Orthopaedic review最新文献

Controversy surrounds the optimal management of a wound in proximity to a major vascular structure without clinical evidence of arterial injury. Current data suggest that physical examination alone can detect significant arterial injuries. If an arterial lesion is clinically silent on initial presentation, the natural history is most likely benign. In the rare case in which the arterial lesion degenerates into a more significant lesion, then it will do so slowly and can be repaired electively. In certain instances, there may be a penetrating wound that presents with a pulse deficit that resolves completely with observation. At this time, this is considered a hard sign of vascular injury and warrants aggressive preoperative evaluation.

Scaphoid nonunion can cause pain, loss of wrist motion, and loss of grip strength. Because initial roentgenograms are not always definitive, patients suspected of having a scaphoid fracture despite negative initial radiographs should undergo bone scan. Treatment of acute nondisplaced fracture of the scaphoid generally nonoperative, involving immobilization in a cast. Treatment of scaphoid nonunion is generally operative, and many procedures and their associated risks are reviewed. There is no consensus about the clinical implications of scaphoid malunion.

The case presented is a 22-year-old man with previously treated synovial chondromatosis of the shoulder. He subsequently presented with pain and tenderness above the biceps tendon. Magnetic resonance imaging and radiographs revealed recurrent synovial chondromatosis in the biceps tendon sheath. The patient underwent an open procedure to remove the loose bodies and partial tenosynovectomy. The patient has subsequently done well and resumed normal activities. To our knowledge there are no reported cases of synovial chondromatosis involving the biceps tendon sheath in the literature.

Among authors over the past 35 years, medial tibial syndrome, or "shin splints," has been interpreted to mean many different things. We present a review of the literature to attempt to ascribe one definition to this clinical entity, and to clearly define its symptoms, signs, pathophysiology, biomechanics, and treatment. In addition, we describe our results with five patients whose seven affected limbs eventually required surgery for this condition, and we compare them to the results in the literature.

A case of bilateral patellar tendon rupture in an otherwise healthy 41-year-old man is presented. This is the 15th case reported in the literature. The mechanism of injury is attributed to a flexion moment coupled with a contraction of the quadriceps muscle in nearly all reported cases. Surgical repair produces excellent results.

A new technique using a minifragmentation plate to assist in the open reduction and internal fixation of displaced, comminuted distal-pole patella fractures was used in three patients with good results. This technique adds to the choices of treatment available to the orthopaedic surgeon who manages these difficult fractures.

Localizing the acromioclavicular joint can be difficult. Using bony landmarks--the clavicle and the spine of the scapula--the acromioclavicular joint can be consistently localized for physical examination, injections, and surgery.

Bilateral posterior hip dislocations with femoral head fractures are rare. We report the case of a 71-year-old woman who was an unrestrained driver involved in a head-on motor vehicle collision. The right hip was stable after reduction, while the left hip was felt to be unstable. Bilateral bipolar endoprostheses were inserted via standard posterior approaches. Fracture fragments composed approximately 35% of the femoral head in both hips. We believe an elderly polytrauma patient with a significant femoral head fracture may benefit from primary arthroplasty as a treatment option, especially in cases of bilateral injury.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The final clinical and differential diagnoses can be found on the following pages.