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

Tibial defects greater than 4 cm and secondary to high-energy trauma or debridement for infected nonunion pose a significant challenge to the treating orthopaedic surgeon. Twelve patients who had been treated with Ilizarov bone transport for tibial defects over the past ten years were retrospectively reviewed. All patients were male with an average age of thirty-two. Ten of the twelve limbs were categorized as Grade IIIB fractures initially. The average tibial defect at initiation of bone transport was 9.45 cm (range 4 to 20 cm). The mean external fixator time (EFT) was 16.7 months with a mean external fixator index (EFI) of 2.0 months per centimeter. There were a total of 36 complications. Twenty were minor, fourteen were major without sequelae and two were major with sequelae. Overall bone results were good or excellent in nine patients. Overall functional results were good or excellent in eight patients. Ten patients achieved union after Ilizarov bone transport. Use of Ilizarov bone transport can be an effective tool for treating large tibial defects. However, the treatment time is lengthy with a considerable risk of complications.

In order to determine the effects of two different headless screw designs on fixation of simulated capitellum fractures six matched pairs of embalmed humeri had simulated capitellum fractures created. Fixation with Acutrac compression screws was compared to Herbert screws in a matched pair experimental design. All specimens were cyclically tested with simulated physiologic loading. Both displacement of the capitellum as a function of the number of cycles and failure loads were determined. Fixation by the Acutrac screws was significantly more stable than Herbert screws at 2000 cycles, 0.17 mm wersus 1.57 mm (p < 0.02) The Acutrac fixation also had a higher failure load, 154 N versus 118 N (p < 0.05). The Acutrac screws tested in this biomechanical study provided more stable fixation of simulated capitellum fractures than Herbert screws. This appears to be related to the design of these screws.

The muscles of 70 patients with lower limb shortening due to various etiologies were studied using three radiographic diagnostic methods: contrast radiography (CR), ultrasonography (US), and computed tomography (CT). The studies were performed before surgery, during lengthening using the Ilizarov external fixator, during the fixation period following distraction, and after apparatus removal. The data compiled using these modalities described alterations in the muscles during lengthening which enabled us to develop algorithms for patient examination during the process of lower extremity lengthening with the aim of solving tactical tasks.

SLAP lesions are becoming a more recognized cause of shoulder pain and disability. The diagnosis of these lesions is difficult due to vague symptoms and high degree of overlap with other shoulder disorders, and this requires a high index of suspicion. Advances in MR arthrography may lead to advances in preoperative diagnosis of labral tears, but definitive diagnosis, classification, and management is greatly facilitated with the use of the shoulder arthroscopy. Further basic science and clinical research should enhance our ability to manage patients with these lesions effectively.

This study performed the first in vitro histological analysis of the effects of bipolar thermal energy on human meniscal tissue. Sixteen fresh human menisci were mounted on a cutting block and placed in a water bath simulating an arthroscopic environment. Each specimen was divided into four sections and randomized to one of four treatment options: 1. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power 3 setting); 2. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power setting 7); 3. resection with a scalpel blade; and 4. resection with a motorized 4.5 full-radius resector. Six micron sections were cut and stained with Hematoxylin and Eosin and Masson's trichrome stain. Menisci were evaluated for the contour of the cut edge: straight, jagged, frayed, or combined. The zone of thermal necrosis and zone of thermal alteration were determined by examining the differential staining of the connective tissue and measuring the affected area. Menisci treated with the bipolar thermal probe were noted to have a smoother contoured edge in comparison to motorized cutters. The zone of thermal penetration for the Arthrocare power setting 3 averaged 0.18 mm (range: 0.09 to 0.20; SD 0.04) and for Arthrocare power setting 7 averaged 0.33 mm (range: 0.26 to 0.36; SD 0.03). The difference in thermal penetration between Arthrocare power settings 3 and 7 was 0.15 mm. This was statistically significant at p < 0.0001 (95% CI: 0.11 to 0.19 mm). The zone of thermal penetration was non-existent for the shaver and scalpel groups. This study provides the first histological description of the effects of bipolar radiofrequency energy on meniscal tissue. It demonstrates that there is intra-substance thermal penetration and alteration of the meniscal tissue. Its clinical significance is unclear and further in vivo studies are needed to address its clinical applicability.

Angioleiomyoma, a relatively rare tumor of smooth muscle origin, has been reported in many anatomical sites. We present a patient who was referred with a diagnosis of nodular Achilles tendinopathy. At exploration, the mass was excised, and histopathology revealed it to be an angioleiomyoma. Tumoral masses should form part of the differential diagnosis of a subcutaneous lesion on an extremity, particularly the lower limb.

Osteosclerosis of the subchondral bone was measured by densitometer on plain radiographs in 55 medial compartmental osteoarthritic knees of 40 patients who were treated with high tibial valgus osteotomy for correction of varus deformity. The ratio of the osteosclerosis value of the medial side of the knee to that of the lateral side (Medial/Lateral ratio) was calculated and used as a parameter. The Medial/Lateral ratio of osteosclerosis decreased rapidly within three years after osteotomy at the reference points of the femur and the tibia. Even 7 to 19 years after osteotomy, a decrease of the ratio was noted in 16 knees with a standing femorotibial angle (FTA) less than 168 degrees (12 degrees of anatomical valgus angulation). This was interpreted to mean that osteosclerosis of the medial condyle decreased compared with that of the lateral condyle after overcorrection of varus deformity. In the cases of more than 7 years after high tibial osteotomy, a positive straight regression line was drawn by calculation between Medial/Lateral ratio and postoperative limb alignment expressed by standing femorotibial angle, with coefficient of correlation (gamma) of 0.295 (p < 0.01).

The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance.

A retrospective study was performed to compare nonoperative and operative treatments of Type II distal clavicle fractures. From a total of 30 diagnosed patients, 16 were identified as receiving nonoperative treatment and 14 open reduction and coracoclavicular stabilization. The average follow-up was 53.5 months for the nonoperative group and 59.8 months for the operative group. All patients were evaluated postoperatively for pain, range of motion, function, and fracture healing as well as for isokinetic strength. Fractures treated surgically achieved union within six to ten weeks. Nonoperative treatment resulted in seven nonunions. There were no significant differences between the two groups in the mean UCLA, Constant, and ASES scores. Nonunion had no significant effect on functional outcome or strength. This study suggests that Type II distal clavicle fractures can be successfully managed nonoperatively. The high incidence of nonunion does not impede a clinical outcome comparable to that achieved by surgical treatment.

There have been conflicting reports in the literature regarding the results of post high tibial osteotomy knee arthroplasty. This study aims to assess the clinical and radiological results as well as patient satisfaction following post high tibial osteotomy knee arthroplasty and to identify the variables affecting the results. A total of 29 cases of post osteotomy knee arthroplasties were retrospectively analyzed. Preoperative and postoperative range of movement and deformity were recorded with knee scores at latest follow-up. Weightbearing radiographs were taken preoperatively and at latest follow-up. Patients were asked if they were satisfied with their results. Average follow-up was 7.5 years with an average interval between osteotomy and knee arthroplasty of 4.7 years. Average age at osteotomy was 62.5 years. Seventeen patients had Maquet's dome osteotomy and 12 had closing wedge osteotomy. The average knee score was 117.4. Overall 5 (17.2%) patients had a poor result. There was a significantly greater pre-osteotomy subluxation (9 mm) in the failed knees compared to the successful arthroplasties (3.64 mm) with p = 0.033 using the Mann-Whitney U test. This has to be tempered by the fact that numbers were small. Failed arthroplasties had a valgus cut of the tibia (1.5 degrees) compared to either a neutral or slight varus cut in successful arthroplasties (average 2.42 degrees varus). Lateral translation of tibial tray was greater in the failed knees whereas posterior translation was greater in the successful knees. However, differences in tibial tray angle and translation were not statistically significant. Four (21.05%) cases went on to revision of their arthroplasty in less than 8 years, 2 for painful valgus instability. This study concludes that post high tibial osteotomy knee arthroplasty is a technically demanding operation with altered anatomy and significant balancing problems. Results of knee arthroplasty after high tibial osteotomy are inferior to that of primary arthroplasties and the amount of lateral subluxation prior to surgery may adversely affect results.