone in the defects was greater for the three putty formulations than the untreated defects. The area of residual cancellous bone graft remaining in the defects was <10% in both CB putties. Residual calcium sulfate was not apparent in any of the histological sections. We conclude that fast-resorbing calcium sulfatebased putties are effective delivery means of bone graft materials for the successful restoration of bony defects.
Oblique Shear Fractures of the Lunate
Authors: Freeland Alan E , Ahmad Nawaiz
Published: April 2021

Traumatic fractures of the lunate are rare. This article presents two patients who had displaced oblique lunate fractures and distal radius fractures. Both fractures achieved union; however, transient avascular necrosis occurred in the proximal healing of one patient
Advancements in Minimally Invasive Total Hip Arthroplasty
Authors: Waldman Barry J
Published: April 2021

Abstract

Orthopedic surgeons have successfully performed total hip arthroplasty (THA) for more than 40 years. During this time it has continued to evolve into a more predictable and refined procedure. Minimally invasive surgery represents one of the most recent techniques to have emerged within THA. In conventional THA, the incision typically measures 20-30 cm depending on the patient. Although conventional THA affords wide exposure of the hip joint, it also leads to a predictably large blood loss and significant rehabilitation time. Minimally invasive approaches, defined as less invasive to the skin, muscles, or bone, may reduce complications and potentially improve recovery time. Minimizing the recovery process is becoming increasingly desirable in a society that demands an individual to return to normal activities after a short recovery. There are a number of potential approaches and methods that may improve the results of THA. Complications of minimally invasive surgery may include sciatic or femoral nerve palsy, component malpositioning, intraoperative fracture, teg length discrepancy, and damage to muscles or skin by excessive retraction.
Modular Femoral Component for Conversion of Previous Hip Surgery in Total Hip Arthroplasty
Authors: Goldstein Wayne M , Branson Jill J
Published: April 2021

abstract

The conversion of previous hip surgery to total hip arthroplasty creates a durable construct that is anatomically accurate. Most femoral components with either cemented or cementless design have a fixed tapered proximal shape. The proximal femoral anatomy is changed due to previous hip surgery for fixation of an intertrochanteric hip fracture, proximal femoral osteotomy, or a fibular allograft for avascular necrosis. The modular S-ROM (DePuy Orthopaedics Inc., Warsaw, lnd) hip stem accommodates these issues and independently prepares the proximal and distal portion of the femur. In preparation and implantation, the S-ROM hip stem creates less hoop stresses on potentially fragile stress risers from screws and thin bone. The S-ROM hip stem also prepares a previously distorted anatomy by milling through cortical bone that can occlude the femoral medullar canals and recreate proper femoral anteversion and reduces the risk of intraoperative or postoperative periprosthetic fracture due to the flexible titanium-slotted stem. The S-RÖM femoral stem is recommended for challenging total hip reconstructions.
The Patulous Proximal Femur
Authors: Cameron Hugh U
Published: April 2021

abstract

Patients with patulous proximal femurs who have hip revision surgery can be treated with reduction osteotomies or with large ingrowth sleeves used with proximally modular stems. Three hundred nine patients had hip revision with >5-years' follow-up (mean 8.6 years). Reduction osteotomies were performed in six patients, all of whom have done well. The overall rerevision rate of 1.7% suggests that either of these methods produces reasonable results in patients with expanded proximal femurs.
Spondylolysis and Spondylolisthesis in the Athlete
Authors: Cassidy R Garter , Shaffer William O , Johnson Darren L
Published: April 2021

Though athletes may be able to return to their sport after treatment of spondylolysis and Spondylolisthesis, prevention of back injury in at-risk patient athletes should be the treating physician's primary goal.