The Journal of bone and joint surgery. American volume
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Plantar fasciitis is one of the more common soft-tissue disorders of the foot, yet little is known about its etiology. The purpose of the present study was to use an epidemiological design to determine whether risk factors for plantar fasciitis could be identified. Specifically, we examined the risk factors of limited ankle dorsiflexion with the knee extended, obesity, and time spent weight-bearing. ⋯ The risk of plantar fasciitis increases as the range of ankle dorsiflexion decreases. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m (2) are also at increased risk for the development of plantar fasciitis. Reduced ankle dorsiflexion, obesity, and work-related weight-bearing appear to be independent risk factors for plantar fasciitis. Reduced ankle dorsiflexion appears to be the most important risk factor.
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J Bone Joint Surg Am · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialOperative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study.
To our knowledge, a prospective, randomized study comparing operative and nonoperative treatment of a thoracolumbar burst fracture in patients without a neurological deficit has never been performed. Our hypothesis was that operative treatment would lead to superior long-term clinical outcomes. ⋯ We found that operative treatment of patients with a stable thoracolumbar burst fracture and normal findings on the neurological examination provided no major long-term advantage compared with nonoperative treatment.
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J Bone Joint Surg Am · May 2003
Multicenter StudyGradual femoral lengthening with the Albizzia intramedullary nail.
Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes. ⋯ Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.
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Despite the good results that are usually reported after fixation at the sites of olecranon fractures and osteotomies, problems such as loss of fixation, nonunion, and the need for revision surgery are still encountered. Various types of fixation have been recommended, but few have been evaluated with use of clinically relevant cyclic load testing at appropriate levels of stress. The purpose of the present study was to test multiple olecranon fixation techniques under physiologic cyclic loads. ⋯ The use of a 7.3-mm screw in conjunction with a tension band provided better fixation of simulated displaced transverse fractures than did the use of Kirschner wires in conjunction with a tension band or the use of a screw only. The AO principle of converting posterior tensile forces to articular compressive forces was not demonstrated in this study. We therefore question the validity of the tension band concept in olecranon fracture fixation and recommend passive rather than active range of motion in the immediate postoperative period to limit fracture distraction.
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J Bone Joint Surg Am · May 2003
Glenoid rim morphology in recurrent anterior glenohumeral instability.
Knowledge regarding the morphology of the glenoid rim is important when patients with recurrent anterior glenohumeral instability are assessed. Ordinary imaging techniques are not always sensitive enough to demonstrate the morphology of the glenoid rim accurately. We developed a method of three-dimensionally reconstructed computed tomography with elimination of the humeral head to evaluate glenoid morphology. The purpose of the present study was to quantify glenoid osseous defects and to define their characteristics in patients with recurrent anterior instability. ⋯ We introduced a method to evaluate the morphology of the glenoid rim and to quantify the osseous defect in a simple and practical manner with three-dimensionally reconstructed computed tomography with elimination of the humeral head. Fifty percent of the shoulders with recurrent anterior glenohumeral instability had an osseous Bankart lesion; 40% did not have an osseous fragment but demonstrated loss of the normal circular configuration on the en face view and an obtuse contour on the oblique view, suggesting erosion or compression of the glenoid rim.