The Journal of bone and joint surgery. American volume
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We undertook an anatomical and histological study to differentiate glomus-cell tumors of the pericoccygeal tissues from the normal coccygeal body. Removal of the coccyx was performed on five consecutive autopsy specimens from patients with no history of coccygeal symptoms. ⋯ The histological appearance was indistinguishable from that of photomicrographs published in case reports of patients with glomus tumors of the coccyx. It is likely that the so-called tumors reported previously were in actuality normal glomus bodies.
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J Bone Joint Surg Am · Mar 1982
Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience.
Twenty-three postoperative peroneal-nerve palsies in twenty-two patients were documented in the records of 2626 consecutive knee arthroplasties that were performed at The Hospital for Special Surgery from 1974 through 1980. This is an incidence of 0.87 per cent. The preoperative knee deformities included fourteen flexion contractures, eleven valgus deformities, and five biplane deformities. ⋯ The possible causes of the nerve palsy appeared to be direct traction on the nerve, traction on the surrounding tissues resulting in vascular compromise to the nerve, direct pressure on the nerve from the postoperative dressing, or a combination of these factors. When the palsy is discovered, the suggested treatment is a change to a looser dressing and flexion of the knee. The value of surgical exploration of the nerve in the immediate postoperative period is not known.
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J Bone Joint Surg Am · Jan 1982
Case ReportsLong-term pain control by direct peripheral-nerve stimulation.
In 1970, we began implanting electrodes for prolonged stimulation of injured peripheral nerves to reduce chronic pain. Thirty-eight peripheral nerves in thirty-five patients have been stimulated with electrodes for a period ranging from four to nine years. Nineteen electrode systems were implanted in the upper extremity (eleven on the median nerve, six on the ulnar nerve, one on the median and ulnar nerves, and one on the median and radial nerves), with successful relief of pain in 52..6 per cent of the patients. ⋯ We speculate that the stress of weight-bearing and the anatomical position of the posterior tibial nerve may partially account for this rate of failure. Use of the electrode-implant systems required careful preoperative assessment by an experienced team, meticulous technique, and a mechanical system that tolerates stress. The location and characteristics of the lesion affect the response to electrical stimulation.
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J Bone Joint Surg Am · Oct 1981
Closed intramedullary nailing of femoral shaft fractures. A review of one hundred and twelve cases treated by the Küntscher technique.
Since May 1972, the standard treatment of femoral shaft fractures at the Western General Hospital has been the closed femoral nailing technique of Küntscher. We have found that the use of intraoperative skeletal traction eliminates the need for immediate operation, preoperative skeletal traction, or the use of a distraction apparatus to prevent preoperative shortening. ⋯ One hundred and twelve consecutive traumatic fractures of the femoral shaft treated in this manner united within three to six months. The clinical results in terms of early joint movement, early weight-bearing, and rapid discharge from the hospital have been excellent.
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J Bone Joint Surg Am · Jun 1981
Efficacy of double-gloving as a barrier to microbial contamination during total joint arthroplasty.
After ten total hip replacements in which a double-glove technique was used, 275 outer and inner gloves were tested for microbial contamination and for holes. The operating rooms were equipped with specially designed air-filtration mechanisms. The results indicated that the gloves that most frequently were contaminated were the ones used exclusively for draping. This finding suggests that using a separate pair of outer gloves only for draping is a valuable technique during total hip replacement. ⋯ Although the practice of using double gloves during a total joint-replacement procedure is accepted widely, there is little evidence that double-gloving actually decreases microbial contamination. The results of this study indicate that changing outer gloves at appropriate times during the procedure is indeed an important way to minimize contamination.