Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 1998
Assessment of neuroforaminal decompression in degenerative spinal stenosis.
Surgical decompression of spinal stenosis is a balance between adequate removal of bone and soft tissue for an effective decompression of neural structures and a sufficient retention of bone to maintain mechanical stability of the spine. To develop an objective, reproducible technique for the assessment of neuroforaminal decompression in the adult lumbar spine, facet sparing laminectomies were performed from L1-S1 on the lumbar spines of 59 human cadavers. A series of semirigid probes in 0.5-mm increments were passed into each successive intervertebral foramen bilaterally, beginning at L2-L3. ⋯ There were no significant differences in interobserver or intraobserver measurements. There were no complications related to passage of the probes. This study provides a method for the intraoperative determination of the adequacy of neuroforaminal decompression.
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Clin. Orthop. Relat. Res. · Mar 1998
Norian SRS cement augmentation in hip fracture treatment. Laboratory and initial clinical results.
Bone quality, initial fracture displacement, severity of fracture comminution, accuracy of fracture reduction, and the placement of the internal fixation device are important factors that affect fixation stability. New high strength cements that are susceptible to remodeling and replacement for fracture fixation may lead to improved clinical outcome in the treatment of hip fractures. Norian SRS is an injectable, fast setting cement that cures in vivo to form an osteoconductive carbonated apatite of high compressive strength (55 MPa) with chemical and physical characteristics similar to the mineral phase of bone. ⋯ Use of this material potentially could improve fracture stability, retain anatomy during fracture healing and improve hip function, thus achieving better clinical outcomes. In vivo animal studies have shown the material's biocompatibility, and cadaveric studies have shown the biomechanical advantage of its use in hip fractures. Initial clinical experience (in 52 femoral neck fractures and 39 intertrochanteric fractures) showed the potential clinical use of this innovative cement in the treatment of hip fractures.
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Clin. Orthop. Relat. Res. · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures.
The Medoff sliding plate was designed to achieve compression along the femoral neck and the longitudinal axis of the femoral shaft theoretically to improve the treatment of intertrochanteric hip fractures. The Medoff sliding plate was compared with a standard compression hip screw in a randomized, prospective study for the fixation of 160 stable and unstable intertrochanteric fractures with an average followup of 9.5 months (range, 6-26 months). Overall, 91 fractures were treated using the compression hip screw and 69 were treated with the Medoff sliding plate. ⋯ The time to union for the 114 unstable fractures was not significantly different between the two devices. For all patients, no differences in lengths of hospitalization, return to ambulatory status before fracture, postoperative living status, or postoperative pain was observed between the two device groups. Use of the Medoff plate for all fracture types was associated with a significantly higher amount of blood loss and operating time.
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Clin. Orthop. Relat. Res. · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialUnipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly.
This paper presents the short term results of an ongoing prospective randomized trial comparing a cemented unipolar with a cemented bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in the elderly. Forty-seven patients with an average age of 77 years completed 6-month followup. Outcomes at 6 weeks, 3 months and 6 months were assessed by completion of a patient oriented hip outcome instrument and by functional tests of walking speed and endurance. ⋯ Patients treated with a bipolar hemiarthroplasty had greater range of hip motion in rotation and abduction and had faster walking speeds. However, no differences in hip rating outcomes were found. These early results suggest that use of the less expensive unipolar prosthesis for hemiarthroplasty after femoral neck fracture may be justified in the elderly.
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Clin. Orthop. Relat. Res. · Mar 1998
Randomized Controlled Trial Comparative Study Clinical TrialIntramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.
One hundred thirty-one patients (135 fractures) who sustained an intertrochanteric fracture were assigned randomly to treatment with either a sliding hip screw or an intramedullary hip screw and followed up prospectively. In patients with unstable intertrochanteric fractures, the intramedullary device was associated with 23% less surgical time and 44% less blood loss; however, use of the intramedullary hip screw in patients who had a stable fracture pattern required 70% greater fluoroscopic time. Intraoperative complications occurred exclusively in patients in the intramedullary hip screw group. There were no differences in the rates of functional recovery between the two fixation groups.