Orthopaedic review最新文献

A young woman presented with recurrent dorsal subluxation of the fifth metatarsal-cuboid joint secondary to trauma. The injury was treated by metatarsal-cuboid fusion without functional residual disability.

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.

Complex dislocations of the metacarpophalangeal (MCP) joint of the hand are uncommon. Most are irreducible by closed means and require open reduction. The structure most frequently blocking reduction is the volar plate, which is often interposed between the metacarpal head and the base of the proximal phalanx by the partially torn deep transverse metacarpal ligaments and MCP collateral ligaments. A review of the literature reveals controversy concerning which surgical approach, dorsal or volar, should be used to reduce these dislocations. We present an unusual case of a closed dorsal complex dislocation of the middle finger MCP joint to advocate the dorsal approach.

Reduction of femoral shaft fractures prior to passing the guide pin during intramedullary fixation may be a challenging problem, especially in delayed reductions or obese patients. We describe a simple and useful instrument for obtaining and maintaining reduction for closed intramedullary fixation. It provides a three-point fixation that may be locked into position to maintain the reduction. The surgeon is not required to hold the device in position while passing the guide pin, the reamer, or the nail. It frees the surgeon's hands, minimizes the need for an assistant, and reduces harmful x-ray exposure to the hands.

A 35-year-old man sustained multiple injuries including a fractured pelvis, a ruptured urethra, and a femur fractured at the neck, the shaft, and the supracondylar region. The fractured femur was grade IIIB open. Urethrography showed a ruptured urethra with extravasation of the dye into the upper thigh. Internal fixation of all femur fractures and the pelvis fracture was successful. A suprapubic cystostomy tube was inserted to manage the urethral tear. The tube became infected, and the infection extended from the pelvis into the thigh region, infecting the femoral fracture. The femur infection was thought to be a postoperative one that had originated locally. Computerized tomography (CT) scan was helpful in localizing the infection and its origin from the pelvis. Treatment included incision and drainage, with aggressive serial débridement of both abscesses. In addition, bone grafting of the femur was performed. The infection was controlled completely, and the patient returned to work 18 months after injury. The authors alert the orthopaedic surgeon to the possibility of this serious lesion, particularly when the initial urethrogram shows extension of the dye below the inguinal ligament.

The accuracy of screw placement was assessed with postoperative computed tomography (CT) scans in 75 consecutive patients treated with transpedicular screw fixation. The pedicular screws (n = 379) were inserted at levels ranging from thoracal (T-8) to sacral (S-2) vertebrae using different systems. Most of the screws (90%) were correctly placed in the pedicle. Ten screws (3%) were inserted medially into the spinal canal. Only 1 screw caused root compression symptoms. Screw misplacement lateral to the pedicle occurred in 18 cases (5%), 9 screws (2%) were inserted superior to the pedicle. No important complications developed that were related to the misplaced screws.

The case of an adolescent Olympic-level gymnast with insidious onset shoulder pain is presented. Radiographic evaluation revealed bilateral physeal irregularities of the proximal humerus similar to those seen in Little Leaguer's shoulder. Roentgenograms of the involved shoulder also demonstrated Salter-Harris type I displacement at this physis and a slipped capital humeral epiphysis was diagnosed. A discussion reviewing proximal humeral physeal injury follows the case presentation.

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.

This paper reviews the treatment alternatives for acute and chronic lateral ankle ligament sprains. Inadequately treated ankle sprains can result in chronic lateral ankle instability, disabling pain, and the early onset of osteoarthritis. There are a multitude of reconstructive techniques used for chronic lateral ankle instability. Morbidity associated with present techniques includes loss of proprioception, stiffness following cast immobilization, loss of subtalar motion, loss of internal rotation of the talus during ankle plantar flexion, and recurrent instability. In addition, this paper reviews the reconstructive techniques used for chronic lateral ankle instability, addresses the shortcomings of current reconstructive techniques, and proposes alternatives that may help decrease associated morbidity.