The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2003
Primary hemiarthroplasty for treatment of proximal humeral fractures.
Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery. ⋯ Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities.
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J Bone Joint Surg Am · Jul 2003
Results of the musculofascial lengthening technique for submuscular transposition of the ulnar nerve at the elbow.
In the absence of a randomized, prospective study comparing different surgical approaches for decompression of the ulnar nerve at the elbow, the choice of an approach relies on the individual surgeon's training and experience. The present report describes the results of a prospective, long-term evaluation of the musculofascial lengthening technique in a large series of patients. In these patients, the degree of ulnar nerve compression was staged with use of a numerical grading system that included measures of both motor and sensory function. ⋯ Surgical decompression of ulnar nerve entrapment at the elbow by means of a musculofascial lengthening technique was associated with an 88% rate of good to excellent results. The results of the present study demonstrate the feasibility of performing a statistical analysis of surgical results by using a numerical grading system to stage the degree of nerve compression. This method may be used to study different surgical techniques for the treatment of this common nerve compression syndrome.
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J Bone Joint Surg Am · Jul 2003
Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive ankles.
The feasibility of replacing the ankle joint has been a matter of speculation for a long time. In recent years, the designs of ankle prostheses have been improved, and three designs, all used without bone cement, currently dominate the market. However, documentation of the clinical results of the use of these prostheses is sparse. We reviewed the intermediate-term results of fifty-one consecutive Scandinavian Total Ankle Replacements (STAR). ⋯ Total ankle replacement may be a realistic alternative to arthrodesis, provided that the components are correctly positioned and are of the correct size. However, the risks of loosening and failure are still higher than are such risks after total hip or total knee replacement.
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J Bone Joint Surg Am · Jul 2003
Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities.
Correction of a distal femoral deformity may prevent or delay the onset of osteoarthritis or mitigate its effects. Accurate correction of deformity without production of a secondary deformity depends on precise localization and quantification of the deformity. We report a technique to correct distal femoral deformities in the coronal plane. ⋯ Percutaneous dome osteotomy combined with temporary external fixation and insertion of an intramedullary nail can correct distal valgus and varus femoral deformities. We attributed the early mobilization of patients and the rapid bone-healing to the limited soft-tissue dissection, the low-energy corticotomy, and the use of intramedullary fixation in our surgical technique.