Contemporary orthopaedics最新文献

Arthrodesis of the wrist with intramedullary rod fixation is a simple technique that provides the opportunity for performing concomitant procedures. Iliac bone graft usually is not required with this technique, as the intramedullary rod is a load-sharing construct that allows compression at the fusion site and facilitates union. Rod removal usually is optional, and the long intramedullary beam effect of the rod can function as an internal splint if fibrous or hypoplastic union occurs. Early mobilization is possible, sometimes with only minimal splinting. The results with use of this technique over a ten year period of time in ten wrists (nine patients) with endstage radiocarpal joint instability are reported.

The incidence of red blood cell transfusion is reviewed in a series of 130 elective total hip arthroplasties performed over a four-year period. A significant downward trend was noted in the hemoglobin level at which patients were transfused (p less than 0.01). Conversely, no significant differences were noted in the rate of rehabilitation, the length of hospitalization, or the incidence of complications. In addition, patients who predonated autologous blood were transfused at a higher rate than those who did not (p less than 0.001), but they received less homologous blood than patients who had not predonated.

A prospective, nonrandomized study was conducted in an attempt to determine if the addition of a stem to the tibial component in noncemented total knee replacement reduces the incidence of sinkage. A stemmed tibial component was used in 125 cases and an identical artificial knee without a stem was used in 307 cases. Follow-up was two to six years. Sinkage occurred in 0.8% of the cases with stemmed tibial components and in 3.5% of the nonstemmed tibial components, among which two (0.8%) required revision. The clinical results for both groups were similar. A small group of 34 patients who had a stemmed tibial component on one side and a nonstemmed component on the other also were examined. Fifty percent of these patients preferred the stemmed component knee. The results of these studies suggest that the addition of a stem to the tibial component in noncemented total knee replacement is of value in preventing tibial sinkage.

Recently, questions have been raised concerning the stability and biocompatibility of metallic orthopaedic implants. Concerns have been expressed regarding cobalt-based alloys and the possibility of a future realization of a gross carcinogenic reaction from chrome-cobalt alloy implants. In this report, selected issues are reviewed and categorized for independent analysis to stimulate more comprehensive future research and theory formulation. Issues examined include those relating to metallic corrosion and potential local and systemic carcinogenic effects. The ionic valences of constituent materials, the electrochemical properties of the implant, and the proposed pathophysiological pathway of ions reportedly released from implants are traced. Tables listing 20 cases of primary neoplasia associated with total joint arthroplasty and seven cases reported in a 1975 study are discussed, compared, and contrasted. Finally, a selected bibliography is provided as a foundation for future study and research. In the author's opinion, the 50-year clinical experience and history of the use of cobalt-chromium as an implant material in orthopaedics, dentistry, and plastic surgery more than adequately establish its safety and effectiveness.

The risks associated with homologous blood transfusions include hepatitis, transfusion reactions, and AIDS. Intraoperative and postoperative red blood cell salvage and reinfusion are techniques available to decrease the need for homologous transfusions. In this article the techniques of red blood cell salvage are described and the benefits and potential risks of these methods are discussed.

An introductory overview of wrist arthroscopy is presented. The relevant anatomy and pathology of the wrist are reviewed, with special emphasis on the triangular fibrocartilage complex. Operative technique and equipment are described, and operative indications are presented. The role of diagnostic arthroscopy is discussed and comparison is made to arthrography in terms of diagnostic efficacy. Some future directions for wrist arthroscopy are presented.

Proximal interphalangeal (PIP) joint fracture-subluxations represent a small component of hyperextension injuries to the finger. Six unstable PIP fracture-subluxations that were not amenable to nonoperative treatment underwent open reduction and internal fixation. Among the patients, the technique of open reduction and internal fixation with temporary transarticular K-wire fixation and early protected range of motion has been found to result in a good range of motion with minimal complaints on follow-up.

It is possible to use a noncemented porous metal-backed acetabular component with an outer diameter as small as 39mm with safety. A two to three year follow-up of the first 40 cases in which this type of acetabular component was used has revealed no particular problems. These small acetabular components have considerably reduced the necessity for acetabular bone grafting in patients with hip dysplasia.