Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsHemodialysis-associated amyloidosis of bone of beta-2 microglobulin origin.
A case of hemodialysis-associated amyloidosis in a patient who had been on hemodialysis for 10 years is described. Bone lesions were found in the humeral heads, carpal bones, and femoral heads and necks. ⋯ We reconfirmed that bone lesions associated with long-term hemodialysis are manifestations of amyloidosis of beta-2 microglobulin origin. Hemodialysis-associated amyloidosis should be considered in the treatment of long-term hemodialysis patients.
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsTreatment of an old infection in a total hip replacement with an interim spacer prosthesis.
When treating a septic hip-joint prosthesis with bone loss of the proximal femur secondary to osteomyelitis, we implanted a specially designed prosthesis to act as a local antibiotic and spacer between the acetabulum and femur until the infection abated. Arthroplasty could then be carried out with no trouble and there was no recurrence of infection.
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Arch Orthop Trauma Surg · Jan 1990
Traumatic soft-tissue defects of the extremities. Implications and treatment guidelines.
The presence of traumatic soft-tissue defects in the extremity indicates serious damage that may compromise the systems of motion, circulation or sensibility and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft-tissue defects, of which several types may be distinguished. Principles for the selection of various flap procedures are outlined, in accordance with the need for elevation and early motion therapy. The requirements placed on flap tissue are described, such as surface characteristics, ability to restore sensibility, cosmesis, capacity to fill voids in the depth of defects and revascularization of adjacent areas.
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyComparison between straight- and curved-stem Müller femoral prostheses. 5- to 10-year results of 545 total hip replacements.
Between 1977 and 1982, 545 cemented femoral prostheses were implanted, in combination with a noncoated cementless polyethylene acetabular component (RM cup). Three hundred and eighty-one straight-stem and 76 curved-stem Müller femoral components were implanted, as well as 88 collared components with a 130-mm stem and a 130 degrees neck-shaft angle, derived from a long-stem steel prosthesis. Survivorship analysis of revisions for aseptic loosening at 10 years revealed 97% straight-stem survival, 91.6% curved-stem survival, and 88.3% 130 degrees stem survival. "Survival" curves were also constructed for radiological loosening, and the survival rates (patients without radiological evidence of loosening) were 69.8%, 78.8%, and 63.1% respectively at 10 years. ⋯ This resulted in less calcar resorption, but there was a higher rate of stem loosening. Acetabular loosening and associated wear products appear to be responsible for calcar resorption, and stress shielding of the calcar appears to be of minor importance in the pathogenesis of aseptic stem loosening. Better cementing techniques have improved survivorship of the curved-stem prosthesis, and early fears of high rates of radiological loosening with the straight stem have not been substantiated.
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Arch Orthop Trauma Surg · Jan 1990
Methods and applications of three-dimensional imaging in orthopedics.
Computed tomography is a commonly used technique for detecting pathological alterations in soft tissues and the skeleton. Three-dimensional images of the skeleton are very useful for planning surgical treatment and monitoring therapy, but unfortunately mental reconstruction of complex three-dimensional anatomical structures from conventional tomography is very difficult. This article describes a process by which automated analysis of the regions of interest in the computed tomographic (CT) images yields the contours of the surfaces which can be presented pseudo-three-dimensionally using Phong's lighting model and Gouraud's shading methods. Three applications in the areas of orthopedics and neurosurgery demonstrate the efficacy of the method.