Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 1999
Phantom limb, residual limb, and back pain after lower extremity amputations.
This study describes the sensations and pain reported by persons with unilateral lower extremity amputations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. ⋯ Back pain was significantly more common in persons with above knee amputations. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study.
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Clin. Orthop. Relat. Res. · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialEffect of pin location on stability of pelvic external fixation.
Pelvic external fixators allow two locations of pin purchase: anterosuperior (into the iliac crest) and anteroinferior (into the supraacetabular dense bone, between the anterior superior and anterior inferior iliac spine). The purpose of this study was to compare the stability of these two methods of fixation on Tile Type B1 (open book) and C (unstable) pelvic injuries. Five unembalmed cadaveric pelves (mean age, 68 years; four males and one female) were loaded vertically in a servohydraulic testing machine in a standing posture. ⋯ There were no significant differences between the frame types. Dissection of the preinserted anatomic specimen revealed no evidence of injury to the lateral femoral cutaneous nerve after blunt dissection and drilling with protective drill sleeves. It is concluded that the anteroinferior location of external fixation pins is a safe technique with the potential for increased stability of fixation.
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Clin. Orthop. Relat. Res. · Mar 1999
ReviewBone repair techniques, bone graft, and bone graft substitutes.
This paper reviews the techniques and materials (bone graft and bone graft substitutes) that currently are used to treat nonunions and bone defects. The techniques reviewed are intramedullary nailing, plating, distraction osteogenesis, and electric stimulation. ⋯ Techniques and management strategies constantly are evolving to accomplish this goal. This paper reviews the history, indications, and limitations of bone repair techniques, methods of bone grafting, and materials available as bone graft substitutes.
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Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. ⋯ In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate.
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Clin. Orthop. Relat. Res. · Feb 1999
Comparative StudyModified Gallie technique versus transarticular screw fixation in C1-C2 fusion.
The effectiveness of a modified Gallie technique versus Magerl and Seeman transarticular screw fixation was compared in the management of 27 patients with symptomatic atlantoaxial instability. Twelve patients were treated using a modified Gallie technique and postoperative halo vest immobilization. Atlantoaxial arthrodesis occurred in seven (58%) patients, stable fibrous union occurred in one patient, and pseudarthrosis with recurrent instability developed in four (33%) patients. ⋯ To ensure that safe transarticular screw placement is possible, preoperative fine cut axial computed tomography with reconstructions is required to assess vertebral artery position and C2 isthmus anatomy. A proportion of patients have anatomy unsuitable for screw placement. Traditional wiring techniques are indicated in these patients.