Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Intra-articular injections and articular cartilage metabolism. An experimental study in rabbits.
We studied the effects of repeated intra-articular injections of sterile 140 mM NaCl solution on articular cartilage in adult rabbits. After 20 injections into the knee joints over a period of 4 weeks, chondrocyte glucosaminoglycan synthesis was evenly reduced in all cartilage layers, accompanied by a significant proteoglycan depletion of the matrix which was most marked in the superficial half of the cartilage. ⋯ Our data underline the need for a clear-cut indication for intra-articular injections. The microtrauma caused by injection, in conjunction with the introduction of a carrier solution into the joint, may, at least when repeated at short intervals, lead to measurable damage to the articular cartilage.
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We treated 66 consecutive type IV comminuted femoral shaft fractures with static Grosse-Kempf interlocking nails and followed them up for at least 1 year (median 27 months). Although the effect of weight bearing was completely lost, 60 fractures healed primarily without dynamization. We conclude that weight bearing contributes only an auxiliary role in promoting fracture healing, and that the most decisive role is adequate mechanical stability with sufficient nutrition.
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The transgluteal approach to the hip, first described by Bauer et al. in 1979, has since become a recognized routine method. Its longitudinal incision of the fibers of the gluteus medius and minimus and the vastus lateralis muscles takes advantage of the tendinous junction of these muscles over the greater trochanter. This paper describes the modifications of the transgluteal approach described in the literature and compares them to the original procedure. ⋯ In 59.6% of all specimens there proved to be a united tendinous junction of all the muscles referred to above, while in 40.4% autonomous insertions of the gluteus medius and/or gluteus minimus were seen. In accordance with the anatomical results, the form of incision described by the original authors can be considered the most favourable. In roughly one-third of all hip operations, autonomous insertions of gluteus medius and minimus must be taken into account, since otherwise total or partial upward displacement of the autonomous muscle insertions could occur.
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsAseptic osteonecrosis of acetabulum following prosthetic replacement of the femoral head. A case report.
Acetabular osteonecrosis is a rare condition. Only five cases with histological analysis have been reported in the literature, and these patients had previously received radiotherapy. ⋯ The necrosis was found during surgery to go so deeply into each bone composing the acetabulum that the hip joint could not be revised, and we had to perform a Girdlestone resection arthroplasty. The radiographic and histological findings resembled those reported in cases of aseptic osteonecrosis of the acetabulum after radiotherapy.