Journal of the Southern Orthopaedic Association最新文献

Sequential compression devices are used to reduce venous stasis and deep venous thrombosis after joint replacement. Thigh-length, calf-length, and foot compression devices were compared in using ultrasonography after unilateral knee arthroplasty. Simulated muscle activity via active ankle motion was also evaluated. Blood flow volume and velocity were recorded above and below the saphenous vein bifurcation, the division of the superficial and deep systems, allowing evaluation of each. Volume and velocity increased in the superficial and deep systems with all devices. A control group was evaluated to determine differences related to age and surgery. The devices performed similarly in the volunteers. However, active motion performed better than any device. Thus, unlike young, healthy patients, muscle activity alone in the operative population was unreliable in increasing blood flow. Thigh-length, calf-length, and foot compression devices are are effective at increasing femoral blood flow volume and velocity in the deep and superficial venous systems after total knee arthroplasty.

Injuries to the acromioclavicular joint are common. For selected injuries, operative reconstruction is recommended. The purpose of the current study was to compare three reconstruction procedures: (1) nine strands of woven polydioxanonsulphate (PDS II) suture passed through the clavicle and around the coracoid; (2) procedure No. 1 with 50% of the coracoacromioclavicular ligament placed through 2 clavicular drill holes; (3) No. 5 Merselene tape passed through 2 drill holes in the clavicle and acromion, with 50% of the coracoacromial ligament transferred to the clavicle. Fourteen fresh frozen human shoulders were tested using a 6 degree-of-freedom testing device. The intact shoulder showed significantly less displacement than any of the reconstructions. Merselene tape plus ligament showed the largest displacement, and PDS II braid plus ligament showed the least displacement. None of the procedures reconstituted acromioclavicular joint stiffness to intact state levels, though improved acromioclavicular joint stiffness was noted with a PDS braid plus ligament.

Reproducible fractures of the midshaft of the clavicle were created in 14 fresh frozen human cadaveric clavicles. Under the three-point bending loading by a materials testing machine, the load to failure of fixation of the clavicular fractures treated with steel reconstruction plates (five specimens) and Herbert cannulated bone screw (nine specimens), was compared with a group control formed by five specimens of clavicles without osteosynthesis material. No statistically significant differences were observed between the three groups. In consequence and in terms of biomechanics, in clavicular acute fractures, both plating and intramedullary Herbert cannulated bone screw may be utilized in the treatment of these lesions.

The management of a child with a perfused, pink, but pulseless upper extremity following reduction and pinning of a type III supracondylar humerus fracture remains controversial. The authors present the initial treatment, evaluation, operative findings, and postoperative course of a 6-year-old with a pink pulseless hand. Review of the literature is included, as well as recommendations regarding operative management.

This retrospective study examined the clinical significance of a radiographic sign associated with periprosthetic metallosis after total knee arthroplasty. Of 71 knees undergoing revision arthroplasty over an 8-year period, 11 had gross evidence of metal debris identified intraoperatively. Histologic preparations confirmed the presence of particulate metal debris in all cases. Radiographs in 7 of 11 cases were positive for metallosis. The radiographic sign identified on lateral radiographs was divided into 3 types based on the size of the mass. The magnitude of soft tissue pathology and the extent of osteolysis correlated with the size of the mass on preoperative radiographs. Replacement of all components was necessary in 71% of cases with radiographs positive for metallosis and 47% of cases with negative radiographs. Only 1 of the 11 knees with metallosis had a late postoperative infection, for which 2-stage revision arthroplasty was required. All cases with positive radiographs had gross and histologic confirmation of metal and polyethylene debris. These data suggest that careful assessment of radiographs can facilitate preoperative planning.

Bilateral symptomatic knee arthritis is a common clinical problem. There are conflicting opinions as to the advisability of simultaneous sequential bilateral total knee replacement. Complication rates of primary unilateral knee replacement are well documented and there are several small series that compare the two techniques. The objective of this study was to identify the complication rate of simultaneous sequential bilateral total knee replacement in a large patient population. Over a 13-year period, 604 primary bilateral sequential simultaneous total knee replacements (1208 knees) were performed. Office notes and hospital charts were retrospectively reviewed to obtain age, sex, diagnosis, knee alignment, associated comorbidities, operative protocol, transfusions, and complications. The study results showed 5.1% local and 15.3% systemic complications and 0.7% mortality rate (none in the past 9 years). With appropriate patient selection and operative technique, patients who present with bilateral symptomatic knee arthritis can enjoy the benefits of simultaneous sequential bilateral total knee replacement without increasing their risks of complications.

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

We present a review of the literature on classification and treatment of osteochondral defects of the talus. We report the case of an isolated Berndt and Harty grade II lesion treated with a fresh osteochondral allograft. We believe that fresh allograft osteochondral grafting of the talus is an excellent technique for symptomatic Berndt and Harty grade II or higher lesion of the talus without significant tibiotalar arthritis. In selected patients, this procedure can provide excellent functional results.