Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Jul 2000
Changes in canine peripheral nerves during experimental callus distraction.
In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started the fifth day after surgery with a distraction rate of 0.5 mm twice per day and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. ⋯ Morphometric analysis of the peroneal nerves revealed a significant increase of fiber density and a reduced mean axon and fiber diameter in the consolidation period (Group B). Similar changes were found in the tibial nerves in Group A and disappeared in the consolidation phase (Group B). These features indicate that callus distraction leads to moderate degenerative changes, followed by repair mechanisms, almost complete recovery, and some nerve fiber growth.
-
Clin. Orthop. Relat. Res. · Jun 2000
Randomized Controlled Trial Clinical TrialEpidural corticosteroid injection in the conservative management of sciatica.
In this prospective randomized clinical trial, the results of epidural corticosteroid injections were evaluated in patients with lumbosciatic pain caused by herniated nucleus pulposus. Thirty-six patients with radicular lumbosciatic pain and positive straight leg raising test because of confirmed prolapsed intervertebral lumbar discs were randomized into two groups with (17 patients) and without (19 patients) epidural corticosteroid injection. Members of the treatment groups received three injections of 100 mg methylprednisolone in 10 mL bupivacaine 0.25% each. ⋯ Results were better in the methylprednisolone group, although not statistically significant for pain relief and mobility. At 6 weeks and 6 months, pain relief, improvement of straight leg raising, and improvement of functional status showed no statistical significance. Epidural corticosteroid injections can be recommended as additional therapy only in the acute phase of the conservative management of lumbosciatic pain.
-
Clin. Orthop. Relat. Res. · Jun 2000
Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan.
A single center, prospective, epidemiologic study was conducted to estimate the incidence of deep venous thrombosis detected by venography in patients in Japan undergoing total hip arthroplasty or total knee arthroplasty without prophylactic anticoagulant therapy. Venograms of 164 patients who had total hip arthroplasty and 138 patients who had total knee arthroplasty were evaluated. The incidences of deep venous thrombosis were 22.6% in patients who had total hip arthroplasty and 48.6% in those who had total knee arthroplasty. ⋯ Statistical analysis revealed that the type of operation influenced the development of deep venous thrombosis. Patients who had total knee arthroplasty were 3.2 times more likely to have deep venous thrombosis develop than were patients who had total hip arthroplasty. Body mass index and age were identified as statistically significant risk factors.
-
Clin. Orthop. Relat. Res. · May 2000
Bipolar hemiarthroplasty for osteonecrosis of the femoral head. A 7- to 18-year followup.
This study evaluated clinical and radiographic results of bipolar hemiarthroplasties for the treatment of osteonecrosis of the femoral head. Forty-eight hips in 35 patients with a mean age of 37 years who underwent primary bipolar hemiarthroplasties were observed for an average of 11.4 years. Osteonecrosis was associated with corticosteroid use (21 patients), alcohol (six patients), idiopathic (four patients), and other conditions (four patients). ⋯ Radiographic proximal migration greater than 4 mm and osteoarthritic signs of the acetabulum indicated a high risk of groin symptoms. The results were inferior to those previously reported for total hip arthroplasty. Thus, for the treatment of osteonecrosis of the femoral head in which necrotic lesions are wide, the authors no longer use this system and currently use total hip arthroplasty.
-
Clin. Orthop. Relat. Res. · May 2000
Historical ArticleBoston's contributions to the development of orthopaedics in the United States. A brief history.
Since the early part of the nineteenth century, physicians from Boston have had a major impact on orthopaedics in America. Initially, the general surgeons such as John Ball Brown and his son, Buckminster had an impact on orthopaedics, but contributors such as Henry Bigelow and Charles Scudder added greatly to the knowledge and capacity for care. The first orthopaedic ward, Ward I, was located at the Massachusetts General Hospital and began the new era. ⋯ Osgood, Joel Goldthwait, Elliot Brackett, Robert Lovett, and Edward Bradford. These physicians not only treated patients at the Children's, Tufts University, Boston City, the Beth Israel, and the Massachusetts General Hospitals, but assumed the academic responsibilities of a major educational center. More recently the contributors to orthopaedics have included Marius Smith-Petersen, Otto Aufranc, Henry Banks, Edward Cave, Carter Rowe, Joseph Barr, and others who have created a spectacular program for education, research, and clinical care.