The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 1989
Wedge resection of the symphysis pubis for the treatment of osteitis pubis.
Ten patients had a wedge resection of the symphysis pubis for the treatment of symptoms of osteitis pubis that had been recalcitrant to non-operative treatment for at least six months. Preoperatively, the average duration of symptoms was thirty-two months. The symptoms included a waddling gait and crepitus, pain, and tenderness over the symphysis pubis. ⋯ At an average of fourteen months postoperatively, all of the patients had marked improvement and were fully active. However, at an average of ninety-two months postoperatively, three of the ten patients were not satisfied with the result. One patient needed bilateral sacro-iliac arthrodesis for pain that was caused by instability.
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J Bone Joint Surg Am · Jan 1989
Case ReportsEmergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous.
In ten children who were less than seven years old, an unstable injury of the cervical spine was found to have anterior angulation or translation, or both, on initial lateral radiographs that were made with the child supine on a standard flat backboard. In all ten patients, extension was the proper position for reduction of the injury of the cervical spine. Young children have a large head in comparison with the rest of the body. ⋯ When they lie supine, the neck is flexed. To prevent undesirable cervical flexion in young children during emergency transport and radiography, a standard backboard can be modified to provide safer alignment of the cervical spine. This can be accomplished by the use of a recess for the occiput to lower the head or of a double mattress pad to raise the chest.
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J Bone Joint Surg Am · Jan 1989
Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis.
Seventy-four patients who had deformity of the spine secondary to a neuromuscular disorder were treated using posterior fusion with Luque-rod segmental instrumentation. The mean curve was 73 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 4 degrees at an average duration of follow-up of forty-two months (range, 2.0 to 7.3 years). ⋯ Failure of instrumentation occurred more frequently with 3/16-inch (4.8-millimeter) diameter than with 1/4-inch (6.4-millimeter) diameter stainless-steel rods. There was a tendency for cephalad progression of deformity when the fusion ended cephalad at or below the fourth thoracic vertebra. We concluded that Luque-rod segmental instrumentation with posterior spinal fusion is an effective treatment for patients who have neuromuscular scoliosis.
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J Bone Joint Surg Am · Dec 1988
Intramedullary nailing of femoral shaft fractures. Part II: Fracture-healing with static interlocking fixation.
A consecutive, prospective series of ninety-seven patients who had 100 fractures of the femoral shaft that were treated with static interlocking nailing was analyzed to determine the incidence of union of the fracture without planned conversion from static to dynamic intramedullary fixation as a technique to stimulate healing of the fracture. Eighty-four patients (eighty-seven fractures) were studied through union of the fracture (average follow-up, fourteen months). Eighty-five (98 per cent) of the eighty-seven fractures healed with static interlocking fixation. ⋯ No deformation or failure of the static interlocking device developed after early walking with weight-bearing, but fatigue failure of one nail occurred in a non-ambulatory patient who had an intracranial injury. Pain related to soft-tissue irritation by the prominent heads of the interlocking screws, clinically presenting as bursitis or snapping of the iliotibial band, was severe enough in six patients to necessitate removal of either the proximal or the distal screw after union of the fracture. We concluded that static interlocking of intramedullary nails in femoral shaft fractures does not appreciably inhibit the process of healing of the fracture, and that routine conversion to dynamic intramedullary fixation, although occasionally necessary, need not be performed.
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J Bone Joint Surg Am · Dec 1988
Intramedullary nailing of femoral shaft fractures. Part I: Decision-making errors with interlocking fixation.
Dynamic intramedullary fixation depends on the configuration of the fracture for postoperative stability. Unanticipated loss of reduction of the fracture after dynamic intramedullary nailing of the femur may result from errors in surgical decision-making, specifically the failure to insert both proximal and distal interlocking screws. Of 133 dynamic femoral intramedullary nailings that were performed after interlocking techniques became routinely available, fourteen (10.5 per cent) were complicated by loss of postoperative fixation and reduction. ⋯ Any increase in comminution of the fracture that occurs with reaming of the canal or insertion of the nail is an indication for static interlocking fixation. Radiographs that are made immediately postoperatively should be analyzed while the patient is under anesthesia, and any previously undetected instability of the fracture should be treated by static interlocking fixation. Dynamic intramedullary stabilization of the femur should be reserved for transverse or short oblique fractures at the femoral isthmus that have type-I or type-II comminution.