Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 1981
Case ReportsTension band fixation of acute cervical spine fractures.
Eight patients had posterior cervical spine fusion utilizing the principle of tension band fixation. Six patients with associated neurologic symptoms improved postoperatively. Solid fusion was achieved and a functional range of motion of the cervical spine was maintained in all of the living patients.
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Acute carpal tunnel syndrome occurred subsequent to fractures of the wrist in four patients. A bone graft operation had been performed on the distal end of the radius in a fifth patient. ⋯ Four patients were treated by carpal tunnel release at 36 to 96 hours after the injury. Carpal canal pressure measurements were performed pre- and postoperatively in one patient.
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Clin. Orthop. Relat. Res. · Nov 1980
Uptake of glycosaminoglycan polysulfate by articular and meniscus cartilage: a biochemical and autoradiographic investigation.
Incorporation of labeled glycosaminoglycan polysulfate (35S-GPS) into the knee joint was studied biochemically and autoradiographically. After an injection into a knee joint of a rabbit, 35S-GPS was taken up into articular and meniscus cartilage. A 35S-GPS macromolecule and a complex of 4 M GuHCl extracted soluble substance (mainly considered proteoglycan) exists in the articular and meniscus cartilages. ⋯ One day after injection of 35S-GPS, numerous grains were observed in the deep layer. Autoradiography also demonstrated that 35S-GPS turnover is greater in articular cartilage than in meniscus. Uptake of 35S-GPS in an unmodified form in extracellular matrix of articular cartilage should be further investigated in experimental animals with degenerative osteoarthritis.
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Clin. Orthop. Relat. Res. · Oct 1980
Case ReportsHemodilution and induced hypotension for insertion of a Harrington rod in a Jehovah's Witness patient.
The case of a 28-year-old Jehovah's Witness illustrates the feasibility of using a combined technique of induced hypotension and hemodilution to minimize the surgical loss of red blood cells during the insertion of a Harrington rod. A Swan-Ganz catheter with thermister tip was inserted to measure pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. Other intraoperative monitoring included continuous arterial pressure, electrocardiography, oropharyngeal temperature, esophageal stethoscope, arm-cuff blood pressure and urinary output from an indwelling Foley catheter. ⋯ The 24-hour postoperative hematocrit was 30% and recovery was uneventful. This method may be useful in any orthopedic procedure in which heavy blood loss is anticipated and the patient refuses transfusion of blood or blood products. However, the patient must be in good health and have an uncompromised cardiopulmonary system.
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Clin. Orthop. Relat. Res. · Oct 1980
Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies.
Both extraosseous and intraosseous blood supply of the femoral head are susceptible to injury in patients with femoral neck fractures. The injury to the extraosseous vessels is proportional to the amount of displacement at the time of fracture. The major intraosseous vessels are damaged if the fracture extends through the superior lateral portion of the neck or head. ⋯ The arthritic changes seen in some patients three or more years after femoral neck fracture seem to be initiated by collapse and fragmentation of small areas of avascular necrosis in or near the weight-bearing portion of the head. The various methods currently available for predicting the vascularity of the head at the time of fracture are not sufficiently quantitative to be used on a routine clinical basis. Biologic factors may explain the difference in the incidence of avascular necrosis in the adult femoral head epiphysis compared with that in the metaphysis and explain why the area of revascularization and reossification of avascular bone is so limited.