Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1998
Dislocated fractures of the talus treated with biodegradable internal fixation.
Six patients with a displaced fracture of the neck or body of the talus were treated using biodegradable screws and rods. During an average follow-up time of 24 (range, 18-31) months, there were no redisplacements nor collapses due to avascular necrosis. ⋯ The functional result was mainly dependent on the presence or absence of other injuries, being excellent in 4, good in 1 and poor in 1 patient who also had bilateral highly comminuted calcaneal fractures. Thus, biodegradable implants seem to be suitable for the fixation of displaced fractures of the talus.
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Arch Orthop Trauma Surg · Jan 1998
Ligament-muscle reflex arc after anterior cruciate ligament reconstruction: electromyographic evaluation.
The purpose of this study was to determine if a ligament-muscle reflex arc exists between the bone-patellar tendon-bone autograft after anterior cruciate ligament (ACL) reconstruction and the hamstring muscle group. We studied four patients, average age 34.2 years (range 32-36 years). The mean time between the ACL reconstruction and the study examination was 56.2 months (range 5-108 months). ⋯ No unequivocal EMG activity could be detected in the ACL-reconstructed knees when we pulled on the graft or in the controls. Three of four patients and all controls felt pain when we touched the graft or normal ACL or applied strain on it with the hook. In conclusion, the ACL autograft presents a noxious sensory innervation, the Lachman test maneuver stimulates a reflex arc with hamstrings activation, and an unequivocal ligament-muscle reflex arc from the graft to the hamstring muscle group could not be demonstrated.
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Arch Orthop Trauma Surg · Jan 1998
Comparative Study Clinical TrialComputed tomography of the spine as an important diagnostic tool in the management of war missile spinal trauma.
Twenty-two patients with spinal injury were evaluated by plain radiography immediately after hospital admission. In 14 patients whose condition was stable, we performed computed tomography (CT) scanning through the involved segments. To provide better planning before neurosurgical management, we divided the vertebral column in thirds. ⋯ Penetrating injuries with a dural lesion were present in the majority of cases, while spinal cord injury was obvious in some. They were all well visualized using spinal CT scanning. Our view is that the role of CT is essential in guiding surgical management of war missile injuries to the spine.
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Arch Orthop Trauma Surg · Jan 1998
Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture.
Sixteen consecutive patients with cutout of a lag screw of a dynamic hip screw fixation in an intertrochanteric fracture were treated with reinsertion of a lag screw, bone cement supplementation in the neck-trochanter, and subtrochanteric valgus osteotomy. Postoperatively, patients were permitted to ambulate with protected weight-bearing. Fourteen patients were followed-up for at least 1 year (median 2 years; range 1-3 years), and all had a solid union. ⋯ There were no complications of wound infection, loss of reduction, cutout of a lag screw, or osteonecrosis of the femoral head. From clinical and theoretical considerations, we conclude that despite cutout of a lag screw of a dynamic hip screw fixation being difficult to treat, out technique still can provide an excellent outcome. Therefore, we strongly recommend its wide use.
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Arch Orthop Trauma Surg · Jan 1998
Compartment pressure in nailed tibial fractures. A threshold of 30 mmHg for decompression gives 29% fasciotomies.
During the past few years we have monitored tissue pressure in patients treated with intramedullary nailing of tibial shaft fractures. A value of 30 mmHg has been used as the threshold for fasciotomy. The purpose of this study was to evaluate this practice. ⋯ At follow-up two patients were dead. All fractures were healed, and there were no major complications such as deep infection, extensive muscle necrosis, paresis or short-foot syndrome. Three fasciotomized patients had significantly reduced muscle strength compared with the contralateral leg.