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At least 721 records · Page 40Linked to original sources
PubMed1981

Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).

Adult↗
PubMed1995

The infected nonunion of the tibia.

Ununited fracture of the tibia complicated by infection is not only a complex surgical problem but also a chronic and at times debilitating condition. The principle methods used to diagnose and stage posttraumatic tibial osteomyelitis are described. Infected nonunions of the tibia are characterized by the extent of bony loss and the presence of a functional ipsilateral fibula. Using this tibial staging criteria, a series of 37 infected nonunions of the tibia are reviewed. Twenty patients were male and 16 were female, with an average age of 33 years. The distal third of the tibia was involved in 19 patients, the middle third in 11, and proximal third in 7. Twenty three of the tibia were infected with > 1 organism. Thirty were Type 3 (tibial defect of 6 cm or less with a long and usable fibula), 4 Type 4 (tibial defect > 6 cm without usable fibula), and 3 Type 5 (tibial defect > 6 cm without usable fibula). The patients were evaluated at an average of 61 months after treatment. Union and eradication of infection were achieved in 35 of 37 patients. The results of the Health Impact Analysis suggest that the infected nonunion of the tibia represented a chronic and debilitating disorder with a lasting impact.

Adolescent↗
PubMed1995

Complex fracture patterns of the upper extremity.

Combined skeletal injuries to the upper limb present complex management problems because they may result in dysfunction of the terminal unit of the upper limb-the hand. This article explores complex patterns of skeletal and soft tissue injuries, including complex soft tissue trauma with closed and open fractures; the floating shoulder, elbow, and forearm; and the role of skeletal fixation in conjunction with the complex fracture patterns. As the functional capacity of the upper limb reflects an integration of all its component parts, a combined approach to skeletal and soft tissue trauma is of fundamental importance in upper limb trauma.

Arm Injuries↗
PubMed1995

The introduction of new condensing lenses for fundus examination.

BACKGROUND: Examination of the inner eye is an important part of any comprehensive eye examination. There are a number of instruments used for examination of the ocular fundus; each has its advantages and disadvantages. Many of these instruments rely on hand-held lenses of which there are a number of options. METHODS: A doublet design lens consisting of two aspheric, plano-convex lenses, which have their convex sides facing toward each other and are separated by an air space, was evaluated and compared with other commercially available condensing lenses. RESULTS: A + 13.5 and +16 diopter doublet lens can be a valuable lens for binocular indirect ophthalmoscopy when compared with currently available, commercially available lenses. CONCLUSIONS: Innovative designs in lenses used with binocular indirect ophthalmoscopy may add considerably to the enhancement of the examination of the ocular fundus.

Equipment Design↗
PubMed1994

A contemporary approach to the management of complex fractures of the distal humerus and their sequelae.

Improvements in both surgical implants and techniques for their application have enhanced the functional outcome after complex distal humeral fractures. Complication rates remain high, however, emphasizing the demanding nature of treatment of these injuries. This article focuses on the recognition and treatment of complex and previously poorly described distal humeral injuries and the prevention and treatment of complications commonly seen with these fractures.

Adult↗
PubMed1994

Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults.

We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.

Adolescent↗
PubMed1993

[The painful ulno-carpal joint. Diagnosis and therapy].

The ulnocarpal joint plays a critical role in hand and wrist function. It serves as part of forearm rotation as well as part of the carpal kinematics. The joint is comprised of the distal radio-ulnar articulation, triangular fibrocartilage complex, lunate, triquetrum, hamate, and pisiform, and the intra and extracapsular ligamentous and soft tissue constraints. Traumatic disruptions as well as chronic inflammatory conditions are commonplace. In addition to standard radiographs, arthrography, CT scanning, and MRI studies prove useful. Wrist arthroscopy is becoming of increasing importance in this region of the wrist. Ulnar impaction syndrome may occur associated with malunion of distal radius fracture, ulna positive variance, or chronic TFCC tears. Osteotomy of the distal radius or ulnar shortening osteotomy should be considered. Instability of the distal ulna can be treated with tenodesis procedures, hemi-resection arthroplasty, matched ulna resection or the Sauvé-Kapandji procedure.

Biomechanical Phenomena↗
PubMed1993

The rationale for precise management of distal radius fractures.

Fractures of the distal radius continue to be one of the most common skeletal injuries treated by orthopedic or trauma surgeons. These injuries account for one sixth of all fractures seen and treated in emergency rooms. The rapid expansion of knowledge regarding the functional anatomy of the hand and wrist, the recognition by treating physicians of the ever increasing functional demands of senior citizens, and improved methodologies of achieving and maintaining anatomic restoration of these fractures have generated a renewed interest in addressing these fractures in a more precise manner.

Arthritis↗
PubMed1993

The operative treatment of intraarticular fractures of the distal radius.

Surgical management of 13 complex intraarticular (pilon) fractures of the distal radius was remarkably effective. Most of the fractures were the result of high-energy impact, with associated soft-tissue trauma in seven cases. The preoperative planning, fracture classification, surgical tactics, and results are presented in detail. Only three patients had any residual functional problems. Follow-up motion showed wrist dorsiflexion/palmar flexion to be 74% of the opposite side, and grip strength was 76% of the opposite side. Twelve of the 13 patients showed no roentgenographic evidence of posttraumatic arthritis at an average follow-up period of 2.5 years.

Adult↗
PubMed1995

Acute exercise-induced bilateral anterolateral leg compartment syndrome in a healthy young man.

While compartment syndrome after traumatic injury is a well-recognized entity, atraumatic or exercise-induced acute compartment syndrome is not as widely reported. This syndrome, usually unilateral, was first described as "march gangrene" in 1943, and can result in the loss of life or limb. Bilateral cases are usually associated with an underlying medical condition. We wish to report a case of acute, bilateral, exercise-induced anterolateral leg compartment syndrome in a healthy young man. Early recognition and prompt treatment by decompressive fasciotomy is of vital importance if limb function is to be preserved and complications are to be avoided.

Adult↗
PubMed1996

Consistency of AO fracture classification for the distal radius.

We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience. Our findings suggest that AO 'type' and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO 'group' and especially AO 'subgroup'. To categorize distal radial fractures according to joint displacement and AO type is simple and reproducible. Our study examined only whether distal radial fractures could be consistently classified according to the AO system. Validation of the classification as a predictor of outcome will require a prospective clinical study.

Acute Disease↗
PubMed1998

Operative management of diaphyseal fractures of the humerus. Plate versus nail.

Although nonoperative treatment is indicated and successful for the majority of diaphyseal humeral fractures, operative intervention is indicated in several situations. Either intramedullary nail or plate fixation commonly is used for the operative management of this problem. Familiarity with the surgical techniques and application of both types (and subtypes) of implants is necessary to allow optimal treatment for the widest range of fracture patterns. In most indications for operative management, internal fixation with plates is preferred. Stable fixation, sparing adjacent joints from iatrogenic injuries, and direct visualization and protection of the radial nerve are of critical importance in maximizing postoperative function and in most cases outweight the potential advantages of a loadsharing implant inserted through a more limited incision.

Biomechanical Phenomena↗