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At least 1,585 records · Page 88Linked to original sources
PubMed1991

Orthopedic surgery and rehabilitation for the prolongation of brace-free ambulation of patients with Duchenne muscular dystrophy.

The purpose of this study was to prospectively evaluate the results of a short comprehensive program involving early lower extremity musculotendinous surgery followed by a definitive course of rehabilitation on contractures and the duration of ambulation for patients with Duchenne muscular dystrophy. Seven patients were treated while ambulating with little difficulty and six were treated just before or after becoming wheelchair-dependent. Predicted post-treatment duration of ambulation was calculated from established clinical criteria. Actual prolongation of brace-free ambulation after treatment was a mean of 0.8 yr greater than predicted for the group as a whole but 0.93 yr for the group treated early by comparison with 0.63 yr for those treated according to the customary approach. The number of falls significantly decreased from 84 +/- 87 to 1 +/- 1 per month postoperatively (P less than 0.05); however, the speed of ambulation over a distance of 10 yards decreased from 10.2 +/- 4 s to 12.1 +/- 7.3 s. Three patients who had tibialis posterior transfers retained antigravity plus dorsiflexor strength and continue to wear normal footwear 2.5, 3.7 and 4.0 yr after loss of ambulation. We conclude that ambulation becomes more stable and brace-free ambulation may be prolonged by a comprehensive program of early orthopedic surgery and rehabilitation. Earlier intervention is also better tolerated.

Adolescent↗
PubMed1991

[Changes in T-lymphocyte subsets in patients with orthopedic trauma and effects of yipanzhu decoction on the impaired immune function].

The effects of yipanzhu decoction (YD) on immune function in 40 patients [2 groups, YD and normal saline (NS) group] with orthopedic trauma by taking T lymphocyte subsets as indexes were observed. The peripheral venous blood samples randomly taken from 30 healthy subjects served as control. The blood were collected within 24 hours after trauma. Then the YD and NS were respectively given to the patients in the 2 groups for 3 days, and the blood were taken 4th, 7th, 14th day after trauma for the observation of T subsets. The results revealed that before administration of YD the percentage of pan-T cells was reduced with an increased percentage of Ts cells and a decreased ratio between Th and Ts cells; 3 days after giving the drugs in YD group the percentage of pan-T cells was slightly increased, and the changed percentage of Ts cells and the ratio of Th/Ts cells mentioned above was recovered to normal, while in NS group all these indexes remained at abnormal range during the period we observed. The results suggested that YD could promote the recovery of abnormal T lymphocyte subsets in traumatized patients, and it possessed to some extent the function of immune regulation that was helpful to reduce the ratio of infection after trauma.

Adolescent↗
PubMed1991

Should methotrexate be discontinued before elective orthopedic surgery in patients with rheumatoid arthritis?

To determine if methotrexate (MTX) contributes to early postoperative complications, we studied 38 patients with rheumatoid arthritis (RA) who underwent elective orthopedic surgery. There were 4 complications of prosthetic joint infection or wound dehiscence or infection among 19 procedures performed on patients who continued MTX until less than 4 weeks before surgery, compared to no complications among 34 procedures performed on patients who discontinued MTX 4 weeks before surgery or who were taking no remittive agent for 3 months before surgery (p less than 0.03, Fisher's exact, 2-tailed). No demographic, clinical, laboratory, nutritional, or intraoperative differences between the 2 groups were apparent, suggesting that MTX may play a role in early postoperative complications in patients with RA. A larger, prospective trial to study this issue is warranted.

Arthritis, Rheumatoid↗
PubMed1991

The efficacy of application of lyophilized, radiation-sterilized bone graft in orthopedic surgery.

The purpose of this study is retrospective analysis of clinical application of lyophilized (freeze-dried), radiation-sterilized allografts in various orthopedic disorders. Grafts of this type have been produced by Polish tissue banks for many years, even before the production of deep-frozen grafts was started. This type of graft is still produced because of their easy storage, transportation, and distribution. Their application is successful in selected cases. Freeze-dried, radiation-sterilized cancellous or cortical-cancellous blocks, cancellous chips, or diaphyseal cortical struts were applied in 435 patients ranging from three to 74 years old. There were five main groups of procedures: posterior or anterior spine fusion, 224 cases; joint arthrodeses, 36 cases; reconstructive operations, 83 cases; filling of bone lesions, 59 cases; and posttraumatic reconstructive operations, 33 cases. The efficacy of application of lyophilized, radiation-sterilized allografts was estimated retrospectively on the basis of physical examination data and roentgenographic assessment collected during postoperative visits. Incorporation and rebuilding of the grafts as well as a satisfactory therapeutic effect were achieved in 394 (91%) patients. Excluding the cases of congenital and hypovascular pseudoarthroses, post-osteomyelitis gap and focuses, as well as Stage 2 bone lesions, it is suggested that lyophilized, radiation-sterilized allografts can be applied on the condition that intimate contact between the donor bone and host bed is complete and sustained.

Adolescent↗
PubMedDate not supplied

[Indications for the use of external fixator in orthopedics and traumatology during the developmental age].

The paper illustrates the characteristics of external fixators (EF) (Wagner, FEA, Ilizarov) regularly used in pediatric surgery. Attention is focused on the indications for their use in orthopedics and traumatology during the developmental age. In conclusion, their use, even though in traumatology this is more restricted than in adults, reduces many complications which may arise from traditional treatment. In addition, it is well tolerated and allows pathologies to be treated which were difficult to cure in the past.

Adolescent↗
PubMed1991

[Binder's syndrome (maxillo-nasal dysostosis) and associated orthopedic malformations].

The authors refer to cases of associated orthopedic malformations reported in 17 patients with Binder's syndrome. Aside from already known anomalies of the cervical spine detected in 58.8% of cases, finger malformations are found in one third of single X-chromosome carriers (boys or Turner's syndrome). This calls for studying these malformations in parallel with X-linked minor isolated recessive chondrodystrophy.

Abnormalities, Multiple↗
PubMedDate not supplied

Orthopedic deformities in Emery-Dreifuss muscular dystrophy.

Orthopedic deformities in Emery-Dreifuss muscular dystrophy are discussed based on a study of four patients and an extensive literature review. The condition is characterized by slowly progressive humeroperoneal muscle weakness; ankle equinus, elbow flexion, and neck extensor muscle contractures; paravertebral muscle tightness; and cardiac abnormalities involving bradycardia and atrioventricular conduction defects. Tendo Achilles lengthening is warranted, since patients remain ambulatory for several decades. Scoliosis occurred in three patients but stabilized in the absence of treatment. Recognition of the condition is important to allow for heart pacemaker insertion because the usually asymptomatic cardiac abnormalities are associated with a high incidence of sudden death in mid-adult life.

Adult↗
PubMed1991

[Orthopedic surgery in rheumatoid polyarthritis].

The authors have determined the timing and details of the recourse to surgery in a cohort of 288 non-selected cases of rheumatoid arthritis. This was necessary in one third of the patients after a mean follow-up period of 10 years. The same was true for patients followed up as out-patients as for those hospitalized during the active progress of the disease. Fifteen percent of the patient in the cohort received total replacement of a large joint by a prosthesis. Orthopedic surgery makes a major contribution towards improving the functional prognosis in rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1991

[Orthopedic problems of the upper cervical spine in children and adolescents].

Because of relatively low frequency of pathological changes of the upper cervical spine in childhood and adolescence, their management is not well known. Diagnostic problems occur due to the variety of malformations possible, persisting growth plates and ligamentous laxity. Because of this laxity, conservative treatment with immobilization is advocated even in severe dislocations as long as they are reducible. Persistent dislocations, chronic atlantoaxial instability (ADI greater than 5 mm), dens fractures type II and existing or progressing neurological deficits all indicate surgical intervention. Internal fixation allows easier postoperative care. Complications are rare. Patients with orthopedic problems of the upper cervical spine are presented, together with their management.

Adolescent↗
PubMed1990

[Thermoformed orthopedic splints].

Initially used to make simple splints, thermoforming has led to the development of a new means of application of orthopedic forces. Here we have presented splints which allow the treatment of Class III, Class II and cases of endomaxillitis.

Dental Stress Analysis↗
PubMed1990

[Orthopedic aspects of Crohn disease. Examples of extra-intestinal organ manifestations].

Articular changes in Chron's disease represent extraintestinal organic manifestations which generally take the form of so-called enteropathic synovitis. Articular alterations - diagnosed as non-specific arthritis in the great majority of cases--may precede the intestinal disease. In very rare cases it can be shown that the joints display histological changes typical of Morbus Crohn. The etiology and pathophysiological mechanisms of the articular changes are not clear. Probable factors are: autoimmune disease, stimulation of the immunological system by exogenous antigens, induction of a self-sustaining inflammatory process, and demonstrable circulation of antigen-antibody complexes. Genetic factors seem to play a role (familial disposition). A pure "colonic Crohn" (= colitis granulomatosa) leads to a higher degree of articular alteration than a pure "small-intestine Crohn" (= ileitis terminalis). The joints preferentially affected are in the region of the lower extremities (knee and ankle joints). Concomitant Bekhterev's disease (spondylitiis ankylopoietica) is found in 7-10% of cases. Osteomyelitis represents a rare and serious complication: it can appear in the course of chronic Chron's disease (mainly with intestinal fistulas), especially in the region of the pelvic bones. Further aspects of interest from an orthopedic viewpoint are hypertrophic osteoarthropathy with periossal neoformation, granulomatous changes in the bone itself, and aseptic osteonecrosis.

Arthritis↗
PubMed1990

Rationale for sequential use of both maxillary and mandibular orthopedic appliances in the treatment of TMJ disorders.

This paper describes how the use of a combination of maxillary and mandibular orthopedic appliances by TMJ patients can reduce iatrogenic stress and improve patient compliance with 24-hour use. This combination provides the patient with a proper appliance for anterior repositioning when sleeping and eliminates the fear of iatrogenic tooth depression or movement.

Humans↗
PubMed1990

[Development of functional jaw orthopedics and function regulator].

Functional jaw orthopedics is an orthodontic treatment which uses muscle stimuli developed from the functions and tonus changes of masticatory, tongue, lip and cheek muscles. The functional regulator which is one of the appliances used in this treatment, takes support not from the teeth, but directly from the soft tissues in order to make changes in alveolar bone and teeth.

Activator Appliances↗
PubMed1990

[Clinical monitoring and prevention of deep vein thrombosis in an orthopedic department: use of enoxaparin for a year].

Enoxaparin appears in a prospective cooperative study able to provide anti-thrombotic activity in total hip arthroplasty. Consequently during the past year enoxaparin was used routinely to prevent deep vein thrombosis after orthopedic surgery. Clinical results are similar to those obtained with standard subcutaneous heparin followed by oral anticoagulant therapy. Nevertheless after hospital discharge and before full support, risks of oral anticoagulant therapy is to be put in balance with the thrombopenic risk of low molecular weight heparin.

Drug Evaluation↗
PubMed1990

Deep vein thrombosis: prophylaxis, diagnosis, and treatment--lessons from orthopedic studies.

Orthopedic surgery patients are at high risk of developing thromboembolic disease simply by the very nature of the procedures they undergo even if no other risk factor is present. In unprotected total hip replacement patients, the incidence of fatal pulmonary embolism is at least 2% and the incidence of deep vein thrombosis reaches 50%. Noninvasive screening methods for deep vein thrombosis such as cuff impedance phlebography and fibrinogen scanning have been proved accurate in patients with suspected symptomatic deep vein thrombosis. In asymptomatic but high-risk total hip replacement patients, however, these methods have a combined sensitivity of only 23%. Radiological venography still remains the screening method of choice in these patients. Low-dose warfarin prophylaxis reduces the incidence of deep vein thrombosis to 16% and lowers the risk of major bleeding complications tenfold over the traditional higher dose warfarin. It also enhances protection against proximal thrombi compared to dextran, aspirin, or external pneumatic compression. When low-dose warfarin is used for 12 weeks after total hip replacement without routine venography, it drastically reduces fatal pulmonary embolism (no cases in 268 consecutive patients). This prophylactic regimen is also safe in terms of bleeding complications before and after patient discharge. Finally, it is very cost effective: a saving of $176,000 in treating 268 patients compared with routine venography.

Adult↗
PubMed1990

Combined orthopedic and vascular injury in the lower extremities: indications for amputation.

A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign.

Accidents, Traffic↗