Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialRelevance of the drainage along the linea aspera for the reduction of fat embolism during cemented total hip arthroplasty. A prospective, randomized clinical trial.
The aim of this study was to assess the relevance of drainage placed along the linea aspera for the prevention of fat embolism and cardiopulmonary impairment during the insertion of a cemented stem. We studied 40 patients with coxarthrosis randomly allocated to total hip arthroplasty with proximal drainage or without it. The venting hole for the drainage of the medullary cavity was placed posteriorly, between the greater and the smaller trochanter, in the prolongation of the linea aspera. ⋯ After major embolism, the pulmonary shunt values increased significantly in the control group (+22.7%), but there were no marked changes in the drainage group (+7.1%). The logical therapeutic measure to avoid intravasation of bone marrow, fat, and bone debris during the insertion of the femoral component is to prevent the rise of intraosseous pressure. The drainage of the venous system located along the linea aspera significantly reduces the risk of intraoperative embolism and cardiopulmonary impairment.
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We report a case of giant trichoblastoma, a rare benign hair germ tumor. A 73-year-old man presented with a soft-tissue mass on his upper arm. ⋯ The size of the tumor was 9.5 x 7 x 9.5 cm, one of the largest trichoblastomas ever reported. The rarity and gigantic size of the tumor, together with its misleading clinical features, prompted us to report our case.
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialCorrelation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion.
Thirty-two patients with radiographic evidence of scaphoid nonunion were preoperatively evaluated by magnetic resonance imaging (MRI), then observed intraoperatively for punctate bleeding of the fragments. Although MRI and intraoperative findings matched in 19 patients, there was no correlation in 13 patients. ⋯ After internal fixation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.
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Arch Orthop Trauma Surg · Jan 1999
Clinical TrialRotational acetabular osteotomy for advanced osteoarthrosis secondary to dysplasia of the hip. Results at 6-11 years postoperatively.
Clinical and radiological studies were done on the results of rotational acetabular osteotomy for advanced osteoarthrosis secondary to dysplasia of 29 adult hips followed up for 6 to 11 years postoperatively (mean 8 years). Clinical evaluation by Merle d'Aubigne and Postel's system showed improvement from a preoperative mean of 12.8 to a follow-up mean of 14.8, with aggravation being observed in 8 joints. ⋯ The most important factor influencing the postoperative results of this procedure was postoperative joint congruency. If the postoperative joint congruency is satisfactory, with the joint congruent index being more than 6.0, progression of arthrosis can be prevented in the long term by this procedure, even in advanced cases.
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Arch Orthop Trauma Surg · Jan 1999
Clinical TrialEffect of reaming bone grafting on treating femoral shaft aseptic nonunion after plating.
Rigid intramdullary nailing with cancellous bone grafting provided by intramedullary reaming was prospectively used to treat femoral shaft aseptic nonunions after plating. Indications for this technique were a femoral shaft nonunion with an inserted plate, no previous infection sign in the treatment course, less than 1.5 cm shortening, and no segmental bony defects. After the plate was removed, a flexible guidewire was inserted antegradely. ⋯ There were no significant complications. We conclude that for indicated cases, reaming bone grafting is a very effective technique and avoided donor site morbidity. Therefore, whenever possible, this technique could be considered first.