Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2003
Case ReportsConcomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations.
We report an unusual case of concomitant plantar tarsometatarsal (Lisfranc) and 1st and 2nd metatarsophalangeal (MTP) joint dislocations and fracture of the neck of the third metatarsal bone which has never been reported before. The plantar dislocation of the Lisfranc joint was treated by open reduction and fixation with K-wires; the dislocations of the MTP joints and neck fracture of the third metatarsal bone were treated by closed reduction and percutaneous fixation with K-wires and immobilized with a plaster cast. At the 5 year follow-up examination, our patient had no complaints, but the radiograph showed degenerative changes of the Lisfranc and the 1st MTP joint.
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Arch Orthop Trauma Surg · Apr 2003
Do orthopaedic journals provide high-quality evidence for clinical practice?
In the hierarchy of research designs, randomized controlled trials and meta-analyses are considered to be evidence of the highest grade, and scientific journals are the main source of scientific information. ⋯ Although the number of randomized controlled trials and meta-analyses is tending to increase, the conclusion of this study is that the high-quality evidence provided by the major orthopaedic journals is quite low, and more randomized controlled trials and meta-analyses are needed for evidence-based orthopaedic practice.
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Arch Orthop Trauma Surg · Apr 2003
Access to the medullary canal in closed antegrade femoral nailing: a technical report.
Although general recommendations exist regarding the correct placement of the skin incision and the direction of deep dissection for closed antegrade intramedullary nailing of the femur, in surgical practice simultaneously establishing the correct entry point and exact direction for insertion of the entry instrument in the lateral (sagittal) plane may be difficult. This is due to sub-optimal radiographic images in the lateral plane as a result of the overlying shadows of the pelvis, variations in the degree of rotation of the femur during patient positioning and fracture reduction manoeuvres, variations in the degree of anterior bowing of the femoral shaft and the anatomy of the greater trochanter, and deviations of the plane of deep dissection caused by the glutei muscle fibres. This may lead to the need for several attempts with increased damage to the glutei muscles, high exposure to radiation and the risk of an iatrogenic fracture. The present technical note describes a simple method for swift, easy and accurate access to the medullary canal during closed antegrade femoral nailing.
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Arch Orthop Trauma Surg · Feb 2003
Case ReportsChondrosarcoma of the hand secondary to multiple enchondromatosis; report of two cases.
Although malignant transformation to chondrosarcoma may occur in some patients with multiple enchondromatosis, this event rarely occurs in the hand. We encountered two patients with chondrosarcoma of the hand secondary to multiple enchondromatosis. One patient was a 27-year-old man and the other, a 76-year-old man. ⋯ Histological examination revealed that the tumour was a grade 2 chondrosarcoma in case 1 and a grade 1 chondrosarcoma in case 2 accompanied by enchondromata. From these findings, the diagnosis of chondrosarcoma secondary to multiple enchondromatosis was made. Because quite a few patients with multiple enchondromatosis develop secondary chondrosarcoma, although rarely in the hand, the enchondromata should be curetted, unless impractical, before malignant transformation occurs.