Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialRelevance of the drainage along the linea aspera for the reduction of fat embolism during cemented total hip arthroplasty. A prospective, randomized clinical trial.
The aim of this study was to assess the relevance of drainage placed along the linea aspera for the prevention of fat embolism and cardiopulmonary impairment during the insertion of a cemented stem. We studied 40 patients with coxarthrosis randomly allocated to total hip arthroplasty with proximal drainage or without it. The venting hole for the drainage of the medullary cavity was placed posteriorly, between the greater and the smaller trochanter, in the prolongation of the linea aspera. ⋯ After major embolism, the pulmonary shunt values increased significantly in the control group (+22.7%), but there were no marked changes in the drainage group (+7.1%). The logical therapeutic measure to avoid intravasation of bone marrow, fat, and bone debris during the insertion of the femoral component is to prevent the rise of intraosseous pressure. The drainage of the venous system located along the linea aspera significantly reduces the risk of intraoperative embolism and cardiopulmonary impairment.
-
Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialOn the timing of soft-tissue reconstruction for open fractures of the lower leg.
The timing of soft-tissue reconstruction for severe open fractures of the lower leg is considered crucial to the later outcome, and yet pertinent publications are few. The purpose of this study was to add some based on evidence arguments for the choice of the most adequate timing in the management of these injuries. Twenty-nine consecutive open fractures of the tibia, including 24 grade 3B and 5 grade 3C fractures, were treated using a protocol of immediate debridement, early definitive skeletal stabilisation and early soft-tissue reconstruction. ⋯ All patients were reviewed at a mean follow-up of 47 months (range 15-89 months). In the delayed reconstruction group the time to full, unprotected weight-bearing (P = 0.0021), the time to definitive union (P = 0.0049), the number of reoperations (P = 0.0001) and the infection rate (P = 0.0374) were significantly higher. The data suggest that immediate reconstruction is, the general condition of the patient permitting, the timing of choice for soft-tissue coverage.
-
Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical Trial Controlled Clinical TrialEffects of glucocorticoids on bone mineral density in rheumatoid arthritis patients. A longitudinal study.
We carried out a comparative study in 78 post-menopausal women with rheumatoid arthritis (RA). Forty-four women with a mean disease duration of 17.5 years had been treated with low-dose glucocorticoid (prednisone at < 5 mg/day) for at least 12 months. They were studied for an average period of 3 years and 8 months. ⋯ Reduction of BMD in the lumbar spine was significant in both groups (P < 0.05 to approximately 0.01), but there was no statistically significant difference between the two groups. BMD of the femoral neck decreased significantly (P < 0.05) in the prednisone group, but again the difference was not significant between the two groups. Our data suggest that low-dose prednisone administration probably does not induce significant axial bone loss in female RA patients.
-
Arch Orthop Trauma Surg · Jan 1999
Diagnosis and treatment of scaphoid fractures, can non-union be prevented?
In order to evaluate the diagnostic management of scaphoid fracture, 100 consecutive patients with clinically suspected scaphoid fractures were investigated. If a scaphoid fracture was seen on scaphoid radiographs, patients were immobilized in a plaster cast. If the radiographs were negative or dubious for scaphoid fracture, patients were referred for three phase bone scintigraphy. ⋯ Of these 68 patients, 17 patients (25%) showed a hotspot on the bone scan in the region of the scaphoid. We found that scaphoid radiographs, additional carpal box radiographs and the bone scan (in radiographically negative patients) in combination with conservative therapy did not lead to non-union at long-term follow-up in patients who were treated for scaphoid fracture. We conclude that when a scaphoid fracture is diagnosed within the 1st week followed by plaster immobilization, non-union of the scaphoid could be prevented.
-
Intraoperative femoral fracture is a well recognized technical complication of cementless total hip arthroplasty (THA). The aim of this study was to establish an in vitro model for initiation of fractures of the femur in cementless THA and to assess the effect of fracture fixation by cerclage wiring. An in vitro comparison of two methods of cerclage fixation was performed using steel wire (Protasul) versus multifilament Vitallium alloy cable. ⋯ After monofile cerclage wire application, a force of 1.8-8.1 times body weight was necessary to press the prosthesis 30 mm deeper into the medullary canal. After polyfile Vitallium alloy cable application in other specimens, the force was 7.7-12 times body weight. The difference was statistically significant (U-test, alpha < 0.025).