Orthopaedic review最新文献

Cervical sprain syndrome is usually the result of a hyperextension injury of the neck; symptoms include neck, intrascapular and arm pain, and headache. Associated complaints of the head, neck, and upper extremities are common. The mechanism and pathophysiology of this injury, and the occurrence of associated injuries are discussed. Patient evaluation, treatment, and prognosis are reviewed. A thorough understanding of this common injury should facilitate treatment and provide the patient and physician with realistic expectations for recovery.

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 page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

A high rate of complications and failure have limited the indications for total ankle replacement to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. Recommended surgical technique for total ankle arthroplasty includes proper patient positioning, an anterior surgical approach, meticulous bone resection, and cemented fixation of components. Results of published studies suggest total ankle arthroplasty should not be performed in patients with posttraumatic arthritis who are younger than 60 years of age.

Acute pyogenic osteomyelitis in children continues to be a problem in orthopaedics. The causes of acute hematogenous osteomyelitis are not adequately known, but the histologic progression of the disease has been described. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibiotic agents is often successful unless pus is obtained on aspiration. In patients with an established abscess, surgical drainage is often required in addition to antibiotic therapy. Oral antibiotics appear to be as effective as parenteral antibiotics, provided adequate serum bactericidal titers can be demonstrated. Staphylococcus aureus is the most common causative organism, although other organisms are often found in special circumstances, such as in neonates, patients with sickle-cell disease, and those with puncture wounds of the foot.

A retrospective review revealed localized femoral osteolysis occurred in 8 out of 134 cementless ceramic total hip arthroplasties (6.0%) performed during an average 9-year period. The average latent period was 8 years. The lesion was usually located in the deeper periprosthetic area. Localized osteolysis usually occurred after loosening of the femoral stem, suggesting the pathogenesis may be a foreign-body reaction to the ceramic debris.

Seven years after total knee arthroplasty, a patient with a well-fixed, uncemented femoral component (cobalt-chromium-molybdenum alloy) developed a large cystic lesion in the distal femur adjacent to the femoral component. This lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction, and a large number of polyethylene particles, but no metal wear debris, infection, or malignancy.

An improved technique is presented for placement of a combined polyethylene and polymethylmethacrylate (PMMA) plug in the femoral medullary canal prior to cementing the femoral component during total hip arthroplasty. PMMA plugs provide excellent occlusion of the canal, but when used alone they often become excessively long. This can make revision surgery, if it becomes necessary, more difficult. By first inserting a polyethylene plug distally in the femoral canal, followed by a bolus of PMMA, the surgeon can limit the length of the cement portion of the plug in the femoral canal while retaining the advantages of a PMMA plug.