The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2009
Comparative StudyTreatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. Surgical technique.
Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft -- a distal radial pedicle graft and a free vascularized medial femoral condyle graft -- in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse. ⋯ A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse.
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J Bone Joint Surg Am · Oct 2009
Vascularized iliac bone-grafting for osteonecrosis with segmental collapse of the femoral head.
Vascularized iliac bone-grafting has been reported to be successful for patients with osteonecrosis of the femoral head. However, its benefit in patients with segmental collapse of the femoral head has not been determined. The purpose of this study was to analyze the results of vascularized iliac grafting in osteonecrotic femoral heads with segmental collapse. ⋯ Vascularized iliac bone-grafting with use of the technique described in this study is not indicated for the treatment of osteonecrotic femoral heads with segmental collapse.
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J Bone Joint Surg Am · Oct 2009
Comparative StudyThe effect of postoperative passive motion on rotator cuff healing in a rat model.
Surgical repairs of torn rotator cuff tendons frequently fail. Immobilization has been shown to improve tissue mechanical properties in an animal model of rotator cuff repair, and passive motion has been shown to improve joint mechanics in animal models of flexor tendon repair. Our objective was to determine if daily passive motion would improve joint mechanics in comparison with continuous immobilization in a rat rotator cuff repair model. We hypothesized that daily passive motion would result in improved passive shoulder joint mechanics in comparison with continuous immobilization initially and that there would be no differences in passive joint mechanics or insertion site mechanical properties after four weeks of remobilization. ⋯ In this model, immediate postoperative passive motion was found to be detrimental to passive shoulder mechanics. We speculate that passive motion results in increased scar formation in the subacromial space, thereby resulting in decreased range of motion and increased joint stiffness. Passive motion had no effect on collagen organization or tendon mechanical properties measured six weeks after surgery.
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J Bone Joint Surg Am · Oct 2009
Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures.
In patients managed with plate fixation for the treatment of an olecranon fracture, the placement of an axial intramedullary screw may obstruct the placement of bicortical screws in the ulnar shaft. To overcome this problem, unicortical screws can be applied with use of a contoured locking compression plate. The present study was designed to assess the effectiveness of this fixation method. ⋯ In the treatment of comminuted olecranon fractures, a contoured locking compression plate combined with an intramedullary screw provides sufficient stability for early postoperative functional rehabilitation, with an excellent fracture union rate and very good clinical outcomes.
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J Bone Joint Surg Am · Oct 2009
Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.
Adductor dysfunction can cause groin pain in athletes and may emanate from the adductor enthesis. Adductor enthesopathy may be visualized with magnetic resonance imaging and may be treated with entheseal pubic cleft injections. We have previously reported that pubic cleft injections can provide predictable pain relief at one year in competitive athletes who have no evidence of enthesopathy on magnetic resonance imaging and immediate relief only in patients with findings of enthesopathy on magnetic resonance imaging. In this follow-up study, we attempted to determine if the same holds true for recreational athletes. ⋯ Most recreational athletes with adductor enthesopathy have pain relief at one year after entheseal pubic cleft injection, regardless of the findings on magnetic resonance imaging. There were similarities between this group of recreational athletes and the competitive athletes in our previous study, in that the adductor enthesis was the source of pain and entheseal pubic cleft injection was a valuable treatment option. The main difference was that, in this group of recreational athletes, magnetic resonance imaging evidence of adductor enthesopathy did not correlate with the outcome of the injection.