Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2001
Radiological signs of osteitis around extramedullary metal implants. A radiographic-microbiological correlative analysis in rabbit tibiae after local inoculation of Staphylococcus aureus.
Radiographic changes in the early stages of osteomyelitis may be subtle and, especially after plate osteosynthesis, frequently missed. A previously described experimental model of local bacterial infection was used in an attempt to determine the reliability of specific changes on conventional radiographs for the diagnosis of osteitis after metal-plate implantation and subsequent inoculation of Staphylococcus aureus in rabbit tibiae. Roentgenograms of the treated limbs were evaluated, and seven radiographic parameters, to which numerical scores were assigned, were determined for each bone. ⋯ Plate implantation does not notably impede the diagnosis of osteomyelitis. An association between the amount of inoculated bacteria and the extent of radiographic changes could be found. The results of this present study closely resemble those described in man and suggest that this model may be useful for future experimental investigations in determining a score judging the severity of osseous involvement in local bacterial infection after plate osteosynthesis.
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Arch Orthop Trauma Surg · Jun 2001
Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study.
In trans-tibial amputees, PTB (patellar tendon bearing) prostheses provide almost physiological mobility of the knee joint in the sagittal plane. Nevertheless, there are characteristic adaptations of the knee joint muscles. Myosonography is a suitable method for depicting muscle atrophy and hypertrophy due to muscle dysfunction. ⋯ During gait, electromyographical activity within the amputated limb was reduced in the vastus lateralis and increased in the biceps femoris muscle. Even long-term adaptation to PTB prostheses results in characteristic deviation from normal gait. Atrophy occurs in the ventral thigh muscles, predominantly on the amputated leg, whereas the dorsal thigh muscles are hardly affected, probably due to compensatory hyperactivity.
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Arch Orthop Trauma Surg · Jun 2001
Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.
The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. ⋯ Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.
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Arch Orthop Trauma Surg · Jun 2001
A technique for accurate reproduction of the femoral anteversion during primary total hip arthroplasty.
Accurate reproduction of the femoral anteversion is important in achieving stability of the prosthetic joint in total hip arthroplasty (THA), while placement of the femoral stem in excessive anteversion or retroversion results in an increased incidence of dislocation. Due to a number of factors, the current surgical technique results in significant variation between the anatomical and the surgically reconstructed femoral anteversion. ⋯ The method is based on the idea that the initial stages of femoral canal preparation can be completed before the femoral neck is osteotomised and therefore at a stage when the femoral head and neck are still accessible and can be used as landmarks for accurate reconstruction of the femoral anteversion. The described technique for accurate reconstruction of the anatomical version of the femoral head is indicated for all cases of primary THA where reproduction of the normal anatomical centre of rotation of the hip joint is a principal aim.
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Arch Orthop Trauma Surg · May 2001
Preoperative radiotherapy without femoral shielding for prevention of heterotopic ossification in hydroxyapatite-coated hip prostheses.
Twenty-seven consecutive patients at high risk of developing heterotopic ossifications (HO) after implantation of a hydroxyapatite (HA)-coated hip prosthesis were irradiated with a single dose of 7 Gy, at least 4 h before the operation. The femoral stem was not shielded during radiotherapy (RT). ⋯ We conclude that single-dose, preoperative RT for HA-coated hip prosthesis can effectively inhibit HO. Not blocking the femoral stem does not result in prosthesis migration.