Orthopaedic review最新文献

A case of malignant fibrous histiocytoma that developed at the site of an infected metallic implant is presented. The total hip endoprosthesis was composed of a cobalt-chromium alloy. There was a relatively short latency period (less than 2 years) between the initial surgery and the development of malignancy in this patient. The authors urge development of a tumor registry to discover if the association between hip replacement and malignancy is coincidental.

Injuries to the sagittal band with subsequent instability of the extensor digitorum communis tendon are uncommon. In an unusual presentation, a laceration to the radial sagittal band of the little finger was manifest as an abduction deformity of the digit. This injury was treated by repair of the sagittal band and extensor digiti minimi tendon transfer.

Many of the current techniques of internal fixation of proximal humerus fractures employ tension-band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. The addition of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advantages. In particular, this lag screw does not violate the subacromial space and provides for impaction and initial stability between the head and shaft. The technique described herein has been used in 13 patients aged 54 to 86 years with two- and three-part fractures. This technique uses a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw is used for lag-screw fixation, and two 18-gauge stainless steel wires are passed beneath the rotator cuff and secured to the shaft distally through drill holes. Passive range of motion of the involved shoulder is begun on postoperative day 1, and active range of motion and strengthening are allowed after the fourth postoperative week. Tension-band wiring combined with lag-screw fixation affords sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation, this technique may have particular advantages in elderly patients with osteoporosis.

Spinal column injuries to the thoracolumbar region are common and leave one fifth of patients with neurological deficit. The authors describe a case of complete fracture-dislocation at lumbar 1-2 level with paraplegia. They detail their surgical technique for reduction, stabilization, and fusion using pedicle screws and plates. Surgical management of such injuries allows rapid rehabilitation of patients with spinal column injuries.

To detect the incidence of preoperative and postoperative deep vein thrombosis (DVT) in elderly patients with hip fracture, 100 patients aged 65 years and older with either a subcapital or intertrochanteric hip fracture were evaluated by duplex beta-mode ultrasonography. Treatment was based on each scan result: if evidence for DVT was seen, the patient was therapeutically anticoagulated; lacking signs of DVT, patients were treated prophylactically. Before their operation, 77 patients (77%) had normal results of their scans, while DVT was diagnosed in 12 patients (12%). An additional 11 patients (11%) developed DVT after the operation. The total incidence of DVT in this series was 23%.

In an uncontrolled prospective study, 100 primary total hip arthroplasties (THAs) using the DF-80 implant were followed up for a minimum of 2 years with rigorous clinical and radiographic examinations to define the natural history of this prosthetic system. Three groups were identified: (I) hips requiring revision because of failure (n = 3); (II) "impending" failures with radiographic indices of loosening (n = 8); and (III) clinically and radiographically benign, stable implants (n = 89). The preoperative Harris hip score was similar for all groups. Postoperatively, the failure group demonstrated early progressive clinical and radiographic deterioration with surgical revision at an average of 33 months. Male sex, increased weight, and greater intraoperative hemorrhage correlated positively with failure. The impending-failure group developed limited radiolucencies in the later postoperative period. Calcar resorption was noted in 26% of the total population and heterotopic ossification in 46%. We conclude that this series of THAs using DF-80 implants included a subset of patients demonstrating early clinical failure and widespread aggressive bone-cement radiolucencies that required early surgical revision.

Cervical spine injuries associated with 3-point (lap-sash) seat belt restraint systems are uncommon and usually without serious sequelae. However, the potential for unstable subluxation or dislocation due to severe flexion-extension mechanism is present and may result in severe disability if not promptly recognized and treated. Such an unstable injury is reported here and was treated with internal fixation. Further attention should be given to the ability of headrests, air bags, and other restraints to protect the cervical spine.