Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty.
We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version; DJOA) and 50 flexible silicone Swanson implants. ⋯ Secondly, adequate coaptation cannot be achieved with this prosthetic design, even in the presence of extensive soft-tissue reconstruction. Thirdly, the use of polyethylene in MP joint replacements is questionable. In contrast, the silicone Swanson implants in our series provided superior results when used as MP implants in the rheumatoid hand.
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Arch Orthop Trauma Surg · Jan 1999
Structural properties of the fibular band in congenital total absence of the fibula.
Nine children with unilateral total congenital absence of the fibula were examined by magnetic resonance imaging (MRI), and histological study of the fibular band was performed in four of them. Both examinations revealed two types of fibular band. ⋯ In type II, the band directly attached to the calcaneus without any evidence of hyaline cartilage, and the feet could be corrected only by total excision. We suggest partial excision of the band in type I and total excision in type II as the initial treatment of congenital total absence of the fibula.
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This study follows the postoperative course of serum collagen type I metabolites in patients after uncomplicated implantation of a cemented total hip endoprothesis (TEP; n = 12, mean age: 69.3 years), a cemented hemiendoprothesis (HEP; n = 13, mean age 79.7 years), a dynamic condylar or hip screw (DCS/DHS; n = 12, mean age 75.1 years) and osteosynthetic treatment of a Weber B or C fracture (OS; n = 17, mean age 54.3 years). The course of the propeptide of human type I procollagen (PICP) as an anabolic marker as well as of I-carboxyterminal telopeptide (ICTP) as a catabolic marker of bone metabolism was characterized. Measurements were done preoperatively and weekly for 3 weeks after surgery. ⋯ In comparison to 54 young and healthy volunteers (median PICP/ICTP ratio: 37), the ratios of the studied groups were still normal but low (median ratios: < 20). This could be an effect of decreasing collagen type I metabolism with age. Although the results are in agreement with animal studies and histomorphometric investigations, the clinical use of PICP and ICTP determination as a tool for the detection of complicated bone healing is limited by the marked interindividual variability and the uncertain bone specificity.
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Arch Orthop Trauma Surg · Jan 1999
The Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in young adults.
The results were evaluated for 29 adult patients (33 hips) who had undergone a Salter innominate osteotomy because of painful developmental dysplasia of the hip (DDH). The mean age at the time of the index operation was 24.8 years (range 19-35 years), and the mean duration of follow-up was 3.5 years (range 2-8 years). Complications included one non-union and one dislocation of the osteotomy after a fall; both patients had to undergo re-operation. ⋯ There was a diminution of coxarthrosis in 11 hips, no change in 17, and worsening in 5 hips. The mean center-edge angle of Wiberg was 11.2 deg (range 0-19 deg) preoperatively compared with 27.4 deg (range 21-37.5 deg) postoperatively and 27.6 deg at the latest follow-up examination. Our findings demonstrate that the Salter innominate osteotomy provides clinical improvement as well as radiographic improvement in adult patients with DDH, and this procedure is, compared with more complex pelvic osteotomies, a relatively simple and safe procedure with a low risk of complications.
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Arch Orthop Trauma Surg · Jan 1999
Case ReportsPrimary reconstruction of traumatic bony defects using allografts.
We retrospectively reviewed 207 patients suffering from traumatic bone defect who had been treated at our institution between 1973 and 1993. Three types of traumatic bone defects were identified: I, minor; II, major cortical; III, major articular. ⋯ Types II and III posed the greatest difficulties in management. However, massive bone allografts can be successfully used in these situations, even in the early phases of treatment, but only given specific prerequisites.