Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialCorrelation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion.
Thirty-two patients with radiographic evidence of scaphoid nonunion were preoperatively evaluated by magnetic resonance imaging (MRI), then observed intraoperatively for punctate bleeding of the fragments. Although MRI and intraoperative findings matched in 19 patients, there was no correlation in 13 patients. ⋯ After internal fixation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialCastor oil decreases pain during extracorporeal shock wave application.
In a prospective single-blind study the contact media ultrasound gel, vaseline and castor oil were examined for their effect on surface pain caused by extracorporeal shock waves used for tendinosis calcarea (n = 25), radiohumeral epicondylitis (n = 23) and plantar heel spur (n = 12). A total of 60 patients was divided into six groups. Using a Compact S shockwave source (Dornier MedTech), an energy flux density up to 0.12 mJ/mm2 was applied three times within 3 weeks. ⋯ For the diagnosis of tendinosis calcarea and plantar heel spur, castor oil was significantly better than the other two contact media, while for epicondylitis there was no significant difference. Castor oil was found to have an advantage over ultrasound jelly and vaseline in all indications used with regard to application pain. The positive effect of castor oil can be explained by its cavitation-free quality.
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialWear of alumina ceramics prosthesis.
To investigate the process of wear in the total knee prosthesis consisting of alumina ceramics (Al-ceramics) and ultra-high molecular weight polyethylene (UHMWP) in vivo, we observed the fine structures of the articular surface of the prostheses used for four patients with osteosarcoma of the distal femur. We also examined the wear debris in the surrounding soft tissues. The prostheses were extracted at autopsy between 13 and 48 months after surgery. ⋯ The streaks had similar widths to the Al-ceramics grains. Al-ceramics debris was detected in the soft tissues around the joint mixed with UHMWP debris. We concluded that the wear of UHMWP in Al-ceramics prosthesis was promoted by interposition of Al-ceramics debris.
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialMeasurement of clinical change caused by knee replacement. Conventional score or special change indexes?
Clinical change may be measured with specific indexes of change or with the difference between single-state examinations. Change scores and transition indexes are the special indexes of change analysed in this study. ⋯ This was judged to be unacceptable. It is recommended that a transitional index be included in the clinical evaluation systems used for knee replacement.
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Arch Orthop Trauma Surg · Jan 1999
Clinical TrialRole of metaphyseal cancellous bone defect size in secondary displacement in Colles' fracture.
The purpose of this study was to evaluate the role of the metaphyseal cancellous bone defect size in secondary dislocation of Colles' fracture. Thirty-five patients with a dislocated Colles' fracture were examined by computed tomography (CT) for metaphyseal bone defects. ⋯ The relative size of the defect correlated with the severity of dorsal angulation of the fracture but not with the shortening of the radius seen after cast immobilization. We concluded that secondary displacement of the distal radius is partly mediated through the metaphyseal cancellous bone defect, and to prevent malunion in dorsal angulation, operative treatment or possibly filling of the defect should be considered even as early as during primary reduction if a large defect is suspected.