Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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We treated 16 patients with equinus contracture using the Ilizarov method without open soft tissue release. No hinge was used in seven patients; instead, their ankle joint was used as the hinge (natural hinge; unconstrained construct). In the remaining nine patients, medial and lateral hinges connecting the tibial and foot rings were placed at the center of the talar dome (rotating hinge; constrained construction). ⋯ The natural hinge system is therefore the method of choice for treating equinus contracture because it is less invasive and simpler. However, particular care is needed during correction to avoid complications such as anterior subluxation of the talus and joint space narrowing. When complications do occur, intervention should be immediate.
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Comparative Study
Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture.
Kyphoplasty and vertebroplasty with polymethylmethacrylate (PMMA) have been used for the treatment of osteoporotic vertebral compression fractures. We performed kyphoplasty and vertebroplasty with alpha-tricalcium phosphate cement (CPC) and PMMA to compare the biomechanical properties. Thirty osteoporotic vertebrae were harvested from nine embalmed cadavers. ⋯ In the vertebroplasty groups, the augmented stiffness was not significantly different from the initial stiffness. There was no significant difference between the two bone cements for either procedure when cement volume and restoration of anterior height were assessed. We concluded that kyphoplasty and vertebroplasty with CPC were viable treatment alternatives to PMMA for osteoporotic vertebral compression fractures.
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We report a patient with a locked left thumb in association with de Quervain's disease. While bathing her baby 1 month after giving birth a 32-year-old woman suddenly noticed that she could not radially abduct her left thumb. Magnetic resonance imaging showed thickening of the abductor pollicis longus tendon with a heterogeneous signal intensity on T2-weighted images. ⋯ Operative findings revealed inhibition of the tendon gliding proximally as a result of nodule formation in the abductor pollicis longus tendon distal to the first dorsal compartment. This condition, locking of the thumb, was improved by excising the extensor retinaculum of the first dorsal compartment and tenosynovium around the abductor pollicis longus and extensor pollicis brevis tendon. At the 1-year follow-up examination the patient had no limitations or pain during active radial abduction of the left thumb.
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This case report describes a lumbar epidural abscess that caused septic shock. A 48-year-old woman who developed a high temperature was diagnosed as having a respiratory tract infection. She became unconscious the next day and was transferred to the intensive care unit for monitoring and treatment. ⋯ Surgical drainage of the epidural abscess was performed as an emergency procedure, and the patient recovered immediately. The primary source of the epidural abscess was probably the respiratory tract infection, which spread to the epidural space through hematogenous dissemination. The initial treatment of the epidural abscess was rest and antibiotics, but surgical treatment was needed to save the patient because of septic shock.
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Fractures of the growth plate are unique to childhood. The risk of growth disturbances depends on the type of fracture, its location, the age of the patient, the vascularization to the epiphysis, the state of the surrounding soft tissues, and whether the injury is open or closed. ⋯ We report a Salter-Harris type II injury in the fifth toe. The patient, a 3-year-old girl, was successfully managed conservatively with no sequelae.