Traumatic bilateral anterior dislocation of the shoulders. A case report in a geriatric patient.
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Biomedical subjects
Publications and source records attributed to A Ganel.
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Pigmented villonodular synovitis (PVS) is an uncommon, usually monoarticular disorder encountered mainly in adults. A boy and a girl, both 7 years old, were referred because of recurrent knee effusions. Both were medically treated for other rheumatic disorders for five years. PVS was diagnosed by arthroscopy and synovectomy was curative in both cases.
We have assessed the donor site of fibula bone graft to detect signs and symptoms of ankle instability in 8 patients. In 1 patient with generalized joint hyperlaxity pain, clinical instability and pathological motion of the proximal end of the distal remaining fibula were encountered. Seven other patients were asymptomatic and had no instability both clinically and on stress radiographs.
Surgery was performed in 31 patients with synovial chondromatosis: 12 had synovectomy and removal of loose bodies, and 16 had removal of loose bodies only. The remaining 3 patients had more radical surgery: 2 had total hip replacement and 1 had resection arthroplasty. Twenty-six patients were reviewed after an average of 6 years and 4 months. Thirteen patients were symptomatic and 11 had residual signs of limited joint motion and localized tenderness. In 1 case of metatarsophalangeal joint involvement, recurrence occurred. Removal of loose bodies only did not differ from synovectomy and removal of loose bodies.
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A case in which 23 recurrent episodes of anterior dislocation of the shoulder occurred in a 76-year-old woman is presented. Du Toit and Roux staple capsulorrhaphy was used to achieve a stable, functioning shoulder. Recurrent dislocation of the shoulder is a problem of youth. Peak incidence occurs at age 20, after age 70, the incidence of recurrent dislocation of the shoulder is extremely low. The surgical treatment of a 76-year-old woman, who suffered 23 documented anterior dislocations of the right shoulder, is discussed and reviewed.
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A 5-year-old boy presented with a limp, fever, and right hip pain of 72 hours' duration. An intensive workup of right hip pain synovitis failed to diagnose any local pathology. Delayed diagnosis of psoas abscess was made on the 12th day of hospitalization. A rapid recovery with no further complications followed surgical evacuation of the abscess.
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Muscle contractures are infrequent in Israel. This report discusses one case of a congenital contracture associated with a skin dimple treated in Israel. A 3-year-old boy presented with difficulty in running, riding a bicycle, and squatting. Flexion of the right hip in adduction was impossible. The hip could be fully flexed in abduction. Congenital contracture of the right gluteus maximus muscle was successfully treated by surgical release.
Synovial chondromatosis of the hip joint is uncommon entity. Two cases are presented, and the spectrum of the disease is discussed. Partial synovectomy with loose body removal is recommended as the treatment of choice. Joint replacement is performed only in patients with severe secondary osteoarthritis, and used only in selected cases.
Villonodular synovitis of the shoulder developed in two elderly patients. Huge soft tissue mass, marked joint effusion, and radiographs demonstrating severe osteoarthritic changes characterized these patients. Localized shoulder muscle atrophy accounts for residual painfree limitation of active shoulder motion following synovectomy of the shoulder joint.
An uncommon etiologic factor of hallux valgus was encountered in two patients. Crush injury and gunshot wound of the foot were associated with metatarsal bone fractures. malunion of the second metatarsal and malunion of an avulsed fracture at the base of the proximal phalanx of the big toe, resulted in a symptomatic hallux valgus deformity.
The problem of subluxation of the hip joint during femoral elongation is reviewed and pathogenesis and prevention of this rare complication are discussed.
Seventy-one operations are reviewed, in which knees were replaced with the total condylar prosthesis. The follow-up period ranged between 1 and 7 years, with an average of 3.25 years. Osteoarthritis was diagnosed preoperatively in 53 knees and rheumatoid arthritis in 18. The results obtained in cases of osteoarthritis were better than those in cases of rheumatoid arthritis. The prognosis was adversely affected by obesity, preoperative flexion contracture of 30 degrees or more, wound-healing problems, wound infection, and postoperative manipulation under general anesthesia. The overall results were excellent in 48% of cases (34 knees), good in 28% (20 knees), fair in 11.3% (eight knees), and poor in 4.3% (three knees). Failure was experienced in 8.4% of cases (six knees).
An original nerve-identification technique based on the enzymatic activity of choline acetylase enables precise differentiation between motor nerve fascicles and sensory nerve fascicles. Within 70 to 80 minutes, an accurate matching of cut nerve ends is possible, both in recent and in late nerve injuries. Preliminary results of the clinical intraoperative application of this method are encouraging.
A 10-year-old boy with Blount's disease was treated by asymmetric distraction of the proximal tibial epiphysis to correct varus deformity of 12 degrees. Gradual hemichondrodiastasis with immediate mobilization resulted in slight overcorrection of the deformity with no complications.
An asthenic 30-year-old dentist presented at the orthopaedic clinic complaining of pain in both hip joints. There was no history of systemic disease, and all of the results of serologic and hematologic investigations were within normal limits. Clinical examination revealed a limitation of hip movement, and roentgenograms showed early osteoarthritis of both joints. In addition, there were bony protuberances between the pelvis and the proximal femur. Whether these bony struts caused the development of the osteoarthritis or whether they developed as a result of the osteoarthritis will be discussed.