Clinical orthopaedics and related research
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The periprosthetic tissue reaction to polyethylene wear debris in metal on polyethylene total hip replacements is strongly implicated as the cause of osteolysis. This has led to a renewed interest in metal on metal total hip replacements. ⋯ As compared with metal on polyethylene cases, the extent of the granulomatous inflammatory reaction and the presence of foreign body type giant cells was much less intense in metal on metal cases, likely because of the lower numbers and overall smaller size of metal wear debris particles. This may lead to a better transport of the particles from the joint tissues and a lower incidence of periprosthetic osteolysis around metal on metal hip replacement.
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Clin. Orthop. Relat. Res. · Aug 1996
Case ReportsElbow dislocation with ipsilateral radial shaft fracture. An unusual outcome.
The authors describe an uncommon injury of the upper limb, namely, dislocation of the elbow with fracture of the ipsilateral radial shaft, in a young man. After closed reduction of the joint, the radial head was found to be subluxated, and when a nonanatomic internal fixation of the radial shaft was undertaken, the radial head became dislocated. Repeat operation with removal of the implants and internal fixation with correction of rotation and angulation at the fracture site and reconstruction of the annular ligament restored normal anatomy.
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From April 1982 to August 1995, the author treated 127 patients with pelvic ring injuries by open reduction and internal fixation within 3 weeks of injury. Fifty-five (43%) patients (none of whom had a symphysis dislocation) had posterior internal fixation without anterior pelvic internal or external fixation. In 37 patients (29%) anterior and posterior internal fixation was performed whereas 35 patients (28%) were treated by anterior internal fixation alone. ⋯ However, even in displaced and unstable pelvic ring injuries, most fractures of the pubic rami do not require stabilization by internal or external fixation. Eighty-eight of 105 fractures of the obturator ring were not internally fixed and none required subsequent treatment for nonunion or loss of reduction; nor did their initial instability cause failure of posterior fixation. Internal fixation of the anterior pelvic ring, though safe and reliable, should be reserved for symphysis pubis dislocations and only a minority of pubic ramus fractures.