Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Mar 1985
Peripheral nerve changes following epineurial injection of saline and blood in rat sciatic nerve.
The effects of warm saline and heparinized autogeneic blood injection on a rat sciatic nerve were observed by histologic, histochemic, and CT planimetry. Demonstrable intraneural degenerative changes and epineurial cellular proliferation were present in both groups. ⋯ Further investigations are needed to study the effect of nonheparinized blood injection. The use of computerized planimetry in assessing quantitative nerve damage proved to be feasible.
-
Clin. Orthop. Relat. Res. · Dec 1984
Case ReportsIliacus hematoma and subsequent femoral nerve palsy after penetration of the medical acetabular wall during total hip arthroplasty. Report of a case.
Intrapelvic perforation of the medial acetabular wall during total hip arthroplasty is not uncommon but has been associated only rarely with adverse effects. A postoperative iliacus hematoma with secondary femoral nerve palsy occurred in a 61-year-old woman. The patient had been on Coumadin prophylaxis against deep venous thrombosis, but bleeding times were never excessively prolonged. ⋯ Conservative therapy produced resolution of the nerve deficit within eight months. Careful attention to the placement of anchoring drill holes in the acetabulum could have prevented this complication. Iliacus hematoma should be considered in the differential diagnosis of a femoral nerve palsy in the postoperative total hip patient, particularly if anticoagulation is employed.
-
Clin. Orthop. Relat. Res. · Dec 1984
The geyser sign and torn rotator cuff: clinical significance and pathomechanics.
The geyser radiographic sign on shoulder arthrogram is characterized by leakage of dye from the glenohumeral joint into the subdeltoid bursa. The dye outlines the acromioclavicular joint. It is usually an indication of a full-thickness cuff tear of long duration. The clinical occurrence and pathomechanics of this finding indicate that repair is generally difficult.
-
Clin. Orthop. Relat. Res. · Nov 1984
Case ReportsLead intoxication 18 months after a gunshot wound.
Lead poisoning can result from a retained intra-articular bullet. A 30-year-old man who was shot with a .38-caliber pistol illustrates the symptoms, signs, and differential diagnosis of lead intoxication.
-
Clin. Orthop. Relat. Res. · Sep 1984
The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain.
Although epidural cortisone injections are commonly used for treatment of lumbosciatic pain, insufficient critical analysis of the end result can be found in the literature. The present study is a retrospective critical analysis of 367 patients with leg pain who were engaged for a minimum of two weeks or an average of two months in multifaceted conservative management without relief of pain. Injections of 10 cm3 of 0.5% bupivacaine and 100 mg of methylprednisolone were given to inpatients treated by the same anesthesiologist. ⋯ The most favorable results (approaching 70% offd-excellent) were observed in patients with subacute radicular leg pain (of less than three months' duration) and chronic leg pain (of greater than three months' duration) with no prior surgery. Negative myelograms and electromyograms (EMGs), in the absence of reflex or motor deficits on physical examination, also pointed toward optimal results. Those patients with chronic pain who had had prior lumbar spine surgery had the least satisfactory results.