Contemporary orthopaedics最新文献

A series of 31 adult patients less than 42 years of age who were treated for avascular necrosis (AVN) following a healed femoral neck fracture were followed for an average of 14.6 years, and the results of their treatment were analyzed. The average age at fracture was 26.3 years (range: 12.2 to 41.4 years). The mechanism of injury was a motor vehicle accident in 18 and a fall in 13. Sixteen patients had multiple injuries. The average time from fracture to diagnosis of AVN was 19.1 months. The management of AVN included one or a combination of the following: non-weightbearing ambulation, decompression and bone grafting, electrical stimulation, femoral osteotomy, cup arthroplasty, resurface arthroplasty, arthrodesis, hemiarthroplasty, and total hip arthroplasty (THA). The average number of hip operations after initial fracture treatment was 2.9 per patient (range: 0-7). Current follow-up was possible in 97% (30 out of 31) of the patients. THA was performed either primarily or following other treatment in 23 patients at an average age of 31.9 years (range: 16.9-55.3 years). The survivorship of these THAs was 89% at five years and 49% at ten years. Revisions have been done for aseptic loosening of cemented components with the exception of two infections and one loose metal-on-metal press-fit THA. The results of this study indicate that total hip arthroplasty has a high long-term failure rate in this population, and alternate treatment should be considered in order to improve the long-term results.

An undertreated group has emerged in modern orthopaedic surgery--patients with degenerative disease of the medial compartment of the knee who are young and active, who may have undergone multiple arthroscopic procedures, and who have been advised to "take it easy and wait for a total knee replacement." If the knee is in varus, unilateral frame distraction with upper tibial corticotomy is advocated to achieve valgus alignment. The procedure is straightforward, with few complications in our first 100 cases, with almost universal success. Even if it is believed that all tibial osteotomies will eventually fail and require a total knee replacement, this method, by which bone stock is actually enhanced, length is maintained, and the ligamentous structures about the knee are undamaged, is superior to methods previously described.

Traumatic radial head dislocation without an associated fracture is an unusual injury in children. Occasionally, the diagnosis is missed or the injury is not treated acutely, leading to chronic radial head dislocation. The recommended treatment has been controversial, ranging from benign neglect to surgical reconstruction. This case report and review of the literature describes treatment indications and options, as well as potential risks and benefits for conservative and surgical approaches.

In a series of 1236 patients who underwent endoscopic carpal tunnel releases using the two-portal Brown technique, the results were favorable in 98%, the failure rate was 2%, the instance of iatrogenic injury was 0.08% (one tendon injury), and the overall complication rate was 0.97%. The patients had resolution of carpal tunnel syndrome symptoms in an average of 14 days and returned to work in an average of 15 days. Recurrence rate to date has been 2%, with the longest follow-up of 30 months. These results indicate that this is a safe and efficacious method of treatment for patients with carpal tunnel syndrome who require surgery.

Quantitative digital radiography (QDR) was used to assess the ability of physicians to determine bone mineral density (BMD) loss from a series of plain radiographs. Twenty-four spinal cord injured patients underwent QDR of the left knee. Seven of the 24 were selected, each of whom had bone mineral loss from 10-70% in 10% increments as assessed by comparison to average BMD of age-matched controls, and a standardized AP radiograph of the left knee was performed. Twenty-five independent examiners (orthopaedic surgeons and residents) were then asked to view the randomly arranged radiographs and visually determine the amount of BMD loss for each radiograph as compared to a control radiograph at 100%. Chi square analysis of the data revealed that the distribution of responses was significantly different than expected at the p less than .01 level. Taking into account that responses may have erred by +/-10%, the distribution of responses was again found to be significant at the p less than .01 level. An accurate determination of BMD loss was achieved only at 10% bone loss and 70% bone loss. The results of this study suggest that the visual determination of bone loss based on plain radiographs is accurate only at very low or very high levels of bone loss. Using standardized techniques, only near normal radiographs or radiographs with at least 70% BMD loss can be assessed accurately.