PubMed · 5801504
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R W Bottoms. 1969-07-19. An easily made compression device.. https://doi.org/10.5694/j.1326-5377.1969.tb105667.x
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Although several types of intercarpal fusion have been advocated for the treatment of Kienbock's disease, the clinical outcome of each procedure is still inconclusive. The joint load and ligament tension based on a three-dimensional model were measured to determine which intercarpal fusion procedures unload the lunate and whether they alter the force transmission through the entire wrist joint. Ten theoretical models of wrists were used to simulate three different operative procedures: capitate-hamate fusion, scapho-trapezial-trapezoidal fusion, and scaphocapitate fusion. A discrete element analysis technique was used to perform these investigations. The joint force and ligament tension of normal wrists and of simulated operative procedures were calculated according to the deformation of each spring element, simulating the articular cartilage and the carpal ligaments. Scaphocapitate and scapho-trapezial-trapezoidal fusions significantly decreased the joint force at the radiolunate joint and the lunocapitate joint compared with the intact wrist. In contrast, these fusions significantly increased this value at the radioscaphoid joint in comparison with the intact wrist. In the midcarpal joint, scaphocapitate fusion also increased the joint force at the scapho-trapezial-trapezoidal joints and at the triquetral-hamate joint, whereas scapho-trapezial-trapezoidal fusion increased it at the scapho-capitate joint. Capitate-hamate fusion yielded no significant changes of the joint forces through the entire wrist joint. In the analysis of ligament tension, scaphocapitate and scapho-trapezial-trapezoidal fusions significantly decreased the tension only in the dorsal scapholunate ligament. These findings demonstrate that scaph-ocapitate and scapho-trapezial-trapezoidal fusions are effective in decompressing the lunate. By contrast, capitate-hamate fusion is ineffective in reducing lunate compression. Although scaphocapitate and scapho-trapezial-trapezoidal fusions are recommended for the treatment of Kienbock's disease, clinicians should consider that the increase of force transmission through the radioscaphoid and the midcarpal joints may lead to early degenerative changes after these procedures have been performed.
Functional recovery after bilateral comminuted fractures of the humeral head with posterior dislocation is poor. When reposition and internal fixation fail, the remaining alternatives are (hemi)arthroplasty and/or arthrodesis. In a 50-year-old patient, we treated the dominant shoulder by arthrodesis; a Neer prosthesis was inserted at the other side. Using this strategy, the advantages of both techniques were combined with an acceptable functional recovery, which ist especially important for young and active patients.
The purpose of this review is to present current information from the literature regarding the pathoanatomy, clinical presentation, differential diagnosis, treatment, and outcome assessment methods for patients with lumbar spinal stenosis. Lumbar spinal stenosis is a frequently encountered condition, particularly in the elderly. Treatment requires an accurate diagnosis, but differential diagnosis of lumbar stenosis can be difficult. The literature to date has focused primarily on surgical treatment. The long-term efficacy of surgery has been questioned, and surgical procedures are associated with increased costs and risks of morbidity in an elderly population. A trial of conservative care is recommended in most cases, but there are presently no randomized controlled studies in the literature comparing surgical versus conservative management, or evaluating the effectiveness of any specific conservative treatment approach. The existing literature has further been criticized for having poorly defined outcome measures. The assessment of treatment outcomes should be multifactorial, including measures of pathoanatomy and impairments, as well as patient-centered measures such as level of disability, patient expectations, and satisfaction. The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment. Future research should address these deficits to improve the management of patients with this condition.