Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Jun 2004
Incongruity versus instability in the etiology of posttraumatic arthritis.
The etiology of posttraumatic arthritis is understood poorly but it clearly has a pathomechanical component. Posttraumatic arthritis likely results from irreversible cartilage damage sustained at the time of injury and chronic cartilage overloading resulting from articular incongruity and instability. However, the relative importance of instability and incongruity is unknown. ⋯ We review the clinical and basic scientific evidence linking incongruity and instability to posttraumatic arthritis. Preliminary data from a newly developed dynamic ankle testing device are presented. Dynamic testing allows measurement of transient contact loads and loading rates that occur through the entire motion cycle and it opens the door to measure mechanical abnormalities associated with instability.
-
Clin. Orthop. Relat. Res. · Jun 2004
Anatomic consideration of nerve supply to the vastus medialis in knee surgery.
A medial approach for exposure of total knee arthroplasty that splits the vastus medialis muscles may damage the distal portion of the muscle. Ten fresh-frozen cadaver knees without deformity and three retrieved knees were used to dissect nerve branches along the femoral nerve distally until they ended in muscle. Two patterns of nerve distribution were observed. ⋯ No nerve branches were found crossing between the vastus intermedius and vastus medialis. These muscles appear to be innervated separately by direct branches from the femoral nerve. Dissecting between the vastus intermedius and medialis is unlikely to damage the nerve supply to the vastus medialis obliquus whereas dissecting between the vastus medialis obliquus and main body of the vastus medialis may damage the nerve supply of both.
-
Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyTreatment of the mangled lower extremity after a terrorist blast injury.
Terrorist bombings, with resultant blast injuries, have been increasing in frequency during the past 30 years. Injury to the musculoskeletal system is common in victims who survive such attacks. Substantial injury to the limbs may occur through several different mechanisms, each of which may affect prognosis and alter the treatment algorithm. ⋯ This management protocol may improve the medical facility's ability to manage system resources while treating patients with severe blast injuries. The decision of whether to salvage or proceed with limb amputation is one of the most difficult in orthopaedic trauma. A basic education in the mechanisms of blast damage, a methodical approach to resuscitation, and mangled extremity treatment, likely can improve surgical success.
-
Clin. Orthop. Relat. Res. · May 2004
ReviewTerrorism and blast phenomena: lessons learned from the attack on the USS Cole (DDG67).
Blast phenomena and injuries to the musculoskeletal system have been well documented for the past 50 years. The USS Cole was attacked in Aden Harbor in Yemen on October 12, 2000. Seventeen sailors were killed and 39 were wounded. ⋯ Fractures of the cranium, spine, pelvis, and long bones denoted increasing severity of injury to critical organ systems. Shipboard firefighting was successful in containing fires and there was very little morbidity from inhalational injuries or burns. Blast phenomena that affect ships or buildings that have been specifically built to absorb a blast attack likely will manifest a different mode and pattern of injury than those seen in traditional terrorist blast events.
-
The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. ⋯ By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.