Clinical orthopaedics and related research
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Eleven patients with fibular malunion after ankle fracture healed with stiff, painful joints and radiographic evidence of fibular malunion, diastasis of the ankle mortice, and talar tilt. Reconstruction was performed by mobilizing the fibula (by osteotomy or through the old fracture site), lengthening the fibula, and restoring the ankle mortice anatomically. The operation was done three months to three years after the initial fracture in patients ranging in age from 26 to 52 years. ⋯ Good functional results were maintained at long-term follow-up examination. The factors that determined the success of the revision were the duration of the malunion, the quality of the reduction achieved, and the condition of the articular cartilage at the time of revision. Late correction of the malunited fibula with diastasis of the ankle mortice is an effective means of salvaging function in a joint otherwise destined to be stiff and painful.
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One hundred premature femoral neck physeal closures in 430 hips with Perthes' disease have occurred in two patterns central and lateral. Abnormal physeal growth can be demonstrated early by a narrowed physeal plate with overlying avascular epiphysis and marked metaphyseal reaction below. Subsequently, a bony bridge forms between the metaphysis and epiphysis. ⋯ If the physeal closure is lateral, the mature hip will have a femoral head that is externally tilted as the medial neck lengthens and the lateral neck remains short, a trochanter that has overgrown the femoral head, an oval femoral head, a short leg, and a deformed acetabulum. A physeal arrest is a contraindication for a varus osteotomy because it accentuates the deformity, especially in the greater trochanter. The leg-length discrepancy may be treated by epiphysiodesis of the contralateral femur, when necessary, and the abductor muscle insufficiency may be treated by an exercise program or distal and lateral transfer of the greater trochanter.
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In 1,377 patients who had severe injuries about the knee joint, vascular complications were present in 28 (2%). Injuries to the popliteal artery or its branches present serious problems. ⋯ In fractures of the lower end of the femur or upper end of the tibia, and in knee dislocations, the importance of early diagnosis of the acute ischemic syndrome cannot be overemphasized. Tibial plateau fractures produced the highest percentage of vascular complications and indicate immediate application of therapeutic measures.
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Clin. Orthop. Relat. Res. · Apr 1982
Scapular manipulation for reduction of anterior shoulder dislocations.
Scapular manipulation is an effective, safe method to reduce an acute anterior shoulder dislocation. The method described by Bosley and Miles in 1979 has been used by the Orthopaedic Staff at Henry Ford Hospital since February 1979. It was the initial reduction method used in 51 patients and was successful in 47. With experience, and a properly executed technique, the method is relatively simple and can be applied to all patients.
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In 55 wrists with dorsal perilunate dislocations, trans-scaphoid dorsal perilunate fracture dislocations and volar lunate dislocations, an anatomic reduction was achieved by closed manipulation in 67% of the cases. After anatomic reduction, 59% of the wrists lost anatomic position during the first six weeks of treatment despite adequate external immobilization. ⋯ Open treatment was successful in gaining anatomic reduction 75% of the time and was uniformly successful in maintaining the reduction. In view of these results, the authors recommend open reduction and Kirschner wire fixation of displaced lunate and perilunate dislocations.