Clinical orthopaedics and related research
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Forty million individuals participate in organized softball leagues each year in the United States. Eighteen million additional student athletes and young adults also participate in organized baseball league play. ⋯ Fortunately, numerous interventions independently have been shown to be effective at reducing the injury scenario, which has grown to be of epidemic proportion. Interventions such as break-away bases, batting helmets, face shields on helmets, lighter mass baseballs, and teaching and reiteration of the fundamentals of softball and baseball all have been effective in preventing millions of injuries and billions of dollars in healthcare costs each year in the United States.
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Clin. Orthop. Relat. Res. · Apr 2003
Comparative StudyCircumferential and posterolateral fusion for lumbar disc disease.
Clinical outcome of low back fusion is unpredictable. There are various reports discussing the merits and clinical outcome of these two procedures. The patients were selected from a population of patients who had chronic low back pain unresponsive to conservative treatment. ⋯ The posterolateral fusion group had a 63.9% satisfactory outcome and the posterior lumbar interbody fusion group had an 80% satisfactory outcome using the Oswestry disability index for postoperative assessment. There was 61.1% improvement in working ability in the posterolateral fusion group and 77.1% improvement in the posterior lumbar interbody fusion group which was not statistically significant. The authors consider instrumented circumferential fusion with posterior lumbar interbody fusion better than instrumented posterolateral fusion for managing chronic disabling low back pain.
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Clin. Orthop. Relat. Res. · Apr 2003
Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury.
Low fibular fractures that were associated with deltoid ligament disruption and inferior tibiofibular syndesmotic disruption were studied. All of the patients had a Type B Weber fibular fracture associated with a deltoid ligament injury. It was difficult to detect the syndesmosis disruption on the initial assessment of the anteroposterior and mortise radiographs obtained preoperatively because there was no obvious talar shift on the plain radiograph. ⋯ On the basis of the current study using the level of the fibular fracture as a guideline for application of the syndesmotic screw as suggested by some authors may not be accurate. There are several factors that should be considered including the depth of the incisura fibularis, posterior malleolus fractures, deltoid ligament injury, and subluxation of the fibula. The surgeon's impression in the operating room of syndesmosis stability should be considered as the best guideline in the application of syndesmosis fixation rather than depending on the level of the fibular fracture.
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Clin. Orthop. Relat. Res. · Apr 2003
Case ReportsExcision of a bony spike without fixation of the fractured clavicle in a jockey.
Various modalities are available for treatment of a clavicle fracture. Conservative treatment is successful in most cases. Open reduction, when indicated, usually is accompanied by fixation of the fracture. ⋯ The fracture was opened and a bony spike was excised extraperiosteally without doing internal fixation of the fracture to avoid skin necrosis and allow early return to work. The patient returned to his profession 2 weeks after surgery. Radiologic and clinical examinations revealed a satisfactory outcome at the 6-month followup.
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Clin. Orthop. Relat. Res. · Apr 2003
Case ReportsThe use of stereolithography for an unusual patellofemoral disorder.
A patient with habitual patellar dislocation which was not treated successfully by the Elmslie-Trillat procedure is described. In the knee, a unique morphologic feature of the patellofemoral joint was suspected as a cause, and a stereolithographic model was produced from the patient's computed tomography data to determine the pathologic features. Because the solid model confirmed the speculation, additional surgery was done to modify the geometry of the joint. ⋯ The second surgery eliminated maltracking of the patella and a satisfactory result was obtained. Therefore, stereolithography is useful for the treatment of atypical patellofemoral disorders, allowing an understanding of the pathologic features and dynamic simulation of the surgery. The surgical procedure could be a promising method to alter the joint geometry without impairing the cartilage.