Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2006
Outcome of partial medial epicondylectomy for cubital tunnel syndrome.
Partial medial epicondylectomy aims to eliminate potential drawbacks of total epicondylectomy for treatment of cubital tunnel syndrome. In this series, we retrospectively evaluated 80 patients (80 elbows) who had partial medial epicondylectomies for established cubital tunnel syndrome. Our main purpose was to compare clinical outcomes among partial, minimal, and total epicondylectomies. Specific attention was given to the functional outcome in severely impaired patients, and potential postoperative complications of total epicondylectomy, such as elbow instability, and medial elbow pain. Preoperatively, 16 patients were classified as having McGowan Grade I lesions, 40 had Grade II lesions, and 24 had Grade III lesions. The mean followup was 32 months (range, 26 months-4.2 years). There was improvement of at least one McGowan grade in 86.2% of the patients, with a 66.7% improvement in severely impaired patients (McGowan Grade III lesions). There was no ulnar nerve palsy, no ulnar nerve subluxation, or medial elbow instability. However, 45% of patients reported mild pain at the 6-month followup. Partial medial epicondylectomy seems to be safe and reliable for treatment of cubital compression neuropathy at the elbow. ⋯ Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2006
Postoperative infections in interbody fusion for degenerative spinal disease.
Scant literature exists on the treatment of infection after interbody fusion. Some authors advocate removal of the interbody grafts. Salvage of the grafts was possible in 92.3% (12 of 13) of the infections in a series of 326 consecutive patients with degenerative spinal diseases treated by three surgeons. Posterior interbody fusion and posterolateral instrumented fusion was performed in 267 patients and anterior interbody fusion was done in 59 patients. Eight infections in the first group (3%) and six in the second group (10.1%) were identified. Mean followup was 18 months (range, 12-38 months). All infections were early, presenting at a mean of 18 days (range, 11-28 months). All but one infection were in the posterior wound and deep. A high number of risk factors were present in these patients. Initial treatment included wound debridement and broad spectrum antibiotics, until culture results indicated the final antibiotic regimen. Infection recurred as osteomyelitis in one patient with multiple previous surgeries and anterior/posterior fusion. This was treated with removal of the posterior instrumentation and the interbody graft and extensive anterior/posterior reconstruction. Clinical outcomes were good in 10 patients, fair in two and poor in one using the Stauffer-Coventry scale. One pseudarthrosis was identified in a patient with anterior interbody fusion at final followup. Salvage of the interbody graft and retaining the instrumentation was safe in most cases in the presented series and did not adversely affect outcome. ⋯ Therapeutic study, level IV (case series). Please see the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2006
ReviewFailed back surgery syndrome: surgical and nonsurgical approaches.
Failed Back Surgery Syndrome is a common and challenging clinical problem. Often the anatomic pain source is unclear. Relevant outcome studies are rarely diagnosis specific, and high level research studies comparing surgical and nonsurgical approaches to Failed Back Surgery Syndrome studies have not been published to date. Surgical strategies focus on decompressing neural impingement or fusing unstable or putatively painful intervertebral discs. Nonsurgical interventions range from nerve root specific blocks for pain relief to multidisciplinary rehabilitation programs geared toward improving function. This paper reviews the most common interventions and concludes with recommendations for the care of the individual patient. ⋯ Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2006
Comparative StudySecond application of low-energy shock waves has a cumulative effect on free nerve endings.
Some physicians recommend treating tendinopathies with multiple sessions of shock waves. Some evidence, however, suggests shock wave application can induce nerve fiber degeneration. We questioned whether repeated shock wave application provides a cumulative effect on nerve fibers compared with the effect of one application. ⋯ Reinnervation occurred slower in the repeated-treatment group. These data show that a second application has a cumulative effect on nerve fibers. Our data suggest multiple applications of low-energy shock waves might a provide longer-lasting antinociceptive effect.
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Clin. Orthop. Relat. Res. · Jan 2006
Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint.
Apprenticeship training of surgical skills is time consuming and can lead to surgical errors. Our group is developing an arthroscopic virtual reality knee simulator for training orthopaedic residents in arthroscopic surgery before live-patient operating room experience. ⋯ The validation study, done at eight orthopaedic residency programs, will commence in early 2006 and will take one year to complete. We anticipate that proficiency obtained on the simulator will transfer to surgical skills in the operating room.