The Journal of bone and joint surgery. American volume
-
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.
-
J Bone Joint Surg Am · Mar 2011
Are dropped osteoarticular bone fragments safely reimplantable in vivo?
There are limited data detailing the appropriate management of nondisposable autologous osteoarticular fragments that have been contaminated by the operating room floor. The goal of the present study was to perform a comprehensive, three-phase investigation to establish an appropriate intraoperative algorithm for the management of the acutely contaminated, but nondisposable, autologous osteoarticular bone fragment. ⋯ The majority of osteochondral fragments that contact the operating room floor produce positive bacterial cultures. Five minutes of cleansing with a 10% povidone-iodine solution followed by a normal saline solution rinse appears to provide the optimal balance between effective decontamination and cellular toxicity for dropped autologous bone in the operative setting.
-
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
Concomitant arthroscopic SLAP and rotator cuff repair: surgical technique.
The outcomes of combined arthroscopic repairs of a SLAP (superior labral anterior-posterior) lesion and a rotator cuff tear are not known. We compared the outcomes in a cohort of patients who had undergone concomitant arthroscopic repairs of a SLAP lesion and a rotator cuff tear with those in a cohort of patients with a stable biceps anchor who had undergone an isolated rotator cuff repair. We hypothesized that the results would be similar between the two cohorts with respect to the range of motion and preoperative and postoperative function. ⋯ Controversy surrounds the treatment of a SLAP lesion with concomitant treatment of a full-thickness rotator cuff tear. This study suggests that, in middle-aged patients, the results of combined SLAP lesion and rotator cuff repair can be comparable with those achieved with rotator cuff repair alone.
-
J Bone Joint Surg Am · Mar 2011
Internal fixation of type-C distal femoral fractures in osteoporotic bone: surgical technique.
Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. ⋯ The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four-screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four-screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability.