Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsCorrection of clubfoot relapse using Ilizarov's apparatus in children 8-15 years old.
Treatment of relapsed or neglected clubfeet between the age of 8-15 years is at present unsatisfactory. Correction by triple arthrodesis with wedge osteotomies is not possible before the end of skeletal maturation. This caused us to use Ilizarov's external fixator, which made it possible to correct all components of clubfoot simultaneously by continuous guided distraction. ⋯ A plantigrade foot was achieved in all cases. All patients were able to wear ready-made shoes. Complications were some slight and two severe pin track infections, temporary edema, and two relapses successfully treated by means of second procedures.
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According to one principle of surgery, the transplantation of vital tissue is the best method of reconstructing a defect. Because of absent immunologic reactions, high osteogenic potency, and preserved stability, transplantation of autogenous bone shows the best results. Necrosis of transplanted bone, leading inevitably to absorption and remodeling of the graft, can be avoided if microsurgically vascularized autogenous bone segments are transferred. ⋯ Demineralized bone matrix can be used if biomechanical stability is not required. Its ability to induce osteogenesis without a major immune reaction or the risk of transmitting diseases justifies its clinical application. Further intensive research in these areas is unavoidable.
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyBone formation in porous implants of delrin and commercially pure titanium.
Clinicians have been using implants made by titanium or delrin with varying results. In this study dividable implants, bone growth chambers (BGC), of titanium and delrin were inserted into the rabbit tibia. ⋯ Results showed that bone ingrowth into titanium implants was significantly larger than into delrin implants (P less than 0.005). The possible reasons for this are discussed.
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Arch Orthop Trauma Surg · Jan 1990
New aspects of lumbar disc disease. MR imaging and histological findings.
Magnetic resonance imaging (MRI) and plain X-ray and CT studies were performed in patients with a history of lumbar back pain due to spinal disc disease. Spin-echo pulse sequences (SE), phase-contrast techniques (partial saturation sequences with delayed readout, PS), and fat-suppressing inversion recovery sequences (STIR) were employed. In 74 of 325 patients, PS and STIR images displayed vertebral marrow changes adjacent to the end-plates of the affected segments. ⋯ In six patients histological diagnosis showed substitution of hematopoietic marrow by fatty tissue, cartilaginous particles, degeneration of fat cells, and an increase in extracellular fluid with different components. The etiology is still unclear, but a correlation with lumbar disc disease is demonstrated. These vertebral marrow changes were best displayed with STIR and phase-contrast MR sequences, both providing contrast changes superior to T2-weighted SE techniques.
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsArterial lesions in major knee trauma: pedal pulse a false sign of security?
In major knee trauma fractures and/or dislocations can be associated with arterial lesions. Two case reports demonstrate the difficulties in the diagnosis of intimal lesions in the popliteal artery. ⋯ The importance of prompt diagnosis and treatment is emphasized. The use of arteriography is discussed.