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

Dr. Campanacci was the 1990 Sir Robert Jones Lecturer of the Hospital for Joint Diseases Orthopaedic Institute. This article is derived from the lecture he delivered in that capacity on October 26, 1990, at the Annual Scientific Program of the Hospital's Alumni Association.

Central chondrosarcoma is an uncommon primary malignancy of the axial skeleton which usually affects the posterior elements or the posterior part of a vertebral body. We present an unusual case of chondrosarcoma involving the anterior part of a thoracic vertebra with massive extravertebral extension into the posterior mediastinum. The roles of computed tomography and magnetic resonance imaging in identifying this pathology are emphasized.

Eighteen patients with nonunions of the humerus were treated by the Ilizarov method at the General Hospital in Lecco, Italy, between 1982-1989. This report is based upon 16 of those patients. The results are encouraging. Union was achieved in 14 patients. There were two failures: one patient had been irradiated 14 years earlier for what was thought to be plasmocytoma of the proximal humerus; the other had a humeral nonunion of the proximal third with advanced disuse osteopenia of the surrounding bone. Complications were few, and none compromised the achievement of union.

The status of the third femoral condyle, which can be seen in routine radiographs of the knee area, may be a useful adjunct for a clinical interpretation of the stresses incurred by patients with certain types of disabilities. Its status may prove to be a better indicator of the stresses in the components of the knee than the status of the articular surfaces of the femoral condyles.

The author performed patellar inversion in four knee joints in two patients with problematic patellae. The results to date are favorable, although the procedure is still very new. The author suggests that the inversion may be useful in cases where destruction of the articular surface of the patella, or patellar lateralization and subluxation exist.

Total knee arthroplasty was performed in 126 knees of 104 patients, using either the UCI, the Kinematic Anteriorly Joined (K-AJ), or the Kinematic Posterior Cruciate Retention (K-PCR) prosthesis. The average patient age at the time of surgery was 59 years; the average follow-up period was 3.3 years. The UCI device was used in 25 knees, the K-AJ in 75, and the K-PCR in 26. Postoperatively, the femorotibial angle was measured yearly for a period of at least six years on an anteroposterior radiograph of the patient standing on one leg. The cases with the UCI prosthesis, with an average standing FTA of 175 degrees one year postoperatively, showed a gradual change of limb alignment toward varus. In contrast, in the cases with the K-AJ and K-PCR prostheses, with an average standing FTA of 172 degrees one year after surgery, limb alignment remained essentially unchanged throughout a long period of follow-up. The authors recommend that total knee arthroplasty be performed to achieve a postoperative femorotibial angle (standing) as close to 172 degrees as possible, which allows the mechanical axis of the lower extremity to pass through the center of the knee.

A case of hamate dislocation associated with triquetral fracture is presented. No other carpal or metacarpal injury was involved. The mechanism of injury was volar flexion and ulnar deviation. An attempt at closed treatment failed because the proximal tip of the hamate was incarcerated between the triquetral fragments. Open reduction, K-wire fixation, and casting were done. The patient was able to use her hand nearly normally 12 weeks postoperatively.

Sixty five patients (51 males and 14 females) underwent a control trial of freeze-dried amniotic membrane applied in the form of split-thickness skin grafts over an area from which skin had been surgically removed. The average size of the grafts was 15 x 20 cm. The patients were randomly divided into two groups. In the first group (36 patients), the membrane was applied at the upper half of the wound; in the second group (29 patients), the membrane was applied at the lower half of the wound. The remaining areas of the wounds were covered by antibiotic-impregnated fine-mesh greased gauze. Pain, infection, and the progress of healing were monitored. Covering the wound with the amniotic membrane had good results in terms of pain reduction, but the promotion of healing and the prevention of infection were not demonstrated. Hyperemia and hypertrophic scar responses to the membrane in some cases were considered as disadvantages.

The bipolar prosthesis was developed to overcome some of the shortcomings of the unipolar fixed-head prosthesis. An additional site of motion would be expected to decrease the amount of loosening, dislocation, and head migration. Although clinical series have shown success rates for bipolar prostheses as good as those for unipolar prostheses, the intended advantages have not been clearly demonstrated.

New Ilizarov rings composed of aluminum (Al) or carbon composite (C) are lower in weight and more radiolucent than the stainless steel (SS) rings currently in use. The new rings were subjected to a variety of mechanical tests. The aluminum rings performed as well as the stainless steel rings in all tests; in some tests the carbon rings proved to be less rigid.