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

Fifty cadaver knees were dissected in order to examine their ligamentous structures and gain an increased understanding of their morphology and their functional contribution to the posterolateral stability of the knee joint. The fabellofibular ligament was found in 34 knee joints (68%); its homologue, the short lateral ligament, was found in only 2 (4%). The arcuate ligament was identifiable in 12 knees (24%) as a thin, membranous capsular structure; more than half of these ligaments lacked either a medial or a lateral limb. The fibular origin of the popliteus was found in 49 knees (98%) with a mean width of 9.3 mm. This strong, tendinous band completes the span of the popliteal tendon between the lateral femoral condyle and the fibular styloid. Based on its course and its relation to the knee joint, we believe it provides static stabilization to the knee by preventing external rotation and posterior translation of the lateral tibial condyle.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have anti-inflammatory, analgesic, and antipyretic properties. Although most NSAIDs inhibit prostaglandin synthesis, these agents also have important pharmacologic actions unrelated to their effects on prostaglandins. This review examines the evidence for diverse mechanisms of action of NSAIDs and their use in sports injuries.

We report a retrospective study of 16 patients with seropositive rheumatoid arthritis who were placed on combination D-penicillamine and methotrexate therapy for a period of 5-86 months. Three patients were lost to follow-up, and one patient died of unknown causes at another institution. Among the 12 remaining patients, there was no withdrawal secondary to drug intolerance. All patients demonstrated improvement in functional class correlated with a reduction in joint count, duration of morning stiffness, erythrocyte sedimentation rate, rheumatoid factor, and prednisone requirement. Eight of the 12 patients achieved remission as defined by the American College of Rheumatology criteria. Remission was sustained for a period of 3-72 months. The dosage of D-penicillamine ranged from 250-1000 mg/d (mean = 750 mg); that of methotrexate ranged from 5-15 mg/week (mean = 10 mg). The study indicates that D-penicillamine and methotrexate combination therapy is effective in the treatment of severe rheumatoid arthritis and warrants further prospective investigation.

A method of rigid occipitocervical fixation is described which uses an occipital pin passed through the external occipital protuberance. Additional rods and wires are used to complete the fixation. The occipital pin was tested in a cadaver skull and was found to be able to withstand a distraction force of 30-50 kgs. Three patients with grossly unstable upper cervical spines due to cancer metastasis were able to walk as a result of this surgery.

The authors describe their experience in treating congenital dislocation of the hip by means of domiciliary traction. Because the children are allowed to live at home during the entire treatment period, family life is not disrupted. The treatment is not only more economical than a prolonged hospital admission would be, it is equally effective and the rate of complications is acceptably low.

We have been using real-time ultrasonographic examination at Srinagarind Hospital since 1988, chiefly for confirming the diagnosis of subluxated and dislocated hips. We have also studied the click sensation, which is usually detected during Barlow and Ortolani tests in normal neonates. This article presents the significance, possible causes, and any correlation of the click sensation with congenital dislocation of the hip resulting from our study using real-time ultrasonography. No demonstrable subluxation or dislocation was found while the click sensation was created during the study.

Intracapsular or paraarticular chondromas are seldom mentioned in the literature. They generally occur in the area around the knee, and must be recognized and differentiated from other soft-tissue tumors that appear at this site such as sarcomas containing focal calcification or ossification, and from other cartilaginous lesions such as synovial chondromatosis. We present a case of intracapsular chondroma of the knee in a 63-year-old woman. A biopsy was performed to rule out the possibility of a soft-tissue sarcoma.

An atypical case of nonossifying fibroma involving the femoral neck of a 7-year-old white male is presented. The radiographic characteristics of the lesion were consistent with this diagnosis, although the location is rare. The differential diagnosis included fibrous dysplasia, unicameral bone cyst, chondroblastoma, and eosinophilic granuloma. A final diagnosis was obtained through tissue biopsy and histopathologic review.

The authors present a case of os hamuli proprium, a congenital anomaly of the hook of the hamate. A unilateral presentation of this anomaly is rare--this is the first to be reported in the literature. The lesion could easily be mistaken for a fracture of the hook of the hamate. Radiologists and orthopaedists should be aware of the possibility of such a misdiagnosis.