Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2004
Comparative StudyNonunion of fractures of the subtrochanteric region of the femur.
There are no large clinical series to guide the clinician treating a subtrochanteric nonunion. Deformity, bone loss from previous hardware, and the high stresses in the subtrochanteric region all pose challenges to achieving successful bony union with reoperation. The purpose of this study was to retrospectively review a consecutive series of patients treated with reoperation using contemporary techniques for subtrochanteric nonunion. ⋯ There was one postoperative complication (4%), an adynamic ileus that was treated medically. Revision internal fixation and selected bone grafting for subtrochanteric nonunion led to a high rate of fracture union and functional improvement. Intramedullary devices with fixation into the femoral head and neck and fixed angled devices were effective in achieving stable fixation of the proximal bony fragment.
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Clin. Orthop. Relat. Res. · Jan 2004
The effects of storage on fresh human osteochondral allografts.
Historically, fresh human osteochondral allografts have been stored in lactated Ringer's solution at 4 degrees C and then transplanted as quickly as possible, generally within 2 to 5 days, to ensure delivery of a high level of viable chondrocytes. Recently, allograft distribution companies have begun to provide fresh osteochondral allografts that are stored in a proprietary culture medium usually for at least 2 weeks before delivery to the surgeon for implantation. The effects of such storage on human cartilage have not been well-defined. ⋯ The biochemical and biomechanical properties of the extracellular matrix remained stable with storage in both solutions with time. These data suggest that osteochondral allografts stored under traditional conditions in lactated Ringer's solution should continue to be implanted as quickly as possible and certainly within 7 days of donor death. If kept in culture media, the storage duration may be extended to approximately 2 weeks.
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This is a case report of a patient with a pseudoaneurysm of the anterior tibial artery after lateral to medial distal locking of an intramedullary nail for a tibia shaft fracture.
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Clin. Orthop. Relat. Res. · Jan 2004
Anatomy of the posterior iliac crest as a reference to sacral bar insertion.
There are no detailed anatomic studies focusing on the posterior iliac crest although it frequently is used for posterior stabilization of unstable pelvic fractures. Anatomic dissections were done to evaluate the size of the extraarticular region of the posterior iliac crest and its relationship to the lumbosacral lamina and to show on cadavers the level of sacral bar placement that offers safe and solid fixation. Sixty cadavers were dissected bilaterally. ⋯ In all the dissections the greatest distances were at the level of the L5-S1 junction, which consequently is the safest level for good bony purchase. The entire length of the posterior iliac crest from the level of the upper border of L5 lamina to the posterosuperior iliac spine was shown to be appropriate for safe and solid bar fixation because all of the distance measurements were greater than 13 mm, which is the smallest safe distance. Below the posterosuperior iliac spine level, insertion of the sacral bars was dangerous because the average measured distance was only 10.38 mm.
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Clin. Orthop. Relat. Res. · Dec 2003
In vivo assessment of patellofemoral joint contact area in individuals who are pain free.
Magnetic resonance imaging was used to quantify in vivo patellofemoral joint contact area and to determine if contact area is affected by quadriceps muscle contraction. Ten subjects without pain (six women, four men) had their right patellofemoral joint imaged. Cartilage-enhanced, axial plane images were obtained at 0 degrees, 20 degrees, 40 degrees, and 60 degrees knee flexion under quadriceps loaded (contracted) and quadriceps unloaded (relaxed) conditions. ⋯ The lateral facet comprised a greater percentage of total contact area compared with the medial facet at each knee flexion angle, suggesting increased load-bearing potential. Quadriceps contraction did not affect patellofemoral joint contact area indicating that the addition of a compressive load to the joint did not alter the area of the load-bearing surfaces. In vivo assessment of patellofemoral joint contact area could provide insight into mechanisms of patellofemoral joint disorders.