Orthopedics
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Autogenous bone is regarded as the gold standard for bone graft materials as it provides 3 elements necessary to generate and maintain bone: scaffolding for osteoconduction, growth factors for osteoinduction, and progenitor cells for osteogenesis. Allograft is more limited than autograft in these essential elements and yields more variable clinical results. Composite synthetic grafts offer an alternative that can potentially unite the 3 salient bone-forming properties in more controlled and effective combinations than can be obtained in many clinical situations, without the disadvantages found with autograft. This article examines the underemphasized but crucial role of the osteoconductive scaffold in the composite synthetic bone graft.
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Conservative treatment had previously been used in our institution to treat the painful stiff knee joint following total knee arthroplasty (TKA). However, the result was not satisfactory. Arthroscopic surgery was then performed in 11 patients with painful knee joints with limited motion who had previously undergone TKA. ⋯ Flexion improved up to 90 degrees in all patients in the early postoperative period following arthroscopy. However, the benefits declined with time. To avoid the potential complications of manipulation and open arthrotomy, arthroscopic surgery is an option for treating the painful stiff knee joint.
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The latissimus dorsi often is used as a functional muscle transfer to restore elbow and shoulder motion. Although less common, its use as a pedicled muscle flap with a split-thickness skin graft provides excellent soft-tissue coverage of large upper extremity wounds. Seven male patients ranging in age from 6-71 years were treated with a pedicled latissimus dorsi muscle flap and split-thickness skin graft for coverage of open wounds of the shoulder, arm, or elbow with exposed vital structures (mean wound size: 15x10 cm). ⋯ At mean 16-month follow-up (range: 3-41 months), all muscle flaps had contoured well, producing satisfactory cosmesis. Functional results were good, and all patients were satisfied with their outcome. The tendinous insertion is left intact to guard against excessive traction on the pedicle when the flap is used for soft-tissue coverage only.
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Comparative Study
Comparison of postoperative pain in patients receiving interscalene block or general anesthesia for shoulder surgery.
A retrospective review of 114 patients who underwent elective shoulder surgery from January 1, 1995 to December 31, 1996 was performed. Eighty-eight patients received general anesthesia and 26 patients received regional anesthesia (interscalene block). ⋯ A higher percentage of patients who received regional anesthesia had a lower pain rating at 4 hours. Regional anesthesia for shoulder surgery decreases pain and facilitates recovery in the immediate postoperative period.