Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1991
Case ReportsTibia valga after fracture: documentation of mechanism.
Tibia valga following fracture in the proximal metaphysis of the tibia in children was previously attributed to various mechanisms. This case report offers an additional explanation based on bone scintigraphy 10 months after injury. Decreased radionuclide uptake at the lateral proximal tibial physis without evidence of increased uptake on the medial side suggests that a Salter type V injury to the lateral growth plate can occur in conjunction with a medial metaphyseal fracture, resulting in the development of tibia valga.
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An extremely rare case of giant cell tumour of the proximal end of the ulna, which was clinically aggressive but histologically benign, is reported in a 28-year-old man. The tumor was excised in en bloc but patient died 8 months after surgery. To the best of our knowledge, this is the first reported case from South East Asia and the second available in the English-language literature. It therefore warrants report.
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Arch Orthop Trauma Surg · Jan 1991
Anterior ankle pain in sports medicine: aetiology and indications for arthroscopy.
Persistent pain and swelling in the anterior part of the upper ankle are encountered very frequently in sports traumatology. Classically, in the patient with a long history of typical anterior ankle pain there is no instability, but pinching effects, a sense of impingement, blocking and a feeling of unsteadiness combined with a certain restriction of movement due to the pathology. By analogy with the anatomical structures, various pathologic changes can lead to the classic clinical symptoms: adhesions, cicatrices, meniscoid-type lesions, osteophytes with synovitis, folds, fibrotic subcutaneous fatty tissue, free arthroliths, osteochondral lesions and arthrotic changes. ⋯ Arthroscopic interventions were carried out in a total of 21 patients, with follow-up times between 6 and 36 months. About two-thirds of all the patients showed good or very good results, while in one-third the results were unsatisfactory, mainly because of degenerative changes. An precise diagnosis is essential, but the significance of a pathologic change as the cause of symptoms can be problematical.
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In three patients a mechanically well-fixed Mathys Ceros 80 (Ha) hydroxyapatite-coated acetabular component was revised 2, 5 and 13 months after total hip replacement due to component malposition. In each case there was a thin cellular connective tissue membrane between hydroxyapatite and bone, the main cell type being fibroblast with only occasional giant cells. Immunohistological analysis revealed some MHC locus II antigen positive cells that were identified as monocytes. ⋯ Hydroxyapatite induced only a slight interleukin-2 receptor expression that did not differ from culture medium on days 1, 3 and 5. CD4 and CD8 positive lymphocytes as well as monocytes were not seen attached to hydroxyapatite particles during the culture days. Our findings suggest that hydroxyapatite is an immunologically inert implant material.
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Arch Orthop Trauma Surg · Jan 1991
Usefulness of a new technique for hind limb immobilization in rats for the study of tendon healing.
To study wound repair in rat Achilles tendon, we utilized a novel surgical method for immobilizing only one hind limb. In this technique, the femoral vessels were preserved while the skin, muscles, nerves and the shaft for the femur were transected. The limb was then rotated and sutured to lie on the posterolateral flank of the animal. ⋯ In 2 weeks, the gap was completely occupied by fibrovascular tissue that was beginning to align along the long axis of the tendon. By the 4th week, remodeling had occurred and the site of the wound had almost blended with the rest of the tendon. We conclude that this new technique of hind limb immobilization causes little stress on the animal, and it can be useful for the study of tendon healing.