Orthopaedic review最新文献

Penetrating wounds, stings, and inoculation of venom are common marine injuries to unwary walkers during the summer season. In many circumstances, foreign bodies such as wood splinters or small shards of glass can be removed readily with fine-pointed forceps. Other times, objects may not be noticed until radiographic examination of the injured area. With deeply penetrated foreign bodies, attempts at removal must often be weighed against the likelihood of continued symptoms and damage should the object be left in the foot. This review presents methods of prevention and treatment for common sources of marine foot injuries.

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 roentgenographic differential diagnoses can be found on the following pages.

According to the literature, approximately half of all patients diagnosed with reflex sympathetic dystrophy respond to nonoperative treatment. Because no long-term studies exist, however, the relapse rate and outcome of this condition are not known. In this paper, a historical review and a brief discussion of the theories of pathogenesis of the disease are presented. The results of treatment, as documented in the literature, are also presented. This paper also reports on 10 patients with reflex sympathetic dystrophy who were treated nonoperatively and for whom a follow-up of at least 1 year was documented. The patient population and short-term results are consistent with those found in the literature. Nine of the 10 patients were contacted for long-term follow-up at an average of more than 5 years after diagnosis. A significant number of patients experienced worsening of symptoms (56%) and reported that their condition negatively affected their activities of daily living (78%). Of those who were employed prior to diagnosis, 67% reported a job change or unemployment directly related to the disease. Therefore, the long-term results of nonoperative treatment are not as encouraging as is indicated in the literature.

The purpose of this study was to determine if biomechanical data obtained in studies on cadavers correlates with clinical results in the surgical treatment of stage IV pronation-external rotation (PER-IV) ankle fractures. We surgically treated 20 patients who sustained isolated PER-IV ankle injuries and followed 18 of the patients for an average of 2.5 years. Radiographs were evaluated using previously established methods, and clinical outcome was based on the criteria of Cedell. Eleven patients sustained a PER-IV injury with a medial malleolus fracture; 2 required a syndesmosis screw due to poor medial fixation. Good or excellent results were obtained in 90% of the patients in this group; the poor outcome of 1 patient was due to the development of reflex sympathetic dystrophy. Seven patients had a PER-IV injury with a deltoid ligament tear; because of widening of the syndesmosis, 1 patient required an early operation (within 1 week), and 2 patients required late operations (after 1 month). None of these patients should have required a syndesmosis screw based on biomechanical studies. Good or excellent results were obtained in 71% of the patients in this group. We conclude that the biomechanical data concerning placement of a syndesmosis screw in PER-IV ankle fractures does not correlate with in vivo outcome when a deltoid ligament injury occurs. A screw that stabilizes the distal tibiofibular syndesmosis should probably be placed in patients who sustain PER-IV injuries with deltoid ligament ruptures regardless of the level of the fibula fracture.

A technique is described whereby a small island of bone at the posterior midline of the tibia is preserved during total knee replacement to protect the insertion of the posterior cruciate ligament.

Proximal humeral fractures can usually be treated closed. However, even with an adequate closed reduction, these fractures are occasionally unstable, fail to remain reduced, and require operative intervention. A percutaneous intramedullary pinning technique is effective in stabilizing these fractures. Two cases that illustrate the adult and pediatric techniques for pin placement/application are presented. In the pediatric population, however, large multiple pins often cannot be used due to the size of the intramedullary canal, and fewer or smaller diameter pins are used.

A patient with post-traumatic mechanical instability associated with a significant posterior acetabular deficiency in the presence of an otherwise good articular surface was treated with an allograft reconstruction. The short-term result was good; at 10-month follow-up there was full range of motion with no clinical evidence of instability. This procedure may be indicated in rare instances of post-traumatic mechanical instability where insufficiency of the posterior acetabular wall is felt to be a significant factor.

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 offered for your consideration. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Glenoid labral tears without capsular or ligamentous detachment are being reported with increasing frequency. Yet, the significance and need for treatment of these injuries remain controversial. Labral tears often occur with other glenohumeral pathology making the diagnosis difficult. The current preferred treatment method is arthroscopic labral débridement, and this has a seemingly good initial outcome. Recent long-term follow-up studies, however, have shown that this treatment has only moderately good results at more than 2-year follow up. Labral tears may occur from instability, and labral débridement in these shoulders has disappointing results unless surgical stabilization is also performed.