Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2007
Multicenter StudyTibiotalocalcaneal arthrodesis using a reamed retrograde locking nail.
New techniques for tibiotalocalcaneal arthrodesis ideally should improve union rate and reduce the complication rate. The purpose of this study was to evaluate the union rate of tibiotalocalcaneal arthrodesis achieved using an intramedullary nail without formal debridement of the subtalar joint and open or percutaneous debridement of the ankle joint. Consolidation time, complication and satisfaction rates, American Orthopaedic Foot and Ankle Society ankle/hindfoot score, and shoe adaptation were assessed. ⋯ The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 70. Tibiotalocalcaneal arthrodesis with a specifically designed retrograde intramedullary nail without formal debridement of the subtalar joint and a choice between open or percutaneous debridement of the ankle is a reliable method to achieve fusion. Opening and debriding the subtalar joint is, in our opinion, not necessary, and percutaneous debridement of the ankle is a good alternative to open debridement.
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Clin. Orthop. Relat. Res. · Oct 2007
The rise in the incidence of pulmonary embolus after joint arthroplasty: is modern imaging to blame?
In recent years, there has been an apparent increase in the incidence of pulmonary embolus after joint arthroplasty at our institution. We hypothesized the use of sophisticated imaging modalities such as the multidetector computed tomography scan, with better sensitivity, resulted in an apparent increase in the incidence of pulmonary embolus. We studied all patients with pulmonary embolus after joint arthroplasty between 2000 and 2005. ⋯ Extremely sensitive imaging tests with unknown specificity have resulted in an increase in diagnosed pulmonary embolus. However, diagnosing pulmonary embolus generates implications for further treatment such as prolonged anticoagulation and/or inferior vena cava filter insertion with potential for catastrophic complications. The challenge is to distinguish which require treatment and which do not.
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Clin. Orthop. Relat. Res. · Oct 2007
Treatment of periprosthetic femoral fractures by effective lengthening of the prosthesis.
The increasing number of hip and knee arthroplasties implies a greater likelihood of periprosthetic fractures and need for successful treatment options. We asked whether in situ effective lengthening of the indwelling prosthesis by a custom-made slotted hollow intramedullary nail provided a reasonable alternative to the established internal fixation techniques and prosthesis exchange. Between 1994 and 2005, we treated 25 patients (four male and 21 female; average age, 80 years) with a hip or knee periprosthetic fracture using this technique. ⋯ We observed fracture healing in all patients, but one female patient had subsequent prosthesis loosening. The major complication rate was 6% (one of 18). We believe effective lengthening of the indwelling prosthesis by a custom-made slotted hollow intramedullary nail is a reasonable option for treating periprosthetic femoral fractures.
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Clin. Orthop. Relat. Res. · Oct 2007
Comparative StudyThe accuracy of computer-assisted percutaneous iliosacral screw placement.
The benchmark fluoroscopic technique of iliosacral screw insertion is disadvantaged by its reliance on ionizing radiation and presentation of dynamic information in only one plane. Multiplane targeting requires interpolation, which may be associated with inherent errors. Computer-assisted surgery enables surgeons to monitor their screw trajectory in 3-D space. ⋯ With both techniques, two of the 10 tracks penetrated the sacral cortex in dysplastic pelvices. A fluoroscopic computer-assisted surgery technique appears as accurate as the standard fluoroscopic technique but no more so. Caution is recommended in dysplastic pelvices.
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Clin. Orthop. Relat. Res. · Oct 2007
Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes.
Many patients with patellofemoral pain have multiple knee disorders, such as chondral defects, malalignment, and ligament insufficiency. I reviewed a treatment approach that included autologous chondrocyte implantation and biomechanical altering procedures to reduce impairment and symptoms in patients with patellofemoral lesions and biomechanical disorders. Thirty-eight patients (39 knees; mean age, 31.2 years) had large isolated (trochlear, 4.3 cm2; patellar, 5.4 cm2) or bipolar (mean total surface area, 8.8 cm2) patellofemoral lesions. ⋯ Twenty-five patients had 32 subsequent surgeries, including 14 to remove hardware from a prior osteotomy. Autologous chondrocyte implantation failed in three patients. Despite the high rate of reoperation, the data suggest combined treatment of autologous chondrocyte implantation and biomechanical altering procedures may be a reasonable option for selected patients with coexisting patellofemoral lesions and mechanical disorders.