Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 1995
Repair of complete acromioclavicular separations using the acromioclavicular-hook plate.
Complete Tossy III acromioclavicular separations in 21 male patients (according to the Rockwood classification: 7 Type III and 14 Type V lesions) with a mean age of 31 years were treated by surgical repair with the acromicroclavicular-hook plate within a period of 6 years. The population consisted of 18 patients with acute injuries and 3 with old injuries. Six patients experienced infections and delayed wound healing; osteitis did not occur. ⋯ A secondary widening of the hook hole in the acromion was seen in 13 patients; this was related to the large range of motion of the acromioclavicular joint. Calcifications and ossifications in the coracoclavicular ligaments, diastases in the acromioclavicular joint, and redislocations were not significantly different when this method was compared with other surgical techniques as reported in the literature. Use of the acromioclavicular-hook plate permits retention in the transverse plane without impairing the joint itself, but the technique is challenging.
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Clin. Orthop. Relat. Res. · Feb 1995
Revision and primary hip and knee arthroplasty. A cost analysis.
The cost of health care in the United States has been rising steadily during the past 10 years. Total joint arthroplasty, a commonly performed orthopaedic procedure, accounts for approximately $10 billion dollars per year. The objective of this study was to perform a clinician-oriented cost analysis of primary and revision hip and knee arthroplasty. ⋯ The total charges for the prosthesis in the 4 groups exceeded 40% of the total charges for the procedure. Primary hip and knee surgery had similar billed costs, and work for revision hip surgery has a significantly higher billed cost than physician's work. The implant selection process by an orthopaedic surgeon performing arthroplasty of the hip and knee needs to include economic aspects.
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Clin. Orthop. Relat. Res. · Jan 1995
Bone graft harvest site as a determinant of iliac crest strength.
Bone graft harvest site fracture can occur after removal of bone from the anterior iliac crest. No biomechanically proven guidelines for safe removal of bone exist. Cadaveric hemipelves were tested in a materials testing system machine, with the harvest site occurring 15-mm posterior to the anterosuperior iliac spine in 8 specimens and 30-mm posterior in 7 specimens. ⋯ Average force at failure was 783 N (standard deviation, +/- 333 N) in the 15-mm group and 1917 N (standard deviation, +/- 735) in the 30-mm group. This study provides objective data which demonstrate that harvest 30 mm posterior to the anterosuperior iliac spine weakens the iliac crest less than harvest 15 mm posterior to the anterosuperior iliac crest. To minimize the possibility of iliac crest fracture after bone graft harvest, bone should be removed at least 30 mm from the anterior superior iliac spine.
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Clin. Orthop. Relat. Res. · Dec 1994
Biomechanical simulation of the anteroposterior compression injury of the pelvis. An understanding of instability and fixation.
Seven fresh cadaveric pelvic specimens were biomechanically analyzed. Testing was first performed on intact pelves and then after progressive disruption of the (1) symphysis pubis, (2) unilateral anterior and interosseous sacroiliac ligaments and capsule, (3) ipsilateral sacrospinous and sacrotuberous ligaments; and fixation with a 4.5-mm narrow dynamic compression plate at the symphysis pubis, or a 4.5-mm narrow dynamic compression plate at the anterior sacroiliac joint with and without the symphysis pubis plate, or a 7.0-mm sacroiliac lag screw anchored into the S1 vertebral body with and without the symphysis pubis plate. Symphyseal gapping occurred after isolated symphysis pubis disruption. ⋯ Use of sacroiliac fixation alone without a symphysis pubis plate did not affect symphysis pubis motion. The symphysis pubis plate is the key to stabilizing symphysis pubis motion, and similarly, sacroiliac joint fixation is required to control sacroiliac joint motion. Both single iliosacral screws and plates produced equivalent decreases in sacroiliac joint motion.