Bulletin of the Hospital for Joint Diseases Orthopaedic Institute最新文献

The author was the 1987 Sir Robert Jones Lecturer of the Hospital for Joint Diseases Orthopaedic Institute. This article is based on the speech he delivered in that capacity on October 30, 1987, at the Annual Scientific Program of the Alumni Association, supplemented by material he presented at a three-day International Conference on the Ilizarov Techniques for the Management of Difficult Skeletal Problems which was sponsored by HJDOI November 1-3, 1987.

Varus, valgus, and retroversion-anteversion displacements of femoral neck fractures are easily identified on standard AP and lateral radiographs, but rotational malalignments are frequently overlooked. Alterations of the normal appearance of the trabecular systems will indicate rotatory malalignments. A misleading picture of what seems to be severe osteoporosis may actually be due to malrotation and disappearance of the normal trabecular pattern on radiograph.

The authors theorize about the possibility of using the knee joint as a tissue culture medium for the development of ova and sperm.

The use of arthrotomography and postexercise spot films has increased the effectiveness of wrist arthrography in demonstrating triangular fibrocartilage abnormalities.

This report reviews the results of the first 2 1/2 years of a comprehensive multidisciplinary inpatient-outpatient treatment program for patients with chronic pain. Functional data indicate a 33 1/3% rate of return to work or involvement in work training programs, while self-report data indicate a 50% improvement rate. Future directions for research are suggested.

Congenital dislocation of the hip and acetabular dysplasia apparently are not constant features of the same disease. Cases of congenital dislocation of the hip with well-developed acetabula are reported periodically. The causative factors are genetically determined or unknown. In routine clinical work, a well-developed acetabulum improves the prognosis, even in the presence of severe dislocation. An acetabular operation is often unnecessary and the reduction is more stable. Once reduction is achieved, acetabular growth seems to continue at its usual pace in these patients.

Anterior cruciate ligament reconstruction can now be accomplished by arthroscopic surgery. With the introduction of a new arthroscopic drill guide and accessory instrumentation, a single tibiofemoral tunnel is created through which an anterior cruciate ligament graft can be anatomically and isometrically positioned. The appropriate graft is secured intraarticularly inside the femoral portion of the tunnel. Any type of graft structure can be used with this technique by varying the diameter of the tunnel or the depth of penetration into or through the lateral femoral condyle as needed. Correct anatomic and isometric positioning of the anterior cruciate ligament graft by this method have been confirmed on cadaver studies, by direct arthroscopic visualization and testing at the time of surgery, and on postoperative radiographs. The procedure has been performed on 45 patients. The longest follow-up is 48 months; the mean follow-up is 26.3 months. Early postoperative clinical results are most encouraging, with the pivot shift test being universally negative. The unitunnel technique for arthroscopic anterior cruciate ligament reconstruction has greatly reduced surgical morbidity without apparently compromising the results of surgery. The technique could become a standard procedure for the experienced arthroscopist and knee surgeon.

A case report of malignant degeneration of a long-standing idiopathic bone infarct into malignant fibrous histiocytoma in a female is presented. Most of the previous cases reported were in males. The pathogenesis is still obscure; however, a cause-and-effect relationship may exist. The prognosis is poor. Most patients die within two years after diagnosis.

This report describes the in-vitro use of mussel adhesive protein (MAP) as a possible adjunct to chondrocyte allograft surgery. Experiments were performed to define the attachment kinetics of chondrocyte onto bone using MAP, and to assess the biocompatibility of this material in vitro. The results indicate that MAP is biocompatible and may have future clinical applications in orthopaedic procedures.