Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyThe Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical "extensive" technique versus a modified "transglenoid" resection.
The authors report on two groups of patients (each with 12) with primary bone tumors of the humerus who underwent either a classical Tikhoff-Linberg (T-L) procedure or a modified technique by which the body of the scapula was saved. The latter procedure was an "en bloc" resection of the glenohumeral joint after an extra-capsular osteotomy of the neck of the scapula, followed by reconstruction with a modular prosthesis. ⋯ Besides producing better aesthetic and functional results, the modified technique offered the advantages of shorter anesthesia time, less blood loss, and a better anchorage of the prosthesis. The results of this study show that the proposed modification of the T-L procedure is indicated in patients with bone tumors of the proximal humerus in which invasion of the joint capsule is present without macroscopic involvement of the glenoid.
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The instability of atlanto-axial subluxation remains a challenging problem in patients with rheumatoid arthritis. In order to preserve as much function of the cervical spine as possible, inclusion of the occiput into the fusion should exclusively be performed when there is a radiologically or clinically manifest pathological condition of the atlanto-occipital joint or marked upward migration of the dens axis. ⋯ This article presents a retrospective analysis of the clinical and radiological results of occipito-cervical fusion in 26 patients with rheumatoid arthritis using a modified Brattström technique. The complications encountered were mainly due to the use of wire fixation, reinforcement using bone cement and insufficient reduction of atlanto-axial subluxation.
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Arch Orthop Trauma Surg · Jan 1990
Restoration of elbow flexion by latissimus dorsi myocutaneous or muscle flap.
Six patients with flail elbow as a consequence of brachial plexus injury or traumatic loss of arm muscles underwent bipolar transposition of latissimus dorsi myocutaneous or muscle flaps to the biceps brachii to restore elbow flexion. The muscle strength achieved was 1.5-2.5 kg and the total range of active excursion is about 95 degrees. ⋯ Elbow flexion of more than 120 degrees is necessary for the affected hand to reach the mouth and should be one of the goals of the operation. Versatile use of the myocutaneous flap facilitates skin closure and improves the contour of the arm.
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsTransient palsy of hip abductors after a fall on the buttocks.
A fall on the buttocks caused monolateral transient palsy of the hip abductors in two patients. Palsy could be ascribed to acute entrapment of the superior gluteal nerve between the piriformis muscle and the incisura ischiadica major.
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Arch Orthop Trauma Surg · Jan 1990
Prognosis of primary anterior shoulder dislocation in young adults.
From 1982 to 1987, 194 patients with 196 primary traumatic anterior shoulder dislocations were treated in our hospital. One hundred and sixty-six patients with 168 shoulder dislocations (87%) were available for study at follow-up an average of 4 years after treatment. The most important prognostic factor in relation to recurrence was the age of the patient at the time of the primary dislocation. ⋯ Athletes in this age group had no worse a prognosis as to recurrence than non-athletes. A fracture of the greater tuberosity improved the prognosis significantly (P less than 0.01). Neither the presence of a Hill-Sachs lesion nor the period of immobilization influenced the recurrence rate in patients aged 30 years and younger.