Biomedical subjects
Publications and source records attributed to L A Kriegshauser.
Three cases of palmar perilunate subluxation associated with a fracture of the palmar pole of the lunate are described. Wrist hyperflexion with a longitudinal loading force transmitted through the capitate probably accounts for this injury.
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The records of 31 patients who were treated by a modified Coventry high tibial osteotomy were reviewed, and the early results of postoperative management with a cylinder cast were compared with those with early motion in a cast-brace. Thirteen patients (15 knees) who had immobilization in a cylinder cast after surgery for an average of 44.3 days had lost a mean of 10 degrees of flexion at three months of follow-up study. Their average total hospitalization was 15.5 days. Eighteen patients (19 knees) treated by early motion in a cast-brace had not lost any preoperative flexion at three months of follow-up study. The two most recent of these patients received continuous passive motion in the immediate postoperative period. The average total hospitalization for this group was 10.7 days. One patient in the cast-brace group had a significant loss of correction at the osteotomy site during healing. Eleven of the patients treated by a cylinder cast (84.6%) and 17 of the patients managed with a cast-brace (94.4%) stated that they had been improved by the surgery at this early stage. There were no nonunions or loss of internal fixation in either of the two groups. Early motion in a cast-brace (with a continuous passive motion machine, if available) is safe and is comfortable for and well accepted by patients.
The authors discuss the pathomechanics of abnormal patellar tracking and excessive patellofemoral contact force that results in patellofemoral pain, chondromalacia, and patellofemoral arthrosis. An understanding of the pathomechanics implies a rational approach to treatment that includes methods to correct the tracking problem and reduce the load on the patellofemoral joint.
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