Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 1986
Comparative StudyMicrocapillary infusion technique for measurement of intramuscular pressure during exercise.
The microcapillary infusion method (MCI) is described and compared to the pump infusion (PI) and the wick catheter methods for recording pressure in the anterior tibial muscle at rest and during exercise in 34 volunteers and in 11 patients with chronic compartment syndrome (CCS). The infusion techniques offered excellent dynamic properties in recording pressure during exercise with infusion rates exceeding 0.1 ml/hour. Infusion rates below 3.0 ml/hour in normal legs and below 1.5 ml/hour in CCS legs were found not to increase the pressure at rest during 30 minutes. ⋯ The MCI method had a lower compliance, a higher resonance frequency, and a shorter response time than the PI method. The muscle relaxation pressure (MRP) during exercise increased to 34.6 (SD = 5.6) mmHg in the CCS patients during exercise compared to 17.3 (SD = 4.6) mmHg in the control group. The MCI technique offers a practical tool for studying equilibrium pressures during muscle contraction and relaxation in routine clinical investigations and research.
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Clin. Orthop. Relat. Res. · Jun 1986
Telangiectatic osteogenic sarcoma. Improved survival with combination chemotherapy.
Since the inception of adjuvant chemotherapy for osteogenic sarcoma (OS), 25 patients were treated for telangiectatic osteogenic sarcoma (TOS) from 1973 through 1980. This represented 12% of all patients with primary OS of an extremity seen during this time period. Tumors that demonstrated only focal areas of TOS with areas of other subtypes were designated not as TOS but as "mixed" subtypes of OS. ⋯ Of the entire group, 17/25 (68%) have remained free of disease at a mean follow-up time of over five and one-half years. This study demonstrates that TOS is responsive to chemotherapy and is potentially curable. Some prior reports of the uniformly poor prognosis of this variant of OS should not discourage attempts of curative therapy by chemotherapy and surgery.
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Clin. Orthop. Relat. Res. · Jun 1986
Case ReportsComplete fracture-dislocation of the thoracic spine associated with spontaneous neurologic decompression. A case report.
"Complete" fracture-dislocation of the thoracic spine without neurologic deficit, a rarely described injury, occurred in a 29-year-old coal miner. Partial lesions or those without neurologic deficit may be associated with spontaneous decompression. Gross translational displacement of one vertebrae on another generally compresses interposed neural structures between the columns and/or fragments. ⋯ The rib cage stabilizes the thoracic spine, decreasing the risk of neurologic injury. Although many surgeons proclaim the advantages of early open reduction and internal fixation, reduction may not always be necessary in this type of severe injury. Reduction entails highly significant risks, especially in neurologically uncompromised individuals with severe thoracic displacement.
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Clin. Orthop. Relat. Res. · Apr 1986
The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations.
In this report, 100 knees in 77 patients, with an average age of 65, were followed for a period between five and 10 years. Rheumatoid arthritis was the diagnosis in 43 patients and osteoarthritis in 34 patients. The majority had varus, valgus, and biplane deformities. ⋯ No dislocations occurred, but 14 patellae showed tilt on skyline view roentgenograms, indicating a tight lateral retinaculum. In view of the good to excellent results achieved in the majority of patients, and the low morbidity associated with replacement, it is recommended that the patellofemoral joint be replaced in the course of total knee arthroplasty. When careful attention is paid to technical details, this procedure improves the quality of the arthroplasty.
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Classification and treatment of polydactyly and polysyndactyly of the fifth toe are described based on a study of 37 patients with 46 affected feet. Polydactyly was seen in 26.1% of duplicated toes, polysyndactyly in 28.3%, and polysyndactyly fused with the fourth toe in 45.7%. Thirty-three patients with 42 toes were surgically treated. ⋯ The lateral digital ray, including the metatarsal, was excised in patients with polydactyly of the metatarsal type. The average age of patients at operation was 12.3 months (range, five days to five years). Reorganization of the foot was facilitated when the child was treated early or before it could walk.