The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Jan 2009
Randomized Controlled TrialDetection of traumatic arthrotomy of the knee using the saline solution load test.
The saline solution load test helps to determine if a wound extends into the knee joint. Little is known about the volume of injected intra-articular saline solution that is needed to effectively rule in or rule out a traumatic arthrotomy of the knee. The purpose of the present study was to determine the appropriate volume and needle location for the diagnosis of a traumatic knee arthrotomy and to assess the effect of associated variables, including knee circumference, body mass index, and sex. ⋯ In order to detect 95% of 1-cm inferolateral arthrotomies of the knee with use of the saline solution load test, 155 mL must be injected. An inferomedial injection location requires significantly less fluid than a superomedial injection location does for the diagnosis of inferolateral arthrotomies of the knee.
-
J Bone Joint Surg Am · Jan 2009
Surgical treatment of early wound complications following primary total knee arthroplasty.
Wound-healing problems are a known complication after primary total knee arthroplasty. However, little is known about the clinical outcomes for patients who require surgical treatment of these early wound-healing problems. The purpose of the present study was to determine the incidence, risk factors, and long-term sequelae of early wound complications requiring surgical treatment. ⋯ Patients requiring early surgical treatment for wound-healing problems after primary total knee arthroplasty are at significantly increased risk for further complications, including deep infection and/or major subsequent surgery, specifically, resection arthroplasty, amputation, or muscle flap coverage. These results emphasize the importance of obtaining primary wound-healing after total knee arthroplasty.
-
J Bone Joint Surg Am · Jan 2009
Anterior-posterior and rotatory stability of single and double-bundle anterior cruciate ligament reconstructions.
Some surgeons presently reconstruct both the anteromedial and posterolateral bundles of the anterior cruciate ligament. The purposes of this study were to measure the abilities of single-bundle and anatomic double-bundle reconstructions to restore anteroposterior laxities and rotational kinematics to intact knee levels and to compare graft forces in reconstructed knees with forces in the native anterior cruciate ligament for the same loading conditions. ⋯ The single-bundle reconstruction produced graft forces, knee laxities, and coupled tibial rotations that were closest to normal. Adding a posterolateral graft to an anteromedial graft tended to reduce laxities and tibial rotations, but the reductions were accompanied by markedly higher forces in the posterolateral graft near 0 degrees that occasionally caused it to fail during tests with internal torque or anterior tibial force.
-
J Bone Joint Surg Am · Jan 2009
Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction.
The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy. ⋯ The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction.
-
J Bone Joint Surg Am · Jan 2009
Comparative StudyComparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model.
There is much to learn about the effectiveness of different methods currently used for the irrigation of open wounds. The purpose of this study was to compare various approaches in a survival animal model. ⋯ Approaches used to remove bacteria from wounds, such as irrigants other than saline solution or high-pressure devices, may not have the best clinical outcome.