The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 1993
Randomized Controlled Trial Comparative Study Clinical TrialCarpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.
To define the role of two-portal endoscopic carpal-tunnel release as a method for the treatment of compression of the median nerve at the wrist, a prospective, randomized, multicenter study was performed on 169 hands in 145 patients. Either open or endoscopic carpal-tunnel release was performed in all of the patients who had clinical signs and symptoms consistent with carpal tunnel syndrome, had not responded to or had refused non-operative management, and had had electrodiagnostic studies consistent with carpal tunnel syndrome. Follow-up evaluations were performed at twenty-one, forty-two, and eighty-four days. ⋯ This parameter was not recorded for three hands in the open-release group and six hands in the endoscopic-release group. The open method also resulted in a longer interval until the patient could return to work (median, twenty-eight days, compared with fourteen days for the open-release and endoscopic-release groups). Four complications occurred in the endoscopic carpal-tunnel release group: one partial transection of the superficial palmar arch, one digital-nerve contusion, one ulnar-nerve neuropraxia, and one wound hematoma.(ABSTRACT TRUNCATED AT 400 WORDS)
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J Bone Joint Surg Am · Jul 1993
Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.
Twenty-nine patients who had diabetic neuropathic arthropathy of the foot and ankle were managed with open reduction and arthrodesis of various joints. Rigid internal fixation was used in all but four patients, who had external fixation. All patients had severe instability or a fixed deformity that precluded successful treatment with bracing. ⋯ There were twenty complications in nineteen of the twenty-nine patients, and there were nine pseudarthroses (six tibiocalcaneal, one tibiotalar, and two talonavicular). However, seven of the pseudarthroses were clinically stable. In these patients, the arthrodesis was performed as an alternative to amputation, and salvage was successful in twenty-seven (93 per cent) of the twenty-nine patients.
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A prospective study of sixty-five orthopaedic procedures performed with fluoroscopic assistance was undertaken to determine the risk to the primary orthopaedic surgeon with regard to radiation. Radiation was monitored with the use of a universal film badge placed outside the collar of a lead apron, and a gas-sterilized thermoluminescent dosimeter ring worn on each hand. The rings were changed with every operation, but the same film badge was transferred from surgeon to surgeon. ⋯ The mean duration of the fluoroscopy was 2.3 minutes for the group for which the rings did not show a positive reading and 4.7 minutes for the group for which the rings did show a positive reading. This was a significant difference (p < 0.0001). There was no positive reading for exposure to radiation from any ring that had been worn during a procedure in which the fluoroscope had been used for less than 1.7 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Bone Joint Surg Am · Dec 1992
Pudendal nerve palsy complicating intramedullary nailing of the femur.
A prospective study of 106 patients who had static interlocking nailing of the shaft of the femur was performed to determine the relationship between the duration and magnitude of intraoperative traction and the development of a pudendal nerve palsy. A strain-gauge, mounted in the countertraction post, measured the magnitude of the perineal pressure over time. All nailings were performed with the patient in the supine position. ⋯ The patients in whom a palsy did not develop had been positioned on the fracture-table and the perineal post for an average of 2.6 hours (range, 1.4 to 5.2 hours) compared with an average of 2.8 hours (range, 2.0 to 4.3 hours) for those in whom a palsy did not develop (p = 0.15). The magnitude of the total traction forces averaged 34.9 kilogram-hours for the patients who did not have a palsy compared with 73.3 kilogram-hours for those who did (p < 0.03). Adduction of the hip, as well as manipulations for reduction of the fracture, significantly increased the traction forces.(ABSTRACT TRUNCATED AT 250 WORDS)