Clinical orthopaedics and related research
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The charts and radiographs of 70 patients older than 50 years of age with thoracic vertebral body collapse were reviewed retrospectively. Fifteen patients had traumatic fractures and 34 had osteoporotic collapse of thoracic vertebrae. Metastasis was the underlying disease process in 18 patients and multiple myeloma in the remaining 3 patients. ⋯ There were 11 metastatic, 80 osteoporotic, 14 traumatic, and 3 fractures secondary to multiple myeloma involving the lower dorsal spine. There were no infections or primary bone tumors. The difference in the frequency of metastatic fractures against other etiologies involving the upper versus the lower thoracic spine was highly statistically significant.
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Clin. Orthop. Relat. Res. · Jul 1996
An axially loaded model of the ankle after pronation external rotation injury.
Using a testing apparatus that allows axial loading and displacement in the sagittal, axial, and coronal planes, 6 ankles were tested under experimental conditions intended to model the Lauge-Hansen pronation external rotation injury. All specimens were rotated through a continuous range of sagittal motion with the ankle under 300 N of axial load as the coupled motion of the ankle in the coronal and axial axes was recorded. Combinations of fibular osteotomy, disruption of the syndesmosis up to 6 cm above the plafond, and deltoid transection were tested to mimic Stages I to III of the pronation external rotation ankle fracture. ⋯ When the deep deltoid was sectioned, the ankle dislocated in plantar flexion unless the fibula was stabilized. This prevented dislocation but failed to restore normal talar kinematics. This study found no biomechanical support for placement of a syndesmotic screw unless the medial side cannot be stabilized anatomically.
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Clin. Orthop. Relat. Res. · Jun 1996
Overlooked spine injuries associated with lumbar transverse process fractures.
Transverse process fractures of the lumbar spine often are considered benign fractures related to direct trauma or psoas muscle avulsion. Treatment of these usually stable injuries is primarily administered when the patient becomes symptomatic. However, significant force often is required to cause these injuries, and other injuries may occur concomitantly. ⋯ Three of the 28 patients (11%) had a lumbar spine fracture that was identified by computed tomography but overlooked on plain radiographs. Approximately 11% of patients with major injuries may be misdiagnosed if only plain radiographs are used in the evaluation of transverse process fractures. Computed tomography scanning of all lumbar spine transverse process fractures resulting from acute trauma should be considered because this diagnostic measure decreases the risk of overlooking potentially serious injuries.
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Clin. Orthop. Relat. Res. · Jun 1996
Use of the minicondylar plate in metacarpal and phalangeal fractures.
The minicondylar plate is used for unstable intraarticular and periarticular fractures of the phalanges and metacarpals to provide stability and to allow early motion. This low profile implant can be placed laterally to avoid injury to the extensor mechanism. The authors retrospectively reviewed 53 consecutive patients from 2 institutions in whom 68 fractures (41 metacarpal and 27 phalangeal) had been treated with 1.5-mm or 2-mm minicondylar plates. ⋯ Metacarpal fractures had a significantly higher percentage of excellent results than did phalangeal fractures. Final motion did not correlate significantly with complication rate, severity of soft tissue injury, location in the bone, open versus closed fracture, or use of bone graft. When fractures cannot be restored and stabilized reliably by less invasive methods, the minicondylar plate provides secure fixation and can result in adequate function, even in the presence of severe combined injuries.
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Once naive T cells encounter antigen, they become primed effector cells. The scope of effector functions mediated by these cells defines the efferent arm of the immune response. The change from naive to primed effector cell is known as adaptive immunity and takes 2 forms: cell mediated, in which T cells mediate effector function, and humoral, in which antibodies are the effector molecules. ⋯ Cytokines function in either autocrine (secreted and used by the same cell) or paracrine (secreted by 1 cell and used by a different cell) circuits and have marked regulatory effects on cells in both the immune and skeletal systems. Many of these cytokines, which were once thought to be products exclusively of immune cells, are now known to be produced by cells of the skeletal system. Both the specific and nonspecific components of the immune response have profound effects on remodeling of the musculoskeletal system during normal and pathologic states.