Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · May 2005
Comparative StudyThe extended anterolateral acromial approach allows minimally invasive access to the proximal humerus.
Lateral approaches to the proximal humerus have been limited by the position of the axillary nerve. Extensive surgical dissection through a deltopectoral approach may further damage the remaining tenuous blood supply in comminuted fractures. The purpose of our study was to explore a direct anterolateral, less invasive approach to the proximal humerus. ⋯ Examination of the entire anterior nerve revealed that no branches besides the main motor trunk crossed the deltoid raphe. Subsequently, this approach was used in 16 patients with proximal humerus fractures, none of whom has had complications related to the surgical approach. This minimally invasive surgical approach seems to be safe, and may be useful in treating proximal humerus fractures.
-
Clin. Orthop. Relat. Res. · May 2005
Comparative StudyThe 20-year outcome of the charnley arthroplasty in younger and older patients.
The purpose of this study is to present the 20-year outcome of 206 Charnley low-friction arthroplasties done by the same surgeon on 181 patients who were separated into two age groups (younger and older). In Group A (76 patients, 92 hips) the mean age at surgery was 44 years (range, 24-55 years), and in Group B (105 patients, 114 hips) the mean age at surgery was 65 years (range, 56-82 years). All patients were evaluated clinically and radiographically. ⋯ The main cause of failure in Group A was aseptic loosening of the components and breakage of the femoral stem, whereas in Group B the main cause of failure was deep infection. We concluded that by eliminating the above factors, and using new cementing techniques and improved implants, the 20-year results of this arthroplasty would be better. Our results show that the Charnley arthroplasty is a reliable procedure for hip replacement, even in younger patients.
-
Clin. Orthop. Relat. Res. · Apr 2005
Comparative StudyLong-term vertebral changes attributable to postoperative lumbar discitis: a retrospective study of six cases.
A clinical, plain radiographic, and magnetic resonance imaging retrospective followup study was done on six patients with postoperative septic L4-L5 lumbar spondylodiscitis to identify the characteristic long-term radiographic findings predicting the clinical outcome. The mean followup was 12 years (range, 9-13 years). Three patients had moderate low-back pain and two were handicapped. One patient had slight peroneal weakness. Flexibility of the lumbar spine was restricted to some extent in all patients. Laminectomy for spinal stenosis (L4-L5) had been done in one patient and reoperation because of recurring disc herniation was done in two patients. Partial or total bone marrow depletion and corresponding enhancement of fat signals in relation to adjacent vertebral bodies, narrowing of the intervertebral disc space, and irregularity or cavitations affecting one or both end plates were long-term findings of magnetic resonance imaging. Plain radiographs and magnetic resonance imaging scans revealed a complete bony fusion in one patient and partial fusion in one patient. In two patients, residual disc protrusion or herniation in relation to the surgically treated disc was evident; three affecting L3-L4 and two affecting L5-S1 disc levels. Septic postoperative lumbar discitis severely hampers clinical recovery after disc operations and results in long-term changes as seen on magnetic resonance imaging scans. ⋯ Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · Apr 2005
Review Comparative StudyOrthopaedic trauma for the general orthopaedist: avoiding problems and pitfalls in treatment.
The Advanced Trauma Life Support program of the American College of Surgeons has developed a de facto standard of care for the first hour of treatment of patients with trauma who are treated in North America. No equivalent for the treatment of orthopaedic trauma has been established. We provide an overview of the important topics every orthopaedist treating patients with musculoskeletal trauma should be familiar with. The topics include: (1) diagnosis of musculoskeletal injury and documentation of physical exam; (2) pelvic ring injuries; (3) open fractures; (4) compartment syndrome; (5) the timing of definitive fixation in the patient with polytrauma; (6) delayed diagnosis of musculoskeletal injury; and (7) deep venous thrombosis prophylaxis.
-
Clin. Orthop. Relat. Res. · Apr 2005
Review Comparative StudyMedicolegal aspects of foot and ankle surgery.
Medicolegal aspects of orthopaedic foot and ankle surgery, including issues of standard of care, complications, and discrepancies between patient and physician expectations, generally are similar to those encountered in other orthopaedic subspecialties. However, there are some unique aspects involving foot and ankle surgery: the standard of care continues to evolve, some complications are specific to the foot and ankle, and patient expectations of particular foot and ankle procedures may exceed those of the foot and ankle surgeon, who often is confronted with challenging pathologic conditions. This review addresses issues of standard of care and complications as they pertain to current practices of orthopaedic foot and ankle surgery.