Acta Orthop Belg
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We report the case of a teenager who was involved in a road traffic accident. She presented a flexion-distraction type of vertebral injury, (Chance fracture). This fracture was associated with an intra-abdominal injury. The child was a passenger in a rear seat using a shoulder seatbelt restraint.
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Acromioclavicular dislocations represent over 10% of acute traumatic injuries to the shoulder girdle. The mechanism is usually a direct impact on the shoulder with the arm in adduction, producing rupture of the acromioclavicular (AC) ligaments, then of the coracoclavicular (CC) ligament, with displacement of the lateral end of the clavicle. Rockwood described 6 grades of injury. ⋯ The choice of the operative technique is controversial, as no single technique has clearly proved to be superior to others. Other authors advocate conservative treatment, which gives functional results which patients consider quite acceptable, with faster recovery; patients should be informed that results are essentially similar, whatever the treatment. The possibility of performing secondary operations with good results in cases with failure of conservative management is a further argument in favor of applying conservative therapy first in acute injuries.
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Comparative Study
Soft tissue stabilization in the management of chronic scapholunate instability without osteoarthritis. A 15-year series.
Management of chronic scapholunate instability without osteoarthritis remains controversial. Some surgeons favor partial wrist arthrodesis; others, soft tissue stabilization. Many techniques for soft tissue repair have been described but with few or unpredictable results. ⋯ Otherwise, all types of repair achieved a relatively pain-free wrist, with acceptable motion, grip strength, scapholunate and radiolunate angles but with a wider than normal static scapholunate distance. A longer follow-up is needed to assess the effect of this abnormal gap. Factors that favorably affected the outcome were: dynamic type of instability and partial disruption of the ligament.
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The study investigates lower lumbar segments with posterior vertebral shifts (retrolisthesis) with respect to the orientation of facet joints, disc height, lordosis of the lumbar spine, and orientation of vertebral endplates. Standing lumbar radiographs as well as CT and/or MRI investigations of 69 patients were analyzed. Data from patients with retrolisthesis (20 cases) were compared to data from patients with degenerative spondylolisthesis (DS, 23 cases), and from patients without signs of vertebral shifts (26 cases). ⋯ The overall lordosis of the lumbar spine and the endplate inclination were considerably reduced in patients with retrolisthesis, especially compared to those with DS. Disc height was comparable in retrolisthesis and DS, but was reduced compared to segments without shifts. The results support biomechanical considerations, that a retrolisthesis of a lower lumbar spine segment is correlated with a reduction of lumbar lordosis, endplate inclination, and segmental height.
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Two hundred three fractures of the patella in 200 patients were treated by tension band wire fixation using one or several wire loops and 2 longitudinally directed Kirschner wires. They were reviewed with a mean follow-up of six years (range 1 to 10 years). There were 143 men and 57 women. ⋯ The complications were sepsis in 11 cases (5%), loosening of material in 20 cases (10%), malunion in 9 cases (4.5%), nonunion in 8 cases (4%), femoropatellar osteoarthritis in 17 cases (8.5%). The results were excellent or good in 169 cases (83%), and fair or poor in 34 cases (17%). The authors recommend this operative technique which allows good anatomic reconstruction of the patella, early mobilisation of the knee and early weight-bearing with a high rate of consolidation.