Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsAn unusual stress fracture of the fibula in a long-distance runner.
A stress fracture of the proximal fibula in a young long-distance runner is reported. Such fractures are rare. The literature is reviewed and diagnosis and treatment are discussed.
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsNon-invasive treatment of long-bone pseudarthrosis by shock waves (ESWL).
Non-invasive treatment of non-union of diaphyses by application of the shock waves known from lithotripsy has proved successful in three out of four cases. Two thousand shock waves with a single-wave energy of 18 kV were applied by the MFL 5000 and HM3 Lithotripters of the Dornier Medizintechnik Company with manual detection of the lesion. The shock waves induced a kind of callus formation in the non-union soft tissue within about 6 weeks, which was successfully maintained and transformed into bony union in all cases but one by dynamic fixation less rigid than a plaster cast. Four cases are documented and the effects of the shock waves and principles of bony union discussed.
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Bone necrosis secondary to avascularity may not only delay or inhibit consolidation of a fracture, it may also be a cause of refracture. Both initial trauma und surgical insult will determine the extent of necrosis. Only the latter is under the surgeon's control; it can be reduced by gentle soft tissue handling and by minimizing periosteal stripping. ⋯ Evaluation of 28 refractures in 25 patients, with biopsies in 14 patients, suggests that the duration of fracture immobilization through external or internal means must be sufficiently long to allow vascular invasion of necrotic areas, their substitution by new bone and bridging of the fracture. These processes must be followed by radiographic studies prior to implant removal. Special attention needs to be paid to adequate visualization of the fracture gap on successive radiographs.
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Arch Orthop Trauma Surg · Jan 1992
Comparative StudyEffect of cup geometry and the presence of cement on acetabular component fixation.
Two series of implanted conical, polyethylene Ring cups were studied clinically and radiographically. In one series the cups were uncemented while in the second cement was used. The results using cemented conical cups were then compared with results using a cemented cup of hemispherical design to study the effect of cup geometry. ⋯ The series of cemented hemispherical cups were reviewed after an identical period. Although the numbers revised for loosening were comparable in this and the cemented conical group, radiological migration was statistically greater in the latter (P < 0.001). Alternative methods of socket preparation and cement technique were thought to be the most likely explanation for the observed differences.
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsBilateral rupture of the patellar tendon without predisposing systemic disease.
Bilateral rupture of the patellar ligament in a 49-year-old woman is reported. She sustained a relatively minor trauma and no underlying systemic disease could be found. This is the 14th case of simultaneous spontaneous rupture of the patellar tendons reported in the literature. The diagnostic features were diffuse swelling around the knees, visible and palpable infrapatellar defects, and an inability to extent either leg.