Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 1997
Anatomy of the posterior interosseous nerve in relation to fixation of the radial head.
The relationship of the posterior interosseous nerve to the radial neck as it relates to internal fixation of radial head fractures was studied in 50 fresh anatomic specimen arms. After a standard posterolateral approach, blind subperiosteal dissection was performed distally until a 4-cm minifragment plate could be placed on the shaft of the radius. Dissection of the radial nerve was performed under loupe magnification. ⋯ The muscular branch to the extensor carpi radialis longus was located 7.1 +/- 1.8 mm from the radial head. These findings suggest that pronation of the forearm with blind subperiosteal dissection for plate placement does not place the posterior interosseous nerve at significant risk for structural injury. However, as with any approach done in the region of the nerve, caution should be used to avoid tension on the nerve that could lead to physiologic injury.
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Clin. Orthop. Relat. Res. · Dec 1997
Neurologic injury in the upper extremity after total hip arthroplasty.
The results of 7150 consecutive primary and revision total hip arthroplasties performed between 1976 and 1990 were reviewed retrospectively. Sixteen upper extremity neurologic palsies were identified in 16 patients. The incidence of upper extremity nerve palsies after total hip arthroplasty was 0.22%. ⋯ Patients with the preoperative diagnosis of an inflammatory arthropathy are at greater risk for experiencing upper extremity neurologic injury. The prognosis is favorable, with 88% of patients having complete recovery. Cautious induction of anesthesia and careful attention to patient positioning in the perioperative, intraoperative, and postoperative period are essential to help minimize the incidence of neurologic injuries in the upper extremity after total hip arthroplasty.
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Clin. Orthop. Relat. Res. · Nov 1997
ReviewUpdate on nerve palsy associated with total hip replacement.
Nerve palsy is an uncommon but acknowledged complication of total hip replacement. The overall prevalence is approximately 1%. The sciatic nerve, or the peroneal division of the sciatic nerve, is involved in nearly 80% of cases. ⋯ Approximately 15% have a poor outcome characterized by weakness that limits ambulation and/or persistent dysesthesia. Patients with some motor function immediately after the operation and those who recover some motor function within approximately 2 weeks of surgery have a good prognosis for recovery. In general, recovery of femoral nerve palsies is more predictable than that of sciatic palsies.
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Clin. Orthop. Relat. Res. · Oct 1997
Review Comparative StudyMagnetic resonance imaging of the musculoskeletal system. Part 8. The spine, section 2.
Magnetic resonance imaging has revolutionized the noninvasive evaluation of degenerative disc disease and its complications. Compared with computed tomography and computed tomographic myelography, magnetic resonance allows specific determination of the nature of disc protrusions and other degenerative related soft tissues about the spine. Magnetic resonance offers the most complete evaluation of specific degenerative disorders including degenerative facet disease, spondylolysis, spondylolisthesis, spontaneous lumbar epidural hematomas, and juvenile discogenic disease.
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Clin. Orthop. Relat. Res. · Aug 1997
Treatment of osteomyelitis with a biodegradable antibiotic implant.
A biodegradable antibiotic implant was developed and evaluated in a localized osteomyelitic rabbit model. The biodegradable antibiotic implant was made of polylactic acid and poly(DL-lactide):co-glycolide combined with vancomycin. Localized rabbit tibial osteomyelitis was developed with Staphylococcus aureus. ⋯ Treatment with antibiotic containing polylactic acid and poly(DL-lactide):co-glycolide beads, with and without systemic vancomycin, resulted in bone colony forming unit levels of 10(2.93) and 10(2.84) colony forming units per gram bone, respectively. These bacterial concentrations were approximately 100 times lower than those observed for all other treatment groups. A biodegradable antibiotic bead may provide extended bactericidal concentrations of antibiotics for the time needed to completely treat the particular orthopaedic infection and does not require the surgery needed to remove the polymethylmethacrylate beads.