Orthopedics
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The viability of transplanted articular cartilage is one of the determinants of outcome following the transplantation of osteochondral allografts. Disappointing results from cryopreservation have led to the practice of fresh transplantation of articular segments, especially for posttraumatic defects. To date, no studies have demonstrated in vitro viability rates for refrigerated human cartilage awaiting transplantation. ⋯ Specimens were stored at 4 degrees C in culture medium. Results showed an average decrease in 35S-sulfate uptake of 0.8% at 24 hours and 6.4% at 48 hours, indicating a high level of chondrocyte viability after refrigeration. Because transplantation typically is performed within 24 hours of tissue harvest, it appears that nearly 100% of chondrocytes should survive fresh transplantation.
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Five patients with breakage of instrumentation when using the cannulated 3.5 mm screw system for fracture fixation are reported. Four 1.25 mm guide wires were sheared off by the cannulated drill and one 3.5 mm cannulated tap sleeve fractured. This article presents potential dangers when using the cannulated 3.5 mm screw system for general fracture care.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of general and epidural anesthesia in patients undergoing primary unilateral THR.
One hundred ninety-five consecutive patients underwent 195 primary unilateral total hip arthroplasties between January 1988 and December 1993. Patients were divided into three groups based on the type of anesthesia utilized for their procedure. Group I consisted of 108 patients (59 women and 49 men; average age 56 years) who had general endotracheal anesthesia alone. ⋯ Postoperative urinary tract infections correlated with duration of Foley catheterization, but not the duration of epidural catheterization. Significant differences among anesthesia groups were observed for two factors: 1) estimated intraoperative blood loss was highest for Group I (P < .05) and was primarily a function of surgical time (P < .0001), and 2) postoperative Hemovac output (over the first and second postoperative 24-hour periods) was greatest for Group II (P < .05). Epidural anesthesia appears to be a safe modality in patients undergoing primary unilateral total hip replacement.
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The upper extremities of two elderly cadavers were amputated at the fore-quarter level and underwent placement of the Biomet uniflex humeral nail in the left extremities and the Richards Russell-Taylor humeral nail in the right extremities. Distal locking screws were placed lateral to medial in the Biomet nails and in the anterior to posterior plane in the Richards nails. Dissection was performed about the distal humerus to identify the neurovascular structures at risk from screw placement. ⋯ The musculocutaneous nerve was at direct risk with placement of a distal screw from anterior to posterior. Sections of the distal humerus demonstrated the medullary canal to begin narrowing at 3 cm and fill with dense bone 1.5 cm superior to the proximal edge of the olecranon fossa. This may interfere with distal placement of the humeral nail, altering the position of the distal fixation holes, and also may contribute to distraction at the fracture site.
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Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. ⋯ There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.