Orthopaedic review最新文献

Subcapital fractures after open reduction and internal fixation of intertrochanteric hip fractures have not previously been attributed to osteomyelitis. We report a unique case of a 63-year-old man with isolated subclinical osteomyelitis of the femoral neck causing ischemic necrosis and subcapital fracture after sliding screw plate fixation of an ipsilateral intertrochanteric fracture.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first two pages. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Twenty legs in 10 cadavers were dissected to determine the course of the deep peroneal nerve from its origin to its termination. Particular attention was paid to defining: (1) its relationship to palpable landmarks, (2) the angle of the course of its proximal portion against the long axis of the fibula, (3) distribution of the proximal branch to the extensor hallucis longus muscle, and (4) safe areas of osteotomy in the proximal fibula during high tibial osteotomy. The extensor hallucis longus was often supplied by only one branch from the deep peroneal nerve at 99.8 mm (31.7%) distally from the apex of the fibula; this seems to explain why osteotomy of the fibula at its proximal one third often causes paralysis of this muscle. The findings suggest that safe areas for osteotomy in the proximal fibula during high tibial osteotomy are located up to 20.5 mm (6.5%) distal to the tip of the fibular head and that the safe angle of a periosteal incision against the fibular neck area is 64.1 degrees.

Conservative management has been successful for mild cases of cubital tunnel syndrome. If conservative treatment fails and clinical signs of nerve dysfunction or electrophysiologic abnormalities are present, surgical decompression should be considered. The indications for and results of simple decompression, anterior transposition (subcutaneous, submuscular, or intramuscular), and medial epicondylectomy, as well as associated complications, are reviewed.

Electromyographic (EMG) monitoring is often desirable in hip and pelvis surgery. This paper describes a technique that allows sterile EMG monitoring of an extremity while still permitting hip motion or dislocation during the operative procedure.

A new species in the family Enterobacteriaceae, Escherichia vulneris, was characterized by the Centers for Disease Control and Prevention in 1982. It has been shown to have a predilection for human wounds, and several case reports have described superficial wound infections with this rare organism. Until now, however, there have been no reports of osteomyelitis occurring secondary to E vulneris infection. The authors present the case of a 13-year-old boy who fell on a stick and sustained a penetrating injury to his right knee. Radiographs and magnetic resonance imaging revealed a lytic lesion with a foreign body in the tibial epiphysis. On culture, only E vulneris was found, and histologic examination showed the foreign body to be surrounded by acute and chronic inflammation, abscess formation, and foreign-body giant-cell reaction. Although a recent study questioned the pathogenicity of this organism after reviewing the cases of 12 patients in whom there was concurrent heavy growth of Staphylococcus aureus, the present case supports the finding that E vulneris is a human pathogen that should be treated when obtained from human wound cultures.

The medical literature has, on the whole, passed seething criticism toward the Chopart foot amputation. The equinous, short, unbalanced stump is prone to pressure injury and the orthopaedic footwear has proved problematic. Many therapeutic modalities have been proposed, such as arthrodeses, tendon transfers, and tenotomies to improve functional ability. Many propose that the results of the Syme amputation are functionally superior and aesthetically more acceptable. The pros and cons of the Syme and Chopart amputations are discussed and a new orthotic device is suggested that improves the function of the Chopart amputation and minimizes the previously described complications.