Clinical orthopaedics and related research
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Despite the advanced age of many patients having total knee arthroplasty, previous attempts to quantify patient function postoperatively have not allowed for normal deterioration of musculoskeletal function that occurs with aging. We determined the effects of aging on knee function, thereby providing a realistic level of normal, healthy knee function for patients and surgeons after total knee arthroplasties. A self-administered, validated knee function questionnaire consisting of 55 scaled multiple choice questions was used in this study. ⋯ However, only approximately 40% of the functional deficit present after a total knee arthroplasty seems to be attributable to the normal physiologic effects of aging. Patients who had total knee replacements still experienced substantial functional impairment compared with their age- and gender-matched peers, especially when doing biomechanically demanding activities. This suggests that significant improvements in the procedure and prosthetic designs are needed to restore normal knee function after a total knee arthroplasty.
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Clin. Orthop. Relat. Res. · Feb 2005
Functional results after treatment of Volkmann's ischemic contracture: a long-term followup study.
The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. ⋯ Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.
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The treatment of diaphyseal nonunion of long bones is difficult and controversial. We retrospectively reviewed 113 patients with diaphyseal nonunion treated by various modalities, during 15 years at one institution. There were 36 cases of nonunion of the tibia, 23 nonunions of the femur, 21 nonunions of the humerus, 13 nonunions of the radius, 18 nonunions of the ulna and two nonunions of the clavicle. ⋯ Residual problems seen in some patients were joint stiffness, limb length discrepancy, and angular deformity. Twenty-six patients required repeat surgery using bone grafting because no satisfactory progress of fracture healing was seen in 4 months. Complications were related to the iliac crest donor site and persistent infection at the nonunion site.
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The problems in infected nonunion include multiple sinuses, osteomyelitis, bone and soft tissue loss, osteopenia, adjacent joint stiffness, complex deformities, limb-length inequalities, and multidrug-resistant polybacterial infection. Bone gap and active infection are the crucial factors relating to treatment and prognosis. Gaps larger than 4 cm likely cannot be effectively bridged by corticocancellous bone grafting. ⋯ Adequate debridement, fracture stabilization, and second-stage bone grafting gives desirable results in Type B1 infected nonunions. Distraction histiogenesis is the preferred procedure for Type A2 and B2. The autogenous nonvascularized fibular graft, posterolateral bone grafting for the tibia, and centralization of the ulna over distal radial remnant (single bone forearm) may be good treatment options in selected cases.