The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Aug 1999
Comparative StudyIntra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation.
There is no consensus that an arthroscopically guided operation can improve the anatomical and functional results of treatment of intra-articular fractures of the distal aspect of the radius. The purpose of the present prospective study was to determine the usefulness of arthroscopically assisted reduction of displaced intra-articular fractures of the distal aspect of the radius by comparing the results of that procedure with those of conventional open reduction and internal fixation. ⋯ An arthroscopically guided operation achieved an accurate reduction of intra-articular fractures of the distal aspect of the radius. Minimum capsular and adjacent soft-tissue scarring reduced postoperative contracture, which improved the overall functional results. We recommend arthroscopically guided reduction and internal fixation not only for young adults but for all patients who are less than seventy years old and have an intra-articular fracture of the distal part of the radius with more than one millimeter of displacement on plain radiographs.
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J Bone Joint Surg Am · Aug 1999
Pathophysiological effect of fat embolism in a canine model of pulmonary contusion.
The objective of this study was to determine the individual and combined effects of pulmonary contusion and fat embolism on the hemodynamics and pulmonary pathophysiology in a canine model of acute traumatic pulmonary injury. ⋯ Pulmonary contusion alone caused a significant increase in the alveolar-arterial oxygen gradient but only after seven hours (p = 0.034). Fat embolism alone caused a significant transient decrease in systolic blood pressure (p = 0.001) and a significant transient increase in pulmonary arterial pressure (p = 0.01) and pulmonary capillary wedge pressure (p = 0.015). Fat embolism alone also caused a significant sustained decrease in the ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration (p = 0.0001) and a significant increase in the alveolar-arterial oxygen gradient (p = 0.0001). The combination of pulmonary contusion and fat embolism caused a significant transient increase in pulmonary capillary wedge pressure (p = 0.0013) as well as a significant sustained decrease in partial pressure of arterial oxygen (p = 0.0001) and a significant decrease in systolic blood pressure (p = 0.001) that lasted for an hour. Pulmonary contusion followed by fat embolism caused a significant increase in peak airway pressure (p = 0.015), alveolar-arterial oxygen gradient (p = 0.0001), and pulmonary arterial pressure (p = 0.01), and these effects persisted for five hours. Total thoracic compliance was decreased 6.4 percent by pulmonary contusion alone, 4.6 percent by fat embolism alone, and 23.5 percent by pulmonary contusion followed by fat embolism. The ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration was decreased 23.7 percent by pulmonary contusion alone, 52.3 percent by fat embolism alone, and 65.8 percent by pulmonary contusion followed by fat embolism. The mean pulmonary edema score was significantly higher with the combined injury than with either injury alone (p = 0.0001). None of the samples from the lungs demonstrated inflammation. Fat embolism combined with pulmonary contusion resulted in a significantly greater mean percentage of the area occupied by fat in the noncontused right lung than in the contused left lung (p = 0.001); however, no significant difference between the right and left lungs could be detected with fat embolism alone. The mean percentage of the glomerular and cerebral areas occupied by fat was greater with fat embolism combined with pulmonary contusion than with fat embolism alone (p = 0.0001 and p = 0.01, respectively). (ABSTRACT TRUNCATED)
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J Bone Joint Surg Am · Aug 1999
Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty.
Nonunion after a periprosthetic femoral fracture associated with total hip arthroplasty occurs rarely. There is little information, to our knowledge, regarding the prevalence of this complication, its treatment, and the functional outcomes of treatment. The purpose of this study was to identify the patterns and frequency of nonunions of femoral fractures around total hip prostheses and to evaluate the results and problems associated with treatment of this complication in a consecutive series of patients. ⋯ Nonunion of a femoral fracture associated with a total hip prosthesis is an infrequent problem. Treatment is difficult, with a high rate of complications and relatively poor functional outcomes. The data from this series must be interpreted with caution, as patients were managed over a period of three decades and many did not have the advantage of modern techniques of revision hip arthroplasty. Prevention of nonunion by optimum treatment of the initial fracture is most important. Treatment of a femoral nonunion about a total hip implant should be implemented on the basis of the status of the fixation of the prosthesis and the quality of the surrounding bone.