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PubMed1976

Bilateral total hip arthroplasty: a simultaneous procedure.

Fifty patients undergoing bilateral total hip replacement as a simultaneous procedure at the Indiana University Medical Center were compared with 50 patients undergoing unilateral total hip replacement. There was an increase in phlebitis and myositis ossificans in the patients undergoing bilateral total hip replacement and while their range of motion was less, there was no difference in mortality with one death in each group. The hospital time for patients in the bilateral group averaged 1 week longer than for those with unilateral hip replacement. The operating time and blood loss in patients of the bilateral group was approximately twice that of patients in the control group. There have been no infections as yet in the bilateral group. On the basis of these preliminary results, we can consider bilateral total hip arthroplasty feasible although it carries a slightly increased risk.

Adult↗
PubMed2005

A series of 146 peripheral non-neural sheath nerve tumors: 30-year experience at Louisiana State University Health Sciences Center.

OBJECT: This is a retrospective review of 146 surgically treated benign and malignant peripheral non-neural sheath tumors (PNNSTs). Tumor classifications with patient numbers, locations of benign PNNSTs, and surgical techniques and adjunctive treatments are presented. The results of a literature review regarding tumor frequencies are presented. METHODS: One hundred forty-six patients with 111 benign and 35 malignant PNNSTs were treated between 1969 and 1999 at the Louisiana State University Health Sciences Center (LSUHSC). The benign tumors included 33 ganglion cysts, 16 cases of localized hypertrophic neuropathy, 12 lipomas, 12 tumors of vascular origin, and 11 desmoid tumors. There were four each of lipofibrohamartomas, myositis ossificans, osteochondromas, and ganglioneuromas; two each of meningiomas, cystic hygromas, myoblastoma or granular cell tumors, triton tumors, and lymphangiomas; and one epidermoid cyst. The locations of benign PNNSTs were the following: 33 in the brachial plexus region, 39 in an upper extremity, one in the pelvic plexus, and 38 in a lower extremity. The malignant PNNSTs included 35 surgically treated carcinomas, 15 of which originated in the breast and nine in the lung. There were two melanomas metastatic to nerve and one tumor each that had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus. CONCLUSIONS: There were more benign PNNSTs than malignant ones. Benign tumors were relatively equally distributed in the brachial plexus region and upper and lower extremities, with the exception of the pelvic plexus, which had only one tumor.

Academic Medical Centers↗
PubMed1986

External callus formation of closed femoral shaft fractures treated by medullary fixation.

Various radiographic patterns were observed for external callus formation of closed femoral shaft fractures treated by closed and open medullary Rush pin fixation. Closed pinning tends to form more adequate lateral callus, to have less looping of bridging callus over the cortex, and to form smooth, dense callus. Open pinning tends to form less lateral callus, to have more looping (radiolucent space under callus) of the callus over the cortex and fracture site, and to have areas of exuberant callus with the appearance of myositis ossificans. The circulatory status of the cortex and soft tissues seem to be a factor in these callus patterns. Avascular cortex of shaft fractures is inferred by the radiographic findings of bridging callus loops over the cortex, relative increased density of cortical bone, and resorption of cortical bone.

Bone Nails↗
PubMed1987

Revision total hip replacement without trochanteric osteotomy.

Revision total hip replacement has traditionally required a trochanteric osteotomy for successful cement removal and component reinsertion. In this study the authors have concluded that in most instances the revision total hip replacement procedure can be successfully performed without trochanteric osteotomy. The advantages are underscored by the high percentage of trochanteric complications with trochanteric osteotomy for revision total hip replacement and the ease of rehabilitation without trochanteric osteotomy. Also, improved functional results without trochanteric osteotomy were noted. The specific indications for the procedure included revision total hip replacement with ununited prior trochanteric osteotomy, revision total hip replacement with femoral shaft fractures, and revision total hip replacement with stem fractures requiring only acetabular revision. The contraindications to the procedure are fibrous union or ununited trochanteric osteotomy from prior total hip replacement, severe acetabular protrusion of the acetabular component, advanced myositis ossificans, ankylosis of the hip, and advanced proximal femoral osteoporosis. The operating room records, x-rays, and outpatient records of 63 total hip revisions in 52 patients were reviewed. There was a minimum 2-year follow up with a range from two years to seven years. The patients were divided into two groups, comparing 21 trochanteric osteotomized revisions to 44 with trochanteric sparing techniques. Both groups were analyzed for age, type of implant, intraoperative perforation of femur, intraoperative femoral shaft fractures, intraoperative cortical window, component malpositioning extraneous cement, intraoperative blood loss, operating time, postoperative leg length inequality, persistent abductor weakness, average first day of ambulation, wound infection, dislocation, nonunion of the trochanter, and postoperative pain. In the nonosteotomized group, there was a 21% decreased blood loss, a 14% decrease in persistent abductor weakness, a 14% decrease in subluxation and dislocation, a 30% decrease operating time and a 50% reduction in intraoperative femoral perforation. In the osteotomized group there were six cases of fibrous union of the greater trochanter, two cases requiring removal of broken wires for trochanteric bursitis. A detailed surgical technique and representative cases are presented. In carefully selected cases, revision total hip replacement is optimally performed without trochanteric osteotomy. Postoperative trochanteric problems of nonunion, broken wires, bursitis, and abductor weakness can effectively be eliminated by avoiding trochanteric osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Elbow heterotopic ossification in head-trauma patients: diagnosis and treatment.

Heterotopic ossification is a disorder characterized histologically and radiographically by normal bone formation in soft tissues that normally have no ossification properties. In severe head-trauma patients, a high incidence of heterotopic ossification occurs. The diagnosis of this pathology in these patients often is difficult for residual neurological damage. The etiology of heterotopic ossification following head trauma is unknown. Similarities have been found between heterotopic ossification and myositis ossificans, a hereditary autosomal dominant disease.

Adolescent↗
PubMedDate not supplied

From bathtub ring to osteoporosis: a clinical review of the bisphosphonates.

BACKGROUND: Etidronate and pamidronate are bisphosphonates, a class of chemical compounds originally used to soften hard water and prevent soap scum. Etidronate was serendipitously found to abate calcification in a child with myositis ossificans progressiva. OBJECTIVE: Review the basic pharmacology of these compounds, as well as clinical uses of the approved and nonapproved forms. DISCUSSION: Etidronate is approved for the treatment of hypercalcemia, Paget's disease of bone, and ectopic calcification, and has been used to treat hyperparathyroidism and nephrolithiasis with limited success. Recently it has been used to treat osteoporosis. Pamidronate is approved to treat hypercalcemia. These two drugs are the only bisphosphonates available in the United States. CONCLUSIONS: Clinical trials with etidronate have aroused widespread interest in the application of bisphosphonates to treat osteoporosis. Many trials are underway to evaluate these new drugs. More information will be available within the next 5 years.

Calcium Metabolism Disorders↗
PubMedDate not supplied

Extremity fractures in the patient with a traumatic brain injury.

Extremity fractures are common in patients with traumatic brain injuries (TBIs). These injuries are often inadequately treated and occasionally are completely missed due to the unique problems inherent to the TBI patient. However, appropriate evaluation of the TBI patient allows prompt diagnosis and optimal treatment of extremity fractures. The increased survival rate of these patients has resulted in a greater emphasis on minimizing dysfunction and disability, especially that due to concomitant orthopaedic trauma. Advances in anesthestic technique permit earlier operative fixation of extremity fractures. Most injuries, particularly those in the lower extremity, require operative stabilization to allow early mobilization and rehabilitation. Upper extremity fractures are often associated with peripheral nerve injuries. Heterotopic ossification is common, especially about the elbow and hip. Contrary to prevalent belief, fracture healing is not necessarily accelerated in the TBI patient; hypertrophic callus, myositis ossificans, and heterotopic ossification occur frequently and are often misperceived as accelerated healing.

Adult↗
PubMed1999

Bone dysplasia series. Melorheostosis: review and update.

Melorheostosis is a rare nongenetic developmental anomaly first described in 1922 by Léri and Joanny. Its etiology is unknown. Patients present at any age, and both sexes are affected equally. Onset is usually insidious, with deformity of the extremity, pain, limb stiffness and limitation of motion in the joints first manifesting in late childhood or early adolescence and progressing into adult life. The characteristic radiographic appearance consists of irregular hyperostotic changes of the cortex, generally on one side of the bone, resembling melted wax dripping down one side of a candle. This appearance gave the anomaly its name, which is taken from the Greek words for member (melos) and flow (rhein). There is usually a distinct demarcation between the affected and normal bone. Dense, sclerotic linear areas are seen mainly in the cortex but also extending into the cancellous bone. Melorheostosis affects mainly the long bones of the upper and lower limbs, but also the short bones of the hand and foot and, rarely, the axial skeleton. It may co-exist with osteopoikilosis and osteopathia striata as well as with tumours or malformations of blood vessels or lymphatics. Soft-tissue ossifications at the site of the joint are common. Bone scintigraphy is positive and shows moderately increased uptake of tracer. Computed tomography and magnetic resonance imaging can further characterize the lesion, but rarely contribute to the diagnosis. The forme fruste of melorheostosis may mimic other conditions such as myositis ossificans, osteoma and parosteal osteosarcoma. Treatment of this chronic and sometimes debilitating condition consists of surgical soft-tissue procedures and even, in very severe cases, amputation.

Adolescent↗
PubMed1999

Case report: paraarticular soft-tissue osteoma of the hip.

A case of paraarticular soft-tissue osteoma of the hip is presented. The patient is a 30-year-old white male with a two year history of progressive left hip pain. Plain film and cross-sectional imaging in conjunction with pathologic correlation are used to make the diagnosis. The lesion lacks the typical zoning pattern of myositis ossificans, shows no direct communication with native bone, and is extraarticular in location as opposed to synovial osteochondromatosis. Soft tissue osteomas most commonly occur around the knee, the foot, and the ankle. Soft tissue osteomas are rare tumors and this case is unusual in that it occurs around the hip.

Adult↗
PubMed2000

The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopedic oncologist and musculoskeletal pathologist.

Soft tissue masses are common in both children and adults. Clinicians must evaluate patients carefully to avoid management errors. The most effective management decisions are made when a working group composed of clinicians, radiologists, and pathologists participates in the interpretation of the imaging studies. Plain-film radiographs and MR imaging scans are the two main imaging modalities used in patients with soft tissue masses. The working group assimilates the clinical and radiographic data to determine if they can identify the nature of the soft tissue mass. When the group can assign a definitive diagnosis, the lesion is designated as a determinate lesion. Determinate lesions include lipomas, ganglions, hemangiomas, neurofibromas, diabetic myonecrosis, muscle tears, myositis ossificans (heterotopic ossification), and pigmented villonodular synovitis. When the process cannot be identified, the lesion is classified as indeterminate. All soft tissue sarcomas are indeterminate lesions. Many benign lesions are also indeterminate. Common examples include schwannomas, myxomas, and giant cell tumor of tendon sheath. Based on the clinical and radiologic features, these diagnoses may be suspected, but because of the inability to distinguish them from sarcomas based on the MR imaging features, they are usually classified as indeterminate. When lesions are judged to be determinate, observation or excisional biopsy are the two major treatment choices. When lesions cannot be identified on the imaging studies, incisional or needle biopsy is performed to establish a diagnosis. Once a diagnosis is made, the proper management choice can be selected. Inappropriate excisional biopsy is the major treatment error in the management of soft tissue tumors. When a high-grade soft tissue sarcoma is resected with multiple positive margins, the risk of local failure after definitive resection is much higher than if the patient had been treated initially with only a needle or incisional biopsy. Also, if a major complication, such as an infection, a major wound-healing problem, or contamination of the major neurovascular structures, occurs at the time of incisional biopsy, amputation of the limb may be necessary. Inappropriate excisional biopsy can occur when a surgeon is not familiar with the features of sarcomas or when a radiologist mistakenly interprets the signal features as a benign lesion.

Adult↗
PubMed2000

Gradual reduction of supracondylar fracture of the humerus in children reporting late with a swollen elbow.

AIM: To study the outcome of gradual reduction by skin traction of supracondylar fracture of the humerus in children with swollen elbow, who seek treatment two days or longer after the injury. METHOD: Fifteen children aged between 4 and 11 years (average 7 years 11 months), who had initially consulted a traditional practitioner, reported between 2 and 21 days (average 7.5) after the injury were treated by skin traction with the elbow kept straight and the forearm in position of comfort. RESULTS: The average duration of stay in hospital was 14 days. All fractures healed; there was no incidence of myositis ossificans or neurovascular deficit. All patients had functional range of movements at the elbow within 6 months. Five patients developed cubitus varus deformity greater than 5 degrees, they were classified as poor result. Four out of these 5 patients had sought treatment after a delay of 7 days or longer. There were 9 good (60%), 1 fair (7%) and 5 poor (33%) results. CONCLUSION: Gradual reduction by skin traction is safe. It is possible to achieve satisfactory reduction if the delay is up to 7 days. The results with regards to deformity and function were comparable with those obtained following open or closed Kirschner wire fixation.

Child↗
PubMed2000

The results of open reduction and pin fixation in displaced supracondylar fractures of the humerus in children.

The treatment of displaced supracondylar fracture humerus (Gartland Type III) in children continues to be a challenging problem. We did a retrospective study of such fractures treated in Hospital Muar, over a 2 years period (from January 1998 to December 1999). A total of 42 cases with displaced supracondylar fractures, treated with open reduction and internal fixation were studied. All cases were operated using a posterior triceps splitting approach and crossed kirschner wires were used to stabilize the fracture site. An excellent outcome was seen in 34 patients (81%) and a good outcome in 7 patients (17%). The incidence of complications such as pin tract infection (14%), nerve injury (2%) was very low. None of the patients had vascular complications or myositis ossificans.

Bone Nails↗
PubMed2002

Use of bisphosphonates in children and adolescents.

The bisphosphonates are chemically simple compounds that have been used mainly for the treatment of osteoporotic conditions and for hypercalcaemia. They have had relatively limited use in children. Their action is principally to interfere with the activity of osteoclasts by causing apoptosis. Their use in children has been for problems of soft tissue calcification (e.g. idiopathic arterial calcification, myositis ossificans progressiva and dermatomyositis), hypercalcaemia (e.g. caused by malignancy, immobilisation or hyperparathyroidism), generalised bone disease (e.g. osteogenesis imperfecta, idiopathic juvenile osteoporosis and steroid-induced osteoporosis) and localised bone disease (e.g. Gaucher's disease and McCune-Albright syndrome). In general they cause few short-term side effects although the long-term side effects have yet to be determined, but are probably relatively unimportant. The bisphosphonates are likely to prove a useful addition to the armamentarium of treatment modalities for bone disease in children.

Adolescent↗
PubMed2003

Computed tomography-guided core needle biopsy for bone and soft tissue tumors.

BACKGROUND: Imaging-guided core needle biopsy is a well-established technique for the diagnosis of bone and soft tissue tumors and tumor-like lesions in specialized orthopedic oncology centers. OBJECTIVE: To present our results of computed tomography-guided core needle biopsy with assessment of the accuracy of the technique. METHODS: Between July 1998 and October 2000, 215 CT-guided core needle biopsies were performed and histologically examined in the Unit of Bone and Soft Tissue Pathology, Tel Aviv Sourasky Medical Center. There were 80 soft tissue and 135 bony lesions. All biopsies were performed by the same radiologist and the histologic examination by the same pathologist. To assess the accuracy of the procedure, we compared the diagnosis at biopsy with the diagnosis after definitive surgery (when available). RESULTS: Bone core needle biopsy (n = 135) showed malignancy in 89 cases (primary or recurrent bone sarcoma, lymphoma, myeloma, metastatic carcinoma or melanoma). There were 29 benign lesions. In 17 cases the result was inconclusive and an open incisional biopsy was performed. Of the 80 soft tissue biopsies, 35 were malignant (25 soft tissue sarcomas, 6 lymphomas, 4 metastatic carcinomas); 40 were benign (myositis ossificans, neurofibroma, desmoid tumor, schwannoma, hematoma and others), and 5 were inconclusive and followed by an open incisional biopsy. The core needle biopsy histologic diagnosis was compared with that of the definitive surgery and the diagnostic accuracy was 90%. Only three samples initially diagnosed as benign turned out to be malignant. No significant complications occurred during the procedures. CONCLUSIONS: CT-guided CNB of musculoskeletal lesions is a safe and effective procedure that assures sufficient and proper material for histologic examination. The accuracy of this method in our center was 90%. Tumor sampling is extremely important, especially in soft tissue sarcomas, and cores should be taken in different directions, including areas of necrosis. The processing is quick, especially for bone CNB, and diagnosis can be achieved within 24 hours. The material undergoes excellent fixation and the immunostains are reliable.

Biopsy, Needle↗
PubMed2003

[Surgical treatment of tibial plateau fractures].

OBJECTIVES: This study was designed to determine surgical indications in tibial plateau fractures and to evaluate the effect of surgical treatment on the outcome. METHODS: Forty patients (12 women, 28 men; mean age 39 years; range 18 to 75 years) underwent surgical treatment for 41 tibial plateau fractures. Final evaluations included 37 patients (38 knees). Fractures were classified according to the Schatzker's system, being type 1 (11 fractures), type 2 (11), type 3 (1), type 4 (6), type 5 (5), and type 6 (7). The indications for surgery were defined as the presence of depression, displacement, and instability being greater than 4 mm, 10 mm, and 10 degrees, respectively. The mean follow-up was 35.8 months (range 6 to 107 months). RESULTS: Clinical results were assessed using the Rasmussen criteria. Successful results accounted for 86.8%. The results were excellent, good, moderate, and poor in 14 knees (36.8%), 19 knees (50%), three knees (7.9%), and 2 knees (5.3%), respectively. Postoperative complications included deep (2 patients) and superficial (2 patients) infections, malunion in two patients, arthrofibrosis in three patients, and myositis ossificans in one patient. Radiologic evaluations were based on the Resnic and Niwayama's system, which showed successful outcome in 73.6%. The results were excellent in 11 knees (28.9%), good in 17 knees (44.7%), moderate in six knees (15.8%), and fair in four knees (10.6%). CONCLUSION: In order to achieve satisfactory results in tibial plateau fractures that meet surgical indications including depression (>4 mm), displacement (>10 mm), and instability (>10 degrees), special attention should be given to obtain a rigid osteosynthesis with early mobilization and to avoid weight-bearing until bone healing is completed.

Adolescent↗
PubMed1952

BRITTLE man.

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Humans↗