Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 1992
Case ReportsLocked patellar dislocation with vertical axis rotation. A case report.
Whereas traumatic lateral dislocation of the patella is a well-described clinical entity, other types of patellar dislocations, specifically those that involve patellar rotation, are unusual. These rare types also present a therapeutic problem in which reduction often requires a general anesthetic and, possibly, an open procedure. A 16-year-old boy sustained a laterally directed blow to his knee, resulting in dislocation of the patella. ⋯ A similar type of dislocation has been described; however, the patella is usually intercondylar. The tear along the medial side was extensive enough to allow the patella to dislocate lateral to the lateral femoral condyle, making this a unique case. In these instances of rare patellar dislocation, the surgeon should be prepared to perform an open reduction, because attempts at closed reduction even with a general anesthetic may be unsuccessful.
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The lumbar facet joint has long been considered a significant source of low back pain (LBP). Facet blocks with anesthetic and cortisone, and even facet denervation procedures, have been recommended as treatment for patients with LBP. The literature, however, fails to conclusively document the role of the facet in the production of LBP. Based on a review of the literature and the author's clinical studies, the following statements appear to be appropriate and defensible: (1) The lumbar facet joints are very important biomechanically. (2) The facet is not a common or clear source of significant pain. (3) The facet syndrome is not a reliable clinical diagnosis. (4) Injection of intraarticular saline into the facets in control cases is as effective as local anesthetic and steroids in relieving the patient's pain temporarily. (5) Response to facet joint injection in patients with LBP does not correlate with or predict their clinical results after solid posterior lumbar fusion, and it should not be used preoperatively as a clinical criterion in selection of patients for fusion. (6) More prospective, controlled and randomized clinical studies are recommended.
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Clin. Orthop. Relat. Res. · Jun 1992
Case ReportsClosing wedge osteotomy with transpedicular fixation in ankylosing spondylitis.
The Smith-Petersen anterior opening wedge osteotomy of the lumbar spine is currently the accepted technique for the correction of spinal deformity in ankylosing spondylitis. It has a mortality of 10%, uses force, is uncontrolled, and fixation is often feeble. ⋯ This technique is controlled, comparatively safe, and provides secure fixation. The procedure is a relatively safe and reliable means of dealing with a dangerous operation.