Clinical orthopaedics and related research
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The occurrence of pain was investigated in 118 patients with posttraumatic brachial plexus injuries (BPI). Ninety-five patients were operated upon by the same surgeon. Three to 14 years after BPI and reconstructive surgery, 91% of the patients experienced permanent pain that was severe in 40% and mild in 51% of cases. ⋯ For 57% of patients with pain, a plurimodal medical treatment with tricyclic antidepressants, antiepileptic drugs, and behavioral therapy efficiently reduced pain. For the patients with unbearable paroxystic pain, when medical treatment failed, the destruction of deafferented dorsal horns at the level of avulsion (Nashold procedure) could produce pain relief. In all cases psychosocial management produced early rehabilitation.
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Clin. Orthop. Relat. Res. · Dec 1988
Comparative StudyPrevention of heterotopic ossification by nonsteroid antiinflammatory drugs after total hip arthroplasty.
The effect of three weeks of postoperative treatment with indomethacin or ibuprofen on the development of periarticular heterotopic ossification (PHO) after bilateral total hip arthroplasty (THA) was investigated. Widespread PHO did not occur in 31 patients who had been treated with indomethacin or ibuprofen after both operations. ⋯ Widespread PHO occurred in 14 of 38 untreated THA, but was not found after THA on the treated side. These findings are indicative of an inhibitory effect of nonsteroid antiinflammatory drugs on the development of PHO, since the development of severe heterotopic ossification is strongly correlated between the two sides after bilateral THA.
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Clin. Orthop. Relat. Res. · Dec 1988
Case ReportsLate treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate.
The outcome of delayed treatment of an unreduced transscaphoid, transtriquetral, perilunate fracture dislocation of the carpus is unpredictable. Long-term follow-up observations in a 22-year-old man treated three months postinjury showed changes in the lunate consistent with avascular necrosis at the time of open reduction and internal fixation. ⋯ Consequently, avascular changes of the carpus following wrist dislocation do not preclude a good result. Anatomic reduction of the scaphoid, as well as the midcarpal joint, and restoration of the articular surface of the lunate, are most important in determining prognosis.
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Clin. Orthop. Relat. Res. · Dec 1988
ReviewNeurotization in brachial plexus injuries. Indication and results.
In neurotization or nerve transfer, a healthy but less valuable nerve or its proximal stump is transferred in order to reinnervate a more important sensory or motor territory that has lost its innervation through irreparable damage to its nerve. In brachial plexus injuries, extraplexal nerves such as the spinal accessory nerve, rami of the cervical plexus, or intercostal nerves are transferred onto trunks, cords, or individual nerves or else segments of the brachial plexus that maintain continuity with the spinal cord may be coapted to trunks or cords the surgeon wishes to innervate. ⋯ Results of other authors are also reported. With these methods, it is possible to obtain good elbow flexion in more than one-half of patients; however, only limited shoulder function and no useful finger function are obtained.