Contemporary orthopaedics最新文献

A safe single-portal technique for performing endoscopic carpal tunnel release is described. The procedure can be done using equipment already available in any standard operating room. Evaluation of 100 cases done by the author using this method has shown encouraging results.

A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique.

The use of the sitting position for performing shoulder surgery is not a new concept. However, a standard surgical table cannot be readily converted for shoulder surgery without extensive and expensive modifications. A modular insert is described that is inexpensive and can easily be built for use in converting, in less than one minute, a standard surgical table into a table for performing shoulder surgery.

A clinical trial is reported that was conducted in an attempt to establish a timeframe for replacement of tricalcium phosphate by bone. In 20 cases, an 8.5mm by 3mm disc of tricalcium phosphate was implanted into the cut surface of the tibia at the time of total knee replacement. When followed radiographically, the disc of tricalcium phosphate generally could not be identified at six months. At two years, no untoward effects have occurred and no vestigial shadows remain, indicating that the block has fully incorporated and largely been absorbed and replaced by host bone. The experience in this series of cases indicates that tricalcium phosphate is a useful resorbable bone filler material.

Although there is a potential hospital cost savings in reusing Ilizarov frame components, such reuse must be carefully considered in view of the deterioration of the parts during clinical use. A study is presented that addresses this issue through examination of clinically removed frames, laboratory testing, and engineering calculations.

A critical step in closed interlocking intramedullary nailing is the insertion of the proximal and distal screws under fluoroscopic control. An intramedullary nailing system is described that does not require the use of direct fluoroscopic control for distal screw insertion. With the SG interlocking intramedullary nail, the location and fixation of the distal screw is achieved by keying in on a transversely placed guide pin, with imaging required only to confirm the alignment and final placement of the instrumentation.

The method and results of preoperative templating for the re-establishment of leg length equality during total hip replacement (THR) are reported. The method is a modification of the technique of Müller and requires an anteroposterior radiograph of the pelvis that includes the proximal third of both femora, appropriate acetabular and femoral templates, and tracing paper. To obtain equalization of leg lengths and tissue tension, a composite drawing is made of the operative plan, with all component sizes and important measurements clearly marked. During THR, the lesser trochanter is identified and the femoral neck is osteotomized after a direct measurement is made. These principles were followed in a prospective, consecutive series of 42 primary THR procedures performed by one surgeon. All the radiographic measurements were performed by a single observer. The leg length discrepancy on the postoperative radiograph averaged 3mm (standard deviation = 3mm, range: -9 to +9mm). The postoperative clinical leg length discrepancy averaged 0mm (range: -10 to +10mm). None of the patients complained of leg length inequality. Preoperative templating allows different alternatives to be traced on paper prior to the actual surgical procedure. This method also helps determine the requirements for special prosthetic implants. Acceptable results for postoperative leg length equality may be reliably achieved using this method.

In a multicenter clinical trial, the efficacy and usefulness of the BPAA Patch in the treatment of extremity trauma were evaluated in 64 patients and the safety was tested in 70 patients. In 89.1% of the patients studied, the final overall improvement was rated "moderate" or better, and no adverse reactions were reported. The results of this study indicate that the BPAA Patch is a highly useful topical antiinflammatory-analgesic agent for use in the treatment of pain and inflammatory symptoms following trauma.