Clinical orthopaedics and related research
-
Reflex sympathetic dystrophy (RSD) is a complex syndrome of pain, trophic changes, and vasomotor instability secondary to an abnormal hyperactive state of the sympathetic nervous system following injury to an extremity. Numerous theories have been proposed to explain the pathophysiology. ⋯ A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment, i.e., sympathetic blockade and physical therapy, provide the greatest opportunity for a successful outcome.
-
Clin. Orthop. Relat. Res. · May 1989
Segmental spinal instrumentation for neuromuscular spinal deformity.
Seventy-six consecutive surgical cases of paralytic neuromuscular spinal deformity were retrospectively analyzed. Posterior arthrodesis with segmental spinal stabilization with Luque L-rods, sometimes preceded by anterior release, was done in all cases. The infection rate of 14.5% was observed to be markedly higher in patients with myelodysplasia. Deep placement of the rods lateral to the spine and well beneath full-thickness skin is recommended to reduce the incidence of this complication.
-
The orthopedic care of unstable pelvic fractures requires reduction and stabilization in order to promote union in a satisfactory position and provide a satisfactory clinical result. The results of three treatment techniques, skeletal traction and/or pelvic sling, anterior frame external fixation, and internal fixation, were evaluated over a four-year period.
-
Clin. Orthop. Relat. Res. · Apr 1989
Randomized Controlled Trial Comparative Study Clinical TrialPlates versus external fixation in severe open tibial shaft fractures. A randomized trial.
A prospective study of 59 patients with Grade II or III open tibial shaft fractures compared internal and external fixation. Bony stabilization was with plating by AO principles or with external fixation with the one-half pin technique, prospectively randomized. In 12 cases, minimal internal fixation of the tibia and external fixation were combined. ⋯ Knee and ankle ranges of motion were affected by ipsilateral femoral shaft fracture, knee injury, or ankle and foot trauma but not by the type of fixation. Both methods yielded excellent results, but the rate and extent of complications were lower with external fixation. Therefore, external fixation using the one-half pin technique should be regarded as a primary method of stabilization for Grades II and III open tibial shaft fractures.
-
External fixation has a definite role in the management of pelvic fractures. Biomechanically, it is not useful for maintaining reduction of the unstable, vertically migrating pelvis and must be used with some other form of treatment, such as traction, spica cast, or internal fixation. In vertically stable fractures, that is, rotationally unstable fractures, the anteroposterior and lateral compression injuries, the external fixator should probably be the first course of treatment.