Clinical orthopaedics and related research
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In 14 patients tarsal tunnel syndrome was associated with varus heels and pronated, splayed forefeet. Review of the literature and the author's experience suggest that these conditions may be a common cause of the tarsal tunnel syndrome. Treatment of fixed varus deformities of the heel by outer heel wedges has been shown to be ineffective. ⋯ The tarsal tunnel syndrome, in the author's experience, is grossly underdiagnosed. Tarsal tunnel syndrome should be suspected in patients who have pain in the bottom of the feet without localized forefoot tenderness, who have a varus heel and a pronated, splayed forefoot, and who have a positive Tinel's sign behind the medial malleolus. It is important to differentiate tarsal tunnel syndrome from a peripheral neuropathy that obviously will not respond to surgical intervention.
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Clin. Orthop. Relat. Res. · Nov 1983
Zielke instrumentation (VDS) for the correction of spinal curvature. Analysis of results in 66 patients.
Sixty-six patients who underwent anterior spinal fusion with Zielke instrumentation for thoracolumbar and lumbar curvatures were reviewed. Results compared favorably with reported series in which the Dwyer instrumentation system was used. The best corrections were obtained in the idiopathic single-curve group (45% correction of upper curve, 87% correction of lower curve, and 95% correction of instrumented curve) as compared with the double-curve group (33% correction of upper curve, 53% correction of lower curve, and 62% correction of instrumental curve). ⋯ Instrumentation kyphosis can be prevented by placement of anterior wedge grafts in the intervertebral spaces. Complications were frequent but usually insignificant. The use of the Zielke instrumentation system offers the advantage of improved ability to derotate the spine while obtaining significant curve correction in a short fusion area.
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Clin. Orthop. Relat. Res. · Nov 1983
Historical ArticleExternal fixation. Historic review, advantages, disadvantages, complications, and indications.
The immobilization of fracture fragments by the insertion of pins connected externally by plaster, metal devices, or other appliances is not a new concept. In the past two centuries external fixation has enjoyed long periods of enthusiastic use alternating with intervals of total disrepute.
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Clin. Orthop. Relat. Res. · Oct 1983
Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome.
One hundred eight patients with lower leg pain of unknown cause underwent intramuscular pressure measurements by the wick technique. Fifteen patients (14%) were found to have a chronic anterior tibial compartment syndrome. In these patients the intramuscular pressure was significantly increased at rest and during and after exercise as compared with normal subjects. ⋯ Biopsies of the anterior tibial muscles showed increased water content, which may explain the elevated pressures. Muscle blood flow during exercise as measured by the xenon-133 clearance technique was decreased, and muscle lactate concentration was increased in the anterior tibial muscles. Fasciotomy relieved pain and normalized intramuscular pressure, muscle blood flow, and skeletal muscle metabolism.
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Clin. Orthop. Relat. Res. · Oct 1983
Evaluation of acute knee injuries with sciatic/femoral nerve blocks.
A preliminary study of the applicability of sciatic and femoral regional nerve blocks in the evaluation of acute knee injuries was conducted. During the period from January 1980 to March 1981, 12 patients with acute knee injuries in whom clinical examination under local anesthesia was considered totally unreliable secondary to patient uncooperation or severe pain were examined at Grady Memorial Hospital. Each of these patients received regional anesthesia by sciatic/femoral nerve block. ⋯ A full range of motion was present in each patient after the block. No complications were encountered. A satisfactory block was obtained in one attempt in 96% of the patients. (One patient had a failed femoral nerve block, but a repeated block was successful).