Clinical orthopaedics and related research
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Triplane distal tibial fractures can occur as two-, three-, or four-part fractures with or without a fibular fracture. Diagnosis of the particular anatomy of each fracture is ascertained by plain radiographs; if the fracture is displaced 2 mm or more on any view, anteroposterior and lateral tomograms and, if possible, a limited computerized tomography (CT) scan should be done. A plaster cast in situ for non-displaced fractures or closed reduction for displaced fractures should be attempted first by internal rotation and anterior movement of the fibular metaphyseal piece. ⋯ Operative treatment consists of screw fixation for the metaphyseal fragment alone in two-part fractures and both metaphyseal and epiphyseal screw fixation in three-part fractures. Associated fibular fractures may also require internal fixation. The prognosis is generally good if adequate reduction has been achieved by closed or open means.
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Clin. Orthop. Relat. Res. · Jul 1984
Case ReportsTransoral atlantoaxial anterior decompression and fusion.
Two patients with atlantoaxial dislocation (one with an accompanying basilar impression) were treated by a combination of transoral anterior decompression and anterior fusion with good results. Transoral odontoidectomy is hazardous and difficult. ⋯ If the displacement is irreducible and significant, removal of the protruding odontoid process is considered essential for relief of myelopathy. Simultaneous anterior fusion eliminates the necessity of a second operation, i.e., posterior fusion for stabilization of the atlantoaxial region.
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The goal of subtotal arthrodesis of the wrist is to provide a stable and pain-free joint, with preservation of a limited but useful range of motion. Experience indicates that the available mobility of the joints that are left unfused tends to increase with time and use of the extremity, and that accelerated wear of these joints has not been a problem. Subtotal arthrodeses of the wrist are indicated for: painful arthritis involving one or two radiocarpal or intracarpal joint surfaces, stabilization of carpal collapse deformities, failed ligament reconstructions or repairs, bone tumors with partial carpal involvement, and supplementation of carpal implants, when their insertion alone could precipitate or increase potential carpal instability.
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Clin. Orthop. Relat. Res. · Jun 1984
Thermally induced bone necrosis in rabbits. Relation to implant failure in humans.
The exposure of bone to high temperatures has become quite common, especially with the increasing use of polymethylmethacrylate (PMMA) bone cement. With particular regard to total hip arthroplasty, many authors have commented on the temperature problem induced by the curing PMMA cement mass. Polymerization temperatures at the bone-cement interface have been measured and range between 40 degrees and 110 degrees, depending on the thickness of the cement line. ⋯ Although an inflammatory reaction replaced by a fibrous tissue scar was seen at the site of surgically damaged periosteum, no control animals showed evidence of either bone or marrow necrosis. These results led the authors to suggest that joint replacement systems in human bone, using PMMA bone cement, be designed to limit intraoperative temperature maximums to a level less than 70 degrees. By preventing excessive bone necrosis at the bone-cement interface, early loosening and subsequent implant failure may be significantly reduced.
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Clin. Orthop. Relat. Res. · May 1984
Case ReportsClosed dorsal dislocation of the metatarsophalangeal joint of the great toe. A surgical approach and case report.
A rare injury consisting of an irreducible, closed complex dorsal dislocation of the metatarsophalangeal joint of the great toe was encountered in a 21-year-old man. A midline longitudinal dorsal incision over the metatarsophalangeal joint allowed easy and rapid approach to the joint, good visualization, and adequate access for reduction. The plantar neurovascular bundles are not at risk from the exposure, and scarring in the weight-bearing area after operation is avoided.