International orthopaedics
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Comparative Study
Cementless total hip arthroplasty with AML, PCA and HGP prostheses.
Two hundred and fourteen patients who had 270 cementless hip prostheses were followed for 2 to 8 years. PCA (Porous-Coated Monatomic), AML (Monatomic Medullary Locking) and HGP (Harris-Galante-Porous) femoral stems and acetabular cups were used without any preference for the prostheses. The overall clinical results were similar for the three prostheses with average Harris hip scores of 93, 93 and 91 respectively. ⋯ There was no loosening in the AML and HGP prostheses. Pain in the thigh, usually slight, occurred in 17% of AML, 21% of PCA and 19% of HGP prostheses. Five years after operation, radiological changes such as migration, calcar remodelling and radiolucent lines were the same for the 3 prostheses, but bony ingrowth was greater with the AML femoral stems.
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The incidence of the major complications of operation have been studied prospectively in 1,722 patients with a proximal femoral fracture treated by either insertion of a hemiarthroplasty, internal fixation with a Dynamic Hip Screw (DHS) or multiple parallel screws. Major complications occurred in 8.0%. ⋯ The most significant benefit from employment of the special team was in reducing the incidence of wound sepsis and of failure of fixation following the operative management of displaced intracapsular and extracapsular fractures. Assigning hip fracture surgery to designated personell will result in a significant reduction in morbidity.
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Review Case Reports
Spontaneous compartment syndrome in a patient with diabetes insipidus.
We describe a case of spontaneous muscle necrosis of the anterior tibial compartment occurring in a patient who had a hypophysectomy for a craniopharyngioma five years previously. We know of no other reported cases of spontaneous muscle necrosis in association with diabetes insipidus and feel that there should be increased awareness of the association between the two.
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A new method of reducing both anterior and posterior shoulder dislocations is described. Force is directed along the axis of the joint and minimal effort is required. The method is safe, simple and successful in both recent and delayed cases.
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We have treated 50 patients (52 cases) of entrapment of the sensory branch of the radial nerve in the forearm (Wartenberg syndrome) between January 1988 and July 1992. Conservative treatment achieved 71% excellent and good results. ⋯ The indications for each type of treatment are discussed. De Quervain's disease was associated in 50% of cases, and it is important to diagnose Wartenberg's syndrome before operating on the tenosynovitis in order to avoid unexpected postoperative complications and medicolegal problems.