Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · May 1997
Magnetic resonance imaging of the musculoskeletal system. Part 8. The spine, section 1.
Magnetic resonance has assumed a preeminent role in the imaging evaluation of the spine. Owing to its multiplanar capability and superior soft tissue contrast, magnetic resonance imaging is the procedure of choice for a host of spinal disorders including degenerative disc disease, tumor evaluation, trauma, and spinal deformities. It represents the most accurate means of distinguishing between recurrent disc herniation and epidural fibrosis, and it excels at the assessment of many postoperative abnormalities such as infection, adjacent segment disc degeneration, and arachnoiditis. ⋯ A consideration of magnetic resonance imaging techniques will follow, followed by a discussion of the imaging manifestations of early degenerative disc disease. Section 2 will be devoted to an in depth discussion of specific pathologic processes encountered in patients with degenerative disc disease. Section 3 will end the series with a consideration of postoperative imaging followed by a discussion of spinal deformities, trauma, and neoplasms.
-
Clin. Orthop. Relat. Res. · Apr 1997
Clinical TrialVascularized iliac bone graft for avascular necrosis of the femoral head.
This is a followup study of 31 hips in 24 patients from 2 to 11 years after receiving a vascularized iliac bone graft for nontraumatic avascular necrosis of the femoral head. The clinical results according to the Merle d'Aubigne score were satisfactory in 24 (77%) of the hips, whereas the radiographic success rate for all hips was 58%. ⋯ All of the hips with a medial type lesion and a lateral head index of greater than 12% had satisfactory results. For the success of this procedure, the lateral buttress of the normal portion in the femoral head was necessary.
-
Clin. Orthop. Relat. Res. · Mar 1997
Case ReportsComplete rupture of the distal semimembranosus complex in a professional athlete.
Complete ruptures of the distal hamstring tendons rarely cause functional disability significant enough to warrant surgical intervention. Isolated ruptures of the distal semimembranosus tendon complex have not been reported previously in the literature. ⋯ Subsequent surgical repair and postoperative rehabilitation is described. Strict attention to recreating the multiple attachments of the semimembranosus tendon complex is recommended.
-
Pelvic bony injuries are uncommon in children except for avulsion fractures. Medical records and radiographs of 54 children, in whom pelvic fractures were diagnosed from 1974 to 1993, were reviewed. Children 16 years of age and younger who were treated as inpatients were included in this study. ⋯ In this series, long term morbidity was rare and was attributed to severe pelvic ring disruptions, acetabular fractures, or concomitant injuries. It is concluded that in unstable pelvic ring disruptions and acetabular fractures, the principles of management in children should not differ greatly from those in adults. Serious associated pelvic or extrapelvic injuries may pose more management problems than does the pelvic fracture.
-
The majority of thoracolumbar spine fractures and fracture dislocations may be considered acute sagittal plane deformities. Unstable thoracolumbar spine injuries require stabilization to (1) allow mobilization of the patient to prevent pulmonary and venous complications; (2) to relieve pain; (3) to realign the spine and spinal canal, and (4) to decompress directly or indirectly the neural elements. ⋯ Posterior spinal instrumentation techniques used rod hook systems or screw rod and screw plate systems. Most of these unstable injuries can be managed using these well established techniques without the need for additional combined or staged anterior spinal surgery.