The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2007
Comparative StudyHallux valgus and first ray mobility. A prospective study.
There have been few prospective studies that have documented the outcome of surgical treatment of hallux valgus deformities. The purpose of this investigation was to evaluate the effect of operative treatment of hallux valgus with use of a proximal crescentic osteotomy and distal soft-tissue repair on the first metatarsophalangeal joint. ⋯ A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated hallux valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane.
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J Bone Joint Surg Am · Sep 2007
Locking compression plate fixation of Vancouver type-B1 periprosthetic femoral fractures.
Fractures occurring at or near the distal tip of a hip prosthesis with a stable femoral stem (Vancouver type-B fractures) are associated with many complications because of the inherently unstable fracture pattern. Locking compression plates use screws that lock into the plate allowing multiple points of unicortical fixation. Such unicortical fixation may lower the risk of damage to the cement mantle or a stable femoral stem during the treatment of a periprosthetic femoral fracture. The purpose of this study was to analyze clinically and radiographically a group of patients with a Vancouver type-B1 periprosthetic femoral fracture treated with open reduction and internal fixation with use of a locking compression plate. ⋯ On the basis of the high failure rate in this series of patients, locking compression plates do not appear to offer advantages over other types of plates in the treatment of type-B1 periprosthetic femoral fractures. Despite the potential to preserve the cement mantle, the locked screws did not appear to offer good pullout resistance in this fracture type. We believe that supplementation with strut allografts should be used routinely if this type of locking compression plate is selected to treat these fractures.
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J Bone Joint Surg Am · Sep 2007
Clinical and structural outcomes of nonoperative management of massive rotator cuff tears.
The natural history of massive rotator cuff tears is not well known. The purpose of this study was to determine the clinical and structural mid-term outcomes in a series of nonoperatively managed massive rotator cuff tears. ⋯ Patients with a nonoperatively managed, moderately symptomatic massive rotator cuff tear can maintain satisfactory shoulder function for at least four years despite significant progression of degenerative structural joint changes. There is a risk of a reparable tear progressing to an irreparable tear within four years.
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While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. ⋯ The medial knee ligament structures have a consistent attachment pattern.
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J Bone Joint Surg Am · Sep 2007
Comparative StudyRemoval of painful orthopaedic implants after fracture union.
Persistent pain in the region of implanted hardware following fracture fixation commonly leads to implant removal. This prospective study evaluated patient outcomes and pain reduction following removal of orthopaedic hardware implanted for fracture fixation. ⋯ Following fracture-healing, removal of hardware is safe with minimal risk. Improvement in pain relief and function can be expected.