Journal of surgical orthopaedic advances
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Four patients with acromioclavicular joint injuries (one type II, two type III, one type V), two patients without acromioclavicular joint injury, and a fresh-frozen cadaver underwent magnetic resonance imaging (MRI) and plain radiographs. The normal conoid and trapezoid ligaments were easily identified in the cadaver and the two uninjured patients. ⋯ Thus, the grade of injury, as determined by the change in the coracoclavicular interval onplain radiography and defined by the Rockwood classification system, failed to correlate with the pathoanatomy seen on MRI in two of the four injured patients. These findings suggest that improvements in the classification of these injuries may be necessary.
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Case Reports
Concomitant sacroiliac joint pain in patients with lumbar disc herniation: case series.
Recent studies have shown that not all lumbar disc herniations are symptomatic and that when followed longitudinally, these patients develop back pain independent of the previous imaging study. This is a case report of two patients with radicular symptoms and lumbar disc herniations that underwent diagnostic injections to locate their pain generator. Both patients failed to respond to transforaminal epidural steroid injections. ⋯ They were both treated conservatively for sacroiliac joint pain and did well. One remained pain free after several months and the second remained with minimal pain until she presented again in her 3rd month of pregnancy with return of her pain. The differential diagnosis of lumbar radicular pain is discussed as well as the authors' experience in using diagnostic injections.
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Comparative Study
Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis.
Eighteen patients with a prior intertrochanteric or basicervical hip fracture had a total or bipolar hip arthroplasty. The clinical and radiographic results of these patients were compared to a control group of patients (matched for age, gender, associated diagnoses, and length of follow-up) who had a primary total hip arthroplasty. ⋯ There was no notable difference in the rates of radiographic loosening or heterotopic ossification between the two groups. The results of this study suggest that patients should be counseled preoperatively that the functional outcome of hip arthroplasty after internal fixation of extracapsular hip fractures is decreased compared to control patients with a primary total hip arthroplasty.
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The Jones fracture, defined as a proximal junctional metaphyseal/diaphyseal fracture of the fifth metatarsal, presents a challenge to the orthopaedic surgeon, especially in the competitive athlete. The purpose of this study is to characterize the Jones fracture in the elite athletic community and review the variety of treatments for these fractures in the National Football League (NFL). Between 1988 and 2002, 4758 elite collegiate football players participated in the NFL Combine. ⋯ A questionnaire was also sent to all NFL team physicians regarding their experience with these fractures. The concensus was that this is not a common injury, but when it occurs, surgical treatment is recommended (77%) over nonsurgical treatment (23%). After reviewing the data, it was found that intramedullary screw fixation of Jones fractures is the treatment of choice for most physicians who treat elite collegiate and professional football athletes.
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Case Reports
Late vascular injury following intertrochanteric fracture reduction with sliding hip screw.
A case involving late injuries to pelvic vessels caused by a sliding hip screw penetrating through the acetabulum has not been previously reported. We present the case of an 88-year-old man who presented with a retroperitoneal and extraperitoneal hematoma 4 months after open reduction and internal fixation of an intertrochanteric hip fracture. Surgical exploration showed a laceration of the left external iliac artery, which was repaired. ⋯ The patient's condition deteriorated, and he expired 2 days later. Postmortem examination revealed a laceration of the left internal iliac vein. Our calculations show that the compression screw utilized in the fixation may not have been properly engaged into the sliding screw.