Journal of the Southern Orthopaedic Association最新文献

Fractures of the distal third of the forearm are common in children. These fractures are known to heal readily and rapidly. We describe a 10-year-old boy who had a closed, low-energy fracture of the distal radius and ulna. The radius healed promptly, but the ipsilateral ulna had radiographic evidence of delayed union. We have not found a report of a nonunion of this kind in the literature. With the increasing use of internal fixation and the lack of guidance in the literature, we questioned the standard use of closed treatment. We treated this patient nonoperatively, despite the delay in union, and the fracture healed in 4 months.

We examined the in vivo alterations of human patellar bone blood flow that occur with surgical dissection of the extensor mechanism during total knee arthroplasty. A laser doppler probe was used to measure central patellar blood flow at baseline after quadriceps tenotomy, after partial fat pad excision, after lateral release, and after completion of the lateral release with superolateral geniculate sacrifice. The initial quadriceps tenotomy and medial arthrotomy decreased patellar vascularity to 60.4% of baseline. Fat pad resection initiated another 10.4% decline. The lateral release resulted in a patellar vascularity that was 43.6% of baseline. Finally, the loss of superolateral geniculate inflow reduced the patellar flow to 30.61% of baseline.

Between November 1982 and November 1991, 45 patients were treated with a new procedure for lateral ankle instability and were available for follow-up. Preoperatively, all patients had a talar tilt of 10 degrees or more and a positive drawer sign. A 9-year follow-up has proven successful in all 45 patients. All patients had increased postoperative stability and returned to their preoperative activities; 70% increased their activities beyond their preoperative level. The rehabilitation time has been shortened by 50%.

This study was conducted to evaluate the clinical and radiographic results of 22 total hip replacements done in 17 consecutive patients for coxarthrosis due to developmental dysplasia or dislocation of the hip. All operations were done using an anterior approach without trochanteric osteotomy. Standard cementless prostheses were used in all cases. There was no custom-designed prosthesis used. The acetabular cup was placed in an anatomic position in the true acetabulum in every case. Bulk autograft was necessary to reconstruct the deficient acetabular roof in only 2 hips. The average follow-up was 63 months (range, 40 months to 95 months). The average Harris Hip Score was improved from a preoperative value of 35 (range, 24 to 46), to 96 (range, 79 to 100) at final follow-up. To date, no revision has been done. Three hips showed radiographic evidence suggestive of aseptic loosening (2 stems and 1 cup), but the clinical results remain satisfactory. There is no incidence of dislocation, sciatic nerve palsy, or infection.

In a prospective study of 35 cemented press fit condylar knees, we studied the prevalence of radiolucent lines 1 mm wide or wider using two methods of detection: conventional (plain) and fluoroscopically-guided radiographs. All films were evaluated in accordance with the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. A total of 12 radiolucencies were detected in nine knees (26% of all knees) using conventional radiographs versus 25 radiolucencies in 13 knees (37% of all knees) using fluoroscopically-guided radiographs. This was a statistically significant difference and suggests that the true prevalence of periprosthetic radiolucencies will be underestimated if conventional radiographs are used to evaluate the bone-prosthesis interfaces and questions the value of routine postoperative plain film radiographs to evaluate the results of knee arthroplasty.

To provide baseline outcome data for a new lumbar microinvasive diskectomy done with standard arthroscopic instrumentation, we retrospectively reviewed the cases of 190 patients. All patients were assessed by a modified MacNab outcome classification with a minimum of a 2-year follow-up. All complications of this procedure were reported as well. No previous outcome data are available for this procedure, since it has been done primarily at one center, by the same surgeon, using his previously reported techniques. Results were good or excellent in 175 patients and fair or poor in 15. Complications were not severe and were easily remedied. This success rate is comparable to rates reported for other minimally invasive operations on the lumbar spine. This new technique of minimally invasive lumbar spine surgery provides minimal morbidity and a long-term outcome comparable to that of other standard procedures. The added benefits of using standard arthroscopic instrumentation are discussed.

The emphasis our society places on physical fitness has produced an ever increasing number of injuries to the anterior cruciate ligament (ACL). To successfully replace the anterior cruciate deficient knee, physicians need to determine the "ideal" location for the femoral tunnel. In the search to find this "isometric point," if there is one, we draw attention to the origin of the distal fascicles of the anterior cruciate from the lateral femoral condyle. Visualizing this surgical landmark can facilitate and expedite accurate placement of the isometric device and thus influence the results of the surgical procedure. Also, magnetic resonance imaging may help the surgeon in locating the origin of the ACL.

Seventeen patients with loose total hip acetabular components and type III osteolytic acetabular defects were prospectively identified and reconstructed with either spherical acetabular components or eccentric acetabular components without use of structural bone graft. A computed tomography (CT) scan and a three-dimensional (3-D) model were obtained in nine patients to determine whether a spherical component or eccentric component should be used. The clinical results were measured using the Harris Hip Score. Hip scores improved from 44 to 73 points for the entire group but were lower in the subgroup with eccentric components. Also, two of the eccentric cups developed loosening. The hip center was better restored in the eccentric implant group. The cost of the prosthesis was higher in the eccentric implant group due to the expenses of the CT scan and the 3-D model.

We performed mechanical induction of heterotopic ossification in the quadriceps of the right hind limb of six male and six female sexually mature New Zealand white rabbits of similar size. The effect of sex difference on heterotopic bone was assessed by analyzing plain radiographs of the femur. The results indicate that a male/female sex difference in heterotopic bone formation cannot be demonstrated.