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At least 397 records · Page 22Linked to original sources

Granulomatous inguinal lymphadenopathy after bilateral metatarsophalangeal joint silicone arthroplasty.

Silicone elastomer arthroplasties for joint diseases involving the small joints of the hands and feet have been used worldwide since the late 1960s. While reports of axillary lymphadenopathy exist, the exact incidence of subclinical adenopathy and its relationship to arthroplasty integrity have been difficult to determine. We report a patient who developed bilateral inguinal granulomatous adenopathy as a foreign body response to regionally disseminated silicone particles from bilateral metatarsophalangeal joint prostheses.

Adult↗

Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment.

Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results. The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort. Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15 degrees on radiographs following a closed reduction mandates open reduction.

Arthrodesis↗

Surgical rehabilitation.

There is hardly any other disorder where the possibility of replacing destroyed joints by artificial ones has transformed the functional outcome so decisively as in rheumatoid arthritis. The advances achieved in surgery may even be regarded as the most important result of any research on rheumatoid arthritis as published in recent years. Arthroplastics account for almost half of all interventions in our own statistics which cover almost 6000 operations on patients with this disease. Surgical synovectomies account for more than 40 per cent, and various other techniques are used in only 10 per cent of operations. Indications and contra-indications are discussed first in a more general way, and the need for close collaboration of family doctor, rheumatologist, orthopaedic surgeon and highly qualified therapeutic staff is emphasized. In the following sections the most rewarding methods used for rehabilitation of the upper limbs are described, including pre- and post-surgical management as well as the results to be expected. Subsequently our standard programme for the surgical rehabilitation of the affected joints of the lower limbs is presented. Special reference is made to a new technique for the fixation of the arthroplasty in cases of rheumatoid acetabular protrusion.

Adult↗

Simulation of human gait using computed torque control.

This paper presents a method for the mathematical modeling of both the single and double support phases of the human gait. The governing equations are obtained by considering the linkage model to be in a floating state and the foot-ground interaction is imposed in the form of geometric constraints. Two stages for the single support phase and one stage for the double support phase are considered, each described by a different foot-ground constraint. Feedback controller functioning according to the computed torque control method is used to achieve the normal gait described by the hip and ankle trajectories. Weighted least square optimization is used to solve the redundancy of control torques during the double support phase. The geometric simulation indicates that the imposed trajectories can be realized by the proposed model with some deviations in joint motions. The control strategy is tested by artificially perturbing the trajectories. The corrective actions are able to resume the desired pattern within half cycle, but with control torque magnitudes considerably away from reasonable limits. This is attributed to the insufficiency of the planar kinematic model and the assumption that the joint torques are unbounded.

Ankle Joint↗

[Symphalangism].

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Female↗

Irreducible dislocation of the hallucal interphalangeal joint.

Irreducible dislocation of the hallucal interphalangeal joint is a rare condition, with only 41 cases reported in the literature. We present a patient with a Miki type 2 irreducible dislocation of the hallucal interphalangeal joint and review literature pertinent to this condition.

Adolescent↗

An anatomic comparison of venous damage resulting from 2 dorsal surgical approaches to proximal interphalangeal joint arthroplasty.

Proximal interphalangeal joint arthroplasties were performed on 40 toes of 10 fresh-frozen cadaveric feet. Twenty toes had a transverse elliptical incision of skin and extensor mechanism, and 20 had a longitudinal incision with transverse excision of extensor mechanism. Venous anatomy, including damage to the dorsal collateral veins, was noted. In the transverse-incision group, 14 (70%) of 20 toes had 1 dorsal vein transected, and 2 (10%) of 20 toes had both dorsal veins transected; in the longitudinal-incision group, no dorsal collateral veins were injured. As transverse incisions carry a high risk for damaging the dorsal collateral veins, and such damage may contribute to postoperative swelling, care should be taken to protect these veins. Longitudinal incisions are less likely to damage these venous structures.

Arthroplasty↗