Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jan 1990
Quantitative and functional restorations and alterations of peripheral lymphocytes in patients with autologous spleen implantation.
To reduce the risk of severe infections in splenectomized patients, new methods for splenic preservation or heterotopic autologous spleen implantation have been established. In the latter case, the immunological and functional benefits are still under discussion. In this study we compared immunological parameters in 16 splenectomized patients with and without heterotopic autologous spleen implantation with a nonsplenectomized control group. ⋯ The latter results support the findings of elevated serum IgA levels in this group. The mitogenic-induced proliferation with PHA, ConA, PWM, and OKT3 was not clearly different within the tested groups. The results may indicate a benefit of autologous spleen implantation in regard to the humoral immune response.
-
Arch Orthop Trauma Surg · Jan 1990
Comparative Study Clinical Trial Controlled Clinical TrialFlurbiprofen inhibits heterotopic bone formation in total hip arthroplasty.
A double-blind prospective parallel group study comparing slow-release flurbiprofen with placebo in the control of ectopic bone formation was carried out in 68 patients undergoing total hip arthroplasty. Eight weeks after surgery there was evidence, significant at the 1% level, that the incidence and extent of periarticular calcification was lower in the flurbiprofen group. At an early phase, serum calcium level decreased and after 8 weeks serum alkaline phosphatase level increased more in the placebo group than in the flurbiprofen group, indicating an effect of flurbiprofen on bone mineral metabolism. ⋯ Anti-inflammatory agents such as indomethacin and ibuprofen have turned out effective. Local irradiation also prevents ectopic bone formation, but diphosphonates seem not be effective in this respect. The aim of the present study was to assess the efficacy of flurbiprofen, a new anti-inflammatory agent, in limiting heterotopic bone formation, and to note the frequency and severity of any side effects of the treatment.
-
Arch Orthop Trauma Surg · Jan 1990
Review Case ReportsBilateral posterior pendulum dislocation of the shoulder. Case report and review of the literature.
A 20-year-old patient with bilateral voluntary and involuntary dislocation of both shoulders is reported on. There was no history of significant trauma, no systemic hypermobility of joints, no signs of neurological or psychological problems, and no evidence of joint disease. According to Reischauer's classification of shoulder instabilities, the patient suffered from bilateral posterior pendulum dislocations of his shoulders. ⋯ After ruling out the possibility of psychological problems, we performed an operative stabilization by arthroscopic means. At 1-year follow-up the patient reported no recurrence, good shoulder musculature, and no disability at work. This result confirms the unsuspicious psychological evaluation and our therapeutic management.
-
Arch Orthop Trauma Surg · Jan 1990
Randomized Controlled Trial Clinical TrialArthroscopic cartilage debridement by excimer laser in chondromalacia of the knee joint. A prospective randomized clinical study.
A new operative technique in arthroscopic treatment of chondromalacia using ultraviolet laser systems is introduced. The postoperative results are evaluated in a prospective and randomized clinical trial. One hundred and forty patients stage II or III chondromalacia according to Outerbridge were randomly assigned to arthroscopic operation using either laser or mechanical instruments. ⋯ In the short-term follow-up laser surgery gave superior results in regard to reducing pain (P less than 0.05) and leading to a lower incidence of reactive synovitis (P less than 0.01). No difference was found in respect of disability and functional impairment. Our results lead to the conclusion that arthroscopic laser application seems to be a successful procedure in the treatment of degenerative cartilage disorders, providing precise ablation of tissue without significant thermal damage to the remaining cartilage.
-
Arch Orthop Trauma Surg · Jan 1990
Reaming versus non-reaming in medullary nailing: interference with cortical circulation of the canine tibia.
Medullary nails have only been used with reluctance in the treatment of open fractures since reaming interferes with the cortical circulation. The technique of interlocking offers the interesting possibility of inserting a relatively stiff nail which does not necessarily require reaming. ⋯ Nail insertion without reaming provided clear advantages for the bone's blood supply, while reaming disturbed perfusion in two-thirds of the cortical area and regionally extended through the entire thickness of the cortex. The disturbance without reaming was limited to the inner layer of the cortex and involved only one-third of the cortical cross-section.