bluuebunny/crossref_metadata_2025 huggingface dataset:
Compression Arthrodesis of the Ankle Following Failed Ankle Arthroplasty Using Hoffmann® External Fixation
Authors: Strazzeri James C , Prietto Miguel P , Anzel Sanford H , McMaster William C
Published: April 2021

ABSTRACT: Nine patients with failed Irvine Total Ankle Arthroplasties have been treated by compression arthrodesis with Hoffmann external fixators. Six were men and three were women; ages ranged from 33 to 70 years. An anterior approach was used with application of a Hoffmann external fixator. Three pins were placed in the distal tibia, and three pins in the talus. After six to eight weeks, the fixator was removed. The patients were placed in a short leg walking cast until fusion was complete. All nine ankles fused primarily, in an average of 16.9 weeks (range: ten to 23 weeks). There were two complications of delayed wound closures. There were no problems with pin tract infections or osteomyelitis.
A Ganglion Arising over the Acromioclavicular Joint: A Case Report
Authors: Burns Stephen J , Zvirbulis Raimonds A
Published: April 2021

ABSTRACT: Ganglion cysts are a common entity arising around joints and tendon sheaths. We present a previously unreported location for a ganglion and review the various theories on etiology, pathogenesis, and treatment. With yet another unusual location for ganglia, over the acromioclavicular joint, we propose ganglia should be considered in the differential diagnosis of masses arising near any synovial joint or tendon sheath.
Functional Electrostimulation of Paraplegics: Experimental Investigations and First Clinical Experience with an Implantable Stimulation Device
Authors: Holle J , Frey M , Gruber H , Kern H , Stöhr H , Thoma H
Published: April 2021

ABSTRACT: A method of functional electrostimulation with an implantable 16-channel device and direct nerve stimulation for mobilization of paraplegic patients is presented. The experimental investigations to develop suitable electrode and stimulation devices, to find out optimal pulse parameters, and to study nerve and muscle alterations during FES are presented and discussed. The first clinical application in two cases and the results after one year are demonstrated.
Multichannel Electrical Stimulation of Gait in Motor Disabled Patients
Authors: Malezic M , Stanic U , Kljajic M , Acimovic R , Krajnik J , Gros N , Stopar M
Published: April 2021

ABSTRACT: Effects of surface multichannel electrical stimulation of the leg muscles during gait were evaluated by a clinical kinesiological analysis of gait and measurements of average step length, gait velocity, ground reaction forces, and joint angles. Direct effects in 11 stimulated motor disabled patients showed 56% improvement at the kinesiological gait analysis during the stimulation. Long term effects of the multichannel therapy were compared in a threeyear control study with a group of ten nonstimulated patients. At the kinesiological analysis, the stimulated group improved 1.75 times better after 2.5 months of the treatment. The other measurements revealed higher and faster improvement at the stimulated group with a partial decrease of the therapeutic effects after a longer period without treatment. Orthotic multichannel stimulation was indicated after the multichannel therapy in the clinical environment, where the stimulation of proximal leg muscles was favored.
External Fixation of the Fracture of the Humerus: A Review of 164 Cases
Authors: Hinsenkamp M , Burny F , Andrianne Y , Quintin J , Rasquin C , Donkerwolcke M , Picchio A A , Asche G
Published: April 2021

ABSTRACT: During our experience with external fixation for the fractures of the shaft of the humerus since 1967, the indications have been extended to include complex metaphyseal and epiphyseal fractures of both the proximal and the distal part of the bone. We propose elastic fixation of the fragments using half frame Hoffmann external fixation. Because of anatomical considerations, the two proximal pins must be inserted laterally in the upper third of the humerus, and the two distal pins in the posterior aspect of the lower third above the olecranon fossa. If the mechanical properties of the bone are poor (due to osteoporosis) more than two pins must be used in each fragment. The advantages of the technique include fast and easy application requiring simple materials; versatility of use for fractures at different levels; possible closed reduction, as in conservative treatments; early rehabilitation of joint function; fast periosteal callus formation; and retrieval of the fixator on an outpatient basis.

The reduction and the immobilization of the fracture by osteotaxis are done in emergency. Closed reduction is performed as in conservative treatments. In cases of important muscular interposition, open reduction is possible. Associated internal fixation was required in 18.4% (unstable or articular fractures). A secondary transient radial palsy is observed in 5% of the patients. Intolerance to the external fixation appears in 5.6% of cases, usually consisting of drain age and redness around the pin tracts. A general evaluation of the results gives 73.8% very good results and 93.6% satisfactory results after rehabilitation.
Peripheral Nerve Compression: Etiology, Critical Pressure Threshold, and Clinical Assessment
Authors: Szabo Robert M , Gelberman Richard H
Published: April 2021

ABSTRACT: A number of experimental studies in our laboratory have been designed to evaluate the functional response of the median nerve at the wrist to various degrees of acute local compression in healthy volunteers and hypertensive patients. The relative significance of ischemia and mechanical deformation in early nerve compression, the critical threshold pressure for nerve conduction impairment, and the clinical sensibility testing system most accurate for evaluating and following patients with acute and chronic compressive neuropathies have been determined using a human model for median nerve compression in the carpal tunnel.

Between 40 mmHg and 50 mmHg there exists a critical threshold pressure in normotensive people at which peripheral nerve is acutely jeopardized. The critical pressure threshold is higher in hypertensive patients. The threshold exists at 30 mmHg below diastolic blood pressure and 45 mmHg below mean arterial blood pressure in both normotensive and hypertensive individuals. The correlation between systemic blood pressure and the function of the nerve in response to local compression favors the concept that reduced microvascular perfusion plays the major role in the early stages of low pressure nerve compression. In acute and chronic compression neuropathy, threshold tests (Semmes-Weinstein pressure, vibratory sensibility) detect the earliest abnormalities of nerve function.
Osteogenic Sarcoma of the Skull: A Case Report and Literature Review
Authors: Goodrich Allan
Published: April 2021

ABSTRACT: Osteogenic sarcoma involving the skull is an extremely rare, highly aggressive tumor with a poor prognosis. Fewer than 50 cases have been reported iri the world literature. A recent case treated at Eisenhower Army Medical Center and literature review are presented.
Oral Therapy for Orthopedic Infections in Children and Adults
Authors: Conrad Dennis A , Marks Melvin I
Published: April 2021

ABSTRACT: Literature and clinical experience in the treatment of both adult and pediatric osteomyelitis by oral antibiotics is reviewed. Antibiotics achieving adequate penetration into joint fluid and bone are listed. Particular discussion is given to penicillins, cephalosporins, and non-β-lactam antibiotics. Techniques for monitoring therapeutic effectiveness and patient compliance are noted.
The Use of Antibiotics in the Management of Open Fractures
Authors: Gustilo Ramon B , Williams David N
Published: April 2021

ABSTRACT: Successful management of Type III open fractures requires adherence to the following principles: 1) treatment of all open fractures as emergencies; 2) thorough initial evaluation to diagnose other life-threatening injuries; 3) appropriate antibiotic therapy for both grampositive and gram-negative bacteria; 4) adequate debridement and irrigation, with repeat debridement and irrigation in 12 to 48 hours; 5) stabilization of the fractures; 6) appropriate wound coverage; and 7) early cancellous bone grafting. Recent experience has warranted categorizing Type III fractures into subtypes A, B and C, in order of worsening prognosis. The increasing prevalence of infection due to gram-negative organisms is treated by combined use of an aminoglycoside with cefazolin, or ceforanide with amikacin, or a third generation cephalosporin in Type III fractures.
INTEGRATING COMPUTERS INTO ORTHOPEDIC RESEARCH
Authors: Aguilar Erwin A , Baratta Richard V , D'Ambrosia Robert
Published: April 2021

ABSTRACT

The role of computers in orthopedic research and education is expanding rapidly. Its potential to manipulate large amounts of data and execute multiple complex assignments with great speed and accuracy indeed make the computer an awe-inspiring device. An important instrument in research is the computerized database, a collection of related data arranged so that useful information may be retrieved. Computer models derived from classical physics and fluid mechanics have been used to study motion of both extremities and spinal articulations. Computers also have found usefulness in clinical orthopedic research. The orthopedist of the future will use the computer directly in clinics and private practice for patient evaluation, computerassisted preoperative planning, and financial recordkeeping.
BENT PLATE FIXATION IN COMBINED INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF THE FEMUR
Authors: Rowe Sung Man , Chung Jae Yoon , Moon Eun Sun , Song Eun Kyoo
Published: April 2021

ABSTRACT

Twenty-five combined intertrochanteric and subtrochanteric fractures of the femur (Type IV of Kyle's or Type V of Seinsheimer's classification) were treated with a bent plate and followed up through union (average: 2 years). All of the patients received immediate supplementary bone grafting and additional external supports. AU but one of the fractures united between 3 and 6 months. Complications were: delayed union (1 case), which was treated by bone graft, trochanteric bursitis (3), and mild coxa vara (2). Anatomical reduction of scattered fragments and its maintenance through bony union were achieved in all cases. The bent plate provided excellent fixation in combined intertrochanteric and subtrochanteric fracture of the femur, and could be a successful alternative for these combined fractures.
POLIOENCEPHALITIS, STRESS, AND THE ETIOLOGY OF POST-POLIO SEQUELAE
Authors: Bruno Richard L , Frick Nancy M , Cohen Jesse
Published: April 2021

ABSTRACT

Post-mortem neurohistopathologies that document polio virus-induced lesions in reticular formation and hypothalamic, thalamic, peptidergic, and monoaminergic neurons in the brain are reviewed from 158 individuals who contracted polio before 1950. This polio-encephalitis was found to occur in every case of poliomyelitis, even those without evidence of damage to spinal motor neurons. These findings, in combination with data from the 1990 National Post-Polio Survey and new magnetic resonance imaging studies documenting post-encephalitis-like lesions in the brains of polio survivors, are used to present two hypotheses: 1) polioencephalitic damage to aging reticular activating system and monoaminergic neurons is responsible for post-polio fatigue, and 2) polioencephalitic damage to enkephalin-producing neurons is responsible for hypersensitivity to pain in polio survivors. In addition, the antimetabolic action of glucocorticoids on poliodamaged, metabolically vulnerable neurons may be responsible for the fatigue and muscle weakness reported by polio survivors during emotional stress.
A RAT MODEL OF THE POST-POLIO MOTOR UNIT
Authors: Pachter Bruce R , Eberstein Arthur
Published: April 2021

ABSTRACT

We examined the long-term effects of muscle usage on a rat model of the post-polio motor unit. Isometric tensions, type I and type II muscle fiber areas, the incidence of collateral sprouting, and motor enripíate morphology were examined following I1 3, 6, and 9 months of partial denervation in rat plantaris muscle. Full morphologic and functional stability of the expanded motor units occurred at 6 months post-partial denervation. Fiber hypertrophy was observed, possibly the result of compensatory work hypertrophy due to muscle overuse. Following 9 months of partial denervation and muscle overuse, the twitch and tetanic tensions and type I and type ? muscle fiber areas were significantly reduced as compared to sham controls; anguIated myofibers and group atrophy also were seen. The percent collateral sprouting, the number of terminal branches per endplate, and the endplate area were all increased, possibly a compensatory response to a decreased synthesis of neurotrophic factor(s) and/or transmitter-related components. These aging-like changes seem to occur earlier in chronically stressed, overenlarged, and overworked motor units.
AUTOGENOUS BONE GRAFTS: NONVASCULAR AND VASCULAR
Authors: Springfield Dempsey S
Published: April 2021

ABSTRACT

Nonvascularized autogenous bone grafts have been used for at least 150 years. Vascularized bone grafts were first done only 17 years ago. We now know that bone grafts act through osteoconductive and osteoinductive mechanisms to produce new bone. Autogenous bone grafts remain the gold standard against which allografts and artificial graft materials should be measured.
DISTAL FEMORAL OSTEOTOMY FOR VALGUS DEFORMITY OF THE KNEE
Authors: Terry Glenn C , Cimino Peter M
Published: April 2021

ABSTRACT

Distal femoral varus osteotomy and bladeplate fixation for valgus deformity of the knee proved effective in restoring axial alignment in 18 of 36 knees (34 patients). Patients were followed for an average of 5.4 years (range: 2 to 19 years). The osteotomies were performed on 14 men and 22 women (average age: 44 years; range: 14 to 77). The patients' average preoperative valgus deformity of the anatomical axis was 19.4° (range: 8° to 33°). The surgical procedures performed were a medial closing wedge osteotomy (14 knees) and a lateral opening wedge osteotomy with bone grafting (22 knees). Postoperative correction of the anatomical axis averaged 3.8° valgus (range: 8° varus to 20° valgus). Maximum improvement was reached within 6.3 months by patients who were less than 60 years old and within 5.1 months by patients who were more than 60 years old. Pain decreased or resolved in 21 of 35 knees (60%); activity level improved in 24 of 35 knees (69%). One patient was unavailable for follow up evaluation. Varus osteotomy in the distal femur was concluded to be an acceptable form of treatment in the valgus knee alone or associated with traumatic or osteoarthritis of the lateral compartment.
LONG-TERM TREATMENT WITH 1αHYDROXYVITAMIN D
3
WITH CALCIUM SUPPLEMENT IN SPINAL OSTEOPOROTIC PATIENTS
Authors: Itoi Eiji , Yamada Yuichiro , Sakurai Minoru , Sato Kozo , Kasama Fumio
Published: April 2021

ABSTRACT

The long-term effect of 1α-hydroxyvitamin D
3
and calcium lactate in osteoporotic patients was evaluated by the bone mineral density (BMD) measured at the distal one third and one sixth of the radius and by the vertebral fracture rate. Forty-five osteoporotic patients medicated for 1 to 13 years (treated group) and 11 osteoporotic patients with no medication for 1 to 3 years (control group) were compared. The BMD of the treated group remained unchanged for the first 4 (one-third site) and 6 years (one-sixth site), followed by significant decreases, whereas that of the control group decreased significantly at the second and third year. The effect on BMD was more prominent in the patients with lower initial BMD. The vertebral fracture rate of the treated group was significantly less than that in the control group at the third year. No serious side effects were recognized. Overall, we believe 1α-hydroxyvitamin D
3
with calcium supplement can be considered a safe and effective agent for long-term use in osteoporotic patients.
PHILOSOPHY OF OSTEOSYNTHESIS IN SHOULDER FRACTURES
Authors: Fleischmann W , Kinzl L
Published: April 2021

ABSTRACT

A wide range of workable instrumentation is available for the treatment of proximal humeral fractures, whereas osteosynthesis of scapular fractures is commonly achieved by plate/screw fixation. Older persons are confronted with a steadily rising incidence of osteoporotic fractures. Especially for this group of patients, minimally invasive and minimally instrumented surgical procedures, such as K-wiring and bone sutures, seem to have superseded plate fixation. For the treatment of scapular fractures, an important question remains: Which fracture types provide better functional results with open reduction and internal fixation, and which with conservative treatment? Our indications for an operative procedure are limited to the floating shoulder, dislocated scapular neck fracture, and dislocated glenoid fracture.
SPINAL INJURIES IN 57 PATIENTS 17 YEARS OR YOUNGER
Authors: Mann David C , Dodds Julie A
Published: April 2021

ABSTRACT

Spinal column and cord injuries are rare in children and adolescents, and few reports in the literature that specifically address this subject. A retrospective review of medical records and radiographs of 57 patients was undertaken to identify age-related injury patterns, the incidence of neurologic deficits, and the presence of associated injuries. The most common injury in very young patients was spinal cord injury without radiographic abnormality or spinal cord injury with noncontiguous radiographic abnormality. The most common injury in older children was flexion-distraction injury, often associated with intraabdominal trauma. Adolescents tended to sustain injury patterns similar to adults.
REHABILITATION FOLLOWING RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT
Authors: O'Meara Patrick M
Published: April 2021

ABSTRACT

A closely supervised rehabilitation program is mandatory if maximum benefit is to be derived from anterior cruciate ligament (ACL) reconstruction. The author describes a postoperative rehabilitation protocol based on kinesiologic, histologic, and biomechanical factors affecting the ACL.
TISSUE REPAIR USING LASERS: A REVIEW
Authors: Dew Douglas K , Supik Larry , Darrow Clement R , Price George F
Published: April 2021

ABSTRACT

Numerous attempts have been made to use heating of tissue to effect an anastomotic union of severed tissue edges. Improvements in electrocautery and lasers have made experimental tissue anastomosis feasible; but clinical application of tissue welding has involved only limited clinical trials. Using heat to anastomose tissue is fraught with complications. The factors that lead to successful tissue welding and the technique's limitations are reviewed.
SUCCESSFUL TREATMENT FOR PHANTOM PAIN
Authors: Davis Roger W
Published: April 2021

ABSTRACT

This article reports a series of 31 patients with true phantom pain. Mexiietine was used in an open-label study to evaluate its effectiveness in the treatment of this disorder. Eighteen of these patients had good to excellent results with mexiletine alone. Eleven other patients responded favorably with a combination of mexiletine and Clonidine. Two patients did not respond to either drug alone or in combination. Three patients elected to discontinue use of the mexiletine because of persistent nausea, even at low doses.
THE PLIGHT OF THE TRAUMATIC AMPUTEE
Authors: Pierce Raymond O , Kernek Clyde B , Ambrose Thomas A
Published: April 2021

ABSTRACT

This retrospective review of the long-term problems of patients with lower extremity amputation from trauma fails to support the opinion that most traumatic amputees do well. Overall, anatomic problems involved 51% of the amputees, and social problems involved 56%. Attempting limb salvage with subsequent secondary amputation did not seem to compromise the long-term outcome for these problems. The surgeon performing the amputation should try to obtain the best possible stump and insure that the patient gets the careful follow up and multidisciplinary team support needed to manage the anticipated problems.
GAIT ANALYSIS OF DYSVASCULAR BELOW-KNEE AND CONTRALATERAL THROUGH-KNEE BILATERAL AMPUTEES: A PRELIMINARY REPORT
Authors: Pinzur Michael S , Smith Douglas , Tornow Devin , Meade Kevin , Patwardhan Avinash
Published: April 2021

ABSTRACT

Four elderly peripheral vascular insufficiency below-knee amputees, average age 58, underwent contralateral through-knee amputation for gangrene. All four became household ambulators with end-weight bearing designed prosthetic sockets and four-bar linkage knees. Gait analysis was performed with two AMTI (Newton, Mass) Biomechanics Force Platforms and a Watsmart Motion Monitoring System (Waterloo, Ontario). All four were observed to apparently "lock" the four-bar linkage prosthetic knee into extension during midstance and double limb support phases of gait All subjectively felt that their through-knee limb was then* more stable limb. Weight-bearing occurred during 63% of the gait cycle on the below-knee limb, 54% on the through-knee limb, and 17% in double limb support Walking propulsion, as measured by forefoot impulse, was similar in the two limbs. The first peak of vertical force, corresponding to the elevation of the center of body weight as it passes over the weight-bearing limb, averaged 98% of body weight on the through-knee limb and only 93% on the below-knee limb. The second peak, corresponding to the kinetic energy of the falling trunk and muscle function providing linear acceleration of the center of body weight during propulsion, averaged 96% of body weight on the through-knee limb, and only 73% on the below-knee limb. Progression of the center of pressure, a qualitative measure of limb stability, was more orderly hi the through-knee limbs. In a preliminary laboratory gait analysis, elderly peripheral vascular insufficiency below-knee amputees who became household walkers following contralateral through-knee amputation derived greater stability from their through-knee limbs without the expected loss of walking propulsion. The authors conclude that, 1) unilateral belowknee amputees who are projected to be marginal walkers following contralateral limb amputation may benefit from the stability afforded by through-knee amputation of the second limb; and 2) elderly patients who possess the ability the heal an amputation at the below-knee level, but project to be marginal walkers, may also benefit from the stability in walking with an end-weight bearing prosthesis afforded by through-knee amputation, without the expected loss of walking propulsion.
ONE-STAGE RECONSTRUCTION OF THE NAILFOLD
Authors: Kasdan Morton L , Stulls John T
Published: April 2021

ABSTRACT

Management of nailfold deformity is a difficult problem, with only seven documented techniques of reconstruction to date. We report 17 who underwent nailfold reconstruction with use of a one-stage, dorsal rotational flap with full thickness skin graft. Results show increases in range of motion and improved nail appearance.
ENDOSCOPIC ACL RECONSTRUCTION
Authors: Jackson Douglas W , Kenna Robert , Simon Timothy M , Kurzweil Peter R
Published: April 2021

ABSTRACT

The endoscopic technique offers the advantage of one incision and a femoral osseous tunnel trajectory that is more in line with the collagen fibers of the graft. Technically, it is more demanding to reproducibly obtain the interference fixation than using the two-incision technique. There is a tendency for screw and graft divergence in the femoral tunnel. The exact clinical significance of this screw and bone plug divergence has yet to be clarified. Surgeons must assess their ability to obtain the best results for the patient There is a definite learning curve for the endoscopic technique. We believe that, with further advances in instrumentation, fixation, and alternative grafts, it will eventually be the approach of preference for ACL reconstructions.
ARTHROSCOPIC CATEGORIZATION OF INTERCARPAL LIGAMENTOUS INJURIES OF THE WRIST
Authors: Ruch David S , Siegel David , Chabon Stephen J , Koman L Andrew , Poehling Gary G
Published: April 2021

ABSTRACT

Recent advances in our knowledge of wrist ligamentous anatomy, as well as improvements in arthroscopic techniques, permit the diagnosis and treatment of a wide variety of wrist injuries. The authors review current concepts in wrist ligamentous anatomy, patterns of instability, and the role of the arthroscope in the evaluation and treatment of such instability. Specifically, wrist portal anatomy and techniques of arthroscopic treatment of patients with partial and complete intercarpal ligament injuries are described. Chronic complete injuries are a contraindication of arthroscopic treatment. The authors conclude that wrist arthroscopy provides a valuable method of diagnosing and treating partial and complete intercarpal ligamentous injuries.
PRACTICE PATTERNS IN PROPHYLAXIS OF DEEP VEIN THROMBOSIS AMONG US ORTHOPEDIC SURGEONS
Authors: Paiement Guy D
Published: April 2021

ABSTRACT

Thromboembolic disease meets all the criteria of a major public health problem. Some studies have estimated that up to 200000 Americans die each year as a result of pulmonary embolism.1 Furthermore, at least 50% of these people had an otherwise very good prognosis and should not have died. Thus, about 100 000 deaths from pulmonary embolism are preventable. This study indicates that, while primary prophylaxis is almost universal among orthopedic surgeons, very few practice secondary prevention, which could be the reason for the large number of deaths attributed to thromboembolic disease.
OLECRANIZATION OF THE PATELLA
Authors: Rungee James L , Fay Michael J , Deberardino Thomas M
Published: April 2021

ABSTRACT

Olecranization of the patella is a technique employed by some to maintain the normal anatomic relationship of the femorotibial articulation following posterior cruciate ligament (PCL) repairs and reconstructions. It involves temporarily placing a large diameter pin longitudinally through the patella and into the tibia. The patella thus becomes a bony shelf and, in theory, holds the tibia forward, protecting the knee from a posterior drawer force. This technique appears desirable in that it allows postoperative knee motion while theoretically affording protection to the PCL. Unfortunately, it is based on an erroneous concept that the spatial relationship of the patella and tibia remains constant throughout knee flexion. Negative experience at our institution with this technique prompted our investigation. Using lateral radiographs of 20 normal knees taken at four different positions of flexion, we studied the relative motion that occurs between the patella and tibia in the sagittal plane during knee flexion from 0° to 90% and defined two separate arcs of patellar motion. The patellar tendon arc is a 30° arc through which the patella traverses relative to the tibia during knee flexion. The patellar arc is a 22° arc on which the patella flexes relative to itself during knee flexion. We also studied the effect that olecranization of the patella has on the PCL in six cadaver knees. Using a combination of direct tension measurement, radiographic measurement, and fluoroscopy, we found that olecranization of the patella not only fails to protect the PCL, but actually induces a detrimental posterior drawer force during knee flexion. Based on clinical experience and laboratory findings, we strongly recommend that olecranization of the patella be abandoned as a means of postoperative ligamentous protection following PCL repair or reconstruction.
THE POROUS-COATED ANATOMIC (PCA) TOTAL HIP ARTHROPLASTY: A REVIEW OF 73 UNCEMENTED CASES WITH 2-YEAR FOLLOW UP
Authors: Billotti Joseph , Zimmerman Mark C , Pizzurro Joseph , Mango Thomas , Billings Joseph , Parsons J Russell
Published: April 2021

ABSTRACT

A total of 73 hips in 62 patients who underwent non-cemented total hip arthroplasties (THA) with porous-coated anatomic (PCA, Howmedica) prostheses have been reviewed. A complete evaluation including preoperative and postoperative Harris hip scores (HHSs), a complete radiographic study, and complication determination has been completed with greater than 2-year follow up. Diagnoses included osteoarthritis (74.0%), rheumatoid arthritis (4.1%), avascular necrosis (15.1%), and posttraumatic arthritis following fracture (6.8%). The complication rate was 10.9% (8 complications/73 arthroplasties); 20 patients (35.6%) received bilateral implants. The mean preoperative HHS for the entire group was 38.7, and the mean postoperative score, irrespective of postoperative time, was 93.6. Key findings regarding the consecutive radiographic review of each arthroplasty included: 9.6% lucencies, 43.8% stress shielding, stable fibrous ingrowth in 74.0%, tip sclerosis in 19.2%, and cortical widening in 4.1 %. The finding of loose beads from the pore ingrowth area of the prosthesis was minimal (7 beads in 6 patients). These results demonstrate the efficacy of the PCA prosthesis.
CERVICAL CHEMONUCLEOLYSIS
Authors: Gomez-Castresana F B , Herrero C Vazquez , Horche J L Baltes
Published: April 2021

ABSTRACT

Forty patients with 44 cervical disc herniations were injected with 1500 to 1800 U of chymopapain from September 1988 to March 1992. After prophylactic H1-H2 receptor antagonist administration and under neuroleptanalgesia, a needle was inserted into the disk through an anterolateral approach, guided by x-ray monitoring. The discography performed before the enzyme injection confirmed the herniation in every case. The diagnosis was established by radiculography, computerized tomography (CT) scan, radiculoCT scan, magnetic resonance imaging (MRI), or discography. Average follow up was 21.4 months (range: 3 to 43). Overall, there were 34 (85%) satisfactory results, 3 fair (7.5%), and 3 poor (7.5%) results. There were no complications, and the average hospital stay was 26 hours. Post-injection MRI performed in 18 cases confirmed the complete disappearance of the herniation in 13 cases. These data support the efficacy and innocuity of chymopapain chemonucleolysis in managing soft cervical disk herniations.
ARTHRODESIS FOLLOWING FAILED TOTAL KNEE ARTHROPLASTY: COMPREHENSIVE REVIEW AND META-ANALYSIS OF RECENT LITERATURE
Authors: Damron Timothy A , McBeath Andrew A
Published: April 2021

ABSTRACT

With the increasing duration of follow up on total knee arthroplasties, more revision arthroplasties are being performed. When revision is not advisable, a salvage procedure such as arthrodesis or resection arthroplasty is indicated. This article provides a comprehensive review of the literature regarding arthrodesis following failed total knee arthroplasty. In addition, a statistical meta-analysis of five studies using modern arthrodesis techniques is presented. A statistically significant greater fusion rate with intramedullary nail arthrodesis compared to external fixation is documented. Gram negative and mixed infections are found to be significant risk factors for failure of arthrodesis.
TIBIAL PILON FRACTURES: A COMPARATIVE CLINICAL STUDY OF MANAGEMENT TECHNIQUES AND RESULTS
Authors: Crutchfield Edward H , Seligson David , Henry Stephen L , Warnholtz Ascan
Published: April 2021

ABSTRACT

Thirty-eight consecutive pilon fractures were reviewed retrospectively to compare the radiographic and clinical results with the original injuries based on three different treatment options: external fixation only, external fixation with limited internal fixation, and internal fixation only. Dates of injury were from February 1985 to February 1989. Treatment method was the surgeon's preference. The mean follow-up time was 28 months. Results were tabulated by clinical and radiographic scores. In general, simple fracture types had good results; complex ones did less well. In this study, fracture severity appeared to be the key variable in outcome.
LOWER LIMB SALVAGE: MICROVASCULAR RECONSTRUCTION OF POST-TRAUMATIC SOFT TISSUE AND SKELETAL DEFECTS
Authors: Tomaino Matthew M
Published: April 2021

ABSTRACT

This study reviews the principles of reconstructive microsurgery for lower limb salvage after severe open tibial fractures. Initial decision-making principles are reviewed with reference to useful scoring systems directed at appropriate patient selection for limb salvage. Soft tissue reconstruction is discussed with emphasis on timing and selection. Skeletal reconstruction focuses on available options and indications.
Use of MRI in Evaluating Postoperative Changes in Patients With Bone and Soft Tissue Tumors
Authors: Griffiths Harry J , Thompson Roby C , Nitke Steven J , Olson Paul N , Thielen Kent R , Amundson Paul
Published: April 2021

ABSTRACT

We reviewed the clinical, surgical and magnetic resonance imaging (MRI) findings in 80 patients who underwent resection of primary benign or malignant bone or soft tissue tumors. There were 18 benign and 62 malignant tumors. Although 31 patients were originally thought to have recurrence, on review only 20 patients were considered to have recurred. Of these, three were found only to have postoperative changes at surgery. Seventeen patients actually had recurrence of tumor. We believe that the presence of an actual mass lesion on MRI is the cornerstone for the correct diagnosis of recurrent tumor.
Complications When Using the Cannulated 3.5 mm Screw System
Authors: Schwend Richard K , Hennrikus William L , O'Brien Thomas J , Millis Michael B , Lynch Michael R
Published: April 2021

ABSTRACT

Five patients with breakage of instrumentation when using the cannulated 3.5 mm screw system for fracture fixation are reported. Four 1.25 mm guide wires were sheared off by the cannulated drill and one 3.5 mm cannulated tap sleeve fractured. This article presents potential dangers when using the cannulated 3.5 mm screw system for general fracture care.
Modified Mitchell's Bunionectomy (Wu's Bunionectomy)
Authors: Wu Kent K
Published: April 2021

ABSTRACT

A standard Wu's bunionectomy consists of an oblique first metatarsal neck osteotomy with a lateral, proximal, and plantar displacement of the first metatarsal head and firm fixation of the osteotomy site with two Herbert screws. The outstanding features of this surgical technique include its surgical simplicity, secure fixation of the osteotomy site, no need for subsequent screw removal, ease of screw insertion, complete absence of screw breakage, little postoperative pain, and a relatively greater degree of correcting the various deformities associated with a hallus valgus foot than those normally achieved by either a Mitchell's bunionectomy or a Chevron bunionectomy.
Evaluation of Herbert Screw Fixation for the Treatment of Displaced Scaphoid Nonunions
Authors: Feldman Michael D , Manske Paul R , Welch Robert L , Szerzinski Jean M
Published: April 2021

ABSTRACT

Ten cases of unstable scaphoid nonunions treated with Herbert screw fixation were compared to nine cases treated with Herbert screw fixation supplemented with a single Kirschner wire (K-wire) across the fracture site. Corticocancellous bone graft from the distal radius was used in all cases to reconstruct the scaphoid. The age of the patients and duration of the nonunions were similar in both groups. Postoperative radiographs demonstrated that only 5 of 10 patients with Herbert screw fixation alone healed, while 8 of 9 patients with Herbert screw and K-wire fixation healed. The time to union averaged 4.9 months in the patients supplemented with a K-wire and 7.8 months in those patients without the K-wire.
Compression Arthrodesis of the Ankle by Triangular External Fixation: Biomechanical and Clinical Evaluation
Authors: Berman Arnold T , Bosacco Stephen J , Parks Brent G , Israelite Craig L , Austin David K , Farrell Eric D , Quartararo Louis G
Published: April 2021

ABSTRACT

This article describes a technique of ankle arthrodesis using a triangular external fixation frame and presents the results of biomechanical analysis and clinical experience with the frame. Clinical evaluation of 23 ankle arthrodeses performed using a triangular external fixation frame yielded a 91 .3% fusion rate at an average of 11 weeks postfusion. The triangular frame was 79% suffer than a compression-only external frame in torsion and 39% stiffer in anteroposterior bending. This high rate of fusion is attributed to the elimination of micromotion at the fusion site because of the increased rigidity of the triangular external compression frame.
Augmented Lateral Ankle Reconstruction Using a Free Gracilis Graft
Authors: Coughlin Michael J , Matt Victoria , Schenck Robert C
Published: April 2021

This article describes a surgical technique for reconstruction of the unstable ankle that uses a modification of the Elmslie procedure for anatomic augmentation of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Our technique is an anatomic reconstruction that uses a free gran of the gracilis tendon to reconstruct the CFL and ATFL.
Inhibition of Particulate Debris-Induced Osteolysis by Alendronate in a Rat Model
Authors: Thadani Peter J , Waxman Bryan , Sladek Eduard , Barmada Riad , Gonzalez Mark H
Published: April 2021

J Abstract

A rat model was used to study the efficacy of alendronate therapy in inhibition of particle-induced periprosthetic osteolysis. A prosthesis was simulated by inserting a cylindrical polymethylmethacrylate plug into the distal femur of 24 rats allowing the plug to communicate with the joint space. Intra-articular injections of irregularly-shaped ultra-high molecular weight polyethylene particles of 20-200 µm in diameter were administered at 2-week intervals. The rats were randomized into two groups (n=12 each). Group A rats received twice weekly subcutaneous injections of alendronate sodium while group B rats received injections of saline vehicle only. At 10 weeks all rats were sacrificed. The distal femurs were harvested and axial sections were prepared for histologic analysis. Each section was graded on a scale of 1-4, quantifying the degree of osteolysis surrounding the polymethylmethacrylate plug. Microscopic examination showed a significant (P<.0001) difference in the amount of periprosthetic bone. Femurs from group A treated with alendronate demonstrated mostly normal or near-normal periprosthetic trabeculations, whereas femurs from group B treated with saline showed extensive bone resorption. There was no qualitative difference in the inflammatory cellular response between the groups. This study established the ability of alendronate to inhibit the osteoclastic-mediated osteolysis around joint implants.
Clinical Assessment and Rehabilitation of Shoulder and Knee Sensorimotor Control
Authors: Uhl Tim L , Mattacola Carl G , Johnson Darren L
Published: April 2021

The orthopedic surgeon must perform a thorough evaluation of an unstable joint to derive the accurate diagnosis. One component of this examination is evaluation of the sensorimotor system. This article provides an overview of techniques and methodology used to assess the sensorimotor system. Rehabilitation concepts are presented to assist the physician during patient consultation following injury or surgery.
Volar Neutralization Plate Fixation of Dorsally Displaced Distal Radius Fractures
Authors: Constantine Kostas J , Clawson Mark C , Stern Peter J
Published: April 2021

Open reduction and volar neutralization plate fixation avoids problems associated with dorsal plate fixation (eg, extensor tenosynovitis and tendon rupture) and minimizes the necessity for secondary plate removal. Volar plating is a useful technique for treating dorsally displaced distal radius fractures with minimal scarring, infrequent bone grafting, and safe early wrist mobilization.
One-Stage Bilateral Total Hip Arthroplasty in Patients ≥75 Years
Authors: Weinstein Marc A , Keggi John M , Zatorski Laurine E , Keggi Kristaps J
Published: April 2021

Abstract

Since 1991, 43 one-stage sequential bilateral total hip arthroplasties (THAs) in patients 3*75 years have been performed by the authors. The results were assessed to determine whether this procedure can be performed safely and with good outcome in this subset of patients. These results were compared to those of 1 36 patients <75 years who underwent the same procedure. The one-stage bilateral procedure was performed in ail patients who had significant arthritic disease of both hips. There was no difference in length of surgery or length of hospital stay. Patients 3*75 years were more likely to experience minor postoperative morbidity such as ileus and urinary tract infections. The incidence of myocardial ischemia was 2.3% in the elderly group. With a mean follow-up of 2.5 years, 90% of the elderly patients lived independently, 80% walked without assistive devices, and 90% were pain free. Therefore, onestage sequential bilatéral THA is a safe and effective option for patients >75 years when pain and functional limitations affect quality of life.
Vertebral Body Fracture of the Lumbar Spine in Elderly Women: More Severe in Osteoarthritis of the Knee Than in Femoral Neck Fracture
Authors: Kanai Hiroyuki , Igarashi Mitsuo , Yamamoto Seizo
Published: April 2021

Abstract

This study investigated bone fragility by comparing fractures of the vertebral body of the spine in elderly women receiving total knee replacement (TKR) (group 1) due to severe osteoarthritis of the knee and those with femoral neck fractures (group 2) attributable to osteoporosis. Forty-two women each were selected retrospectively for group 1 and prospectively for group 2. Patient age ranged from 64-83 years. Vertebral body fractures of the lumbar spine were significantly more severe in group 1 than in group 2 (P<.001). Patients undergoing TKR due to osteoarthritis of the knee had systemic bone fragility, which included the spine.
Distal Radius Fractures in Adults
Authors: Krishnan Jegan
Published: April 2021

Although distal radius fractures are a common injury in the elderly and young adult population, the classification, treatment options, and assessment of outcomes of these fractures remain controversial. Since there is no uniform fracture classification system, it is difficult to compare studies. An evidence-based model of management needs to be developed.
Alternate Surgical Approaches in Mobile-Bearing Total Knee Arthroplasty
Authors: Keblish Peter A
Published: April 2021

Abstract

Surgical approaches in nonconstrained mobile-bearing total knee arthroplasty (TKA) should provide the best access for specific deformity correction. Alternatives to the standard medial approach include the medial midvastus and subvastus approaches, and the direct lateral approach, with or without tibial tubercle osteotomy or proximal "rectus snip." The direct lateral approach is a recommended alternative for fixed valgus knees, especially if there is lateral patellar subluxation and significant rotational deformity. The subvastus and midvastus medial approaches preserve quadriceps integrity and patella stability, and are recommended for severely unstable knees in nonobese, non-fixed valgus, and medial unicompartmental knee replacements.
Revision Total Knee Arthroplasty Using Large Distal Femoral Augments for Severe Metaphyseal Bone Deficiency: A Preliminary Study
Authors: Werle Jason R , Goodman Stuart B , Imrie Susanna N
Published: April 2021

Abstract

Managing severe structural femoral metaphyseal bone loss in revision total knee arthroplasty is a challenging problem facing the revision knee surgeon. This study assesses the use of large (30 mm) metal distal femoral augments to compensate for severe bone deficiencies. Hospital for Special Surgery scores, Knee Society scores, and range of motion improved after implantation of femoral components with 30-mm distal femoral augments. There was no radiographic evidence of loosening, and no implants had been revised at mean 37-month follow-up. This appears to be an acceptable technique based on the intermediate-term results.
Vascularized Muscle Pedicle Flap for Osteonecrosis of the Femoral Head
Authors: Stein Haim , Volpin Gershon , Hörer Dori
Published: April 2021

Osteonecrosis is a devastating, locally progressive degeneralive condition that mainly affects young adults. Osteonecrosis of the femoral head requires biological hip reconstruction. This article describes a technique that uses a vascularized muscle pedicle flap as a viable bone gran for treatment of this condition.
The Impact of Mixed Components on Polyethylene Wear
Authors: Bowen Richard E , Dorey Frederick J , Thomas Bert J
Published: April 2021

Abstract

Wear rates were measured in 50 mixed and 71 matched total hip arthroplasties with s* 3-year follow-up to determine whether implanting mixed hip components increased polyethylene wear. Average patient age was 61 years for the mixed group and 57 years for the matched group. Average radiographic follow-up was 5.8 years and 6.8 years, respectively. The average linear wear rate for the mixed and matched groups was 0.11 mm/y. Therefore, implanting same-size, total hip components from different manufacturers did not lead to large increases in polyethylene wear.
Photoelastic and Thermoelastic Measurement of Stress on the Proximal Femur Before and After Implantation of a Hip Prosthesis With Retention of the Femoral Neck
Authors: Refior Hans J¨rgen , Schidlo Christoph , Plitz Wolfgang , Heining Sandro
Published: April 2021

Abstract

This study demonstrated the improved medial support and the transfer of load onto the retained neck of the femur using seven fresh frozen femurs. Results confirm the reliability of the thermoelastic stress analysis method, which is comparable to the photoelastic surface coating method, but with greater sensitivity. The loading pattern after stem implantation shows a homogeneous transfer of force onto the preserved femoral neck. After femoral neck removal, an inhomogeneous increase of the intertrochanteric compression loading was observed. Therefore, improved biomechanical conditions are created for a permanently stable implantation of stem prostheses with retention of the femoral neck.
Phalen's Test With Carpal Compression: Testing in Diabetics for the Diagnosis of Carpal Tunnel Syndrome
Authors: Edwards Andrew
Published: April 2021

Abstract

Phalen's test with carpal compression is a reliable clinical test for the diagnosis of carpal tunnel syndrome. Along with classical clinical symptoms and positive clinical tests, there may be no need to perform additonal electrodiagnostic studies, thus saving time and money. However, in the diabetic population this test has been shown to be a less reliable clinical tool in the diagnosis of carpal tunnel syndrome. Therefore, Phalen's test with carpal compression is not a predictive indicator of carpal tunnel syndrome in the diabetic population.
Thrombosis of the Greater Saphenous Vein in a Collegiate Football Place Kicker
Authors: Robbe Rudy , Mair Scott , Johnson Darren , Madaleno Jim
Published: April 2021

The greater saphenous vein is vulnerable in its superficial course overlying the distal tibia in the zone of impact of a kicker's foot Minor repetitive trauma or a single traumatic event to this area may subject the vein to intimai trauma or other irregularities that may lead to vein thrombosis.
Synovial Abrasion for Isolated, Partial Thickness, Undersurface, Medial Meniscus Tears
Authors: Tetik Onur , Kocabey Yavuz , Johnson Darren L
Published: April 2021

Synovial abrasion and rasping provides good healing potential of isolated, partial thickness, undersurface medial meniscal tears. It is an effective, easy, and valuable treatment modality.