Archives of orthopaedic and trauma surgery
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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
Case ReportsA case of hip osteoarthrosis contaminated by fungi. A histological study.
A pathological study of a surgical specimen of hip osteoarthrosis presenting a superficial fungal infection (presumably Aspergillus) without any known origin is reported. Fungal penetration was mild in cartilage and fibrocartilage and more pronounced in naked cancellous bone, but it did not occur in eburnated bone or in the deep osteomedullar area. This observation indicates an unusual combination of infection and osteoarthrosis. Relationships between fungi and bone or cartilage as well as interaction between osteoarthrotic remodeling and a superimposed disease are discussed.
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Arch Orthop Trauma Surg · Jan 1990
Comparative StudyBlood levels of active metabolites of vitamin D3 in fracture repair in humans. A preliminary report.
Blood levels of the active metabolites of vitamin D3, 25-hydroxycholecalciferol [25(OH)D3], 1,25-dihydroxycholecalciferol [1,25(OH)2D3] and 24,25-dihydroxycholecalciferol [24,25(OH)2D3] were determined in seven patients. Two subjects suffered from delayed union of tibial fractures; one showed a delayed union after a proximal tibial osteotomy; one patient suffered from bilateral femoral neck fractures, of which one failed to unite and the other united late; two patients had multiple fractures that united normally; and one patient exhibited staged bilateral femoral neck fractures whose occurrence was separated by a short interval and which united without undue delay. ⋯ A decrease in 1,25(OH)2D3 levels was noted in only two patients. We postulate that these changes reflect the consumption of these metabolites during healing at the fracture site.
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Arch Orthop Trauma Surg · Jan 1990
Biomechanics of the interlocking nail. A study of the proximal interlock.
Conventional interlocking nails for the femur use an inclined proximal interlocking screw; the AO/ASIF universal interlocking nail utilizes a transverse interlocking screw which is anchored in cortical bone. The transverse position of the screw allows one to employ the nail for either the right or left side. The yield strength of the thinner diameter transverse screw, (thread 4.5 mm. core 3.0 mm) was compared with that of the Grosse-Kempf nail oblique screw (thread 6.3 mm, core 4.5 mm) by testing in cadaver femora to evaluate the risk of fatigue failure. ⋯ Taking the highest load without plastic deformation as a criterion, the mechanical strength of the two screws was evaluated for each fracture situation. The thinner but shorter transverse interlocking screw demonstrated higher strength (4500 N vs. 3000 N; P less than or equal to 0.02) than the thicker inclined screw in the diaphyseal and the subtrochanteric fracture situation (2300 N vs. 1100 N; P less than or equal to 0.06). The biomechanical test showed the transverse screw to have sufficient and superior strength.
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Arch Orthop Trauma Surg · Jan 1990
Ultrastructural changes in synovium and cartilage in experimental hemarthrosis in dogs.
This paper reports electron-microscopic findings in synovium and cartilage in experimental hemarthrosis in dogs. The results are correlated with the total amount of glycosaminoglycans in the cartilage matrix, measured by the fixed-charge density method. Very early, changes are seen in the synoviocytes, similar to synovitis, and especially phagocytosis of iron-containing particles forming secondary lysosomes or siderosomes. Siderosomes are also a constant feature seen in the chondrocytes, together with changes in the rough endoplasmic reticulum and in the glycogen content, correlating with the changes in the ground substance.