Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2005
Comparative StudyLateral femoral cutaneous nerve: an anatomic study.
The purpose of our study was to determine the location of the lateral femoral cutaneous nerve and its branches at the inguinal ligament and proximal thigh. We think that further defining the location of the nerve and its branches based on certain measurements from known anatomic landmarks would enable us to determine a danger zone that could aid in preventing iatrogenic injury to the lateral femoral cutaneous nerve. The anatomic course of the lateral femoral cutaneous nerve was studied in 29 cadaver specimens and distances from various landmarks were recorded. ⋯ The lateral femoral cutaneous nerve was found to potentially be at risk as far as 7.3 cm medial to the anterior superior iliac spine along the inguinal ligament and as much as 11.3 cm distal on the sartorius muscle from the anterior superior iliac spine. As many as five branches of the lateral femoral cutaneous nerve were found and in 27.6% of cases the lateral femoral cutaneous nerve branched before traversing the inguinal ligament. We used this information to describe a danger zone, which could be used as a guide to help prevent unnecessary injury during certain procedures.
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Clin. Orthop. Relat. Res. · Jul 2005
Randomized Controlled Trial Clinical TrialEpinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement.
Tourniquets commonly are used during total knee arthroplasties to reduce intraoperative blood loss, despite their various side effects. The goal of this study was to determine whether tourniquet use could be avoided using epinephrine-augmented hypotensive epidural anesthesia during a total knee arthroplasty without negative effects on perioperative hemoglobin values. One hundred patients having total knee arthroplasties were included in a prospective, observer-blinded, controlled, and randomized study. Forty-nine patients received epinephrine-augmented hypotensive epidural anesthesia without use of a tourniquet (Group A), and 51 patients received normotensive epidural anesthesia with use of a tourniquet (Group B). Hemoglobin was evaluated and is reported preoperatively, immediately and 6 hours postoperatively, and on Days 1, 2, 3, 5, and 6 in absolute and relative values. Data were not collected for Day 4. Greater absolute and relative postoperative hemoglobin values were observed in Group A immediately postoperative, on Day 5, and on Day 6. In patients who did not have transfusions, the mean relative hemoglobin values were greater in Group A at all times evaluated (except on Day 1). Epinephrine-augmented hypotensive epidural anesthesia is an effective method to avoid the use of a tourniquet during total knee arthroplasty without the negative effects on perioperative hemoglobin values. ⋯ Therapeutic study, Level I-1a (randomized controlled trial, significant difference). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialAlumina ceramic bearings for total hip arthroplasty: five-year results of a prospective randomized study.
Three hundred twenty-eight ceramic bearings were implanted by six surgeons in 316 patients as a part of a prospective randomized US Investigational Device Exemption study comparing alumina ceramic bearings with cobalt chrome-on-polyethylene bearings. There was no difference between the control metal-on-polyethylene and the alumina bearing couple patient cohorts regarding demographics or clinical scores through 7 years. Revision for any reason occurred in 2.7% of the patients with alumina bearings and 7.5% of the control patients with polyethylene bearings. Osteolysis was found in 1.4% of the patients with alumina bearings and in 14.0% of the control patients. At an average followup of 5.0 years (range, 1-86 months) no ceramic fractures or ceramic bearing failures have occurred. Results of this study suggest that alumina ceramics perform as well as the metal-on-polyethylene in clinical scores, but the patients with ceramic bearings had fewer revisions and less osteolysis. These results lead us to think that this new alumina ceramic bearing provides a safe option for younger and more active patients. ⋯ Therapeutic study, Level I-1b (randomized controlled trial, no significant difference, but narrow confidence intervals). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jul 2005
Anatomic study of the semispinalis cervicis for reattachment during laminoplasty.
Some patients who had cervical laminoplasty with subsequent substantial loss of cervical lordosis have shown failed healing of a repaired semispinalis cervicis. We also have identified some patients in whom it is difficult to repair the C2 spinous process during laminoplasty. We therefore quantitatively analyzed the morphologic features of the C2 insertion of the semispinalis cervicis and obtained data relevant to the repair of the muscle. ⋯ In most of the cases, the width of the insertion was narrower than the width of the spinous process spacers that commonly are used in laminoplasty. Preoperative prediction of the morphologic features of insertion at the original site is possible by measuring the opening angle of the C2 spinous process using three-dimensional computed tomography because the muscle insertion correlated with the angle of the C2 spinous process. This information may be useful in reattaching the semispinalis cervicis during cervical laminoplasty.
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Clin. Orthop. Relat. Res. · Jun 2005
Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.
We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. ⋯ Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.