The Orthopedic clinics of North America
-
This article discusses a study of 36 patients with chronic osteomyelitis that had local or free muscle flaps. Reconstruction of chronic osteomyelitis requires infection control and assessment of soft tissue and bone. In patients with osteomyelitis with an ununited fracture or nonunion, stabilization of the fracture is needed.
-
Orthop. Clin. North Am. · Apr 1993
ReviewImaging techniques for distal radius fractures and related injuries.
In patients with distal radius fractures, routine roentgenographic examination in at least two or three planes should be performed first and is usually sufficient for correct diagnosis and adequate treatment. A careful examination of the soft tissues of the forearm and wrist on conventional roentgenograms may be key for correct diagnoses. Routine roentgenographic examination of the wrist, preferable in four views, should be performed in every patient with a distal radius fracture acutely as well as at follow-up. ⋯ Additionally, CT is the imaging technique of choice for the correct diagnosis of subluxations of the distal radioulnar joint. Magnetic resonance imaging is an important diagnostic technique for the evaluation of suspected injuries of soft tissues related to distal radius fractures, such as to the flexor and extensor tendons or the median nerve, and for the early diagnosis of necrosis of the scaphoid or lunate. Other indications include identification of triangular fibrocartilage complex perforations, ruptures of carpal ligaments, and demonstration of contents of the carpal tunnel.
-
Orthop. Clin. North Am. · Oct 1992
ReviewArthroscopic evaluation and treatment of the patellofemoral joint.
Patellofemoral pain is a multifactorial problem. No single successful solution for problems related to the patellofemoral joint has been identified. One needs to consider the interaction of all of the factors affecting the extensor mechanism. ⋯ Arthroscopy can provide additional information regarding the condition of the articular cartilage, patellar tracking, and the presence of other intra-articular lesions. Conservative treatment is the cornerstone of management and is effective in more than two-thirds of patients, making surgical treatment necessary in only a minority of instances. ALRR, although not an innocuous procedure, has an acceptably low complication rate and provides predictably good results when used in properly selected patients.
-
Infection of the skeletal system in immunocompromised hosts is a legitimate concern. Indolent presentations and unusual pathogens are more common among impaired hosts. ⋯ Accurate diagnosis requires specific requests for the microbiology laboratory to plate specimens onto fungal, mycobacterial, viral, and mycoplasmal culture medium. Effective treatment appears to require (1) open drainage or debridement of the affected site more frequently in immunocompromised patients than in normal hosts and (2) prolonged antimicrobial therapy.