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PubMedDate not supplied

Interference screw divergence in femoral tunnel fixation during endoscopic anterior cruciate ligament reconstruction using hamstring grafts.

PURPOSE: To compare the divergence angles between bioabsorbable interference screws inserted into the femoral tunnel with the screwdriver placed through the anteromedial portal to those inserted with the screwdriver placed through the tibial tunnel and to examine the effect of the femoral tunnel interference screws' divergence angles on fixation strength of hamstring grafts after anterior cruciate ligament (ACL) reconstruction using hamstring grafts. TYPE OF STUDY: Cadaveric biomechanical pullout study. METHODS: ACL reconstruction was performed in 8 pairs of fresh-frozen human cadaveric knees using hamstring grafts fixed within the femoral tunnels using bioabsorbable interference screws. Within matched pairs, 1 screw was placed into the femoral tunnel using a screwdriver placed through the tibial tunnel (group 1), and in the other knee it was placed into the femoral tunnel using a screwdriver placed through the anteromedial portal (group 2). Radiographs were taken to measure the degree of divergence between the interference screw and the femoral tunnel. After disarticulation, pullout strength was then measured using a cyclic-loading model. RESULTS: In group 2, there was significantly more divergence between the screw and the femoral tunnel compared with group 1, particularly in the sagittal plane (average 14.4 degrees compared with 3.4 degrees, P =.00014). With the number of specimens available for comparison, no significant difference was detected between the 2 groups with regard to 3 mm and 5 mm of pullout when cyclically loaded (P =.77 and.74, respectively). CONCLUSIONS: The increased technical difficulty, combined with the potential risks of tibial tunnel widening and graft damage, with placement of the screwdriver through the tibial tunnel for the purpose of decreasing femoral interference screw divergence in ACL reconstruction using hamstring grafts may not be justified.

Absorbable Implants↗
PubMed2003

Newborn with an open posterior hip dislocation and sciatic nerve injury after intrauterine radiofrequency ablation of a sacrococcygeal teratoma.

Advanced prenatal ultrasonography techniques have allowed for better understanding of the natural history, treatment, and prognosis of sacrococcygeal teratomas. Several intrauterine surgical techniques to debulk the tumor when fetal and maternal life are in jeopardy have been described. Orthopaedic impairment, such as lower extremity weakness and swelling, also has been described in association with sacrococcygeal teratomas. The authors report on a newborn in whom a large soft tissue defect overlying the posterior hip region with direct exposure of the disarticulated hip joint existed at the time of birth, which resulted from intrauterine radiofrequency ablation of a sacrococcygeal teratoma. This unexpected complication has resulted in a loss of sciatic nerve function, malformation of the acetabulum and femoral head, and loss of the left ischium, coccyx, inferior sacrum, gluteal, adductor and piriformis muscles, and posterior hip capsule. At 16 months of age, the patient has a flaccid left lower extremity with a hypoplastic hip joint.

Catheter Ablation↗
PubMedDate not supplied

Sensitivity of radiographic evaluation of radio-ulnar incongruence in the dog in vitro.

OBJECTIVE: To determine the sensitivity and specificity of radiographic evaluation of radio-ulnar incongruence in canine elbow joints in vitro. STUDY DESIGN: Radiographic evaluation of induced radio-ulnar incongruence in canine cadaveric forelimbs by radiologists blinded to study design. SAMPLE POPULATION: Six cadaveric canine left forelimbs. METHODS: Extended lateral, 90 degrees flexed lateral, and cranio-caudal projections were taken of the elbow joint of six cadaveric canine forelimbs. A four-pin, type I external skeletal fixator (ESF) with a linear motor side bar was attached to the medial aspect of the radius, and a 2-cm segment of bone was removed from the mid-diaphysis. A 3.5-mm cortical bone screw placed from the medial to lateral styloid processes prevented relative movement between the distal radius and ulna during radial shortening. The ESF was used to progressively shorten the radius in increments of 0.5 mm to a total of 4 mm. The three radiographic projections were repeated after each incremental change of length. After the study, each elbow joint was disarticulated to confirm the presence of a step defect. The original radiographs and three copies were randomized and then evaluated by four radiologists blinded to the study design. Radiologists were asked to evaluate whether the joint was normal or abnormal and if there was evidence of radio-ulnar incongruence. The ability of each radiologist to correctly identify congruent elbows (specificity) and incongruent elbows (sensitivity) was calculated. RESULTS: The median specificity was 86% using the lateral projection and 82% using the cranio-caudal projection. The median sensitivities using the lateral and cranio-caudal radiographic projections were 78% and 79%, respectively. The degree of radial shortening required for individual radiologists to achieve a sensitivity of 90% ranged from 1.5 mm to greater than 4 mm. CLINICAL RELEVANCE: Standard radiographic evaluation for radio-ulnar incongruence in the dog may be associated with relatively poor sensitivity and specificity. Invasive surgical procedures and screening programs that rely on radiographic diagnosis of radio-ulnar incongruence should be discouraged until a more reliable method of diagnosis of this type of elbow joint incongruence is available.

Animals↗
PubMed2001

Modified dorsalis pedis flap for coverage of a pretibial pressure sore after hip rotationplasty.

Rotationplasty is a well-established procedure after total femur resection, especially in children. Rehabilitation is superior to disarticulation of the hip or hemipelvectomy because patients regain hip and knee function.(1) A tight fit of the prosthetic shaft is essential. The pretibial area has a low physiological resistance to pressure and shear forces, and is thus at increased risk of developing pressure-related complications. Skin defects with exposure of skeletal elements require flap coverage. The dorsalis pedis flap is one of the surgical options available for skin coverage of the proximal anterior leg. It can be rotated to cover almost any site on the anterior aspect of the leg if the pedicle is mobilised up to the anterior tibial artery.(2)Since donor site complications are common, this flap has few indications.(3)

Antineoplastic Agents↗
PubMed2002

[Decubital ulcer--causes, surgical therapy and prognosis].

7.6 % (n = 134/1 769) of all inpatients in Leuven, but 30.1 % of risk patients suffer of pressure sores (Norton Scale 10.4 points). Predisposed are geriatric patients or those of intensive care units. While fasciocutaneous flap likewise the superior gluteal artery perforator flap are more resistant to mechanical forces, myocutaneous flaps are the working horse for pressure sores with deep-tissue pockets or osteitis (Campbell stage > IV). Partial resection of the median sacral crest or ischiectomy are obligatory. In analyzing a 16 years period only 33 percent of myocutaneous flaps healed uneventful, while due to multiple enumerations more than 50 percent presented complications. Partial flap and complete necrosis happened in 6 respectively in 2 percent. Rectus abdominis myocutaneous flap reconstruction as well as the free tissue transfer are useful alternatives to hip disarticulation with total thigh flap coverage or a complete fillet flap of the lower extremity. Independently of the selected closure 50 percent of all decubitus patients will develop recurrences in longterm follow up. Thus prevention is of utmost importance. In Europe the costs for the hospitalisation of a patient with concomitant decubital ulcers are 2.5-times higher than for an average, non-afflicted patient.

Humans↗
PubMed2003

Lateral Transmandibular Approach to the Skull Base in Children: Three Case Reports.

The choice of surgical approach to tumors of the cranial base in children is determined by strict criteria. The criteria include optimal visibility for the surgeon, minimal possible impairment of facial skull growth, and the preservation of motor and sensory nerve integrity. From 1993 to 1996, three children (6 years old, 22 months old, 6 months old, respectively) underwent surgery to resect cranial base tumors through a modified lateral transmandibular approach. In all three patients a preauricular incision with temporal and submandibular extensions was performed. After the mandible was prepared, an osteotomy was conducted cranially to the mandibular foramen. When the capitulum was temporarily disarticulated, wide access to the cranial base was provided and the tumors were resected. Two of these children were available for follow-up, and we continue to observe their development. Given the severity of their conditions, treatment yielded good results. Growth impairment of the mandible was corrected by the distraction osteogenesis technique.

Case Reports↗
PubMed1992

Fetal limb allograft transplants in young rabbits.

The behavior and growth pattern of a transplanted fetal allograft limb in young rabbits were studied. No previous similar studies have been reported in the English literature. Ninety-four fetuses of four-weeks gestation were obtained through hysterectomy. The left hind limb of the fetus was dissected and disarticulated at the hip joint, preserving the long pedicle consisting of the inferior vena cava and abdominal aorta. The skin was stripped and nails were removed from the fetal limb prior to transplantation into a subcutaneous pouch on the medial aspect of the right thigh of a six-week old rabbit. The aorta and the inferior vena cava of the fetus were anastomosed to the femoral vessels of a recipient young rabbit, using the operating microscope. The rabbits were radiographed at fortnightly intervals to assess growth in the transplanted fetal limb. The rabbits were divided into three experimental groups: Group 1 (n = 26)--vascularized fetal allograft; Group 2 (n = 6)--non-vascularized fetal allograft; Group 3 (n = 5)--vascularized fetal allograft with Cyclosporin A. Preliminary results in Group 1 showed growth in the vascularized fetal limb allograft, with a maximum accelerated growth in the first four weeks. All Group 2 non-vascularized fetal allografts showed no growth. Group 3 showed an increased and accelerated limb growth in the first six weeks of transplant. The results demonstrated that vascularized fetal allograft has the potential for low-grade immunogenicity and of growth at the initial stage, especially with adjunctive immunosuppressive therapy.

Animals↗
PubMed1987

Bilateral functional mandibular reconstruction using the iliac crest free flap. A case report.

A patient who developed multiple metachronous primary carcinomas of the oval cavity is presented. After initial radiation therapy, a right hemimandibulectomy was required, followed ten months later by a left hemimandibulectomy. Immediate reconstruction of each defect was performed with a free vascularized iliac crest osteocutaneous flap. Using this flap, both bony continuity and intraoral lining were successfully restored. The patient was able to return rapidly to his previous activities. The results of this case suggest that preservation of the mandibular condyle for lateral fixation of the bone graft is superior to disarticulation of the temporomandibular joint in terms of cosmetic and functional outcomes.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

[Walking ability in bilateral leg amputees following prosthetic rehabilitation].

Between January 1989 and March 1993 117 patients were treated after acquired bilateral amputation of the lower extremities at the "Klinik und Poliklinik für Technische Orthopädie und Rehabilitation der Westfälischen Wilhelms-Universität Münster", Germany. Information from patients files and telephone interviews were collected to assess the degree of use of prostheses. All patients with levels of amputation not higher than above-knee on one side and hind-foot on the other side used their prostheses for daily walking. None of the patients with bilateral knee-disarticulation or higher levels of amputation used prosthetic devices for regular walking. In patients with amputation levels between these extremes the result of rehabilitation with prostheses is determined mainly by the cause of the amputation.

Adolescent↗
PubMedDate not supplied

[Beginnings of hip surgery--heroic times?].

In a historical review we look back at some of the earliest operations on the hip joint--osteotomy and arthroplasty, disarticulation, hip joint excision, osteosynthesis--belonging still to the era when anaesthesia, antiseptic and aseptic techniques were not available. We are indeed curious to know how the surgeons prepared their patients for the intervention and for the great risks entailed. There is no doubt that these surgeons were brave, but we should not refer to these times as being heroic.

Arthroplasty↗
PubMedDate not supplied

[Limb-saving resection procedures in primary malignant bone tumors].

Thoroughly indicated and performed limb salvaging resections of primary malignant bone tumors can be as well affective as amputations and disarticulations. Possible limb salvaging operative procedures are described with regard to histodiagnosis grading, localisation, expansion of neoplasma as well as to the personality of the patient.

Adolescent↗
PubMed1994

Distal cervical internal carotid artery stenosis.

This report describes a case of distal cervical internal carotid artery (ICA) occlusive lesion managed by saphenous interposition vein graft after exposure of the ICA up to the skull base. The skull base approach described herein emphasizes the mobilization of the mandible without mandibular osteotomy or disarticulation. Instead, the stylomandibular and stylosphenoidal ligaments are resected to allow mandibular mobilization. In addition, the distal ICA lesion represented a form of diffuse intimal thickening without any plaque formation. This required the resection of the thickened, stenotic segment and reconstruction of the distal cervical ICA with a saphenous interposition graft. The surgical management implications of diffuse intimal thickening are discussed.

Case Reports↗
PubMed1985

En-bloc resection for proximal humerus osteogenic sarcoma.

From 1975 to 1982, 101 children were treated for osteogenic sarcoma at the Children's Hospital of the Medical Center and Dana Farber Cancer Institute, Boston. 12 of these patients presented proximal humerus localisation and 8 underwent a local en-bloc resection. In the past these lesions were surgically treated by disarticulation of the shoulder or by interscapulothoracic amputation (forequarter amputation); the death rate was very high. Nowadays, high-dosage chemotherapy and resection of lung metastases carry new hopes for better and prolonged survival, and also for a higher rate of complete remissions. The quality of this prolonged life can be improved if en-bloc resection of the shoulder with upper limb preservation is performed.

Adolescent↗
PubMed2001

Dentoalveolar changes related to mandibular forward growth in untreated Class II persons.

The purpose of this study was to investigate dentoalveolar changes related to mandibular forward growth in persons with Class II malocclusions. The longitudinal cephalometric films of 40 subjects with untreated Class II malocclusions from mean age 8.8 to 17.8 years (before and after pubertal growth) were analyzed and compared with the Bolton norms. There was no statistically significant difference in mandibular growth between the Class II samples and the Bolton norms upon cross-sectional comparison. In the Class II subjects, forward growth of the mandible was greater than that of the maxilla by 4.36 mm on average; the dentoalveolar complex moved forward relative to the maxillary basal bone (point A) 2.16 mm and moved backward relative to the mandibular basal bone (pogonion) 2.28 mm; a strong linear relationship (almost a 1:1 ratio) existed between mandibular forward growth and dentoalveolar complex movement (r = 0.881; y = 0.976 x + 0.183). Results indicated that the effect of forward growth of the mandible, which could potentially bring the lower dentition forward, vanished into the adaptation movements of the dentoalveolar complex through intercuspal locking. Disarticulating the occlusion to minimize the effects of the adaptive mechanism and taking advantage of normal mandibular forward growth could be fundamental biological bases in treating Class II malocclusions in growing patients.

Adaptation, Physiological↗
PubMedDate not supplied

Posterior surgical approaches to the elbow: a comparative anatomic study.

Triceps splitting, triceps reflecting, and olecranon osteotomy are the most common posterior surgical approaches to the adult elbow, but no comparative data exist as to the exposure provided by each approach. The aim of this study was to determine which of these approaches provides the greatest exposure of the distal humeral articular surface. Each approach was performed on 4 adult cadaveric elbows. After the completion of each approach, the visible articular surface was painted with methylene blue. The elbow was then disarticulated, and the percentage of articular surface visible was measured. The median exposed articular surface for the triceps splitting, triceps reflecting, and olecranon osteotomy approaches was 35%, 46%, and 57%, respectively. Olecranon osteotomy exposed more articular surface than the triceps splitting approach (Mann-Whitney test, P =.03) but was not significantly greater than the triceps reflecting approach. However, even the olecranon osteotomy approach failed to provide visualization of more than 40% of the distal humeral articular surface.

Adult↗
PubMed2001

Archaeological evidence of teosinte domestication from Guilá Naquitz, Oaxaca.

Analysis of the three most ancient Zea mays inflorescence fragments from Guilá Naquitz, Oaxaca, Mexico shows they did not disarticulate naturally, indicating that agricultural selection of domesticated teosinte was underway by 5,400 (14)C years before the present (about 4,200 dendrocalibrated years B.C.). The cooccurrence of two-ranked specimens with two rows and four rows of grain and numerous additional morphological characteristics of these specimens support hypotheses based on molecular and quantitative genetic analyses that maize evolved from teosinte. Domestication of the wild ancestor of maize occurred before the end of the 5th millennium B.C.

Agriculture↗
PubMed2006

Perforated appendicitis during near-term pregnancy causing necrotizing fasciitis of the lower extremity: a rare complication of a common disease.

A 33-year-old woman presented with pain in the right side of the abdomen at 35 weeks of gestation. She was treated for cystitis. A few days later, her abdominal pain had disappeared; however, she had developed pain in the right thigh and fever. She delivered a healthy child, but postpartum her leg symptoms deteriorated. She was found to have a necrotizing fasciitis, which necessitated disarticulation of the hip. The source of the infection was a perforated appendix.

Adult↗
PubMedDate not supplied

Hyperlactacidaemia in isolated hyperthermic perfusion of tumour bearing rat limbs: a study of feasibility using a novel infusion solution.

PURPOSE: In a methodological study the applicability of hyperlactacidaemia in isolated hyperthermic perfusion of tumour-bearing rat limbs was investigated. METHODS: In 50 Sprague Dawley rats, DS-sarcoma growth was initiated on the right food dorsum by subcutaneous injection of 0.5 ml ascites cells. In the anaesthetized animals isolated limb perfusion was performed under steady state conditions for 60min using a miniature equipment. Thereafter tumour volume was measured daily. (a) Investigation of feasability: 40 rats were allocated to four groups. Group I: Normothermic perfusion at 38 degrees C, n = 10; Group II: Hyperthermic perfusion at 40-41 degrees C, n = 10; Group III: Normothermic perfusion at 38 degrees C and hyperlactacidaemia of 10 mmol/l, n = 10; Group IV: Hyperthermic perfusion at 40-41 degrees C and hyperlactacidaemia of 10 mmol/l, n = 10. (b) Investigation of survival and histological changes: In group V hyperthermic perfusion at 40-41 degrees C and hyperlactacidaemia of 10 mmol/l, n = 10 was performed. After the animals had died, hip disarticulation of the tumour-bearing limb was performed for histological examination. RESULTS: Normothermic and hyperthermic perfusion of tumour-bearing rat limbs using miniature equipment was feasible and tolerated by the animals. Regional hyperlactacidaemia of 10 mmol/l could be maintained throughout the perfusions. After combined treatment with hyperthermia and hyperlactacidaemia, tumour volume decreased and extensive tumour necrosis occurred, while in other animals aggressive tumour growth with bone infiltration could be observed. CONCLUSIONS: The present study demonstrates the applicability of hyperlactacidaemia in hyperthermic isolated limb perfusion in the rat and proved a tumour growth delay due to an induction of tumour necrosis thereafter. Further investigations in other tumour entities and experimental models are required to confirm this impressive therapeutic effect of hyperthermia in combination with hyperlactacidaemia.

Animals↗