901
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Rahme H, Wikblad L, Nowak J, Larsson S. Long-term clinical and radiologic results after Eden-Hybbinette operation for anterior instability of the shoulder. J Shoulder Elbow Surg 2003; 12:15-9. [PMID: 12610480 DOI: 10.1067/mse.2002.128138] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A retrospective study was done to assess long-term results after surgery with the Eden-Hybbinette technique for unidirectional anterior glenohumeral instability. Between 1962 and 1976, 118 patients (119 shoulders) were treated. Eighty-seven patients answered a questionnaire. Of 119 shoulders, 77 were examined clinically and 74 radiographically a mean of 29 years after surgery. Forty-two were lost to follow-up. For 74% of shoulders, patients were satisfied, and for 26%, patients had some remaining discomfort. The most common reason for discomfort was persistent instability. The recurrence rate was 20%, although only 8 patients required reoperation. The mean time from surgery until redislocation was 15 months (range, 1-60 months). The mean Rowe shoulder score was 84 +/- 15 (range, 45-100), with 48 of 77 shoulders rated as excellent, 16 of 77 as good, 9 of 77 as fair, and 4 of 77 as poor. The Constant-Murley score averaged 85 +/- 14 (range, 20-100). Glenohumeral arthrosis was seen in 35 of 74 shoulders (47%). There was no significant difference between those with arthrosis and those without as far as age at first dislocation, age at surgery, or follow-up. Shoulders with arthrosis had a tendency to have reduced external rotation (P =.056) when compared with shoulders without radiologic changes. This study showed that most patients were satisfied with their shoulders. There was a high rate of radiologic arthrosis, but in most patients it caused limited restriction of movement as the only symptom.
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902
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Golec E. [Long-term clinical and radiological assessment of talocrural joint stability after acute traumatic injury of ligamentous-capsular apparatus]. CHIRURGIA NARZADOW RUCHU I ORTOPEDIA POLSKA 2002; 67:357-64. [PMID: 12418399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The author presents an assessment of clinical and radiological talocrural joint stability after acute traumatic ankle sprain treated non-operatively. Radiological evaluation of joint stability was performed using a special stand designed by the author. Joint stability was evaluated in both the sagittal and frontal planesusing Zwipp's technique, along with the author's own technique. I degree and II degree lateral and antero-lateral instability were found most often found in the 368 patient series that was examined. Joint instability was recognised more frequently radiologically than clinically.
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903
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Damen L, Buyruk HM, Güler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine (Phila Pa 1976) 2002; 27:2820-4. [PMID: 12486354 DOI: 10.1097/00007632-200212150-00018] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To determine the prognostic value of asymmetric laxity of the sacroiliac joints during pregnancy on pregnancy-related pelvic pain postpartum. SUMMARY OF BACKGROUND DATA In a previous study, we observed a significant relation between asymmetric laxity of the sacroiliac joints and moderate to severe pregnancy-related pelvic pain during pregnancy. METHODS A group of 123 women were prospectively questioned and examined, and sacroiliac joint laxity was measured by means of Doppler imaging of vibrations at 36 weeks' gestation and at 8 weeks' postpartum. A left to right difference in sacroiliac joint laxity >or=3 threshold units was considered to indicate asymmetric laxity of the sacroiliac joints. RESULTS In subjects with moderate to severe pregnancy-related pelvic pain during pregnancy, sacroiliac joint asymmetric laxity was predictive of moderate to severe pregnancy-related pelvic pain persisting into the postpartum period in 77% of the subjects. The sensitivity, specificity, and positive predictive value of sacroiliac joint asymmetric laxity during pregnancy for pregnancy-related pelvic pain persisting postpartum were 65%, 83%, and 77%, respectively. Subjects with moderate to severe pregnancy-related pelvic pain and asymmetric laxity of the sacroiliac joints during pregnancy have a threefold higher risk of moderate to severe pregnancy-related pelvic pain postpartum than subjects with symmetric laxity. CONCLUSION These data indicate that in women with moderate to severe complaints of pelvic pain during pregnancy, sacroiliac joint asymmetric laxity measured during pregnancy is predictive of the persistence of moderate to severe pregnancy-related pelvic pain into the postpartum period.
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904
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Berg-Johnsen J, Magnaes B. Rib bone graft for posterior spinal fusion in children. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:709-11. [PMID: 12553523 DOI: 10.1080/000164702321039723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Treatment of columnar instability in children with conventional fusion procedures may preclude normal growth and cause dysfunction and pain due to malalignment or reduced mobility. To achieve normal growth, we have treated spinal instability in 7 children with posterior fusion, using bilateral rib transplants secured by horizontal laminar cerclages. Solid fusion was obtained and no serious complications occurred.
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905
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Moon MS, Choi WT, Moon YW, Moon JL, Kim SS. Brooks' posterior stabilisation surgery for atlantoaxial instability: review of 54 cases. J Orthop Surg (Hong Kong) 2002; 10:160-4. [PMID: 12493928 DOI: 10.1177/230949900201000209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the effectiveness of Brooks' posterior stabilisation and fusion for the unstable atlantoaxial joint due to congenital dysplastic dens and trauma. METHODS We retrospectively studied records of 54 patients (36 males and 18 females; age range, 3-58 years) who underwent Brooks' posterior stabilisation procedure between March 1975 and December 1999, at the Catholic University of Korea Medical Center and Dong-Shin General Hospital, Seoul. A single-stranded Kirschner wire was used to stabilise the first 19 cases (thin wires in 12 cases and thick wires in 7), and double-stranded wires were used in the next 35 cases (thin wires in 4 cases and thick wires in 31). After surgery, patients were immobilised in bed with light Halter traction of the head, followed by cervical bracing. RESULTS Fusion was observed by X-ray postoperatively at 15 weeks in 48 patients. Reduction was achieved in 3 luxation cases (including the single case of rotatory fixation). Brooks' fusion failed in 4 patients with dens fractures and 2 with dens anomaly. Four dens fractures in cases of successful Brooks' fusion in Brooks' fusion did not unite. Wire failure occurred in 4 cases of thin single-stranded wire fixation, namely, 2 cases of dens fractures and 2 of dens anomaly. CONCLUSION Brooks' procedure is safe and has a high fusion rate when double-stranded strong wire fixation of the atlantoaxial joint is combined with meticulous bone grafting and subsequent cervical bracing.
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906
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Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 2002; 51:1351-6; discussion 1356-7. [PMID: 12445339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2002] [Accepted: 07/24/2002] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVE We review our experience with the use of the plate and screw method of fixation in the treatment of 160 patients with atlantoaxial instability during a 14-year period at our center. We previously described this method of fixation in 1994. METHODS Between 1988 and 2001, 160 patients with atlantoaxial instability were treated with the use of a plate and screw method of fixation at the Department of Neurosurgery at King Edward Memorial Hospital in Bombay, India. The study group was composed of 91 males and 69 females (mean age, 23 yr; age range, 18 mo-79 yr). Atlantoaxial instability was a result of congenital abnormality in 132 patients (83%) and occurred after trauma in 28 patients (17%). All patients had mobile, completely reducible atlantoaxial dislocation. For 3 months postoperatively, a hard cervical collar was used. The mean follow-up period was 42 months (range, 4 mo-14 yr). RESULTS Three patients died in the postoperative phase. Successful stabilization of the atlantoaxial region was documented with dynamic radiography in the other 157 patients. There was no incidence of implant rejection. In one patient, one screw was found to be broken 18 months after surgery; however, firm bony fusion was documented in this patient. There were no neurological, vascular, or infective complications. CONCLUSION The plate and screw method of fixation with the use of intra-articular bone grafts in patients with atlantoaxial instability yielded a 100% fusion rate with a low incidence of complications.
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907
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Kothe R, Wiesner L, Rüther W. [Rheumatoid arthritis of the cervical spine. Current concepts for diagnosis and therapy]. DER ORTHOPADE 2002; 31:1114-22. [PMID: 12486537 DOI: 10.1007/s00132-002-0399-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The involvement of the cervical spine in patients with rheumatoid arthritis (RA) is common,and has recently received growing attention. In the early stage of the disease, there is an isolated atlantoaxial subluxation (AAS). With further progression, osseous destruction of the joints can lead to vertical instability. While the involvement of the middle and lower cervical spine can cause a subaxial instability, neurological deficits can occur at any time. The onset of cervical myelopathy in patients with RA is often missed because of additional problems related to the hands and feet. If patients show clear symptoms of cervical myelopathy, the progression of the disease cannot be stopped by conservative treatment. Other indications for operative treatment are severe pain and radiological evidence of progressive instability. In the case of an isolated AAS, fusion can be restricted to the C1/C2 segment. If there is evidence for vertical or subaxial instability, an occipitocervical fusion has to be performed. To avoid instability adjacent to the fusion, the surgeon must check for signs of potential subaxial instability. If this is the case, fusion should include the entire cervical spine. Additional transoral decompression may be necessary when there is persistent retrodental pannus or osseous compression by an irreducible transverse dislocation or cranial migration of the dens. Non-ambulatory myelopathic patients are more likely to present severe surgical complications with limited prospects of functional recovery. Therefore, it is important to avoid the development of severe cervical myelopathy by early surgical intervention.
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908
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Stanton DA, Bruce WJ, Goldberg JA, Walsh W. Salvaging unstable or recurrent dislocating total hip arthroplasty with the constrained acetabular component. J Orthop Surg (Hong Kong) 2002; 10:165-9. [PMID: 12493929 DOI: 10.1177/230949900201000210] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney. METHODS A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients. RESULTS From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14-121 months) and the mean age at the time of surgery was 73 years (range, 52-84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell. CONCLUSION We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.
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909
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Abstract
A stable and pain-free wrist is a prerequisite for normal hand function. Since the wrist joint is involved early in rheumatoid disease and progress is rapid, operative treatment is of major importance. It is indicated not only for treatment of established osseous changes with instability, deformation, and extensor tendon ruptures but for early treatment of drug-resistant synovitis and monarthritis of the wrist.A considerable number of operative procedures is available: arthroscopic or open synovectomy of the radio- and midcarpal as well as the distal radioulnar joint, possibly with resection of the ulna head, partial arthrodeses, complete arthrodeses,and arthroplasty. When choosing the procedure, type and stage of wrist changes as well as the pathobiomechanic situation have to be considered. The individual course of the disease and patient requirements have to be taken into account.Thus, for long periods of time a pain-free stable wrist can be preserved, albeit sometimes with only limited but functional mobility.
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910
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Fitzgerald BT, Gillingham BL. Fixed subtalar subluxation in a pediatric patient: an unusual entity. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2002; 31:686-7. [PMID: 12498528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Atraumatic, fixed subluxation of the subtalar joint in the pediatric population has not been described. This report describes such a case in a skeletally immature boy.
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911
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Malicky DM, Kuhn JE, Frisancho JC, Lindholm SR, Raz JA, Soslowsky LJ. Neer Award 2001: nonrecoverable strain fields of the anteroinferior glenohumeral capsule under subluxation. J Shoulder Elbow Surg 2002; 11:529-40. [PMID: 12469076 DOI: 10.1067/mse.2002.127093] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although tears of the glenohumeral capsule have been observed in anteroinferior instability, prefailure, nonrecoverable deformation is suspected but has not been shown to exist after shoulder subluxation. The inferior glenohumeral ligament in the anteroinferior capsule (AIC) is a primary stabilizer in anteroinferior instability. The aim of this study was to examine the nonrecoverable strain field of the AIC due to shoulder subluxation. Nonrecoverable strains were calculated between a nominal strain state and a postsubluxed state. AIC marker coordinates were reconstructed from stereoradiographs, and strains were calculated from these coordinates. Nonrecoverable strain was shown to develop, varying from 3% to 7% through a range of joint subluxation. High strain tended to occur on the glenoid side of the AIC. Interestingly, strains were generally not oriented along major ligamentous bands. This is the first study to quantify planar nonrecoverable strain fields in the glenohumeral joint capsule.
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912
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Abstract
Symptomatic chronic distal radioulnar joint (DRUJ) instability can be a challenging disorder to treat surgically. This study used a cadaver model to assess the effect of functional forearm bracing on DRUJ instability. The specimen upper extremities were mounted on a platform and the DRUJ was destabilized sequentially. The effect of both prefabricated commercial braces and custom-made braces on joint stability was documented by computed tomography. Both braces markedly reduced DRUJ translation in both full pronation and full supination. The custom-made brace overreduced the DRUJ in full pronation. Our results suggest that functional forearm bracing may be effective in reducing instability of the DRUJ without greatly restricting motion of the wrist, forearm, or elbow.
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913
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Fukui N, Nakamura K, Fukuda A. A unique mechanism of giving way of the knee after tibial plateau fracture. J Orthop Trauma 2002; 16:735-7. [PMID: 12439198 DOI: 10.1097/00005131-200211000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This report describes a patient with a 31-month-old previously operated tibial plateau fracture who had frequent giving way of the involved knee. The symptoms and physical examination suggested a meniscus injury, which was finally ruled out by arthroscopy. Magnetic resonance imaging (MRI) in dynamic knee positions was then done, which showed that a bone ridge on the articular surface caused the symptoms by interfering with the lateral meniscus. The ridge was removed arthroscopically, and a satisfactory result was obtained.
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914
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Wang CJ, Chen HS, Huang TW, Yuan LJ. Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee. Injury 2002; 33:815-21. [PMID: 12379393 DOI: 10.1016/s0020-1383(02)00120-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2-5-year follow-up. MATERIALS AND METHODS This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2-24) months, and the average follow-up time was 40 (range 32-60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time. RESULTS The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5-10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time. CONCLUSION Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.
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915
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Brockmeyer DL. A bone and cable girth-hitch technique for atlantoaxial fusion in pediatric patients. Technical note. J Neurosurg 2002; 97:400-2. [PMID: 12408404 DOI: 10.3171/spi.2002.97.3.0400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new technique for performing a posterior rib and multistranded cable atlantoaxial fusion in children is described. The technique has been used successfully, in two patients 22 and 18 months of age, respectively. In both cases, fusion was used to augment C1-2 transarticular screw fixation, and solid arthrodesis was achieved without a halo orthosis.
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916
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Attmanspacher W, Dittrich V, Stedtfeld HW. [Revision of the anterior cruciate ligament in TransFix(R)- and OATS(R)-technique]. Zentralbl Chir 2002; 127:855-60. [PMID: 12410451 DOI: 10.1055/s-2002-35130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transplant failure after anterior cruciate ligament-plastic is a typical complication. In larger collectives, revisions amount to about 8-12 % of the reconstructive operations of the anterior cruciate ligament. The number of revisions is also growing in our clinic and makes at present 11 %. There are different reasons of transplant failure. Many mistakes occur as a result of technical pitfalls during the preparation. A new "adequate trauma" is rarely the cause of a rerupture. In this paper a new concept of revision in failed anterior cruciate ligament reconstructions will be presented, which can be frequently performed as one-step technique even in bone tunnel enlargement or sclerosis of the tunnel. Our results in 21 cases will be discussed with the literature. In our opinion the TransFix(R) technique, if necessary in conjunction with the OATS(R) technical equipment, is a reproducable alternative for one step revision surgery and should be recommended.
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917
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Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2002; 11 Suppl 2:S170-8. [PMID: 12384741 PMCID: PMC3611570 DOI: 10.1007/s00586-002-0438-2] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2002] [Accepted: 04/30/2002] [Indexed: 12/14/2022]
Abstract
Various forms of lumbar instability require a surgical stabilization. As an alternative to fusion, a mobile, dynamic stabilization restricting segmental motion would be advantageous in various indications, allowing greater physiological function and reducing the inherent disadvantages of rigid instrumentation and fusion. The dynamic neutralization system for the spine (Dynesys) is a pedicle screw system for mobile stabilization, consisting of titanium alloy screws connected by an elastic synthetic compound, controlling motion in any plane (non-fusion system). This prospective, multi-center study evaluated the safety and efficacy of Dynesys in the treatment of lumbar instability conditions, evaluating pre- and post-operative pain, function, and radiological data on a consecutive series of 83 patients. Indications consisted of unstable segmental conditions, mainly combined with spinal stenosis (60.2%) and with degenerative discopathy (24.1%), in some cases with disc herniation (8.4%), and with revision surgery (6.0%). Thirty-nine patients additionally had degenerative spondylolisthesis, and 30 patients had undergone previous lumbar surgery. In 56 patients instrumentation was combined with direct decompression. The mean age at operation was 58.2 (range 26.8-85.3) years; the mean follow-up time was 38.1 months (range 11.2-79.1 months). There were nine complications unrelated to the implant, and one due to a screw malplacement. Four of them required an early surgical reintervention. Additional lumbar surgery in the follow-up period included: implant removal and conversion into spinal fusion with rigid instrumentation for persisting pain in three cases, laminectomy of an index segment in one case and screw removal due to loosening in one case. In seven cases, radiological signs of screw loosening were observed. In seven cases, adjacent segment degeneration necessitated further surgery. Mean pain and function scores improved significantly from baseline to follow-up, as follows: back pain scale from 7.4 to 3.1, leg pain scale from 6.9 to 2.4, and Oswestry Disability Index from 55.4% to 22.9%. These study results compare well with those obtained by conventional procedures; in addition to which, mobile stabilization is less invasive than fusion. Long-term screw fixation is dependent on correct screw dimension and proper screw positioning. The natural course of polysegmental disease in some cases necessitates further surgery as the disease progresses. Dynamic neutralization proved to be a safe and effective alternative in the treatment of unstable lumbar conditions.
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918
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Schill S, Lühr T, Thabe H. [Radiolunate arthrodesis of the rheumatoid wrist - mid- and long-term results]. Z Rheumatol 2002; 61:551-9. [PMID: 12399883 DOI: 10.1007/s00393-002-0387-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Late Synovectomy of the rheumatoid wrist combined with ulna head resection and dorsal wrist stabilization will not prevent carpal instability and dislocation. Depending on the radiological destruction pattern and the natural course of the wrist according to Simmen, dorsal wrist synovectomy is combined with soft-tissue or osseus stabilization procedures.This article describes the mid- and long-term results of radio-lunate arthrodesis in patients with rheumatoid arthritis. We present a retrospective study of 69 radiolunate arthrodesis performed from 1988 to 1994. Fifty patients with 57 wrists were available for clinical and radiological follow-up. All patients were suffering from rheumatoid arthritis (dominating female). The average length of R.A. illness was 9.6 years. The mean age at operation was 54.4 years. Postoperative results were reviewed with the Clayton score. The radiographic analysis included measurement of the carpal height index and ulnar translation of the carpus. The follow-up period ranged from 4 to 10.8 years (average: 7 years). The postoperative Clayton score averaged 74.2 points, representing 70% good or excellent results. Twelve wrists achieved satisfactory results and five were judged poor. The most benefit was achieved in pain relief and restoration of wrist function and extensor strength. Complete pain relief was achieved in 36 wrists, while 16 reported slight pain from loads. Five patients still complained about pain with daily wrist activity. We noticed a moderate decrease for extension-flexion (-39 degrees ) and for combined ulnar-radial deviation (-10 degrees ). The radiographic analysis proved stabilization of ulnar translocation in most cases. We routinely noticed a moderate radiographic progression according to the Larsen classification (+0.7) with reduction of the carpal height ratio. In conclusion radioulnate arthrodesis proved satisfactory pain relief and maintenance of functional wrist motion. Despite radiographic deterioration, partial wrist arthrodesis restrains ulnar translocation, while stabilization of the rheumatoid wrist is achieved.
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919
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Healey D, Letts M, Jarvis JG. Cervical spine instability in children with Goldenhar's syndrome. Can J Surg 2002; 45:341-4. [PMID: 12387536 PMCID: PMC3684635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE To study the vertebral involvement of the cervical spine, in particular the stability of C1-C2, in children with proven Goldenhar's syndrome. DESIGN A case review. SETTING The Children's Hospital of Eastern Ontario, Ottawa. PATIENTS Eight children who had a minimum of 2 out of 3 Goldenhar criteria plus other strong associations with the syndrome and for whom detailed radiographic spinal assessment, including flexion-extension views of the cervical spine and computed tomography of the congenital anomalies, were available. OUTCOME MEASURES Radiographic findings. RESULTS Seven children demonstrated cervical spine anomalies. Of particular concern was the high incidence of C1-C2 instability in 3 children, 2 of whom required occiput to C2 fusion. The presence of hemivertebrae and failures of segmentation were most common and resulted in thoracic scoliosis, leading to spinal fusion in 2 children. CONCLUSIONS In patients with Goldenhar's syndrome the cervical spines must be monitored carefully for C1-C2 subluxation before any proposed surgery for other malformations associated with the syndrome, so that any instability can be identified to avoid cord impingement during a general anesthetic.
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920
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Kristof RA, Aliashkevich AF, Schuster M, Meyer B, Urbach H, Schramm J. Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. J Neurosurg 2002; 97:281-6. [PMID: 12408380 DOI: 10.3171/spi.2002.97.3.0281] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to determine the results of decompressive surgery without fusion in selected patients who presented with radicular compression syndromes caused by degenerative lumbar spondylolisthesis and in whom there was no evidence of hypermobility on flexion-extension radiographs. METHODS The medical records and radiographs obtained in 49 patients were reviewed retrospectively. Clinical status was quantified by summing self-assessed Prolo Scale scores. All 49 patients (55% female, mean age 68.7 years) presented with leg pain accompanied by lumbalgia in 85.7% of the cases. Preoperatively the median sum of Prolo Scale scores was 4. The mean preoperative degree of forward vertebral displacement was 13.5% and was located at L-4 in 67% of the cases. Osseous decompression alone was performed in 53%, and an additional discectomy at the level of displacement was undertaken in the remaining patients because of herniated discs. Major complications (deep wound infection) occurred in 2%. During a mean follow-up period of 3.73 years, 10.2% of the patients underwent instrumentation-assisted lumbar fusion when decompression alone failed to resolve symptoms. At last follow up the median overall Prolo Scale score was 8. Excellent and good results were demonstrated in 73.5% of the patients. Prolonged back pain (r = 0.381) as well as the preoperative degree of displacement (r = 0.81) and disc space height (r = 0.424) influenced outcome (p < or = 0.05); additional discectomy for simultaneous disc herniation at the displaced level did not influence outcome (p > 0.05). CONCLUSIONS These results appear to support a less invasive approach in this subgroup of elderly patients with degenerative lumbar spondylolisthesis-induced radicular compression syndromes and without radiographically documented hypermobility. Additional discectomy for simultaneous disc herniation of the spondylolisthetic level did not adversely influence the outcome. Complication rates are minimized and fusion can eventually be performed should decompression alone fail. A prospective controlled study is required to confirm these results.
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921
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Insall JN, Scuderi GR, Komistek RD, Math K, Dennis DA, Anderson DT. Correlation between condylar lift-off and femoral component alignment. Clin Orthop Relat Res 2002:143-52. [PMID: 12360020 DOI: 10.1097/00003086-200210000-00022] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The current study analyzed subjects having a total knee arthroplasty to determine the incidence of condylar lift-off and correlate lift-off with the alignment of the femoral component with respect to the transepicondylar axis. Twenty-five subjects, implanted with a posterior stabilized total knee prosthesis, were asked to do weightbearing deep knee bends while under fluoroscopic surveillance. The two-dimensional fluoroscopic images were converted into three-dimensional images using a fully automated computer model-fitting technique. Each subject then was assessed for the incidence of condylar lift-off. The five subjects having the maximum amount of lift-off were reanalyzed for comparison using computed tomography. Using digitization, the angle between the posterior femoral condylar line and the transepicondylar axis was measured and correlated with the presence of femoral condylar lift-off. The incidence of condylar lift-off was significantly less for subjects in this study compared with subjects reported in previous fluoroscopic studies. Forty percent (10 of 25) of the subjects experienced condylar lift-off. The maximum amount of lift-off was 2.3 mm and the average for subjects experiencing lift-off was 1.4 mm. There also was a distinct correlation between femoral component alignment and condylar lift-off. Using computed tomography, it was determined that 69.2% of the subjects had a correlation between condylar lift-off and malalignment of the femoral component relative to the epicondylar axis. Placement of the femoral component parallel to the transepicondylar axis seems to lessen the incidence of femoral condylar lift-off and may reduce polyethylene wear by reducing eccentric edge loading.
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922
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Abstract
Revision surgery after failed anterior cruciate ligament reconstructions has increased tremendously. Reasons for revisions are persistent loss of motion, recurrent joint laxity, a painful knee or joint infections. In a retrospective study with a mean follow-up of 35.2 months 82 patients were examined after revision surgery. Time interval between primary and revision surgery, causes of revisions and treatment modalities were evaluated and compared to subjective, clinical and radiological parameters. In all cases a clinical improvement could be achieved. But results after revision operations are inferior to first reconstructions. The mean Tegner score improved after revision surgery from 2.4 to 4.6 points. The mean Lysholm score increased after secondary surgery from 54 to 76 points. The overall IKDC results of follow-up showed category A - 35.4 %, B - 39 %, C - 13.4 % and D - 12.2 % of the patients. A distinction between patients with preoperative isolated loss of motion and patients with isolated joint laxity seems useful. Revision operations with an improvement of joint mobility showed a higher subjective satisfaction, a lower rate of joint instability and better overall IKDC result compared to those with a high grade of preoperative joint laxity. Better results could be also achieved for early revision compared to late revisions and also for autologous grafts compared to alloplastic revision plasty. Transplant retaining procedures are only possible in selected cases and showed no clinical benefit compared to second revision of cruciate replacements. As a result of this study we conclude that early revision operation and the use of an autologous graft can be recommended but the surgeon has to be prepared to encounter many demanding technical problems.
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923
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Abstract
BACKGROUND The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone. METHODS Three women and two men (average age, forty-nine years) with an unreduced dislocation of the elbow without associated fractures were treated with open relocation of the joint and hinged external fixation at an average of eleven weeks (range, six to thirty weeks) after the initial injury. The lateral soft tissues, including the origin of the lateral collateral ligament complex, were reattached to the lateral epicondyle in three patients, but no attempt was made to reconstruct the ligaments, tendons, or bone. A passive worm gear incorporated into a hinged external fixator was used to mobilize the elbow initially, and active mobilization was gradually introduced. The hinge was removed at an average of five weeks after the procedure. RESULTS At an average of thirty-eight months (range, twelve to ninety-eight months), a stable, concentric reduction had been maintained in all five patients, with radiographic signs of mild arthrosis in four. The average arc of flexion was 123 degrees, and all patients had full forearm rotation. The average score on the Mayo Elbow Performance Index was 89 points, with two excellent and three good results. The average scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons outcome instruments (13 and 92 points, respectively) reflected mild residual pain and disability. CONCLUSIONS Treatment of unreduced elbow dislocations with open reduction and hinged external fixation as much as thirty weeks after the injury can restore a stable, mobile joint without the need for tendon-lengthening or transfer, ligament reconstruction, or deepening of the trochlear notch of the ulna.
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924
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Abstract
Published studies have recommended correction of osseous alignment in patients with chronic deficiencies of multiple knee ligaments and varus angulation. However, similar treatment for isolated chronic lateral collateral ligament deficiency has not been reported. We report such a case treated successfully with a medial high tibial osteotomy using a dynamic external fixator.
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925
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Aladin A, Lam KS, Szypryt EP. The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee 2002; 9:233-6. [PMID: 12126684 DOI: 10.1016/s0968-0160(02)00012-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unilateral fibula head dislocation is an uncommon injury. Ogden in 1974 reviewed the literature and detected 108 cases [J. Bone Joint Surg. 56(A) (1974) 145-154]. There since have been few reported cases. Bilateral fibula head dislocation only has been reported once [Rheumatol. Int. 5(1) (1984) 45-47]. We report a patient who had developed bilateral fibula head dislocations, each side independently over a 5-year period. We emphasise the rarity of the injury, the necessity of prompt recognition and reduction, and the uncertainty for best management of this injury.
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