Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialSpontaneous subcapital femoral neck fracture complicating a healed intertrochanteric fracture.
A spontaneous subcapital femoral neck fracture is an uncommon complication of a healed intertrochanteric hip fracture. To determine the etiology of this complication, 274 patients who had been treated for intertrochanteric hip fractures were followed up over an 8-year period from June 1988 to June 1996. We found 7 fractures of the subcapital femoral neck without a history of a trauma. ⋯ The difference in the Singh index between the patient and control groups was statistically significant (P < 0.01). However, with regard to the position of the screw, spinal score, age, ambulatory ability, height, weight, and intertrochanteric fracture type (Jensen type), the differences between the patient and control groups were not statistically significant. Based on our findings, we conclude that a high grade of osteoporosis is the most important predisposing factor in the spontaneous development of a subcapital femoral neck fracture after a healed intertrochanteric hip fracture.
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Arch Orthop Trauma Surg · Jan 1999
Clinical TrialClassifying the location of osteosarcoma with reference to the epiphyseal plate helps determine the optimal skeletal resection in limb salvage procedures.
Between 1989 and 1996, 21 skeletally immature patients were treated for osteosarcoma of the extremity. Their average age was 12.6 years (range 9-16 years). We classified the location and extent of the lesion in bone on magnetic resonance imaging (MRI) with reference to the growth plate and joint margin into five subtypes. ⋯ Patients were assessed for (1) local tumour recurrence, (2) metastatic disease, (3) allograft complications and (4) extremity function and joint stability. Excellent function was retained in 2, good in 13 and fair function in 6 patients. The MRI classification proved useful for the resection and provides an insight into the possible functional outcomes.
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Arch Orthop Trauma Surg · Jan 1999
Case ReportsTransoral missile removal from the anterior C1 region following transpharyngeal missile wound.
We present a successful treatment result in a rare case of low velocity missile transpharyngeal wound to the upper cervical area in a 33-year-old man. There are very few reports concerning related cases, with some disagreement regarding their treatment. The retained missile was successfully removed from the anterior region of the C1 vertebra through a transoral-transpharyngeal approach using the explosive transpharyngeal wound sustained. ⋯ The early soft-tissue debridement, missile removal, pharyngeal closure without wound drainage and broad-spectrum antibiotic coverage resulted in an uneventful postoperative course and good long-term outcome. Early surgery is important to prevent complications in such cases. However, the prophylactic tracheostomy, wound drainage and applying of a nasogastric tube could be left to the surgeon's judgment based on the individual patient's respiratory status, intraoperative findings and wound contamination/colonization.
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Arch Orthop Trauma Surg · Jan 1999
Comparative StudySeverity of upper limb injuries in snowboarding.
A retrospective survey of 1,445 snowboarders and 10,152 skiers was undertaken to determine the incidence, pattern and severity of both snowboarding and skiing injuries. The incidence of snowboarding injury (0.33%) was higher than that of skiing injury (0.11%, P < 0. 01). Also, in showboarding there was frequent involvement of the arms (51.3%) when compared with skiing (25.9%, P < 0.001). ⋯ The severity of arm injuries in snowboarding seems to be caused by direct force on the wrist and elbow, which receive the full impact of a fall. These data suggest that beginners should have appropriate lessons of basic skills including safe falling. The development of a safety system also appears sensible to prevent such severe injuries in snowboarding.
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialPatellar motion analyzed by kinematic and dynamic axial magnetic resonance imaging in patients with anterior knee pain syndrome.
Ten consecutive patients (12 knees), all women, with anterior knee pain syndrome participated in the study. The patellofemoral joints were examined with the knee in 0 degrees, 10 degrees, 20 degrees, and 30 degrees of flexion. At each knee position, kinematic and dynamic, an axial magnetic resonance (MR) image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. ⋯ There were no statistically significant differences of SA between the groups, regardless of muscle contraction or flexion angle. At 30 degrees of flexion, muscle contraction increased CA and decreased PTA. In our opinion, imaging in the first 30 degrees of flexion with thigh muscle contraction is necessary for a correct diagnosis.