Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 1994
The relationship of pes planus and calcaneal spur to plantar heel pain.
A prospective study of pes planus by using calcaneal pitch and calcaneal spur was carried out in 82 patients with plantar heel pain and in 400 normal subjects. The mean normal calcaneal pitch was 20.54 degrees. The mean calcaneal pitch in patients with plantar heel pain was 15.99 degrees, which was significantly lower than in normal subjects. ⋯ Again, this was a highly significant difference. Excessive weight gain, aging, and gender may be important factors effecting the lowering of the pitch and the increasing of spur formation. These factors could lead to the development of plantar heel pain.
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Clin. Orthop. Relat. Res. · Sep 1994
Complications of anterior approaches to the thoracolumbar spine. Emphasis on Kaneda instrumentation.
One hundred eighty five consecutive patients underwent anterior decompression, stabilization, and/or fusion procedures of the thoracolumbar spine. At 1 year or more followup, the incidence of complications was analyzed. ⋯ The use of Kaneda anterior instrumentation provided marked improvement in the prevention of this problem. A custom made carbon fiber reinforced cage packed with autogenous cancellous bone graft used in the treatment of ten patients with large corpectomy defects resulted in a good outcome.
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Clin. Orthop. Relat. Res. · Aug 1994
Surgical anatomy of the superficial peroneal nerve in the ankle and foot.
The subcutaneous (sensory) portion of the superficial peroneal nerve was dissected in 25 cadaver lower limbs under loupe magnification. Three distinct branching pattern types were noted. Type A (72%) consisted of a pattern where the nerve penetrated the crural fascia to become subcutaneous at an average distance of 12.3 cm proximal to the ankle joint, then divided at a mean distance of 4.4 cm proximal to the ankle into two major branches: a large medial dorsal cutaneous nerve and a smaller more laterally located intermediate dorsal cutaneous nerve. ⋯ At the level of the malleoli, the medial dorsal cutaneous nerve was located approximately one half the distance from the lateral malleolus to medial malleolus while the intermediate dorsal cutaneous nerve was approximately one third the distance. Appreciation of these branch patterns and the quantified relationships should assist nerve protection during surgical procedures as well as aid rapid nerve isolation for exploration or decompression. Branches especially at risk for iatrogenic injury include: (1) the intermediate dorsal cutaneous nerve of Type B where the nerve crosses the lateral surface of the distal fibula; (2) the intermediate dorsal cutaneous nerve of Type C where the nerve travels adjacent to the anterior border of the fibula; and (3) the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve at the level of the ankle, where they are at risk during anterior ankle arthrotomy or arthroscopy.
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Clin. Orthop. Relat. Res. · Aug 1994
Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery.
In a prospective nonrandomized study, a protocol was examined for prophylaxis of deep venous thrombosis and pulmonary embolism in patients with operative treatment of acetabular and pelvic fractures. There were 197 patients in the study with 203 fractures, including 148 acetabular and 55 pelvic fractures. There were 2 cases of bilateral acetabular fractures and 4 cases with both acetabular and pelvic fractures. ⋯ There were 6 cases of postoperative deep venous thrombosis and 2 cases of pulmonary embolism. The incidence of postoperative venous thrombosis and pulmonary embolism was 3% and 1%, respectively. The protocol was found to be effective for preoperative detection of venous thrombosis and prevention of deep venous thrombosis and pulmonary embolism in trauma patients with minimal bleeding complications and no morbidity from embolic disease.
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Clin. Orthop. Relat. Res. · Aug 1994
Biography Historical ArticleAcetabular fractures. A tribute to Emile Letournel.