Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyTotal hip arthroplasty revision using the press-fit CLS Spotorno cementless stem. Twenty-four hips followed between 1987 and 1998.
A retrospective study of uncemented femoral revision for loosening after total hip arthroplasty was conducted for the period 1987-1998. The study included 24 hips in 22 patients (7 men, 15 women). The revision procedure consisted of the replacement of the loose hip prosthesis using the CLS (Protek) press-fit stem. ⋯ The mean interval between the primary operation and the revision was 10 years (range 2-16 years). Using the Merle D'Aubigné hip score and radiographic findings, a favorable outcome was noted in 20 hips. We suggest that the femoral revision procedure using the uncemented Spotorno stem is a very useful method of correction of loosening after total hip replacement.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyThe saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative intervals.
The first purpose of this study was to evaluate the saddle prosthesis in patients with periacetabular tumors in terms of the functional results obtained after several postoperative intervals. The second purpose was to evaluate the complications and how they might be prevented in the future. Functional results according to the MSTS functional rating system were evaluated at several postoperative intervals in 15 patients treated with internal hemipelvectomy and reconstruction with the saddle prosthesis because of periacetabular primary (n = 9) or secondary (n = 6) malignancies. ⋯ Deep infection occurred in 4 patients and fracture of the iliac remnant in 2. Heterotopic ossifications along the interpositional component were seen in 5 patients, but they did not negatively influence the functional outcome. Three (relative) contraindications to reconstruction with the saddle prosthesis could be ascertained: osteoporosis, extended involvement of the iliac wing by tumor, and insufficient soft-tissue quality after previous procedures. (Short-term) functional results after reconstruction with the saddle prosthesis are satisfactory if the above-mentioned contraindications are taken into consideration.
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Arch Orthop Trauma Surg · Jan 2000
Reduction of fat embolic risks in total hip arthroplasty using cannulated awls and rasps for the preparation of the femoral canal.
Fat embolic phenomena during cemented and non-cemented total hip arthroplasty occur even during the preparation of the femoral canal. This should be avoided in order to reduce the rate of fat embolic syndrome. In the present prospective study we demonstrate the benefit of cannulated awls and rasps in the reduction of fat embolic phenomena by means of transoesophageal echocardiography and extended cardiopulmonary monitoring. ⋯ In contrast to these findings, three macroemboli and four embolic showers grades 1 and 3 were demonstrated in group 2. We recommend cannulated awls and rasps for the preparation of the femoral canal in cemented and non-cemented total hip arthroplasty. They are a simple and inexpensive aid to avoid fat embolic syndrome.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyRepair of muscle and musculotendinous junction injuries with an autogenous fascial patch.
We have used an autogenous fascia lata patch to repair muscle and musculotendinous junction injuries affecting 99 individual muscles in 23 patients with multiple incised wounds to the upper limbs. All patients were followed up for at least 2 years. Two patients with severe dystrophic changes following nerve injuries were excluded from the final analysis. ⋯ Tightness of the flexor pollicis longus was seen in 2 patients, one of whom had a deformity of the interphalangeal joint of the thumb that was passively stretched and subsequently reduced. Scar adhesions were noted in 4 other patients, but this did not affect wrist or finger motion, except in one. The autogenous fascial patch repair technique provides strong and good apposition of muscle fibres simply by distributing the force and tension over a large area of the muscle, thereby allowing early mobilization and functional restoration of the extremity.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsCompression of the ulnar nerve in Guyon's canal by uremic tumoral calcinosis.
We describe the case of a 70-year-old woman with chronic renal failure on haemodialysis presenting with an ulnar nerve compression in Guyon's canal secondary to uremic tumoral calcinosis. Excision of calcium deposits and external neurolysis of the ulnar nerve were successfully performed. ⋯ Clinical and radiological features and therapy are discussed. Uremic tumoral calcinosis is an unusual etiology of ulnar nerve compression in Guyon's canal not previously reported in dialysis patients.