Archives of orthopaedic and trauma surgery
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The instability of atlanto-axial subluxation remains a challenging problem in patients with rheumatoid arthritis. In order to preserve as much function of the cervical spine as possible, inclusion of the occiput into the fusion should exclusively be performed when there is a radiologically or clinically manifest pathological condition of the atlanto-occipital joint or marked upward migration of the dens axis. ⋯ This article presents a retrospective analysis of the clinical and radiological results of occipito-cervical fusion in 26 patients with rheumatoid arthritis using a modified Brattström technique. The complications encountered were mainly due to the use of wire fixation, reinforcement using bone cement and insufficient reduction of atlanto-axial subluxation.
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Arch Orthop Trauma Surg · Jan 1990
Aseptic osteonecrosis of the humeral trochlea (Hegemann's disease).
A differential diagnosis of diseases affecting the elbow joint in children should also give due consideration to osteonecroses. They are very rare in the context of the humeral trochlea, the case with which we are concerned being one of a total of 15. In the light of this syndrome's relative rarity, we will report on the case of a 7-year-old boy. This is also the first time that a MR image of Hegemann's disease has been shown.
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Arch Orthop Trauma Surg · Jan 1990
Open fractures of the femur treated by the pin-in-plaster technique. Contribution to the art and practice of trauma surgery in the Third World.
In order to cope with the frequent lack of adequate and sufficient external fixator systems in Third World countries, the pin-in-plaster technique was adopted and used in the management of open fractures of the femur. It consists of the use of Steinmann and Schanz pins incorporated into a plaster of Paris cast. ⋯ The advantages and disadvantages of the method are discussed. The method is recommended as an effective improvisation of the Hoffman apparatus for use in exceptional circumstances, such as war and adverse socioeconomic conditions as are found in most Third World countries.
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Arch Orthop Trauma Surg · Jan 1990
Comparative Study Clinical Trial Controlled Clinical TrialFlurbiprofen inhibits heterotopic bone formation in total hip arthroplasty.
A double-blind prospective parallel group study comparing slow-release flurbiprofen with placebo in the control of ectopic bone formation was carried out in 68 patients undergoing total hip arthroplasty. Eight weeks after surgery there was evidence, significant at the 1% level, that the incidence and extent of periarticular calcification was lower in the flurbiprofen group. At an early phase, serum calcium level decreased and after 8 weeks serum alkaline phosphatase level increased more in the placebo group than in the flurbiprofen group, indicating an effect of flurbiprofen on bone mineral metabolism. ⋯ Anti-inflammatory agents such as indomethacin and ibuprofen have turned out effective. Local irradiation also prevents ectopic bone formation, but diphosphonates seem not be effective in this respect. The aim of the present study was to assess the efficacy of flurbiprofen, a new anti-inflammatory agent, in limiting heterotopic bone formation, and to note the frequency and severity of any side effects of the treatment.
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Arch Orthop Trauma Surg · Jan 1990
Review Case ReportsBilateral posterior pendulum dislocation of the shoulder. Case report and review of the literature.
A 20-year-old patient with bilateral voluntary and involuntary dislocation of both shoulders is reported on. There was no history of significant trauma, no systemic hypermobility of joints, no signs of neurological or psychological problems, and no evidence of joint disease. According to Reischauer's classification of shoulder instabilities, the patient suffered from bilateral posterior pendulum dislocations of his shoulders. ⋯ After ruling out the possibility of psychological problems, we performed an operative stabilization by arthroscopic means. At 1-year follow-up the patient reported no recurrence, good shoulder musculature, and no disability at work. This result confirms the unsuspicious psychological evaluation and our therapeutic management.