Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1991
Case ReportsOverdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine.
In acute cervical spine trauma, skull traction is used to reduce a dislocation or fracture dislocation, to immobilize an unstable lesion until definitive treatment (operative or conservative) is possible or, more rarely, as a definitive treatment until healing occurs. This method may be dangerous when an unstable lesion is accidentally overdistracted. A few cases have been reported in the literature, some with neurological complications. ⋯ After reduction is completed, traction is reduced to 2 kg. This weight is sufficient to immobilize a lesion until definitive treatment is possible. Inadvertent rotation may be prevented by placing sandbags on both sides of the head.
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Arch Orthop Trauma Surg · Jan 1991
Decalcified and undecalcified cancellous bone block implants do not heal diaphyseal defects in dogs.
In a previous study it has been shown that granulae of decalcified bone matrix do not induce bony healing of 8-week-old mid-diaphyseal defects in dogs. The aim of this study was to test whether osteoinduction combined with the osteoconductive mechanisms provided by the natural structure of cancellous bone blocks would yield better results. A 30-mm-long diaphyseal defect of the left ulna was created in eight adult mongrel dogs and the bone was stabilized with a plate. A Silastic spacer was inserted in the defect for 8 weeks, followed by implantation of frozen undecalcified or decalcified allogeneic cancellous bone blocks for 16 weeks. Healing was analyzed using morphologic methods. At 16 weeks after implantation all grafts had been resorbed. In the decalcified group one defect healed, while none in the other group did so. The implant material was bioassayed in nude rats for osteoinductivity, which was found to be low in decalcified matrix and not detectable in undecalcified bone. ⋯ Allogeneic cancellous bone blocks, demineralized or not, have no osteoinductive capacity and no osteoconductive function that promotes healing of mid-diaphyseal bone defects in dogs.
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Arch Orthop Trauma Surg · Jan 1991
ReviewKnee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the "floating knee".
The incidence of rupture of the knee ligaments was retrospectively studied in 47 patients with ipsilateral fractures of the femoral and tibial diaphyseal shaft. Fifteen patients proved to have an instability of the knee at the time of follow up. Disruption of the knee ligaments had not been recognised initially. ⋯ After stabilisation of both fractures in these cases, the knee ligaments had been repaired; at re-examination these patients had no complaints and their knees were perfectly stable. In view of the high incidence of missed cases, the possibility of disruption of the knee ligaments should be considered in all patients with fractures of both the femoral and tibial shaft. Meticulous examination of the knee at the time of injury is strongly advocated.
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Arch Orthop Trauma Surg · Jan 1991
ReviewPathological fractures and lytic bone lesion of the femoral neck associated with beta 2-microglobulin amyloid deposition in long-term dialysis patients.
A correlation is demonstrated between chronic hemodialysis using cuprophane membranes (mean duration: 13 years) and pathological fractures (n = 7 in 6 patients) after lytic bone deposits of beta 2-microglobulin amyloid (n = 13 patients). The characteristic symptom complex includes painful impingement syndrome of the shoulder, carpal tunnel syndrome, painful hip and recurrent knee effusions. ⋯ Due to reduced regeneration capacity in amyloid bone lesions the resulting surgical therapy should aim at total joint replacement or augmented osteo synthesis. Definitive operative treatment should be aspired even in the absence of manifest fractures, as the natural course of the disease is characterized by progression of the bone destruction and a continuous pain syndrome.
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Back school is behavior training for the prevention and treatment of back problems arising from faulty body posture and muscular dysfunction. This paper describes the conception and evaluation of a back school program for patients with vertebral fractures. ⋯ The effectiveness of the program was measured by a knowledge test and a behavior test. The results suggest that this back school is an effective addition to conventional concept using physiotherapy exclusively.