Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1993
Pathogenesis and prophylaxis of circulatory reactions during total hip replacement.
Circulatory reactions such as a drop in blood pressure, bradycardia, cardiac arrest, and even intraoperative death after insertion of the stem are well known events during total hip replacement. The present paper reports bone marrow intravasation after rise of intramedullary pressure in the femoral cavity during insertion of hip prostheses, demonstrated by intraoperative transesophageal echocardiography. In an animal study, the ultrasound echoes were identified as "mixed emboli" consisting of a core of bone marrow surrounded by thrombus. ⋯ In the second series, the drop in blood pressure did not occur. In conclusion, it was demonstrated that effective venting of the bone marrow cavity by a bore hole, and avoidance of compression of the bone-marrow-filled distal femoral cavity by using a plug, results in effective prevention of circulatory reactions: no drop in blood pressure occurred. The use of an intramedullary plug is discussed and recommended.
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Arch Orthop Trauma Surg · Jan 1993
Clodronate increases the calcium content in fracture callus. An experimental study in rats.
Eighty-eight rats underwent intramedullary pin fixation and fracture of both tibiae. Half of the animals were given clodronate 50 mg/kg s.c. weekly. Clodronate treatment did not affect the growth of fibrocartilage or the endochondral and membranous new bone formation. ⋯ Calluses were remodeled to lamellar bone in both groups. However, although the total area invaded by mineralized tissue in callus remained unaffected by the drug, the areas of hematopoietic bone marrow tissue within mineralized callus were observed to be markedly smaller in clodronate-treated animals than in controls. The calluses in the clodronate group were significantly heavier and contained more calcium at 2 months after fracture than those in the controls.
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Arch Orthop Trauma Surg · Jan 1993
Irreducible isolated dislocation of the radial head in a skeletally mature teenager. A case report.
Isolated dislocation of the radial head is an uncommon injury. This injury has been reported in children; in the skeletally mature it is extremely rare. An irreducible dislocation has been previously reported in a young child, but no case has to date been reported in an adult. The present case is reported to demonstrate this rare injury and to suggest a possible explanation for the cause of the irreducibility.
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Man-made bone implant materials as substitutes for autogenic spongiosa transplantation are reviewed, specifically materials made from collagen. The intra- and extracellular biosynthesis of collagen is described. Manufacture, properties and indications of sterile Collagen-fleece, a well proven surgical biomaterial prepared from porcine collagen, is presented. Further research led to the development of a new bone-replacement material called Collapat.
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Arch Orthop Trauma Surg · Jan 1992
Randomized Controlled Trial Multicenter Study Clinical TrialPrevention of deep vein thrombosis with low molecular-weight heparin in patients undergoing total hip replacement. A randomized trial. The German Hip Arthroplasty Trial (GHAT) Group.
In a double-blind, randomized multicentre trial, the efficacy and safety of two regimens for the prevention of postoperative venous thrombo-embolism, low-molecular-weight heparin (LMWH) CY 216 and unfractionated heparin (UH), were compared in 341 patients undergoing elective total hip replacement. A group of 169 patients received one subcutaneous injection of 48 mg (approximately 10,000 anti-Xa IC units) LMWH and two placebo injections per day and 172 patients received a fixed dose of 5000 IU UH t.i.d. Deep vein thrombosis was assessed by bilateral phlebography on day 14 +/- 1 after surgery. ⋯ The safety of the treatments, as assessed by the incidence of major haemorrhage, intra- and postoperative blood loss, transfusion requirements, haemoglobin drop and frequency of wound haematomata, was similar in the two groups. It is concluded that prophylaxis of postoperative thrombo-embolism in hip surgery with one subcutaneous injection (48 mg) of LMWH CY 216 is as effective and as safe as prevention with fixed low-dose heparin (5000 IU t.i.d.). A tendency to reduced rates of pulmonary embolism (3.6% vs. 1.2%) and proximal deep vein thrombosis (19% vs. 10.3%) was observed in favour of LMWH CY 216.