The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2006
Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy.
Internal rotation contractures due to external rotation weakness secondary to brachial plexus birth palsy frequently lead to glenohumeral deformity and impaired shoulder function. Our surgical approach to treat these contractures relies on arthroscopic release for young children (less than three years old) and combines arthroscopic release with latissimus dorsi transfer for older children. We report the results for the first thirty-three children followed for a minimum of two years after such treatment. ⋯ In children who are younger than three years of age, arthroscopic release effectively restores nearly normal passive external rotation and a centered glenohumeral joint at the time of surgery. In most of these children, external rotation strength is sufficient to maintain this range of motion and to improve glenoid development when preoperative deformity was present. The addition of a latissimus dorsi transfer in older children predictably results in similar improvements. Gains in active elevation are minimal. All children have a loss of internal rotation, which is moderate in most of them but is severe in some.
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J Bone Joint Surg Am · Mar 2006
ReviewUse of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique.
Distal radial fractures with extensive comminution involving the metaphyseal-diaphyseal junction present a major treatment dilemma. Of particular difficulty are those fractures involving the articular surface. One approach is to apply a dorsal 3.5-mm plate extra-articularly from the radius to the third metacarpal, stabilizing the diaphysis and maintaining distraction across the radiocarpal joint. ⋯ The use of a distraction plate combined with reduction of the articular surface and bone-grafting when needed can be an effective technique for treatment of fractures of the distal end of the radius with extensive metaphyseal and diaphyseal comminution. A functional range of motion with minimal disability can be achieved despite a prolonged period of fixation with a distraction plate across the wrist joint.
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Symptomatic lumbar degenerative disc disease is a challenging entity to treat. The results of arthrodesis may be compromised in the short term by pseudarthrosis and in the long term by pain at the iliac-crest donor site and by junctional degeneration. Total disc replacement has the potential to provide long-lasting relief to these patients. The purpose of this study was to present the clinical and radiographic results assessed seven to eleven years following a Prodisc total lumbar disc replacement. ⋯ The Prodisc lumbar total disc replacement appears to be effective and safe for the treatment of symptomatic degenerative disc disease. Gender and multilevel surgery did not affect the outcomes, whereas prior lumbar surgery or an age of less than forty-five years was associated with slightly worse outcomes. Longer follow-up of this cohort of patients and randomized trials comparing disc replacement with arthrodesis are needed.
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J Bone Joint Surg Am · Mar 2006
Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair.
In a previous study, we found that medical comorbidities have a negative effect on preoperative pain, function, and general health status in patients with a chronic rotator cuff tear. In this study, we evaluated the relationship between medical comorbidities and the postoperative outcome of rotator cuff repair. ⋯ Patients with more medical comorbidities have a worse general health status after rotator cuff repair. Interestingly, it also appears that these patients have greater improvement in overall shoulder pain, function, and quality-of-life scores compared with preoperative scores. Therefore, despite a negative effect of comorbidities on outcomes, patients with more comorbidities have greater improvement after the repair, to the point where postoperative shoulder function and pain are not significantly influenced by medical comorbidities. Consequently, a higher number of medical comorbidities should not be considered a negative factor in determining whether a patient should undergo rotator cuff repair.