Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 1994
The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees.
Patellofemoral contact pressures resulting from fixed rotational deformities of the femur were studied in human cadaver knees. The increase in the degree of fixed rotational deformities of the femur results in a nonlinear increase in patellofemoral contact pressures on the contralateral facets of the patella (i.e., external rotational deformity resulted in a contact pressure increase on the medial facet, and internal rotational deformity resulted in a contact pressure increase on the lateral facet of the patella). With the initial isometric tension of 200 N in the quadriceps tendon for 30 degrees, 60 degrees, 90 degrees, and 120 degrees knee flexion, the peak contact pressure showed no significant differences between the medial and lateral facets of the patella in its anatomic position. ⋯ However, at 30 degrees rotational deformity of the femur, both the external and internal rotational deformity of the femur showed a significant increase in the tension of the quadriceps tendon and the patellofemoral contact pressures on contralateral facets of the patella. The greatest increase in patellofemoral contact pressures was observed at 30 degrees and 60 degrees knee flexion for both the external and internal rotational deformity of the femur. The external rotational deformity of the femur for all knee flexion angles showed significantly higher peak patellofemoral contact pressure increases on the medial facet of the patella as compared with the lateral patellofemoral contact pressure increase resulting from internal rotational deformity of the femur.
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Clin. Orthop. Relat. Res. · Apr 1994
Innervation of the human knee joint and implications for surgery.
The anatomy of the articular and cutaneous nerves about the knee was investigated through 45 dissections of human anatomic specimens. The variability and location of these nerves are described and related to soft tissue and bony landmarks. Three constant nerves exist at the medial aspect of the knee, two of which have cutaneous territories that extend across the midline. ⋯ Two lateral articular nerves were found consistently in relation to reliable landmarks. The innervation to the lateral knee skin is variable from either the lateral femoral cutaneous nerve or branches of the femoral nerve. This anatomy provides a basis for nerve blocks and selective denervation in the treatment of knee pain.
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Clin. Orthop. Relat. Res. · Apr 1994
Case ReportsCompartment syndrome in the well leg resulting from fracture-table positioning.
A variety of patient positioning options exist on modern fracture tables for use during intramedullary nailing procedures. With the advent of interlocking and reconstruction nailing, some of these procedures can be complicated and prolonged. The use of the hemilithotomy position for prolonged intramedullary nailing procedures can result in the development of a compartment syndrome in the uninjured leg, no matter what type of suspension device is used for that leg. ⋯ Two patients at this institution have had such a condition in the past two years, and the authors have revised their positioning procedures. Review of the surgical literature shows that this complication has been seen in urologic, gynecologic, and general surgical patients, but has not been widely reported in the orthopaedic population. Recommendations for avoiding this problem include the use of other positions or distraction devices when performing intramedullary nailings, or, when the hemilithotomy position cannot be avoided, early intraoperative repositioning of the leg when possible.
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Clin. Orthop. Relat. Res. · Mar 1994
Case ReportsCoracoid process fracture combined with acromioclavicular dislocation and coracoclavicular ligament rupture. A case report and review of the literature.
A coracoid process fracture associated with acromioclavicular joint dislocation and with rupturing of the coracoclavicular ligaments of an adult has been reported only once in the literature. This report adds another unusual case to the literature to reemphasize the importance of recognizing this unusual lesion. Two separate mechanisms--direct trauma to the shoulder girdle and sudden pull on the coracoid process by the conjoined tendons of short head biceps and coracobrachialis muscles--appear to be responsible for this unusual triple lesion. Open reduction with coracoid screw and acromioclavicular fixation, combined with an All-dredge repair to replace the ruptured coracoclavicular ligaments, resulted in an excellent outcome.
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Clin. Orthop. Relat. Res. · Mar 1994
Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release.
Ten cases of acute carpal tunnel syndrome (ACTS) and six cases of nerve contusion were identified in patients with acute median neuropathy associated with blunt wrist trauma. The patients with ACTS initially had normal sensation and subsequently developed objective sensory loss (2-point discrimination greater than 15 mm) in the median nerve distribution associated with severe wrist pain. Patients with nerve contusion injuries had immediate sensory loss and symptoms were nonprogressive. ⋯ The results of this study and review of the literature reflect the urgency of carpal tunnel release in ACTS. Neuropathy, secondary to nerve contusion without coexisting ACTS, may be treated initially by observation. Acute carpal tunnel syndrome must be distinguished from nerve contusion as a cause of acute posttraumatic median neuropathy.