The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialAnterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study.
The purpose of this investigation was to evaluate replacement of a torn anterior cruciate ligament with either a bone-patellar tendon-bone autograft or a two-strand semitendinosus-gracilis autograft to compare the results of clinical testing, patient satisfaction, activity level, functional status, and muscle strength. ⋯ After three years of follow-up, the objective results of anterior cruciate ligament replacement with a bone-patellar tendon-bone autograft were superior to those of replacement with a two-strand semitendinosus-gracilis graft with regard to knee laxity, pivot-shift grade, and strength of the knee flexor muscles. However, the two groups had comparable results in terms of patient satisfaction, activity level, and knee function.
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J Bone Joint Surg Am · Sep 2002
Comparative StudyComparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less.
Subcapital hip fractures in younger patients are generally treated with internal fixation rather than with primary hemiarthroplasty, which is generally reserved for older, low-demand patients. Avascular necrosis can occur following this injury because of disruption of the femoral head blood supply. Some believe that emergent fracture reduction is necessary to minimize the risk of avascular necrosis. The purposes of this study were (1) to investigate the functional outcomes of subcapital hip fractures in patients sixty years old or younger and (2) to compare the rates of avascular necrosis after early and delayed fracture fixation. ⋯ Although delayed surgical treatment of subcapital hip fractures was associated with a higher rate of avascular necrosis, this complication did not significantly affect functional outcome. Longer follow-up is required to assess the effect of avascular necrosis on the development of arthritis and on long-term patient function. Although the results could be biased because patients were not randomly assigned to delayed or early fixation, the data suggest that urgent reduction and fracture fixation within twelve hours after a displaced subcapital hip fracture in high-demand patients may be associated with a reduced rate of radiographic signs of avascular necrosis.
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J Bone Joint Surg Am · Sep 2002
Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation.
Periprosthetic fractures are among the most challenging complications of elbow arthroplasty, and published information about the outcome of treatment is limited. The purpose of the present study was to determine the results of implant revision and strut allograft augmentation for the treatment of humeral periprosthetic fractures that occur around a loose humeral component. ⋯ Periprosthetic humeral fractures that are associated with a loose humeral component can be effectively treated with revision elbow arthroplasty and strut allograft augmentation. The technique is associated with a high rate of fracture union, implant survival, and satisfactory clinical results. However, the complication rate is substantial.
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J Bone Joint Surg Am · Sep 2002
High-energy fractures of the tibial plateau. Knee function after longer follow-up.
Studies of the long-term outcomes of treatment of fractures of the tibial plateau have included wide mixtures of fracture types and mostly low-energy split and split-depression fractures. The long-term results of treatment of high-energy intra-articular proximal tibial fractures are unknown. The purpose of this study was to assess the function of the knee and the development of arthrosis at a minimum of five years after injury in a consecutive series of patients in whom a high-energy fracture of the tibial plateau had been treated with a uniform technique of external fixation. ⋯ Patients with a high-energy fracture of the tibial plateau treated with external fixation have a good prognosis for satisfactory knee function in the second five years after injury. The knee joint cartilage appears to be tolerant of both the injury and mild-to-moderate residual articular displacement, which was associated with a low rate of severe arthrosis.