Clinical orthopaedics and related research
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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.
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Some of the experimental, pathologic, and clinical features of extremity compression are reviewed with special reference to vulnerability of peripheral nerves to compressive forces at specific anatomic locations. Attention is directed toward syndromes resulting from mechanical factors, and it should be pointed out that a nerve can be compressed at more than one level. Localized peripheral nerve compression is common in clinical medicine; carpal tunnel syndrome is the most common example. Physicians who maintain a high index of suspicion to the signs and symptoms of peripheral nerve compression will diagnose and treat these conditions earlier and thereby reduce the number of patients who develop permanent functional disabilities.
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Clin. Orthop. Relat. Res. · Jan 1982
Growth of the proximal femur after varus-derotation osteotomy in the treatment of congenital dislocation of the hip.
The growth of the upper end of the femur was studied in 50 children with congenital dislocation of the hip in whom a femoral osteotomy had been carried out. All children had unilateral dislocations and had been treated by a proximal femoral varus-derotation osteotomy after closed reduction, excision of the limbus, or open reduction. The average age at osteotomy was 2.3 years. ⋯ Although no cases of avascular necrosis of the capital epiphysis occurred, 21 children developed deformities of the femoral head, of whom eight showed an abnormal angulation of the capital-epiphyseal plate. The neck-epiphysis angle is described as an alternative to the shaft-epiphysis angle in assessing the orientation of the capital-epiphyseal plate. The best radiographic outcome was obtained when the neck-shaft angle measured 100 degrees to 110 degrees immediately after osteotomy.
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Clin. Orthop. Relat. Res. · Jan 1982
The development of the spinal deformities in osteogenesis imperfecta.
Evaluations were made of the spinal deformities in 22 of 30 patients (osteogenesis imperfecta congenita, eight; osteogenesis imperfecta tarda I, 13; osteogenesis imperfecta tarda II, one) treated at Hamagumi Gakuen Children's Hospital from 1959 to 1980. Seven of the congenital type patients were in the severe curve group (greater than 50 degrees), four of whom showed more than 100 degrees of curvature. ⋯ The complications of the spinal deformities included disability on ambulation, inactivity in daily living, and possibly respiratory dysfunction. Progression of the spinal curvature should be prevented by functional bracing or surgical treatment before severe complications arise.