Archives of orthopaedic and trauma surgery
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This report presents the case of an 8-year-old boy who underwent a second clubfoot operation following early-stage reflex sympathetic dystrophy (RSD). After other conditions had been ruled out, the patient was submitted to physiotherapy supported by antiphlogistic and analgesic drugs as well as a partial immobilisation of the affected extremity. ⋯ RSD in children is not a well-recognised entity. This case of early-stage RSD illustrates the need to be aware of this possible complications after operation in the differential diagnosis of local pain and swelling of a limb.
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Arch Orthop Trauma Surg · Jan 2000
Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine.
From March 1984 to April 1996, 60 consecutive patients with spinal metastasis underwent palliative surgery by anterior corpectomy and Zielke instrumentation. Their ages ranged from 21 to 76 years (mean 54 years). Thirty-two patients had metastasis to the thoracic spine, 20 to the lumbar spine, and 8 had both thoracic and lumbar metastases. ⋯ Forty of 52 patients with severe pain obtained significant symptomatic relief for 3 months or more, and 33 of the 46 paralyzed patients gained neural improvement. Sphincter dysfunction became better in 10 patients, and none became worse. We conclude that anterior corpectomy to decompress neural encroachment with instrumental reconstruction to stabilize the collapsed spine is a good adjunctive treatment in these highly selected patients.
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Arch Orthop Trauma Surg · Jan 2000
Magnetic resonance imaging as a screening procedure to avoid arthroscopy for meniscal tears.
The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) as a screening procedure before arthroscopy of meniscal tears. Forty-one knees in 40 patients underwent MRI and arthroscopy. ⋯ The overall accuracy for MRI of the medial and lateral menisci combined was 84%. On the basis of the high predictive value of negative MRI, we conclude that MRI is useful to exclude patients from unnecessary arthroscopy.
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Several years ago, low-intensity pulsed ultrasound (frequency 1.5 MHz; signal burst width 200 micros; signal repetition frequency 1 KHz; intensity 30 mW/cm2) was shown to accelerate fresh fracture healing both clinically and experimentally. On the basis of a prescription use registry, this paper reports on the use of low-intensity pulsed ultrasound in the therapy of 951 delayed unions and 366 nonunions. The overall success rate for delayed unions was 91% (average healing time 129+/-2.7 days) and for nonunions 86% (average healing time 152+/-5.3 days). ⋯ Therefore, the results of these two populations support each other. Low-intensity pulsed ultrasound may provide a method of nonoperative treatment of great promise for healing disorders. Determination of ranking of this new method should be done within the near future.
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We measured radiographically the interspinous distance in 50 normal children and in 50 children with congenital dislocation of the hip. The value increased proportionally with age in normal children, but not in those with congenital dislocation of the hip. Our results indicate that a bony parameter, rather than the age of the child, is suitable for the indication of lower age limit for Salter's innominate osteotomy.