[Classification of multiple injuries of the musculoskeletal system].
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Chronic injection of mercazolyl to rats aged from 5--7 days to 4 months induces a decrease in motor activity, in the relative and total weight of bones and muscles, in oxygen consumption and cardiac activity. It also leads to hypercholesterolemia associated with a decreased cholesterol level in the skeletal muscle tissue. Abnormal growth and development of the muscles and bones along with a diminished oxygen consumption in rats under one month of age produce a reduction in the body weight as compared to that in control animals. In rats aged from 1 to 4 months the same factors lead to the weight increase accounted for by abnormal oxygent consumption and lipid metabolism. The goitrogenic effec was revealed in young rats chronically administered mercazolyl, this effect was not manifested in 4-month-old rats.
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To demonstrate the potential impact of computed tomography on orthopaedics, a brief review was done of four generations of scanners and of one new development (assay of bone mineral in the spine) that is presently being researched. To assess the utility of the method in treating orthopaedic problems, the cases of 140 patients, including patients with congenital anomalies, tumors, infections, and traumatic lesions, were analyzed. In the majority of the patients the technique provided useful information, often unobtainable with any other technique.
Allografts are an effective method of reconstructing defects following the resection of benign or malignant tumors. The surgeon must carefully plan the procedure in two stages. Stage I involves resection of the tumor with an adequate margin to prevent local recurrence, and stage II involves reconstruction of the limb with a durable and functional technique that has a low risk of morbidity. Allograft reconstructions are technically demanding. The prerequisites to a successful reconstruction include rigid internal fixation of the allograft, competent soft tissues to cover the graft, preoperative and postoperative antibiotic coverage, meticulous hemostasis and postoperative wound drainage to prevent hematoma formation, and protection of the allograft to allow union. Whenever soft-tissue coverage of the graft is in question, local rotational flaps or free microvascular transfers should be used to cover the allograft with healthy muscle. Second surgical procedures, such as revision of necrotic soft-tissue flaps, drainage of hematomas, bone grafting of nonunions, and revision of internal fixation, should be avoided by careful technique at the index operation because additional procedures place the allograft at risk for infection. Further basic science investigations and clinical studies should expand the applications of allograft reconstructions and lower the incidence of complications.
Ultrashort turbo spin-echo sequence (TSE) has the advantage of shorter scan times, minimizing motion artifacts, but has the disadvantage of a lower signal-to-noise ratio and suffers from different artifacts. T2-weighted ultrashort TSE (echo train 24) and TSE (echo train 11) were compared in degenerative lesions of the spine (n = 9) and ligamentous lesions associated with sprained ankle injuries (n = 5). The imaging quality of ultrashort TSE was very similar to TSE. There was no difference in diagnostic reliability with ultrashort TSE compared to TSE in the spine or ankle. With regard to contrast properties a higher signal intensity of fatty bone marrow was obtained with ultrashort TSE, with consecutive lower contrast between fluid and edema on the one hand and fatty tissue on the other.
Absorbable implants made of synthetic biodegradable polymers were recently used clinically especially for the fixation of small intra-articular fractures and physical fractures. In the paper history research and current concepts concerning biological response to biodegradable polymers and main indications for using absorbable implants for fixation of fractures are presented.
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The in-vivo effectiveness of continuous cold pressure therapy was evaluated in 24 patients following elective knee or hip replacement surgery. A cooling of the skin surface down to 8 degrees C resulted in a reduction of the epifascial tissue temperature to 22 degrees C. A significant reduction of subfascial pressure in combination with decreased protein leakage via redovac output were notable. Observing a constant decreased pH-level increased oxygen saturation and reduced drop of base excess were interpreted as signs of reduced enzyme-linked metabolism activity. Clinically these findings were found in correlation to a 50% decrease of postoperative analgetic demands as well as a 20% increased range of motion level.
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It is sometimes difficult to make an unequivocal diagnosis of tumours of bone and soft tissue based upon classical morphology alone, which has led to an increased use of additional diagnostic tools. In the past decade new techniques have become available, based on tumour specific genetic alterations, for instance chromosomal translocations. With the cloning of the translocation breakpoints and the identification of the genes involved, the reverse transcriptase polymerase chain reaction (RT-PCR) detection of the fusion gene has become an important diagnostic test. Also, non-tumour specific genetic alterations with prognostic value can be detected.
Magnetic resonance imaging in the patient who has had surgery is discussed. The most common indication for postoperative imaging is in the distinction between postoperative fibrosis and recurrent disc herniation. Magnetic resonance imaging is invaluable in the assessment of potential causes of failed back surgery syndrome such as postoperative infection, arachnoiditis and adjacent segment degeneration. Magnetic resonance imaging assumes a less important role in postoperative patients with metal hardware owing to image degradation secondary to metal artifact. Magnetic resonance imaging has a complementary role with computed tomography evaluation of spinal trauma. It excels at the noninvasive evaluation of spinal deformities and neoplasms.
Infantile hemangiopericytoma is an uncommon cause of a soft-tissue mass in the neonatal period. Only 86 of these tumors have been reported in the literature. Thirty of these were located in the extremities. This review presents a case of infantile hemangiopericytoma localized to the knee in an 8-month-old infant. Current literature suggests that the majority of these lesions are benign, and surgical excision is curative. Recurrence and metastatic disease rarely occur. Because 30-50% of infantile hemangiopericytomas occur in the extremities, orthopaedic surgeons should be aware of and familiar with this tumor.
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The health benefits and quality-of-life outcomes of a fit musculoskeletal system (musculoskeletal fitness) are reviewed in this article. The World Health Organization suggests health is a state of complete physical, mental or social well-being and not merely the absence of disease or infirmity. Physical health includes such characteristics as body size and shape, sensory acuity, susceptibility to disease and disorders, body functioning, recuperative ability and the ability to perform certain tasks. One aspect of physical health is the musculoskeletal system, which consists of 3 components; muscular strength, endurance and flexibility. Muscular strength (dynamic) is defined as the maximum force a muscle or muscle group can generate at a specific velocity. Muscular endurance is the ability of a muscle or muscle group to perform repeated contractions against a load for an extended period of time. Flexibility has 2 components, dynamic or static, where dynamic flexibility is the opposition or resistance of a joint to motion, that is, the forces opposing movement rather than the range of movement itself. Static flexibility is the range of motion about ajoint, typically measured as the degree of arc at the end of joint movement. If strength, endurance and flexibility are not maintained, musculoskeletal fitness is then compromised which can significantly impact physical health and well-being. Many health benefits are associated with musculoskeletal fitness, such as reduced coronary risk factors, increased bone mineral density (reduced risk of osteoporosis), increased flexibility, improved glucose tolerance, and greater success in completion of activities of daily living (ADL). With aging, the performance of daily tasks can become a challenge. Additionally, falls, bone fractures and the need for institutional care indicate a musculoskeletal weakness as we age. The earlier in life an individual becomes physically active the greater the increase in positive health benefits; however, becoming physically active at any age will benefit overall health. Improved musculoskeletal fitness (for example, through resistance training combined with stretching) is associated with an enhanced health status. Thus, maintaining musculoskeletal fitness can increase overall quality of life.
UNLABELLED: The aim of the study was to analyze the present status of neurologic abnormalities, major orthopaedic deformities and ambulatory status in a large myelomeningocele population. PATIENTS AND METHODS: Cross-sectional study based on the clinical and radiographic records of 322 patients treated and followed-up from 1967-1995. The setting was a multidisciplinary spina bifida unit within a third-level university hospital, which serves as the referral centre for these patients in Catalonia (Spain). We collected information on diagnosis, central nervous system, musculoskeletal system (spinal and hip deformities) and functional level in each patient. To study relationships among the variables, the Mann-Whitney U and the Chi-squared tests were applied. Results were considered to be statistically significant at P levels of < or = 0.05. RESULTS: Mean age was 15.9 years. 78.1% of patients had mid-lumbar, low-lumbar or sacral neurological levels; 97.5% had hydrocephalus and 68.8% were shunted. Prevalence of spine deformities was 45.3%; 38.8% had dislocation of one or both hips. Median age of walking onset was 37.1 months and 74.8% of patients were ambulatory. Median age at which ambulation ceased was 128 months (10 years and 8 months). The bivariate analysis showed statistically significant relationships between neurological level and all the variables studied (P<0.001, P<0.02) except body mass indexes and intelligence quotient. CONCLUSIONS: Neurological level was the main factor that determined neurological abnormalities, major orthopaedic deformities and ambulatory status.