Acta Orthop Belg
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An anatomical cadaver study was carried out on 13 human cadavers to disclose the close anatomical relationship between the peroneal nerve and the surgical area of the high tibial osteotomy techniques. The common peroneal nerve passes within 3 to 6 mm. of the posterior aspect of the fibular head and neck and divides into its superficial and deep branches, 22 to 28 mm. distal to the fibular apex. Generally the extensor hallucis longus (EHL) muscle is innervated by one of the motor branches of the deep peroneal nerve which is anatomically located 74 to 82 mm. distal to the fibular apex. To avoid neurological complications with a high tibial osteotomy, fibular osteotomy should be carried out at the junction of the middle and distal thirds of the fibula without excessive medial and anterior displacement of fragments; a small fibular segment should be resected in knees which have a severe deformity and need a significant angle correction.
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The elbow possesses two degrees of freedom: flexion-extension and pronation-supination. The axis of flexion-extension joins the centers of the capitellum and of the trochlea. The axis of pronation-supination passes through the head of the radius, and through the distal ulnar dome. ⋯ The elbow is submitted to high articular contact forces. The joint stability depends on the articular surfaces, capsulo-ligamentous restraints and dynamic muscular contractions. As a practical application of this fundamental knowledge, an experimental study of the effects of total elbow arthroplasty on joint stability and muscle moment arms is reported, insisting on the deleterious effects of implant malpositioning.
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Cerebral embolism poses one of the most perplexing problems in cerebrovascular disease; fat emboli and marantic air emboli occur occasionally. However, the most common cause for a cerebral embolism is degenerative changes in the central arteries. ⋯ The patient awoke slowly, and when awake she showed a combination of contralateral hemiplegia, and right hemianesthesia with global aphasia; the CT scan showed an ischemic lesion in the territory of the middle cerebral artery; during the following two weeks the patient showed complete recovery from the clinical syndrome. This complication must be recognized by every orthopedic surgeon, and a high clinical index of suspicion remains essential to early diagnosis.
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A case of a bilateral posterior four-part fracture dislocation of the shoulder after a convulsive seizure was treated conservatively on one side, while the other shoulder was replaced by a hemiarthroplasty. A review of the literature and a treatment protocol for managing these injuries are presented. In four-part fracture-dislocations good results can be achieved with conservative treatment, but when avascular necrosis is likely to occur (delay in diagnosis or dubious relationship of the fragments after reduction) it is better to replace the humeral head.
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We retrospectively reviewed the radiographs of 255 patients with intertrochanteric fractures over a 2 year period. The incidence of osteoarthritis of the hip joint in these patients was 12.16%, which is less than that reported in the general population, and which confirms the protective effect of osteoarthritis against intertrochanteric fractures. Osteoarthritis was mild in 14, moderate in 19, and severe in 4 hips. ⋯ Three patients with severe osteoarthritis, who were waiting for a total hip replacement before the hip fracture occurred became asymptomatic. There was no significant clinical or radiographic progression of mild and moderate hip osteoarthritis in the remaining 13 patients (15 hips). Intertrochanteric fractures appear to have a beneficial "osteotomy-like" effect on hip osteoarthritis in symptomatic patients.