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At least 667 records · Page 37Linked to original sources
PubMed1999

A study of joint mobility in a normal population.

Joint hypermobility is a clinical entity that has been little studied in Southeast Asia in contrast to the many studies that have been conducted in the West. A pioneer study was conducted in Singapore involving 306 subjects from the three major races i.e. Chinese, Malays and Indians. Their ages ranged from 15 to 39 years. The objective was to ascertain the joint mobility profile in a study sample representative of the Singapore population and the prevalence of joint hypermobility amongst normal individuals. Joint mobility was assessed using criteria according to Carter and Wilkinson modified by Beighton et al. The distribution of the three major races in the study sample was based on the 1990 census of the Singapore population. The prevalence of joint hypermobility was found to be 17%. The results showed that joint mobility decreases with age and that females had consistently higher degree of joint mobility compared to males throughout the age group. Among the racial groups, Malays had the highest degree of joint mobility followed by Indians and Chinese.

Adolescent↗
PubMed1999

Types of persistent dysplasia in congenital dislocation of the hip.

This article reports five types of persistent bony dysplasia in patients with congenital dislocation of the hip (CDH), suggests the pathogeneses, and discusses the treatment options. We consider the five types to be (1) maldirected acetabulum, (2) capacious acetabulum, (3) false acetabulum, (4) lateralized acetabulum, and (5) femoral deformity. The maldirected acetabulum persists when the acetabulum continues to face forward and laterally. The capacious acetabulum arises from joint instability; capsular laxity permits the proximal femur to slide within the acetabulum. The false acetabulum results from an ectopic fibrocartilaginous cavity in the pelvis created by the subluxated or dislocated femoral head.44 The lateralized acetabulum occurs with ossification of the cotyloid cavity from longstanding lateral subluxation or dislocation or premature closure of the triradiate cartilage. Femoral deformities include valgus and anteversion of the femoral neck, capital femoral physeal growth arrest, discrepancy between the greater trochanter and the femoral head, and femoral head asphericity. After clinical and radiographic evaluation, we believe that an understanding of the pathogeneses and types of dysplasia will facilitate appropriate treatment programs. Treatments consist of acetabular redirection, acetabular reconstruction, femoral osteotomies, and salvage procedures.

Acetabulum↗
PubMed1999

Hip revision arthroplasty. Approach to the femoral side.

Total hip arthroplasty has proven to be a highly successful procedure but with its increased use in elderly patients and in young patients with high physical demands, there are an increasing number of joints requiring revision. Many factors, including loss of bone stock, joint instability, infection, fracture, trochanteric nonunion, and difficulty in implant or cement removal, make revision of the femoral component challenging to the surgeon. To address these factors and to achieve the goals of revision surgery, several key questions should be addressed. What exposure should be used? How can the implant be removed? What type of reconstruction should be used and which implant should be chosen? How can stable fixation be achieved? How can the bone defects be treated? The approach that the authors recommend to the femoral component in revision hip arthroplasty is outlined, taking into consideration each of the questions above. The classification system used by the authors for femoral bone defects present at the time of revision arthroplasty has four categories based on the integrity of the proximal cancellous bone and the cortical tube, which is used to select the technique of reconstruction. The literature on techniques for revision of a failed femoral component is reviewed.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Shoulder prosthesis subluxation: theory and experiment.

The articular shapes of the humeral and glenoid components in total shoulder arthroplasty affect the loading, translation, and contact stresses in the joint, thereby affecting stability, glenoid loosening, and wear. Experiments were conducted to determine the subluxation load and corresponding translation for 6 types of glenoid components. The effects of shape, size, testing direction, compressive load, testing speed, testing medium, bone substitute properties, and repeated subluxations were investigated and compared with theoretical, rigid-body predictions. The subluxation load, varying from 45% to 98% of the axial load for the prostheses tested, is affected by glenoid constraint (i.e., the maximum slope at the glenoid articular rim), the compressive load, the coefficient of friction, and the deformability of the articular edge. Rigid-body theory overestimated the experimental load, which was not surprising given the visible deformations, but provides a framework to highlight the relevant design parameters. The subluxation translation, ranging from 1 to 13 mm for the prostheses tested, is determined by the glenoid length and by the conformity between the humeral and glenoid radii. Experimental translations were greater than rigid-body predictions for the most conforming prostheses and roughly equal for less conforming prostheses. The goals of this study were to characterize the subluxation load and translation of a variety of types of prostheses, to develop the rigid-body basis for these results, to compare the rigid-body and experimental results, and to locate experimentally the glenoid articular rim for further testing.

Biomechanical Phenomena↗
PubMed2001

Management of ankle sprains.

Without adequate care, acute ankle trauma can result in chronic joint instability. Use of a standardized protocol enhances the management of ankle sprains. In patients with grades I or II sprains, emphasis should be placed on accurate diagnosis, early use of RICE (rest, ice, compression and elevation), maintenance of range of motion and use of an ankle support. Sprains with complete ligament [corrected] tears (grade III) may require surgical intervention. Although early motion and mobility are recommended, ligamentous strength does not return until months after an ankle sprain.

Ankle Injuries↗
PubMedDate not supplied

Staged closure of the pelvis in secondary repair of cloacal exstrophy in the older patient.

The authors describe a staged approach for pelvic closure applied in preadolescents and adolescents with previously failed closure of cloacal exstrophy. Closure of the pelvis was performed in four patients, 11 to 16 years old, with history of previous closures for their cloacal exstrophy that had resulted in either dehiscence or severe disfigurement. They were treated with pelvic osteotomies and external fixation; three later underwent internal fixation of the pubic rami. Genitourinary reconstructions were performed with the final stage of pelvic ring closure. Genitourinary closure was successful in all four patients despite a recurrent pubic diastasis resulting from sacroiliac joint instability in the patient not receiving internal fixation. Staged closure of the pelvis with iliac osteotomies, external fixation, gradual correction, and subsequent internal fixation of the approximated pubic rami can facilitate soft tissue closure of preadolescents and adolescents with unacceptably closed cloacal exstrophy.

Adolescent↗
PubMed2001

Short stature, abnormal face, joint laxity, dislocation, hernias, delayed bone age, and severe psychomotor retardation in two brothers: previously undescribed MCA/MR syndrome.

We describe two brothers with severe psychomotor retardation, short stature, microbrachycephaly, flat occiput, ptosis, low set and prominent ears, "beaked" nose, joint hyperlaxity and dislocation, hernias, delayed bone age, and abnormalities on skin biopsy. Their parents are first cousins. To the best of our knowledge, this syndrome has not been reported before.

Abnormalities, Multiple↗
PubMed2002

[Management policy for osteoarthritis of the knee joint].

Osteoarthrosis of the knee joint (KJA) is a most prevalent orthopedic disease. There are some questions as to the policy of treating KJA that remain to be decided. Results are analyzed of treating 3243 patients with KJA (stage I--889 individuals, stage II--1276 ones, stage III--1078 patients) over the period 1983-2000. The patients underwent nonoperative treatment, arthroscopic operations, plasty of the ligamentous apparatus, osteotomy, arthrodesis, total endoprothetics. Our scheme proposed some time ago allowed judgement about the function of the knee joint. Recommendations are given in the article, that include the following: Arthroscopic operations should be widely used during stage I and II for the debridgement of the joint to be done, the proper recovery of the ligamentous apparatus to be ensured. Correcting osteotomy is indicated in axial deformity of the joint at stage I to II. Total andoprothetics is indicated at stage III osteoarthrosis and also at stage II in case of joint instability and axial deformity.

Algorithms↗
PubMed2003

Physical and monetary costs associated with autogenous bone graft harvesting.

Although autogenous iliac bone is frequently used for bone graft, many well-documented complications are associated with this procedure-including chronic pain; nerve, arterial, and ureteral injury; herniation of abdominal contents; sacroiliac joint instability; pelvic fractures; hematoma; and infection. An understanding of the morbidities associated with bone graft harvesting and of the strategies for avoiding them is imperative for surgeons using this grafting source. In addition, although synthetic grafting materials are considered relatively expensive compared with autogenous sources, the majority of physicians are unaware of the actual direct and indirect costs associated with autogenous bone graft harvesting. Contemporary allograft and synthetic grafting composites are being developed to optimize and surpass the native qualities of autogenous sources (ie, osteogenesis, osteoinductivity, osteoconductivity). Careful comparison of the cost of these alternative sources with the physical and monetary costs of autogenous bone graft will undoubtedly make allograft, recombinant, synthetic graft composites the logical choice in the very near future.

Anesthesia↗
PubMed2003

[Total elbow arthroplasty].

The authors describe indications and contraindications for total elbow arthroplasty. The brief characteristic of total elbow replacement is done. The authors describe its own case of clinical use of the Coonrad-Morrey implant.

Arthroplasty, Replacement↗
PubMed1992

Knee-ligament injuries associated with leg fractures. Prospective study.

It has been proved in 25-35% of the cases that knee-ligament injuries are associated with fracture of the femoral diaphysis. No such association has been confirmed between leg fractures and knee ligaments. In order to find out if this is a coincidence, a prospective study was conducted on 229 patients who had undergone operations for leg fractures at various locations and of variable intensity. It was established in 41 cases (17.34%) that the leg fracture was associated with knee-ligament injuries, resulting in joint instability. A significantly higher percentage of associated ligament lesions was found in open fractures as opposed to closed leg fractures. The examination was carried out with the patient under general or block anesthesia. On the basis of what was established it is recommended that the knee be examined clinically in all leg osteosynthesis cases.

Adolescent↗
PubMed2003

The reversed Delta shoulder prosthesis in reconstruction of the proximal humerus after tumour resection.

The authors present two series of six and seven patients respectively, with a tumour of the proximal humerus, who were treated at two different institutions with a Delta type inverted shoulder prosthesis (DePuy International Ltd) after a Malawer type Ia or Ib resection. The rationale of using an inverted shoulder prosthesis is the aim to improve the functional outcome in rotator cuff deficient shoulders. This type of prosthesis medializes and lowers the centre of rotation, lengthens the lever arm of the deltoid muscle and improves its function. At one institution the resected part of the humerus was re-implanted after extracorporeal irradiation. It was fixed intramedullarly by cementation of the humeral prosthetic component to facilitate restoration of humeral height. This graft allowed reinsertion of muscles (deltoid, pectoralis, biceps) thus improving power generation postoperatively. The largest glenosphere, size 42, was routinely used to reconstruct the glenoid; this theoretically improves the functional outcome (increased external rotation) and stability. At the other institution no graft augmentation was used except in one patient. The height of the humeral prosthetic component was assessed after resection of the tumour by measurement of the resected part. The prosthetic stem was fitted in the remaining part of the humeral diaphysis, in three cases by cementation and in three cases by press-fit (hydroxyapatite coating). Muscle balance was appreciated intra-operatively. Stability of the prosthesis was directly related to the level of resection. Both techniques resulted in a minimum active abduction of 60 degrees, reaching 90 degrees or more in most patients. When compared to other results in the literature, this is a major functional improvement. The mean adjusted postoperative Constant score was 72.5% (range: 30-90%), and the mean MSTS score was 75.8% (range 36.7-96.7%).

Adult↗
PubMed2003

Souter-Strathclyde total elbow arthroplasty: medium-term results.

The Souter-Strathclyde unconstrained elbow prosthesis was prospectively studied in 36 patients (45 prostheses) with rheumatoid arthritis (Larsen grade 4 and grade 5). The mean age of the patients at the time of operation was 63 years (range: 39 to 75 years). Eight patients (9 prostheses) died within five years of implantation, from causes unrelated to the elbow arthroplasty. One patient was lost to follow-up, leaving 27 patients (35 prostheses) for review. The mean length of follow-up was 98 months (range: 60 to 174 months). At 8.2 years follow-up, the prosthesis showed a probability of survival of 76% (SD 9%) with revision of the humeral component as an end point; the percentage dropped to 67% (SD 9%) when radiographic loosening was taken as an end-point. Survival of the ulnar component was 98%. Loosening of the humeral component seems to be related to both the short humeral stem and a persistent extension deficit.

Aged↗
PubMed2004

Total joint arthroplasty for osteoarthritis of the thumb basal joint.

A survey of 43 cemented arthroplasties of the trapeziometacarpal joint with a la Caffinière prosthesis in 40 patients is presented. A 70% patient satisfaction rate was obtained, with a mean DASH score of 24.2. Good range of motion was preserved (opposition 9/10 on Kapandji's scale) and gripping force as well as key pinch force increased from 18 kg to 24 kg and from 5.3 to 6.0 kg respectively. However loosening was seen in 44% of the implants. Loosening was related to younger age. We conclude that despite good clinical outcome, radiographic loosening is a threat for the future of this implant.

Adult↗
PubMed2004

[Anterior cruciate ligament reconstruction in skeletally immature patients].

Anterior cruciate ligament (ACL) reconstructions in skeletally immature patients present unique difficulties, one major concern being reconstruction-induced growth disturbances. Another issue is the failure of adolescent patients to comply with the treatment programs. Initially, activity limitations and bracing can be recommended for isolated ACL tears in young skeletally immature adolescents who are at stages I, II, and III according to the modified Tanner classification, and for whom reconstruction can be delayed until completion of skeletal maturity provided that any joint instability or meniscal injury do not develop. For symptomatic patients, partial or complete transphyseal techniques or complete transphyseal reconstruction with doubled or quadrupled hamstring tendon grafts can be applied, with special care being afforded to keep clear distance between fixation materials and the physeal plates. In patients who are at pubertal stages of IV or V or with skeletal ages above 13 (F) or 14 (M) years, a transphyseal reconstruction with hamstring autografts seems to be the best solution. It should be kept in mind that functional outcomes of ACL reconstructions in skeletally immature patients are inferior to those obtained in adults even after a prudent surgical approach without associated growth disturbances.

Adolescent↗
PubMed2004

Joint mechanics in osteoarthritis.

The primary goal of our research has been to quantify the in vivo loading of normal and osteoarthritic (OA) joints, and to determine the corresponding biological responses. Much of the research in this area has been performed using articular cartilage explants. We feel that, although critically important to our understanding of cartilage mechanics and biology, these experiments may not be directly transferable to interpreting the in vivo joint mechanics and elucidating the detailed mechanisms of onset and progression of OA. Therefore, we have attempted to measure the loading of the knee in freely moving feline and lapine models of OA. We have found that, upon anterior cruciate ligament transection in the cat, knee joints are more flexed, muscle forces are decreased and muscle control patterns are destroyed. Articular cartilage initially becomes thicker, softer and more permeable, resulting in generally increased joint contact areas and decreased peak pressures in the initial stages of joint degeneration compared to control values. Based on our results, we speculate that unloading of the joint (rather than overloading), combined with poor muscular control and weakness, might constitute risks for the onset of joint degeneration.

Animals↗
PubMed1992

[Mechanical properties of PDS-augmented patellar tendon transplants in reconstruction of the anterior cruciate ligament].

In 25 sheep the anterior cruciate ligament (ACL) was reconstructed after resection. Twelve modified "Jones procedures" were performed (transplantation of the central third of the patellar tendon with an initial load of 50 N) and 13 polydioxanone (PDS) augmentations. In 15 cases the ACL was resected from the right knee. Twenty-one sheep survived for 1 year and were then evaluated. Loss of the ACL leads to instable joints in this experiment. Within the first 6 months anterior translation occurs; after 1 year subluxations can be seen on the X-ray films. Macroscopical signs of extensive arthrosis were seen in the femorotibial and femoropatellar joints; the menisci were totally destroyed. Macroscopically strong ligaments were seen 1 year after PDS-augmented reconstruction as well as after transplantation of the patellar tendon with an initial load of 50 N. There was no difference between the two groups. The mechanical strength reached 54% of the maximum load of a control group in the Jones reconstructions and 61% after additional augmentation with a 2-mm biodegradable PDS cord. There was no statistically significant difference. Both methods are suitable for reconstruction of the ACL; the patellar tendon replaces the ACL very well.

Animals↗