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At least 487 records · Page 27Linked to original sources

PubMed1984

[Carpal instability--ligamentous instabilities and intracarpal malalignments--explication of the concept of carpal instability].

Normally, intracarpal stability is due to the carpal ligaments as well as to the "spatial coherence" of the carpal bones. "Destabilization" may be due to ligamentous attenuation when sprains and dislocations occur. This will lead to "dynamic instability" in extreme movements of the wrist or to malalignments in the case of long-standing dislocations. The scapholunar, triquetral or midcarpal ligamentous structures may be involved. The loss of spatial coherence by modifications in the form or in the volume of the carpal bones may lead to "compensatory carpal re- or malalignments".

Humans↗

PubMed1984

The treatment of infected and uninfected non-union.

One hundred and sixteen patients with 129 ununited fractures were treated either by rigid internal fixation and bone grafting or, in 14 tibial non-unions, by posterolateral bone grafting. In 37 actively infected cases this was combined with sequestrectomy and appropriate antibiotics. The final success rate was 98.4%. Technical errors or inadequate immobilisation after operation in patients with severe osteoporosis led to some early failures. No patient had a discharge or evidence of osteomyelitis after removal of metal. Rigid internal fixation with or without bone grafting is the treatment of choice for established non-union with bone loss when true synovial pseudarthrosis is present, when malalignment or shortening needs correction, and when prolonged immobilisation is either difficult or would lead to unacceptable stiffness in adjacent joints. Active osteomyelitis is not a contra-indication to internal fixation.

Adolescent↗

PubMed1984

The value of conventional views and radiographic magnification in evaluating early rheumatoid arthritis.

Fifty-four patients with suspected early rheumatoid arthritis had radiographs taken of their hands and wrists in 4 views (posteroanterior [PA], oblique, reverse oblique, and Brewerton) using conventional techniques and, in the PA view, using radiographic magnification. The radiographs were "masked" and presented in random order to 2 radiologists specializing in bone and joint radiology who interpreted them for malalignment, erosions, joint space narrowing, and soft tissue swelling. The PA was the best conventional view for demonstrating malalignment, joint space narrowing, and soft tissue abnormalities; the Brewerton view was better for detecting erosive disease. Radiographic magnification was more sensitive than conventional films for evaluating erosive disease, but otherwise was no better than the conventional PA view. These results help the physician choose the radiologic technique or combination of techniques that is most likely to detect specific abnormalities.

Arthritis, Rheumatoid↗

PubMed2005

[Ankle arthrodesis using the arthroscopic technique].

OBJECTIVE: Fast, safe and reliable ankle fusion through minimally invasive technique. INDICATIONS: Painful ankle arthritis unresponsive to conservative treatment. CONTRAINDICATIONS: Severe axial malalignment of ankle. Significant anteroposterior talar translation. Extensive bone defect. SURGICAL TECHNIQUE: Standard anteromedial and anterolateral arthroscopic portals. Excision of all anterior hypertrophic synovium using a soft-tissue shaver. Removal of anterior osteophytes with a motorized arthroscopic abrader (burr) to get better access to the joint. Removal of the remaining ankle cartilage using a sharp curette. Superficial opening of the subchondral bone with a motorized burr and deeper opening with an osteotome. Without arthroscopy but under image intensification, ankle fixation in neutral position by inserting two (or three) 6.5-mm cancellous lag screws from the tibia (medial and lateral) into the talus. POSTOPERATIVE MANAGEMENT: Partial weight bearing (15 kg) with a removable boot for 6 weeks. Then, first radiologic follow-up and in the presence of evidence of consolidation, full weight bearing with the boot for additional 2-4 weeks. RESULTS: Between September 1998 and February 2003, 28 arthroscopic ankle arthrodeses were performed. 23 ankles (82%) showed definite radiologic evidence of consolidation at 6 weeks postoperatively; patients were allowed to bear full weight without any consequences. All patients except two (93%) showed complete ankle fusion at their last radiologic follow-up at 1 year. Both patients with absent fusion were smokers; one of them was asymptomatic (stable fibrous union) and the other's ankle finally fused after surgical revision with open technique and bone grafting.

Adult↗

PubMed2001

Treatment of diaphyseal fractures of the forearm using the Point Contact Fixator (PC-Fix): results of 387 fractures of a prospective multicentric study (PC-Fix II).

Fractures of the forearm are considered to be a very good indication for plating. Conventional plating is still technically demanding. Extensive animal studies show that there is potential for improvement. The method consists of using an internal fixator that minimizes implant contact to the bone to reduce biological damage. Furthermore, foregoing the need for precise reduction and interfragmental compression makes it easier to use and, therefore, it should be safer. The goal of the study was to observe handling qualities, healing, and complications. For this purpose the study was designed to yield a very high follow-up in clinics with adequate experience and with a number of different surgeons performing the internal fixation. The study was designed as a prospective multicentre investigation in 16 trauma centres worldwide. To test the new approach to internal fixation, diaphyseal fractures of the forearm were stabilized surgically with the PC-Fix (Point-Contact Fixator) system, namely, 387 fractured bones involving 277 forearms in 272 patients. Internal fixation was performed using 387 PC-Fixators. 21% of the fractures were open and 25% occurred in polytraumatized patients. The rate of follow-up was 97%. 355 fractured bones healed uneventfully within four months. Overall, there were 32 complications before bone union occurred; 27 of these bones required re-operation (27 of 387, 7%). All of them subsequently healed without further complications. There were 15 delayed or non-unions and seven implant loosenings, two of which were associated with infection. Two superficial (0.6%) and two deep infections (0.6%) occurred in 306 closed fractures. Deep infection developed in one of 81 osteosyntheses of open fractures (1.2%). Other complications included one synostosis, fractures with the implant in situ with adequate trauma involving three bones, and two secondary correction procedures for postoperative malalignment. There were seven refractures occurring at a mean of three weeks after the removal of 150 PC-Fixators (4.7%). This study demonstrated that the technique of using an internal fixator is a simple one for the fixation of forearm fractures, resulting in shorter duration of surgery with a low rate of complications compared with the data reported in the literature on conventional techniques for forearm fracture stabilization.

Adolescent↗

PubMed2001

Treatment of instability after total elbow arthroplasty.

Instability after total elbow arthroplasty can be due to incorrect component selection or position, inadequacy of the medial or lateral ligaments or triceps tendon, polyethylene wear, limb malalignment, or trauma. Patients with significant loss of bone structure, ligament deficiency, and tendon deficiency around the elbow are at increased risk of instability following total elbow arthroplasty.

Arthroplasty, Replacement↗

PubMed2006

Hybrid external fixation for arthrodesis in knee sepsis.

Several techniques for knee fusion have been described with success rates ranging from 29% to 100%, with worse results occurring in patients with joint sepsis. We treated 21 patients with persistent infections using knee arthrodesis with a hybrid Ilizarov frame at our institution. There were 13 men and eight women ranging from 21 to 75 years (mean, 49.7 years). Sixteen patients had chronic osteomyelitis and five had previous fusion trials. Two patients required bone transport using the same arthrodesis frame. We corrected associated malalignment in three patients. Solid knee fusion was achieved in all but one patient after a mean external fixation time of 22.7 weeks (range, 11-47 weeks). Limb shortening averaged 2.8 cm (range, 1.5-5 cm). No patients required secondary bone grafting to achieve fusion. Nine patients had complications develop, three of whom required reresection and frame application to treat persistent infection or delayed union. Our results emphasize the clinical success of using the Ilizarov fixator for knee arthrodesis after persistent sepsis.

Adult↗

PubMed1982

Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.

A corrective osteotomy for post-traumatic malalignment of the distal end of the radius was performed in twenty patients who were followed for an average of 3.6 years. The indications for correction were based on age, degree of deformity, limitation of function, pain, and appearance of the wrist. The procedure included an opening-wedge metaphyseal osteotomy combined with insertion of a graft and rigid internal fixation with a plate and screws to permit early motion. Depending on the direction of the angulation, a dorsal or volar approach was employed to guarantee a buttressing effect of the plate. The procedure gave satisfactory results when there were no degenerative changes in the radiocarpal or intercarpal joints and when the preoperative range of motion of the wrist was adequate. The results were graded as excellent in five patients, good in ten, fair in four, and poor in one.

Adult↗

PubMed2006

Percutaneous plating of lower limb long bone fractures.

We conducted a study on indirect reduction and percutaneous plating in the treatment of 22 cases (mean age 50.3, S.D. 18.5, range 18-88) of non-diaphyseal fractures of long bones of the lower limb mainly using the lateral tibial head buttress plate. All cases achieved radiological union and full weight bearing walking. No major malalignment resulted and only one Gustilo III-b compound fracture required bone grafting. None required revision surgery from problem with union. One case required revision in the early learning phase and another patient suffered wound complication from self-herbal application which required local flap surgery. The satisfactory functional results and the lack of soft tissue complications suggest that this method should be considered in metaphyseal fractures where intramedullary nails are not applicable.

Adolescent↗

PubMed1992

[Possible uses for callus distraction. Bridging bone defects and bone lengthening in leg length inequality].

AIMS: Representation of the possibilities of callus distraction for bridging bone defects on the basis of four typical cases successfully treated with this procedure. MAIN TOPICS: The filling of large diaphyseal bone defects through the use of callus distraction is reliable, relatively simple to carry out, and in most cases can be done on an outpatient basis. After prior osteotomy, a segment of the remaining bone is forced, millimeterwise, into the defect zone. As a result of continuous distraction of the callus forning in the osteotomy, tubular bone with weight-bearing capability is formed, and the patient is spared the defect resulting at the donor site when an autologous bone graft is taken, or the implantation of exogenous material. The same principle is employed for leg lengthening, and also permits simultaneous compensation of axis malalignment.

Adult↗

PubMed2003

Cherubism: clinical evidence and therapy.

Cherubism is a hereditary childhood disease of autosomal dominant inheritance that is more common in the male sex. Some cases have also revealed a mutation of the gene FGF-RIII (fibroblast growth factor receptor III). The clinical picture of cherubism is characterized by painless symmetrical swelling of the mandible and polycystic destruction of the mandibular bone structure. Complications include delayed dentition, dental root resorption, malalignment of teeth, and impacted teeth. The disease progression comes to a halt of its own accord at the end of puberty. Spontaneous recoveries have been observed. Histologically, multinuclear giant cells with osteoclastic activity, which correspond to a giant cell granuloma, are found in fibrous stroma. It is generally agreed that decisions about surgical intervention should be considered carefully. A case report describes the course of the disease and therapy of a female patient with a periorbital manifestation of cherubism. The latero-orbital enlargement of the intraorbital and latero-orbital region of the zygomatic bone resulted in displacement of the orbital contents with a motility disorder of the eyes. The motility disorder was eliminated by reduction of the diseased hard tissue as well as by carrying out a modeling orbitotomy and by reconstructing an anatomically correct localized and irregular bilateral osseous structure of the zygomatic bone in the intraorbital and latero-orbital region.

Adult↗

PubMed1992

[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Neoplasms↗

PubMed1994

Realignment of postoperative cervical kyphosis in children by vertebral remodeling.

STUDY DESIGN: This study analyzed radiographically change in the sagittal curvature of the cervical spine after atlantoaxial (C1-C2) posterior fusion in children. OBJECTIVES: This study clarified the process of spinal remodeling after postoperative cervical deformation in children. SUMMARY OF BACKGROUND DATA: Postoperative spinal deformations in children are observed frequently. However, there have been only a few reports on postoperative changes in the sagittal curvature of the cervical spine and spinal remodeling after those changes. METHODS: Between 1979 and 1991, there was a total of 12 children who underwent C1-C2 posterior fusions. The average age at the time of surgery was 9.8 years. The alignment of the cervical spine was classified into four groups (lordosis, straight, kyphosis, and swan-neck deformity). Radiographic findings suggestive of the remodeling were as follows: 1) new bone formation on the anterior vertebral cortex, and 2) increase in body/canal ratio (BCR). The follow-up period averaged 6.2 years. RESULTS: Postoperative cervical malalignment (kyphosis or swan-neck deformity) occurred in four patients. In all four patients, new bone formation and increase in BCR at the apex of kyphosis were observed. Therefore, there was gradual improvement of the malalignment by vertebral remodeling. This phenomenon was not observed in eight patients with normal alignment. CONCLUSION: Realignment of postoperative cervical kyphosis by vertebral remodeling was observed in children. The results of this study suggested that remodeling occurred even in the spine, which was similar to the remodeling in long bones.

Atlanto-Axial Joint↗

PubMed2006

Cytokine-induced osteoclastic bone resorption in charcot arthropathy: an immunohistochemical study.

BACKGROUND: Charcot arthropathy is a chronic, progressive destructive process affecting bone architecture and joint alignment in people lacking protective sensation. The etiologic factors leading to progressive bone resorption have not been elucidated. The purpose of this study was to histologically examine surgical specimens with Charcot arthropathy for cell type and immunoreactivity of known cytokine mediators of bone resorption. METHODS: Tissue samples of 20 specimens with known Charcot arthropathy were stained for Hematoxylin and Eosin (H&E) to quantify cell type. Nine of the specimens were stained with interleukin-1 (IL-1) antibody, nine with tumor necrosis factor (TNF) alpha antibody, and nine with interleukin-6 (IL-6) antibody. Distribution of staining was graded as focal (less than 10% of cells), moderate (10% to 50% of cells), and diffuse (more than 50% of cells) by two independent investigators. Inflammatory cells in tissue sections of rheumatoid synovium served as a positive control. RESULTS: Osteoclasts were seen in excessive numbers lining the resorptive bone lacunae. There was a disproportionate increase in osteoclasts to osteoblasts in the Charcot-reactive bone. In each case, osteoclasts demonstrated immunoreactivity for IL-1, IL-6 and TNF-alpha with a grade of moderate or diffuse reactivity. CONCLUSION: The findings of excessive osteoclastic activity in the environment of cytokine mediators of bone resorption (IL-1, IL-6, and TNF-alpha) suggest enhanced bone resorption through the stimulation of osteoclastic progenitor cells as well as mature osteoclasts. Alteration in the synthesis, secretion, or activity of these important regulatory molecules through the use of pharmacologic agents may, in turn, alter bone remodeling and loss and lead to accelerated healing without collapse or malalignment.

Adult↗

PubMed1995

Computer-aided preoperative planning in knee osteotomy.

It has been demonstrated that osteoarthritis (OA) is activity related and may worsen when joint contact stress becomes excessive due to overloading. Hence, joint alignment and loading are considered to be the key biomechanical determinants for OA. The initiation of pathologic changes in the knee has been described by the mechanism termed, "vicious cycle" in which joint axial malalignment creates excessive stresses to the localized joint cartilage/subchondral bone regions and the surrounding soft tissue which in turn produces more laxity and joint deformity and thus repeats the cyclic degradation mechanism. If this degenerative cycle can be broken with joint alignment surgery such as osteotomy, a procedure to realign the knee joint and thus redistribute joint forces applied to each compartment, performed properly and at the appropriate time, the osteoarthritic disease process can be decelerated and even reversed. The main goals of this paper are to emphasize the importance of accurate preoperative planning for osteotomy in order to properly correct joint alignment, and to justify the application of an existing computer program, OASIS (Osteotomy Analysis and Simulation Software) using plain radiographs to perform appropriate surgical planning. Normal subjects and knee osteotomy patients were studied to establish a database for the purpose of establishing the utility and efficacy of the presently proposed concept. We wish to rationalize knee osteotomy as a preferred and cost-effective treatment for patients with early symptoms of OA in the knee. This paper presents a new concept of preoperative planning for knee osteotomy based on the underlying etiology of the disease and biomechanical viewpoint with strong emphasis on surgical treatment rationales. The established principles in this paper can be applied to other joints of the body and will help implement preventive measures and other non-surgical means to manage patients with axial malalignment or early degenerative changes.

Algorithms↗

PubMed1991

Measurements of carpal bone angles on lateral wrist radiographs.

Measurements of carpal bone angles on lateral wrist radiographs can be of assistance in the diagnostic evaluation of wrist malalignment. A series of 75 normal wrists was examined by use of a standardized radiographic technique. The normal carpal bone angles were determined using the bone axes with the least observer variability (mean and range): radiolunate, -1.02 (-10 to 12), radioscaphoid, 51.80 (35 to 65), and scapholunate, 50.77 (36 to 66). Normal mean values and ranges for intercarpal bone angles may be of assistance in the diagnostic evaluation of ligamentous injury to the wrist.

Adult↗

PubMed2006

[Minimally invasive implantation of a unicondylar knee system].

OBJECTIVE: Unicondylar medial surface replacement of the knee joint by arthrotomy with short incision and in bone-sparing resection technique. INDICATIONS: Unicompartmental medial arthritis of the joint knee. Unilateral osteonecrosis. Posttraumatic unicompartmental gonarthrosis. CONTRAINDICATIONS: Pangonarthrosis. Rheumatoid arthritis. Knee joint instability. Status following osteotomy of the tibial head. SURGICAL TECHNIQUE: The patient should be placed in the supine position with the knee joint uncovered and freely mobile. Short anteromedial skin incision and arthrotomy. Bone-sparing resection at the tibia and femur. Axial malalignment (varus deformity) is not completely corrected. The implants are centered perpendicular to one another. POSTOPERATIVE MANAGEMENT: Early functional postoperative management adapted to the symptoms with pain therapy, local application of ice, passive mobilization on an electric exercise splint and physiotherapy. Full weight bearing is usually possible from the 2nd postoperative day. RESULTS: 28 Accuris unicondylar knee systems were implanted medially in 26 patients (14 women, twelve men) in minimally invasive technique from March 2003 to July 2004. One patient was not included in the evaluation because the operation was changed to a bicondylar surface replacement due to a deep-seated infection. The patients' average age at the time of the operation was 73.8 years. On average, the operation scar was 8.2 cm long. The average quantity of secretion in the Redon drain was 155 ml. The hemoglobin value fell from 13.3 to 12.3 g/dl. The total HSS (Hospital for Special Surgery) Score increased significantly from 55.5 (34-75) to 87.4 (71-95) points. In the follow-up examination, 21 unicondylar knee systems (77.8%) were evaluated as excellent and six (22.2%) as good.

Aged↗

PubMed1991

Observer variability in measurements of carpal bone angles on lateral wrist radiographs.

Determinations of carpal bone angles are used in the clinical evaluation of carpal malalignment. Eleven frequently referred radiological measures in lateral projection of the wrists in 23 wrists were assessed using different definitions of axes. Interobserver- and intraobserver variations were calculated. The standard deviation of the interobserver variation ranged from 2.60 degrees to 18.15 degrees, and the intraobserver variation from 1.89 degrees to 4.66 degrees depending on the angles measured. The use of three angles for the least observer variability in assessment of carpal alignment is recommended. These angles were defined from the following carpal bone axes: radius, the line through the center of the medullary canal at 2 cm and 5 cm proximal to the radiocarpal joint; lunate, the line perpendicular to the tangent of the two distal poles; scaphoid, the tangent of the palmar proximal and distal margins, and capitate, the tangent of the dorsal margin of the diaphysis of the third metacarpal bone (substitute axis).

Adult↗