Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1994
Review Case ReportsMissed scapular fracture after trauma. A case report and a 23-year follow-up report.
Scapular fractures are important in that they are often associated with high morbidity and mortality. Frequently they are overlooked because of the severity of other associated injuries. Extraarticular scapular fractures are often treated conservatively, even when displaced. ⋯ This case report presents a missed scapular fracture and associated rib fractures with subsequent malunion and a 23-year follow-up assessment. Surgical resection of a distorted inferior medial border of the scapula and dorsal rib prominences relieved the patient's symptoms. The case presentation, diagnostic modalities, treatment, and possible long-term sequelae of this complex fracture are reviewed.
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Clin. Orthop. Relat. Res. · Feb 1994
Comparative StudyContinuous epidural analgesia using fentanyl and bupivacaine after total knee arthroplasty.
Eighty consecutive patients undergoing unilateral total knee arthroplasty received postoperative analgesia consisting of a continuous epidural infusion of fentanyl and bupivacaine. Nineteen patients (24%) were unable to complete the three-day course of epidural infusion: two thirds for technical reasons and one third because of adverse effects. The remaining 61 patients (76%) successfully completed the 72-hour protocol. ⋯ Nausea was problematic in both groups. The incidence of respiratory depression was 5% for either opiate. The degree of hypoventilation and treatment required for it were less severe with fentanyl, however.
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Classification and treatment options for the management of tibial pilon fractures are reviewed. For comminuted and/or displaced fractures that require open reduction and internal fixation, a detailed description of the surgical technique, including indirect reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. ⋯ In the 26 Type II fractures, functional grading found 17 excellent (65%) and six (23%) poor results. In the eight Type III fractures, there were four (50%) excellent and three (37%) poor results. Complications included one superficial pin-tract infection and two deep wound infections, both in Grade II open fractures.
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Eighteen patients were treated for nonspecific diskitis (diskitis without microbial cause) at the University Children's Hospital in Helsinki during 1970-1990. The mean age at admission was three years three months. The characteristic findings were restriction of spinal mobility and an elevated erythrocyte sedimentation rate (ESR). ⋯ The clinical picture is typical, but diagnostic difficulties may be encountered during the first weeks when radiographic signs are absent. The disease is self-limiting in most cases, and only minor radiographic changes remain after healing. The results after routine operative biopsy raise the question of a possible nonmicrobial cause.
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Clin. Orthop. Relat. Res. · Dec 1993
Case ReportsCase report of a successful closed reduction without anesthesia.
Intraarticular dislocation of the patella is a rare clinical entity. Horizontal dislocation occurs when the patella rotates 90 degrees about its horizontal axis. ⋯ Furthermore, all previously successful closed reductions have required general anesthesia to accomplish the reduction. Intraarticular dislocation of the patella in a 24-year-old man was successfully reduced in a closed fashion without anesthesia.