Bulletin (Hospital for Joint Diseases (New York, N.Y.))最新文献

Because of several failures by dissociation of a redesigned bipolar prosthesis, a new, dynamic test was developed. This dynamic cam-out test represents a closer simulation of one possible clinical mechanism of bipolar disassociation. The results of dynamic testing are affected by the bipolar design, particularly the locking mechanism that was the problem with the redesigned prosthesis.

The objective of this study was to determine the efficacy of postoperative single dose radiation therapy of 700 centigray on fracture/dislocations of the elbow in the prevention of heterotopic ossification. Eleven patients were reviewed for this study. Each patient sustained high-energy trauma to the extremity causing a fracture/dislocation of the elbow. After open reduction and internal fixation, a postoperative single dose of 700-centigray radiation therapy was administered to the patients within 72 hours of surgery. Primary outcome measurements were clinical physical examination of range of motion and radiographic analysis of heterotopic bone formation at 12 months follow-up. Three of eleven patients (27%) had radiographic evidence of heterotopic ossification formation. Ten of eleven patients (91%) however, were without functional limitations. All fractures healed without complications. There were no complications from the radiation therapy. A single dose of 700-centigray radiation therapy postoperatively within 72 hours may lessen the functional loss from heterotopic ossification formation without effecting healing at the fracture site.

The size and shape of the suprascapular notch may be a factor in suprascapular nerve entrapment. The suprascapular notches of 623 scapulae were digitally photographed and used to determine notch type and area. Three researchers used to different classification systems for suprascapular notch typing. These systems were compared for interobserver reliability and intraobserver reproducibility using the kappa test. The mean kappa value for the classification used by Rengachary and colleagues was 0.468 and for the classification used by Ticker and associates was 0.531 for the inferior border of the notch and 0.736 for the superior border of the notch. The classification system used by Ticker and associates was more reliable and reproducible and produced both a superior and an inferior classification, making it possibly more clinically relevant than the classification system used by Rengachary and colleagues.

Scaphoid fractures are a common injury in young, active populations. Non-displaced fractures have a high union rate if promptly treated with cast immobilization. Displaced fractures and proximal pole fractures are best treated with operative fixation. There are a variety of techniques and implants available to the surgeon. The surgical approach and fixation device should be based on fracture characteristics and surgeon experience. Operative fixation of non-displaced fractures is an option in patients who would prefer to avoid prolonged cast immobilization.

Claims championing exotic substances that produce healing or ergogenic powers have been around for centuries. The competitive, peer-pressured environment enveloping today's athletes and adolescence makes these groups particularly susceptible to the uproar surrounding the current ergogenic aid market. Presently, it seems that rumor and anecdotal information overwhelms the available scientific data. While there is evidence that some touted ergogenic aids do indeed enhance performance, there are many unanswered questions about product safety, efficacy, and long-term consequences. A working knowledge of specific ergogenic aids is essential for the treating physician in order to best advise patients and athletes as to the possible benefits and risks of any substance they may be using.

There are several options available for management of the middle-aged arthritic knee. Arthroscopic techniques continue to evolve, but the true natural history of the arthritic process is probably not altered. Good to excellent short-term results can be expected with proper patient selection. Patient counseling is important in order to discuss the nature of the underlying disease process, the limited goals of the arthroscopic procedure, and the possible need for further surgery. Proximal tibial osteotomy for the treatment of medial compartment osteoarthritis can be effective for as long as 15 years. There is a deterioration of results over time that can often be correlated to the degree of correction achieved. Strict selection criteria can maximize success. Revision surgery to total knee replacement, albeit technically difficult, is a viable option with results similar to primary TKR. Unicompartmental knee arthroplasty remains a controversial procedure as its indications continue to evolve. Good to excellent results can be expected in 80% to 90% of patients at 10 years follow-up. Unicompartmental knee arthroplasty occupies a special niche in the treatment of unicompartmental osteoarthritis and supplements total knee replacement and high tibial osteotomy surgery.

Although Achilles tendon ruptures are a common occurrence, bilateral ruptures of the Achilles tendon are not. We present the case of a 33-year-old female who sustained metasynchronous (i.e., very close in time) bilateral ruptures of her Achilles tendons with no obvious predisposing factors. She was treated using a percutaneous technique and six months following surgery has returned to her normal activities.

The value of caudal epidural steroid injections (CEI) in treatment of low back pain and sciatica is controversial. It is believed that CEI are mainly effective in treating acute radiculopathy at intermediate term follow up and have no long-term benefit. The objective of this study was to evaluate the role of CEI in the management of low back pain. This study reviews all patients with low back pain and sciatica treated with CEI in a one-year period (1997) in the orthopaedic department at Aberdeen. The case notes of 163 out of a possible 175 patients (87 female 76 male) with mean age of 51 years (range: 17 to 88 years) were reviewed. Data collected included primary symptoms, presentation time, presumed diagnosis, MRI diagnosis, grade of the surgeon ordering and performing the procedure, the quality and duration of response, and final outcome. Patients were regarded as having an Excellent response if they had good or excellent pain relief for more than 3 months, a Good response (6 weeks to 3 months), Fair (4 to 6 weeks), Brief (any pain relief for less than 4 weeks), and No relief. Forty-one percent of patients had either an excellent/good response to CEI while 34% were no better or worse. Patients presenting acutely or with predominantly leg pain symptoms did not respond any better to the CEI than chronic presentations or low back pain alone. Only 36 of 73 patients who were discharged had an Excellent/Good response. Therefore the response to CEI did not influence the decision to discharge half of the patients. The experience of the surgeon performing the procedure did not make a difference in the outcome. We found that the outcome of CEI was unpredictable. The clinical value of CEI remains unproven. The decision to perform the procedure may well remain a matter of personal choice and experience.

A 72-year-old asian woman who had immigrated from Vietnam 10 years ago presented with a soft tissue mass around the proximal fibula. Conventional radiographs and magnetic resonance imaging demonstrated a destructive lesion of the head of the fibula with an intact superior tibiofibular joint and an abscess surrounding the destroyed bone. Histopathology obtained by a CT-guided needle biopsy revealed necrotizing epithelioid granulomata without demonstrating acid-fast bacilli. However, culture grew Mycobacterium tuberculosis. When tuberculosis affects the end of a long tubular bone, the adjacent synovial joint is usually involved. Cases where joint involvement does not occur are extremely rare and unusual. We report such a case.