Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Cemented femoral impaction bone grafting for severe osteolysis in revision hip arthroplasty. Good results at 4-year follow-up of 10 patients.
Ten hips underwent impaction bone grafting with cement as revision of the femoral stem for severe osteolysis. At clinical follow-up of a median of 4 years (range 3.0-4.6 years) there were no failures. The median Harris hip score increased from 53 to 80, and pain score from 25 to 40. ⋯ All of the 9 patients with radiographical follow-up of more than 1 year showed trabecular remodelling, 7 of whom had signs of cortical repair. Subsidence was a median of 2 mm, with the maximum subsidence being 5 mm. The results appeared clinically stable after 4 years with radiographic reconstitution of the bone stock.
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Arch Orthop Trauma Surg · Jan 2000
Shockwave application in calcifying tendinitis of the shoulder--prediction of outcome by imaging.
This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. ⋯ In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA.
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Arch Orthop Trauma Surg · Jan 2000
Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head with preoperative superselective angiography.
A prospective radiologic and scintigraphic study was made of 15 joints in 12 patients who underwent transtrochanteric rotational osteotomy of the femoral head after identifying by preoperative superselective angiography which arteries should be preserved during surgery. The preoperative superselective angiography revealed that the blood supply to the femoral head was provided by the medial femoral circumflex artery in 12 joints and a branch of the internal iliac artery in 3 joints. ⋯ At the follow-up examination made after at least 2 years, there were no cases of collapse of the new femoral head weight-bearing site, and also there were no cases with a large cold area in the femoral head on the scintigram obtained 2 months postoperatively. For this operative procedure, the nutrient arteries of the femoral head should be confirmed by preoperative superselective angiography, and it is essential that these arteries be preserved during surgery.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyUltrasonically driven instruments in the transfemoral approach--an aid to preservation of bone stock and reduction of implant length.
The transfemoral approach to the femur with implantation of the Wagner SL stem provides a means of dealing with the difficult revision problems of extensive endosteolysis and with peri-prosthetic fractures. This surgical approach has been modified such that with the aid of an ultrasonically driven cement removal instrument (OSCAR) the length of the osteotomy is reduced, preserving bone stock, and it is possible to implant a shorter prosthesis in approximately 60% of cases.
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A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15 degrees or more, with 5 having more than 30 degrees of varus. The osteotomy was fixed by three different methods. ⋯ We propose this method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required, can also be performed. It also avoids a second operation for implant removal.