Journal of the Southern Orthopaedic Association最新文献

Autonomic nervous system dysfunction occurs rarely after botulinum toxin type A (BTX-A) intramuscular injections. We report a case of a 23-year-old man with spastic diplegia who had transient erectile dysfunction after intramuscular injection of BTX-A (total dosage, 300 IU, body weight 95 kg) in both hamstring muscles. Some investigators believe that the local spread of the toxin is responsible for autonomic dysfunction, while others believe that the transportation of the toxin to the spinal cord via retrograde flow or via the blood flow after entering the circulation are possible mechanisms of neurologic side effects. On the basis of our case, a retrograde axoplasmic flow to the spinal cord could probably occur because the spinal cord level of hamstring muscles is close to spinal cord levels responsible for erection control.

Cat-scratch disease (CSD) is usually a self-limited illness, though atypical presentations of infection with Bartonella henselae can occur, including osteomyelitis, oculoglandular syndrome, and granulomatous hepatitis. We describe a 6-year-old boy who had atypical CSD osteomyelitis of the left proximal femoral metaphysis due to a cat scratch. This is the second paper to report serial serology of B henselae, and the second paper to identify plasma cells on histologic examination, compatible with chronic osteomyelitis. The diagnosis was made by clinical, serologic, and histologic examination. Sixteen cases of atypical CSD osteomyelitis have been reported in the English literature and are reviewed in this paper.

We have reviewed the results of arthroscopic treatment of pigmented villonodular synovitis (PVNS) with reference to both recurrence and to function. Between 1985 and 1995, a single surgeon treated eight patients. At an average 5-year follow-up, all patients were interviewed and had assessment of Hospital for Special Surgery (HSS) knee score for both the affected and unaffected knees. Also recorded were age, sex, and whether disease was recurrent, localized, or diffuse. Disease recurred in 4 patients, all with diffuse PVNS, and 3 of them required a further arthroscopic synovectomy at a mean of 16 months after the index procedure. All patients had good or excellent functional results. There was no significant difference between HSS knee scores for affected and unaffected knees. Arthroscopic synovectomy is a successful treatment in patients with localized PVNS of the knee and results in a knee that is functionally not different from its unaffected partner.

From the foregoing, one may reduce the following principles for the management of ankle injuries: The mechanism of injury and the diagnosis, including ligamentous injury, can be made from initial radiographs. A displaced fracture of only one malleolus must be accompanied by ligamentous injury of either the deltoid or syndesmotic ligaments, or both. When there is only one break in the ring of the ankle mortise, there is no potential for significant displacement; thus, ORIF is rarely necessary. With two breaks in the ring, the potential for displacement exists, even after successful manipulation, which usually makes operative treatment a more attractive option. Closed reduction is done by reversing the direction of the injuring forces, though it is not necessary to do so in precise inverse order to their occurrences. When ORIF is used, all significant malleolar fractures should be rigidly fixed to allow early motion, which, along with delayed weight bearing, is especially beneficial when comminution of the articular surface exists. Syndesmotic fixation is usually unnecessary if the malleolar fractures can be reduced anatomically and securely fixed. The reduction, whatever technique is used, should result in full congruency of the ankle mortise and a level joint line. Trimalleolar fractures, especially when they involve more than 25% of the tibial plafond, are much more likely than bimalleolar fractures to be associated with posttraumatic arthritis.

Autogenous bone grafting is often done in orthopaedic surgery for a variety of conditions. The iliac crest is currently the most common donor site for obtaining autogenous bone graft. We searched the literature to summarize reported complications related to the donation of autogenous bone from the iliac crest. Our review revealed reports of arterial injury, ureteral injury, herniation, chronic pain, nerve injury, infection, fracture, pelvic instability, cosmetic defects, hematoma, and tumor transplantation. Currently, autogenous bone grafting is a necessary part of the treatment of various orthopaedic conditions. Obtaining bone from the iliac crest can be associated with significant morbidity. As bone grafting technology emerges, the known complications of the current standard should be weighed against the risk of alternate therapies.

We quantified the embolic load to the lungs created with two different techniques of femoral nailing. Eleven patients with 12 traumatic femur fractures were randomized to reamed (7 fractures) and unreamed (5 fractures) groups. Intramedullary nailing was with the AO/ASIF* universal reamed or unreamed nail. Transesophageal echocardiography (TEE) was used to evaluate the quantity and quality of emboli generated by nailing. Data were analyzed using software that digitized the TEE images and quantified the area of embolic particles in each frame. The duration of each level of embolic phenomena (zero, moderate, severe) was used to determine total embolic load with various steps (fracture manipulation, proximal portal opening, reaming, and nail passage). Manual grading of emboli correlated highly with software quantification. Our data confirm the presence and similarity of emboli generation with both methods of intramedullary nailing. Unreamed nails do not protect the patient from pulmonary embolization of marrow contents.

Rupture or transection of the digital pulley may necessitate repair or reconstruction to treat symptomatic flexor tendon bowstringing. When reconstruction is necessary, intrasynovial tendon grafts may provide superior gliding characteristics when compared with traditional extrasynovial tendon grafts. Lacerations of the membranous portion of the digital sheath and of noncritical annular pulleys usually do not require operative repair.

Two cases of arthroscopic removal of multiple loose bodies are presented. Successful results were achieved, and patients had 4-year follow-up. Both cases involved classic manifestations of synovial chondromatosis. Associated degenerative changes were present in one case; histologic examination could not confirm synovial origin of the disease. Arthroscopy for removal of symptomatic loose bodies is an excellent choice as exemplified by these two cases. Care should be taken to review histologic findings, which may help in understanding the natural history of this type of process.