Archives of orthopaedic and trauma surgery
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A patient who suffered from severe deforming arthritis secondary to chronic tophaceous gout with multilobular, solid, tender, enlarged subcutaneous nodules and draining tophi in both hands was evaluated and treated by second ray amputation of the most deformed second finger to provide a more functional result.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyInfluence of trypsin on the biological bonding of cartilaginous surface to bone in rabbits.
Biological healing between cartilage and bone is difficult, because their histological structure and physiological function are completely different, and the healing ability of cartilage is limited. A full-thickness articular cartilage defect was created in the femoral groove of 48 Japanese white rabbits. The defects were filled with a piece of articular cartilage from the contralateral patella with its superficial zone facing down to the defect. ⋯ We found that the incorporation process of cartilage implant treated with trypsin was much better than that of PBS-pretreated cartilage. Proliferation and reorganization of chondrocytes in the cartilage implant and subchondral bone ingrowth were observed in the trypsin-pretreated group. Although the observation period in our study was not very long, our results suggest that trypsin pretreatment might be one of the most promising methods to facilitate the repair process between cartilage and bone.
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Arch Orthop Trauma Surg · Jan 2000
Electromyographically evident changes in skeletal muscles during tibial lengthening in dogs using the Ilizarov method.
Twenty-four beagle dogs underwent a lower leg lengthening on the right side of 2.5 cm at a distraction rate of 2 times 0.5 mm per day using a circular fixator system. After a latency phase of 5 days and a distraction phase of 25 days, 12 dogs (30-day dogs) underwent electromyography (EMG) of the gastrocnemius muscle on the lengthened and on the control side. The remaining half of the dogs underwent EMG after a consolidation phase of 25 days following the end of distraction (55-day dogs). ⋯ In the 55-day dogs, no significant differences were observed in the various parameters between the lengthened and the control side. Comparing 30- and 55-day dogs, the duration of the potentials on the distraction side was not significantly shorter in the 55-day dogs, and the amplitude significantly higher. These findings could indicate combined neurogenous and myopathic alterations of the muscles during the early distraction phase which will be compensated during the later distraction period and the consolidation phase by reparative and reinnervation processes, leaving no lasting functional damage.
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This report presents the case of an 8-year-old boy who underwent a second clubfoot operation following early-stage reflex sympathetic dystrophy (RSD). After other conditions had been ruled out, the patient was submitted to physiotherapy supported by antiphlogistic and analgesic drugs as well as a partial immobilisation of the affected extremity. ⋯ RSD in children is not a well-recognised entity. This case of early-stage RSD illustrates the need to be aware of this possible complications after operation in the differential diagnosis of local pain and swelling of a limb.
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Arch Orthop Trauma Surg · Jan 2000
Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release.
Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure for moderate to severe hallux valgus deformity [intermetatarsal (IM) angle > 15 degrees, or hallux valgus (HV) angle > 30 degrees]. At an average follow-up of 26 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were retrospectively reviewed. The HV angle averaged 41.1 degrees preoperatively and 14.6 degrees postoperatively. ⋯ Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this first study exclusively focusing on moderate to severe hallux valgus deformity, we conclude that proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus (IM angle > 15 degrees or HV angle > 30 degrees).