Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Vascularized pedicled bone graft into the femoral head--treatment of aseptic necrosis of the femoral head.
Revitalization of the femoral head in cases of aseptic necrosis was attempted in 13 hips of 11 patients 15-33 years of age. The necrotic bone was replaced by a vascularized pedicular iliac bone graft and free cancellous transplants. The results after an average follow-up of 53 months are satisfying in some cases. The surgical technique used is simple and applicable when a vascularized bone graft is needed in the hip region.
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Arch Orthop Trauma Surg · Jan 1990
Diagnosis of bone and joint infection by leucocyte scintigraphy. A comparative study with 99mTc-HMPAO-labelled leucocytes, 99mTc-labelled antigranulocyte antibodies and 99mTc-labelled nanocolloid.
Fifty-five patients with 60 suspected infections of bones or joints were studied with 99mTc-hexamethylpropyleneaminooxine- (HMPAO-) labelled leucocytes and 99mTc-labelled antigranulocyte antibodies, in part supplemented with 99mTc-labelled nanocolloid. The findings using the different procedures were in good agreement. ⋯ Spondylitis usually shows as non-specific cold lesions. A subtraction technique with computer assisted analysis of HMPAO and nanocolloid scans provides a more precise diagnosis of this condition.
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyThe APS knee joint prosthesis. A review of 32 patients.
First clinical and radiographic results with a new knee joint prosthesis, implanted without cement, are reported and the characteristics of the implant (dowel fixation and special instrumentation) presented. The first series of 35 joints with a follow-up period of 1-3 years shows excellent results. ⋯ If these two conditions are met, there is every probability of successful implantation. No problems specific to the implant have been encountered.
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Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. ⋯ In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.
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Arch Orthop Trauma Surg · Jan 1990
"Physiological osteoporosis" and "osteoblast insufficiency" in old age. Comparative radiological-morphometric and statistical studies on the spongy bone of lumbar and cervical vertebral bodies.
To investigate the expectation of general insufficiency of osteoblasts with increasing age, we studied autotopsy material from 105 deceased persons of both sexes who had died between 16 and 91 years and in whom clinically manifest diseases of the bone had been excluded. Quantitative morphometric examination of the structure of the spongy bone of the 3rd-5th lumbar vertebral bodies (LVBs) and of the 5th-7th cervical vertebral bodies (CVBs) was carried out in frontal and sagittal planes, the parameters analysed being volumetric density (Vv), surface density (Sv) and specific surface area (S/V), and the results were subjected to statistical evaluation. The results showed that in the three LVBs, Vv, Sv and S/V behave in a similar manner, Vv and Sv decreasing after the age of 50 years by more than one-third while S/V remains constant throughout life. ⋯ This differing behavior of the spongy bone in the two regions of the spinal column is an expression of the different characteristic loading forces in each regions: LVB loading is predominantly static, CVB loading mainly dynamic. Thus, from the functional point of view, what is known as "physiological osteoporosis due to ageing" is nothing more than adaptation by an ageing bone to physical activity, reflecting--like the bone of the young adult--the current loading of the cancellous bone by the actions of the musculoskeletal system. Since such physical activity is often age-related, the performance of the osteoblasts does not depend upon age per se, but merely on the remaining functional adaptive capacities of the ageing organism as whole.