Orthopaedic review最新文献

Ninety-six successful cervical spine fusions performed for trauma, with a minimum of 5 years' follow-up, were retrospectively reviewed. Radiographic degenerative changes adjacent to fusion masses were assessed and correlated with clinical symptoms. The type of fusion, fusion extension, and final kyphosis of the involved segments were also analyzed. Twenty-eight patients had fusion masses aligned in 20 degrees or more of kyphosis. There was a significant increase in complaints of cervical pain in patients with neck fusions equal to or exceeding 20 degrees of kyphosis (P < 0.01). Evidence of mild degenerative changes adjacent to fusion masses was common, but did not correlate with symptoms.

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 differential diagnoses are presented on the following page.

Injuries to the ulnar collateral ligament complex in the thumb are common and require prompt attention. Early diagnosis is essential and must differentiate a partial ligament sprain from a complete disruption. Accurate diagnosis requires a precise examination and roentgenographic evaluation. Provocative maneuvers and stress radiographs may be necessary to delineate the extent of injury. Partial injuries are treated effectively by thumb spica immobilization. Complete ruptures require operative intervention and anatomic repair. To optimize outcome, the operative procedure requires meticulous technique and should result in minimal morbidity. Late ulnar collateral ligament reconstruction is more complicated and inferior to early surgical repair.

Mismatch between a structural femoral allograft and the distal host canal is a difficult problem in femoral reconstruction for revision of total hip replacement. A technique is presented that satisfactorily solves this problem and offers additional advantages over other allograft techniques, as illustrated in two cases.

We attempted to determine if nonsurgical treatment could be successful in treating instability of upper thoracic spine fractures, which may receive some stabilization and splinting from the ribs. From 1966 to 1989, the records of all patients treated at Rancho Los Amigos Medical Center for fractures from T-1 to T-8 were reviewed. Penetrating injuries and malignant lesions were excluded. A total of 118 patients were admitted during this period; 49 patients had nonsurgical treatment. Complications included 1 patient with neurologic worsening, brace-related skin necrosis in 8 cases, and deep venous thrombosis in 12 patients. No failure of arthrodesis was noted. Rib fractures did not adversely affect late stability. We conclude that orthotic treatment of thoracic spine instability from T-1 to T-8 can be successful, especially in cases where early surgery is not possible.

Extensor tenosynovitis is caused by a variety of conditions, but most commonly is associated with inflammatory arthritis. Extensor tenosynovitis with secondary tendon rupture due to occupational repetitive direct trauma to the dorsal compartments of the wrist and hand is reported in a woman. Tenosynovectomy and tendon transfer were performed to relieve pain and restore hand function.

An operative technique for the surgical management of the recurrent lumbar disc herniation is illustrated and presented. Five cases of ipsilateral, same-level, recurrent disc herniations are reviewed and discussed in light of the available literature. All patients presented with severe recurrent sciatica at variable times from the incident surgery. The treatment and possible factors favoring recurrence are discussed.

The authors have devised an "arthroscopy language" to make orthopaedic surgeons' intraoperative communication clear, comprehensive, and concise. This language specifically eliminates surgeons' "freestyle" conversation at the most crucial moments of their procedure, when concentration and the coordinated work of two surgeons are essential. The language uses current arthroscopic terminology and new words that have been adapted by the authors to describe all the basic maneuvers that are used during any arthroscopic procedure. The authors believe the language brings the necessary scientific sophistication into arthroscopic surgeons' speech in the operating theater.

Acute exertional compartment syndrome has been described as occurring after sustained maximal exertion. The case described is that of acute exertional compartment syndrome of the leg occurring in a soldier after he attempted to complete the Army physical fitness test. This condition was initially neglected; necrotic muscle and acute tubular necrosis were sequelae. Earlier intervention could have occurred if the signs and symptoms were considered by the treating health care professionals. All active duty troops are required to perform to maximum exertion. Their complaints should be considered with the same differential diagnosis as those of a highly trained athlete.