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At least 577 records · Page 32Linked to original sources
PubMed1999

Current transfemoral sockets.

Clinicians have two types of prosthetic sockets for patients with a transfemoral amputation: the quadrilateral socket introduced in the 1950s and the ischial containment socket introduced in the 1980s. For many years, the quadrilateral socket was acceptable to clinicians and patients alike. With the introduction of the ischial containment socket claims were made that the quadrilateral socket had been inadequate from its inception. It also was claimed that the ischial containment design was the answer to all problems than patients with transfemoral amputations may have. Unfortunately, there is only one scientific study that lends any support to claims of the ischial containment socket's superiority and its findings are limited. Still, clinicians must make recommendation and prescription decisions daily regarding what is best for their patients. There are two acceptable socket designs for patients with transfemoral amputations. Experience with both supports the concept that they have more similarities than differences and that each has a legitimate place in the treatment of patients with transfemoral amputations. A comprehensive understanding of each socket design and its biomechanical intentions is essential for successful clinical application and treatment of patients with amputations.

Amputation, Surgical↗
PubMed2000

Congenital vertebral anomalies in ischiopagus and pyopagus conjoined twins.

A review of clinical records and radiographs revealed that five of 10 patients with conjoined twinning (three of six ischiopagus and two of two pyopagus twins) had congenital vertebral anomalies including hemivertebrae (3), multiple thoracic anomalies (1), right hemisacral agenesis (1), and three lumbar vertebra (1). No mirror image anomalies were identified, and different regions of the spine were involved in the two cases in which both twins had anomalies. Coexisting visceral and musculoskeletal anomalies included dextrocardia (3), atrial septal defect (1), congenital vertical talus (2), Sprengel's deformity (1), and multiple unilateral foot anomalies (1). Hip subluxation or dislocation was seen in five of eight ischiopagus or pyopagus twins after separation and required femoral and pelvic osteotomies. Lumbar scoliosis not associated with congenital vertebral anomalies was seen in two ischiopagus twins. These observations suggest an association between ischiopagus and pyopagus conjoined twins and congenital vertebral anomalies, and their coexistence is explained best by a nonspecific teratogenic insult during early embryogenesis.

Humans↗
PubMedDate not supplied

Subtle bone marrow edema assessed by frequency selective chemical shift MRI.

Subtle edema in yellow bone marrow from tumors (14 subjects) and osteomyelitis (9 subjects) were examined by selective nonexcitation (SENEX) water imaging using a short five pulse frequency selective excitation with lipid suppression greater than 96%. Standard spin-echo (SE) proton density-, T1- and T2-weighted images, and fat suppression methods such as short inversion time inversion recovery and also the chemical shift selective Dixon method are discussed in comparison with SENEX. Application of the SENEX method is described and images from four typical cases are demonstrated. Sensitivity to edema is obviously better using the SENEX chemical shift selective method than using other imaging techniques. Improved delineation of abnormal areas in yellow bone marrow is provided by SENEX water imaging in one slice after multislice standard imaging. After shimming, only one SE scan with frequency selective excitation is necessary to get a pure water image.

Adult↗
PubMedDate not supplied

CT and MRI of Gorham syndrome.

Gorham syndrome, also known as massive osteolysis or vanishing bone, is a rare disorder (135 cases reported) leading to extensive loss of bony matrix, replaced by proliferating thin-walled vascular channels. Three histologically proven cases of the disease are reported, including the clinical presentation and modern imaging features with CT (with 3D reconstruction) as well as T1- and T2-weighted MRI. Two cases in young women were located in the pelvis with extensive osteolysis reaching to the acetabulum. The third case in a 2-month-old boy is the youngest case ever reported and involved the humerus. The radiological appearance of the disease is discussed and the importance of the modern imaging methods debated.

Acetabulum↗
PubMed1996

Optimal technique of screw placement in the ischial tuberosity for posterior acetabular fractures.

Thirty dry adult bony specimens and eight embalmed cadavers were used to report on the morphological data of the ischial tuberosity and to determine the most optimal technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fractures. The average width, height, and depth of the ischial tuberosity were 27.0 mm, 32.2 mm, and 32.4 mm, respectively. The average angles between the posterior and medial aspects and between the posterior and lateral aspects of the ischial tuberosities were 79.5 degrees, and 111.5 degrees, respectively. The risk to the internal pudendal neurovascular bundle increases with either a more medially placed screw or a laterally placed screw that is angled medially. The tendinous origin of the hamstrings becomes quite substantial (7-10 mm thick) at a point 2 cm distal to the inferior acetabular margin. The exposure of the ischial tuberosity should therefore be restricted to this level. The entry point of the screws should be 5 mm or 10 mm medial to the lateral margin of the ischial tuberosity, and the screws should be directed 35-40 degrees, 45-50 degrees, and 50-55 degrees caudally at the level of the inferior acetabular margin and 1 cm and 2 cm below it, respectively, to obtain the most favorable bony purchase.

Acetabulum↗
PubMed2000

Pelvic fractures in pregnant multiple trauma patients.

OBJECTIVE: To study the outcome of pelvic fractures and fetuses in pregnant patients involved in blunt multiple trauma. DESIGN: Retrospective follow-up study. SETTING: Level I trauma center. PATIENTS: Pregnant multiple trauma patients with pelvic fractures between 1974 and 1998. INTERVENTIONS: Conservative and operative treatment of pelvic fractures adapted to the clinical status of the mother. MAIN OUTCOME MEASURES: Clinical, functional, and social outcomes were evaluated. RESULTS: Out of 4,196 patients with blunt multiple trauma treated between 1974 and June 1998, seven demonstrated the combination of blunt multiple trauma, pregnancy, and pelvic fractures. These patients had a mean Injury Severity Score of 29.9 points. Five mothers and three fetuses survived their injuries. All dead fetuses died on the scene. One surviving fetus was found to have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fetuses survived, the treatment of the pelvic fracture was modified for the sake of fetal well-being. In all of these patients, acceptable outcome was achieved. CONCLUSION: Modification of the treatment of the pelvic fracture in pregnant women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment did not severely alter the clinical outcome of the mother's pelvic fracture.

Acetabulum↗
PubMed2006

A surgical approach for an avulsion fracture of the ischial tuberosity: a case report.

We report a case of an avulsion fracture of the ischial tuberosity treated with a new surgical approach early after injury. Although surgical treatment of this fracture is usually avoided because of the difficulty of the procedure and the risk of sciatic nerve complication, we believe our subgluteal approach is simple and safe. We therefore recommend it for treating avulsion fractures of the ischial tuberosity, especially when the fragment is displaced by >2 cm and the sciatic nerve is not involved. If there is clinical evidence of sciatic nerve disturbance, it is likewise an indication for surgery. However, the incision needs to be deepened to approach the nerve, along the lines of the incisions advocated by both Miller and Spinner.

Adolescent↗
PubMed1976

Unstable hemipelvic fractures with internal rotation displacement.

Two cases of unstable hemipelvic fractures with internal rotation displacement successfully treated by outward (external lateral) rotation and continuous skeletal traction by wires passed through the crest of the ilium are described. X-rays show both patients before and 2 years after treatment.

Adult↗
PubMed1976

The management of decubitus ulcers by muscle transposition. An 8-year review.

Our 8-year experience with the management of decubitus ulcers by means of muscle transposition and skin cover is reviewed. The role of infection and its management are discussed. Some modifications of our previous techniques and newer operative approaches are detailed. Our complications and follow-up results are presented.

Bacterial Infections↗