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

An audit of high tibial osteotomy was done for 96 knees in 81 patients who had pain due to medial compartment osteoarthritis (OA) of the knee. The mean follow-up was 4.5 years. A modified preoperative and postoperative knee score was used to assess the knee pain and function for each patient. The standard 5-year follow-up results for this procedure, as described in the literature, is 85%. Our results were 71% satisfactory and good. This was because a large proportion of the Salisbury population was involved in farming and they wanted to carry on strenuous activities. Therefore they were not suitable candidates for total knee replacement. Since then we have changed our practice and are restricting this procedure to people who are less than 65 years old and we perform a pre-osteotomy arthroscopy as a matter of routine. It has been 2 years now since we have changed our practice. We will have to wait for at least 3 more years to evaluate our 5-year results in order to close the audit loop.

The purpose of this investigation was to compare the biomechanical analysis of a new plating technique for olecranon fractures to tension band wiring, and review early clinical results. Six matched pairs of cadaveric ulnae were used for the biomechanical analysis. A transverse osteotomy of the mid part of the olecranon was made. One ulna of each pair was stabilized using a tension band and the other with a posterior hook plate. The ulnae were mounted and loaded, and displacement at the osteotomy site recorded. Twenty patients treated with this new technique (14 fractures and 6 osteotomies) were reviewed at one year (range: 8 to 18 months) for infection, union rate, hardware related complaints. and removal. Statistical analysis showed significantly less displacement occurred at the osteotomy site in the plating group. Clinically, all patients had fracture union, and there were no hardware related problems. Posterior plating with this technique achieves greater stability compared to tension band wiring. Early clinical results indicate a low level of hardware related complications.

The relative stiffness of five different external wrist fixators currently in use for distal radius fractures was determined using a uniform fracture model consisting of wood dowels to isolate the effects of the fixators themselves. Each construct was loaded in axial compression, eccentric and cantilever modes of bending, and torsion. The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices.

All high tibial osteotomies (HTOs) performed in the Royal Bournemouth Hospital from June 1987 to February 1995 were retrospectively analyzed looking at the preoperative and postoperative radiographs, preoperative and postoperative range of motion (ROM), alignment, and knee scores. Patient perception was also recorded. In all there were 68 high tibial osteotomies (HTOs), of which 40 were performed by Maquet's dome method and 28 were done by closing wedge osteotomy. Average follow up was 8.6 years (range: 5.2 to 13 years) and 16 (23.5%) cases went on to have total knee arthroplasty after an average interval of 3.7 years. The results of the two methods are compared. Average preoperative HTO alignment was a varus of 4.72 degrees and average postoperative HTO alignment was a valgus of 1.48 degrees. The average radiological grade of osteoarthritis and compartments affected was comparable in the two groups. Overall 35 (51.5%) patients were dissatisfied with their results. A larger percentage of people (57.5%) who had a Maquet's dome osteotomy were unhappy with their operation as compared to 42.9% of people who were unhappy following a closing wedge osteotomy. There was consistent undercorrection after dome osteotomy, with an average alignment of a varus of 1.45 degrees compared to a valgus of 5.67 degrees after a closing wedge procedure. The preoperative subluxation was greater in the patients with a relatively poor result, 3.86 mm compared to 2.03 mm in those with a good result. It is felt that the rather poor results following osteotomy in this series was due to insufficient correction obtained and the advanced stage of osteoarthritis resulting in subluxation. In this series the correction obtained with closing wedge method was better than with the dome method, although it was inadequate with both methods. Although the wedges appeared to do better than the domes, this was not statistically significant. Overall, there was no significant correlation of our results with post osteotomy alignment. Preoperative lateral tibial subluxation was, however, a poor prognosticator of results.

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. The athlete's symptoms and signs, as well as radiographic imaging, are key elements in arriving at a diagnosis of shoulder injuries. 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.

The lack of literature on residency selection criteria used by orthopaedic program directors has left medical students in the position of relying on rumor and anecdotal information as to what program directors value most highly when sorting through large candidate pools. The purpose of this study was to compare the perspectives on resident selection criteria solicited from orthopaedic program directors and residency applicants. A power analysis was done to determine adequate sample size. A 26-item questionnaire was mailed to 98 residency applicants who interviewed at our program and 156 orthopaedic program directors. The program directors were also asked to elaborate on those factors that were most important in their selection process. A two-tailed Student's t-test was employed to compare the two groups. Significance was set at p < 0.05. Statistically significant differences between applicant and program director ratings were found in 12 of the 26 questionnaire items. Applicants (n = 91) ranked the following criteria as most important: a letter of recommendation from an orthopaedic surgeon (8.6 on a scale of 1 to 10, 10 being most important), USMLE I score (7.7), and rank in medical school (7.6). The most important criteria for the directors (n = 109) were: the applicant performed a rotation at the director's program (7.9), USMLE I score (7.8), and rank in medical school (7.8). This study provides the most comprehensive empirical data to date as to the factors which orthopaedic program directors consider most important during the residency selection process. To our knowledge, this is the first study in the orthopaedic literature that compares the program directors 'and residency applicants' views on resident selection criteria. Significant differences were found between applicant and program director views on resident selection criteria.

Eleven children with spastic cerebral palsy (CP) who could walk underwent exercise at the anaerobic threshold (AT) point. The subjects exercised for 20 minutes per session, twice a week for a period ranging from 6 to 20 weeks. The subjects were divided into two groups. The leg exercise group contained six CP children who exercised on a cycle ergometer with average attendance of 1.8 days a week. The other five CP children constituted the arm exercise group and exercised using an arm cranking ergometer with average attendance of 1.5 days per week. After the exercise period, the oxygen uptake (VO2) at the AT point increased significantly in the children in the leg exercise group. On the other hand, the VO2 at the AT point did not change in children in the arm exercise group. These results demonstrate that cycle ergometer exercise at the AT point is effective in improving the physical endurance of children with CP. In contrast, arm exercises for children with CP seem to have little effect on increasing physical endurance.

Ganglia may be found near any joint. The hip joint is one location where these lesions have been reported. In most instances the ganglia found around the hip are small, deep-seated, and not palpable. Palpable ganglia are commonly larger and present as a groin mass. We report a ganglion cyst that was not palpable due to its intrapelvic location.

In 1998, orthopaedic manufacturers started to introduce highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) for total hip replacement bearings. Today's highly-crosslinked UHMWPEs materials are irradiation processed with a total dose ranging between 50 and 105 kGy, depending upon the manufacturer. Each manufacturer has adopted a different route for producing their highly crosslinked UHMWPE that includes a combination of three important processing steps: an irradiation step, an intra or post-irradiation thermal processing step, and a sterilization step. This paper reviews the choices available to an implant designer when developing a highly-crosslinked UHMWPE as an orthopaedic bearing material. We suggest that the application of annealing rather than re-melting in the thermal processing step allows the retention of important mechanical properties in the finished material. This approach will be illustrated with test data on Crossfire (Stryker Howmedica Osteonics, Mahwah, NJ), an annealed, highly-crosslinked UHMWPE developed specifically for total hip replacements. We compare the physical, mechanical, and wear properties of Crossfire with that of conventional (N2-Vac) UHMWPE and with materials produced using published melt irradiation technology. At the short term (2 and 3 years) the results demonstrated through clinical follow-up, clinical results for Crossfire, are encouraging. Longer follow-up is necessary to confirm the benefits to patients from reduction of debris released from the articulation.