Journal of the Southern Orthopaedic Association最新文献

The nocebo effect creates negative expectations about symptoms and can have devastating influence on patient recovery. Just as the placebo effect works by making patients believe they will get better, the nocebo effect can serve to make patients worse. Two case histories are presented in which patients were assigned diagnoses without objective physical findings. This resulted in poor outcomes. Physicians should avoid assigning a diagnosis without objective physical evidence and thus avoid creating the nocebo effect in patients.

Congenital dislocation of the knee (CDK) is rare and includes a spectrum of hyperextension disorders of the knee. Early recognition of CDK is important, and careful evaluation is required to rule out associated hip deformity. Early manipulation, combined with splinting and casting, is the mainstay of initial treatment. Patients with seemingly fixed contractures may respond rapidly to serial casting and then can be placed in a Pavlik harness. Severe recalcitrant deformities or late presentation of the deformity may require surgical release. We highlight the importance of diagnostic categorization, show management options, and provide an overview of this rare but clinically significant problem. We present two case reports that illustrate the full range of management options.

Heterotopic ossification after total elbow replacement is a new complication. In this particular case, it resulted in severe limitation of motion. Excision of the heterotopic bone resulted in an excellent functional outcome for the patient.

All wrist arthrodeses done between 1990 and 1996 using a Synthes wrist fusion plate were reviewed. Independent assessment done by a certified hand therapist included a patient survey, standardized Jebsen-Taylor hand function test and activities of daily living test, and a Buck-Gramcko and Lohmann evaluation. We evaluated 13 wrists in 11 patients. Overall satisfaction was 100% of patients (mean follow-up, 31.5 months; range, 13 to 61 months). Mean preoperative and postoperative pain scores improved from 7.2 to 0.8, respectively, and functional scores improved from 5.0 to a postoperative mean value of 7.4. Jebsen-Taylor scores were virtually identical for fused and uninvolved wrists. There were no pseudarthroses, no plate failures, no tendon ruptures, and no significant postoperative infections; there was a single plate removal because of tenuous skin coverage. Short-term results using a comprehensive assessment of a custom plate designed for wrist arthrodesis show promising clinical outcomes.

Twenty-five volunteers had unilateral elbow immobilization for 24 hours in each of two positions of flexion, 45 degrees and 90 degrees . Twenty-two of the 25 volunteers preferred a position of 90 degrees of flexion. Standard functional testing revealed significant limitations in each position of immobilization, confirming that there is no single optimal position of elbow arthrodesis. This study suggests that, for most individuals, 90 degrees is the preferred position of elbow arthrodesis for activities of daily living. However, factors such as age, sex, occupation, and dominance of the extremity should be considered when choosing a position of arthrodesis.

Cancellous bone screws are frequently used to improve the early stability of HA coated acetabular components during total hip arthroplasty. Avoidance of the anterosuperior and anteroinferior quadrants is recommended for transacetabular screw placement to minimize the risk of injury to intrapelvic structures. Revision arthroplasty in rheumatoid patients presents additional hazards in that the acetabular bone is often soft and deficient, and the protective depth of obturator internus and psoas is usually reduced. I report a case of delayed, but fatal, perforation of the bladder associated with a medially placed acetabular screw during revision arthroplasty in a rheumatoid patient. Unless directed safely into the superior pubic ramus, anterior quadrant screws should be avoided in these circumstances.

We describe a patient with a preexisting posttraumatic brachial plexopathy who had a complete high median nerve palsy due to rupture of the pectoralis major to biceps transfer near its distal insertion at the elbow region.

To determine if any factors are associated with knee stiffness after total knee arthroplasty (TKA), we retrospectively reviewed the medical records and radiographs of patients who had knee manipulation after total knee replacement at Scott & White Memorial Hospital from 1983 to 1993. Twenty-five patients who had knee manipulation after TKA were matched by surgeon, year of surgery, and age (+/- 5 years) with a study group of 25 patients who did not have knee manipulation after TKA. Patients in the manipulated group had decreased flexion at the time of discharge from the hospital after the knee arthroplasty and a decreased final flexion. The age of the patient, time from surgery to manipulation, and preoperative flexion did not correlate with final flexion attained in the manipulated group. Relative to the control study group, the manipulated group had an increase in postoperative anteroposterior femoral thickness. A decrease in patellar height was noted both in the manipulated group and in the control nonmanipulated group. There was no significant difference between groups for a change in patellar height.

Review of the literature reveals chronic low back pain has not responded well to conventional medical treatment with medication and surgery. The addition of cognitive-behavioral approaches to complement conventional medicine seems to improve the results and lessens pain in this group of patients.

The purpose of this study was to determine long-term complications of upper-extremity snake envenomations. The records of 73 patients, who were seen for snake bites were obtained; 46 of these patients had bites to the upper extremity, and 27 had bites to the lower extremity. These patients were graded according to the severity of the bite. The snakes involved were eastern diamondback rattlesnake, coral snake, pigmy rattlesnake, water moccasin, and unknown. Fourteen of the 46 patients receiving upper extremity bites were examined by a hand surgeon and an occupational hand therapist 1 to 3.2 years after their bite. Subjective pain data, range-of-motion, intrinsic, extrinsic, finger-flexion tightness, grip strength, pinch strength and objective sensory data were collected. Four patients had continued pain and tissue atrophy at the bite site. There were no long-term sequelae from a missed compartment syndrome.