Orthopedics
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Coalitions of the foot are relatively uncommon abnormalities, occurring in approximately 1% of the population. Talocalcaneal and calcaneonavicular are the most common types of coalitions. Coalitions in the forefoot, however, are rare, with only a small number of case reports in the literature. ⋯ In our patient, rigidity between the first and second metatarsals contributed to a stiff first ray with higher plantar pressures beneath the first metatarsal head with walking. The abnormal kinematics likely contributed to her medial forefoot pain with prolonged ambulation and sports activities. Prompt identification and resection of these less common coalitions affecting the forefoot allows symptomatic relief and restoration of normal kinematics.
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The Echelon Primary femoral stem is an extensively porous coated cylindrical cobalt chrome hip component. A prospective review of 392 Echelon stems revealed excellent survivorship of the stem, with a 99.3% survival rate for aseptic loosening and a 98.3% survival rate for revision for any reason at 8 years. Normalized Western Ontario and McMaster Universities Osteoarthritis Index and short-form health survey outcome scores were significantly improved and subsequently maintained after replacement, with 82% of patients obtaining a good or excellent result at the mean follow-up period. There have been no changes in manufacture or design of the stem during the review period.
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This article describes a case of a patient with a type II-variant, unstable distal clavicle fracture that was successfully treated with a novel arthroscopic technique using the Tightrope system (Arthrex, Naples, Florida). The arthroscope was placed into the anterolateral portal after a bursectomy was performed. An anterior portal was made lateral to the coracoid using superficial landmarks and arthroscopic visualization. ⋯ Once the inferior button was pulled out of the coracoid drill hole, the button was deployed to anchor it under the inferior coracoid. With the fracture held reduced, the Tightrope was tied down over the superior clavicle, obtaining reduction and fixation of the distal clavicle fracture. Fracture consolidation was confirmed at 3 months, and the patient returned to painless, unrestricted activity at 5 months.
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Pedicle screw fixation is frequently used for spinal fusion in elderly patients. The application of pedicle screw fixation for elderly patients with degenerative lumbar disease remains controversial due to problems such as surgical invasion, osteoporosis, and cost performance. Outcomes of spinal fusion using pedicle screw fixation were evaluated in patients older than 70 years with lumbar spinal canal stenosis. ⋯ The grade of independence (Independence [Bedridden] Criteria of the Daily Life of the Impaired Elderly) had been rank J (life independence) in all patients 1 year preoperatively, but deteriorated to rank A1 (capable of going out with a helper) in 51.8% of patients and rank B1 (using a wheelchair) in 19.8% immediately preoperatively. The grade of independence was rank J in 85.6% of patients 3 years postoperatively and remained rank J in 40 (87.0%) of the 46 who were alive 10 years postoperatively. Few complications associated with surgical invasion were found, and the grade of independence tended to remain at a high level for 10 years postoperatively.