Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 1996
Flexible intramedullary nail fixation of pediatric femoral fractures.
The management of pediatric femoral shaft fractures gradually has evolved toward a more operative approach in the past decade. This is because of a desire for more rapid recovery and reintegration of the patients, and a recognition that prolonged immobilization can have negative effects even in children. Economic pressures also favor a treatment that does not require as prolonged a hospitalization as that required with the traditional traction method. ⋯ Likewise, minor limb length discrepancies were measured (range, -11- +14 mm) with no consistent pattern of overgrowth noted. There was no evidence of a complete trochanteric growth arrest on radiographic followup. Flexible intramedullary nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in the child between 6 and 12 years of age.
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Clin. Orthop. Relat. Res. · Oct 1996
Multicenter Study Clinical Trial Controlled Clinical TrialRange of motion in total knee replacement.
This is a multicenter prospective clinical study using a modified Knee Society scoring system which evaluated the effect of age, gender, weight, preoperative range of motion and knee score, previous surgery, and modification of the posterior femoral condyle geometry on postoperative range of motion. The primary outcome variable was change in flexion. The data were collected from 5 surgeons using a single total knee system. ⋯ Analysis of delta range of motion and delta pain showed similar results. Age, weight, previous open surgical procedure, and altered femoral component contour, did not seem significantly correlated with changes in postoperative flexion. The best predictors of postoperative clinical results are the preoperative scores.
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Clin. Orthop. Relat. Res. · Oct 1996
Randomized Controlled Trial Clinical TrialRandomized trial of epidural versus general anesthesia: outcomes after primary total knee replacement.
To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement, 262 patients were randomly assigned to receive either epidural or general anesthesia. All patients received a common rehabilitation protocol including a standardized assessment of progress. One hundred eighty-eight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin, and had a standardized surveillance protocol to detect thromboembolic complications. ⋯ Epidural anesthesia is associated with more rapid achievement of postoperative in hospital rehabilitation goals after total knee replacement. A minor reduction in postoperative deep vein thrombosis rate was observed with epidural anesthesia, but this did not reach statistical significance. No difference in early postoperative pulmonary embolism was observed between the 2 types of anesthesia.
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Clin. Orthop. Relat. Res. · Sep 1996
Case ReportsSalmonella osteomyelitis presenting as fibrous dysplasia. A case report.
Salmonella osteomyelitis is uncommon in healthy patients. Because of its slow, indolent course and often remote presentation, its diagnosis may be difficult. A case of osteomyelitis of the tibia secondary to Salmonella enteritidis was diagnosed after a biopsy for presumed fibrous dysplasia was performed.
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Dissections on 42 anatomic specimen hips were performed to study proximal femoral anatomy as it pertains to entry sites for intramedullary nailing. The precise relationships of muscle insertions on the greater trochanter were documented, as were the boundaries of the digital fossa. Measurements of trochanteric bony anatomy were made on a separate group of 30 dry bone unpaired proximal femora. ⋯ This second area is the tip of the trochanter posterior to the piriformis fossa. This study suggests that either location may be suitable for an insertion point for intramedullary nailing. Precise sagittal plane localization of the entry site, which can be made on lateral views with an image intensifier, is recommended.