The Journal of bone and joint surgery. American volume
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Twenty-three children who were treated for rotatory atlanto-axial subluxation between 1975 and 1986 were retrospectively studied. The success of closed reduction with traction and the length of hospitalization were related to the duration of symptoms before admission. ⋯ Of the seven remaining children, who were seen more than one month after the onset of symptoms, three eventually needed a posterior atlanto-axial arthrodesis. Dynamic computed-tomography scans, with the head rotated maximally to each side, were made for five children, and proved to be an excellent method of documenting the presence of rotatory atlanto-axial subluxation.
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Fifty-nine fresh osteochondral allografts were consecutively transplanted into the knees of fifty-eight patients. The preoperative diagnoses were chondromalacia or degenerative arthritis of the patella, osteochondritis dissecans, a traumatic defect or osteonecrosis of the femoral condyle, a painful healed depressed fracture or traumatic defect of the tibial plateau, and unicompartmental traumatic arthritis of the knee. All of the patients had disabling pain after the failure of previous attempts to correct the problem surgically. ⋯ The result was rated excellent after thirteen of the successful transplants, good after fourteen, and fair after four. Transplantation of a fresh osteochondral allograft proved to be a satisfactory intermediate procedure for the treatment of the disabling conditions, except unicompartmental traumatic arthritis, in the young patients in this series. For the patients who had unicompartmental traumatic arthritis, the rate of success was only 30 per cent.
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J Bone Joint Surg Am · Jun 1989
One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.
We reviewed the results of primary operative treatment in twenty-five patients (thirty-three hips) who were two years or older and had congenital dislocation of the hip. None of the patients had had previous treatment for the dislocation. Preliminary traction was not used in any patient. ⋯ According to the rating system of Ferguson and Howorth, there were seventeen excellent, seven good, and three fair results; one hip had a poor result. It was concluded that children who are two years or older and who have a congenital dislocation of the hip can safely be treated with an extensive one-stage operation consisting of open reduction combined with femoral shortening and, often, pelvic osteotomy, without increasing the risk of avascular necrosis. The limb-length discrepancy that is produced by the shortening does not appear to cause a clinical problem.
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J Bone Joint Surg Am · Jun 1989
Measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome.
In forty-six patients who had carpal tunnel syndrome, a technique of continuous infusion, given under local anesthesia and without a pneumatic tourniquet, was used to measure pressures in the carpal canal before and after endoscopic release of the transverse carpal ligament (retinaculum flexorum manus). Pressures were similarly measured in sixteen subjects in a control group. ⋯ The mean pressures improved significantly postoperatively and were in the range of values that were found under each condition for the control group. Measurement of pressure in the carpal canal before and after operation may be useful in diagnosing carpal tunnel syndrome and in determining the effectiveness of endoscopic management.