The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2011
Variations in the anatomic relations of the posterior interosseous nerve associated with proximal forearm trauma.
The posterior interosseous nerve is at risk for iatrogenic injury during surgery involving the proximal aspect of the radius. Anatomic relationships of this nerve in skeletally intact cadavers have been defined, but variations associated with osseous and soft-tissue trauma have not been examined. This study quantifies the effect of a simulated diaphyseal fracture of the proximal aspect of the radius and of a radial neck fracture with an Essex-Lopresti injury on the posterior interosseous nerve. ⋯ Forearm pronation has minimal effect on posterior interosseous nerve position within the surgical window following a displaced diaphyseal osteotomy of the proximal aspect of the radius. The nerve migrates proximally toward the capitellum with proximal migration of the radius in all forearm positions following a simulated Essex-Lopresti lesion. Visualization and protection of the posterior interosseous nerve is recommended when operatively exposing the traumatized proximal aspect of the radius.
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J Bone Joint Surg Am · Jan 2011
Segmental lumbar rotation in patients with discogenic low back pain during functional weight-bearing activities.
Little information is available on vertebral motion in patients with discogenic low back pain under physiological conditions. We previously validated a combined dual fluoroscopic and magnetic resonance imaging system to investigate in vivo lumbar kinematics. The purpose of the present study was to characterize mechanical dysfunction among patients with confirmed discogenic low back pain, relative to asymptomatic controls without degenerative disc disease, by quantifying abnormal vertebral motion. ⋯ The greatest range of motion in patients with discogenic back pain was observed at L3-L4; this motion was greater than that in normal subjects, suggesting that superior adjacent levels developed segmental hypermobility prior to undergoing fusion. L5-S1 had the least motion, suggesting that segmental hypomobility ensues at this level in patients with discogenic low back pain.
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J Bone Joint Surg Am · Jan 2011
Comparative StudyComparison of CT and MRI for diagnosis of suspected scaphoid fractures.
There is no consensus on the optimum imaging method to use to confirm the diagnosis of true scaphoid fractures among patients with suspected scaphoid fractures. This study tested the null hypothesis that computed tomography (CT) and magnetic resonance imaging (MRI) have the same diagnostic performance characteristics for the diagnosis of scaphoid fractures. ⋯ CT and MRI had comparable diagnostic characteristics. Both were better at excluding scaphoid fractures than they were at confirming them, and both were subject to false-positive and false-negative interpretations. The best reference standard is debatable, but it is now unclear whether or not bone edema on MRI and small unicortical lines on CT represent a true fracture.
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J Bone Joint Surg Am · Dec 2010
Treatment of slipped capital femoral epiphysis with a modified Dunn procedure.
Surgical procedures with use of traditional techniques to reposition the proximal femoral epiphysis in the treatment of slipped capital femoral epiphysis are associated with a high rate of femoral head osteonecrosis. Therefore, most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal part of the femur. This residual deformity can lead to secondary osteoarthritis resulting from femoroacetabular cam impingement. ⋯ The treatment of slipped capital femoral epiphysis with the modified Dunn procedure allows the restoration of more normal proximal femoral anatomy by complete correction of the slip angle, such that probability of secondary osteoarthritis and femoroacetabular cam impingement may be minimized. The complication rate from this procedure in our series was low, even in the treatment of unstable slipped capital femoral epiphysis, compared with alternative procedures described in the literature for fixation of slipped capital femoral epiphysis.
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J Bone Joint Surg Am · Dec 2010
Comparative StudyPain and function in patients after primary unicompartmental and total knee arthroplasty.
Unicompartmental knee arthroplasty has received renewed interest; however, its short-term advantages over total knee arthroplasty should be weighed against a higher risk of reoperation. Information regarding pain and function after unicompartmental and total knee arthroplasty is therefore needed. ⋯ We found only small or no differences in pain and function between the scores, at least two years following surgery, of patients who underwent unicompartmental knee arthroplasty and those of patients who underwent total knee arthroplasty; however, patients with unicompartmental knee implants had fewer problems with activities that involved bending the knee.