The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Mar 2011
Distribution and progression of chondrocyte damage in a whole-organ model of human ankle intra-articular fracture.
Despite the best current treatments, intra-articular fractures commonly cause posttraumatic osteoarthritis. In this disorder, death and dysfunction of chondrocytes associated with acute cartilage injury presumably plays an important role in triggering the pathomechanical cascade that eventually leads to whole-joint degeneration. Information regarding this cell-level cartilage injury, particularly at the whole-organ level in actual human joints, has been lacking. In this study, the distribution and progression of fracture-associated cell-level cartilage damage were assessed using a novel whole-organ model of human ankle intra-articular fracture. ⋯ Progressive chondrocyte damage along fracture lines appears to be a reasonable target of therapeutic treatment to preserve the whole-joint cartilage metabolism in intra-articular fractures, eventually to mitigate the risk of posttraumatic osteoarthritis.
-
J Bone Joint Surg Am · Mar 2011
Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia.
The purpose of this retrospective study was to analyze the functional and radiographic results of cementless, modular total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients who had had Crowe Group-IV developmental dysplasia of the hip as a child. ⋯ Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · Mar 2011
Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.
The etiology of shoulder and elbow contractures following neonatal brachial plexus injury is incompletely understood. With use of a mouse model, the current study tests the novel hypothesis that reduced growth of denervated muscle contributes to contractures following neonatal brachial plexus injury. ⋯ Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis muscle, which correlates with internal rotation contracture of the shoulder. Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture. Impaired muscle growth cannot be explained solely by absence of functioning satellite cells.
-
J Bone Joint Surg Am · Mar 2011
Randomized Controlled Trial Comparative StudyComparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial.
We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.
-
J Bone Joint Surg Am · Mar 2011
Comparative StudyA comparison of five treatment protocols for contaminated bone grafts in reference to sterility and cell viability.
Occasionally, a bone graft or comminuted fracture fragment is dropped on the operating-room floor and becomes contaminated. The purpose of this study was to determine an optimal method for sterilizing this bone with the minimum sacrifice of cell viability. ⋯ Of the easily accessible protocols studied, mechanical agitation and serial washes of bone graft in povidone-iodine that is allowed to dry offers the best balance between complete sterilization of contaminated bone and maintenance of tissue viability.