Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 1982
Case ReportsComplex dorsal dislocation of the thumb metacarpophalangeal joint.
Complex dorsal dislocation of the thumb metacarpophalangeal joint is an infrequently reported injury. Distinction from its simple counterpart is facilitated by specific physical and radiographic findings. The presence of skin dimpling without gross joint deformity represents physical evidence of a complex lesion. ⋯ The current treatment of choice is immediate operative reduction followed by a brief period of immobilization. Surgery may be performed through a volar, lateral, or dorsal incision. We favor the dorsal approach, in that it provides excellent exposure while reducing the risk of neurovascular injury.
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Clin. Orthop. Relat. Res. · Apr 1982
The relationship of thoracic outlet syndrome and carpal tunnel syndrome.
The elusive diagnosis of thoracic outlet syndrome and its controversial relationship with carpal tunnel syndrome is examined by a retrospective study of 1000 cases of carpal tunnel syndrome and 63 cases of thoracic outlet syndrome. Thoracic outlet syndrome is rare and difficult to accurately diagnose. The signs and symptoms of thoracic outlet syndrome lack specificity. ⋯ The relationship of carpal tunnel and thoracic syndromes does not represent an example of the double crush syndrome. In this study, the incidence of combined carpal tunnel and thoracic outlet syndromes approached zero. Surgical treatment of the carpal tunnel syndrome alleviated pain from the upper extremity in the majority of patients.
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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.