Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialThe classic nail in the therapy of trochanteric fractures.A prospective, controlled study.
In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric fractures. By means of lateral bending of 4 degrees, unreamed implantation is generally possible. Our collective of 85 patients was characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without relevant additional injuries, and a high rate of concomitant disease (92%). ⋯ The mortality (30 days: 18%, 6 months: 25%) as well as the high rate of unspecific complications (20%) were caused by the patients' multiple morbidity. Deficits in the Merle d'Aubigne score at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.
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Arch Orthop Trauma Surg · Jan 1999
Combined sciatic and femoral nerve block for knee arthroscopy: 4 years' experience.
Selective block of the femoral and sciatic nerves was performed on 601 patients undergoing knee arthroscopy. The results were good in 87%, adequate in 12%, and poor in 1%. ⋯ No correlation was observed between the effectiveness of the anesthesia and type of surgery performed. The technique described thus proved adequate for knee arthroscopic surgery, reproducibility was excellent, costs and hospital stays were reduced with respect to general anesthesia, and surgeon and patient satisfaction was high.
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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 Trial Controlled Clinical TrialCastor oil decreases pain during extracorporeal shock wave application.
In a prospective single-blind study the contact media ultrasound gel, vaseline and castor oil were examined for their effect on surface pain caused by extracorporeal shock waves used for tendinosis calcarea (n = 25), radiohumeral epicondylitis (n = 23) and plantar heel spur (n = 12). A total of 60 patients was divided into six groups. Using a Compact S shockwave source (Dornier MedTech), an energy flux density up to 0.12 mJ/mm2 was applied three times within 3 weeks. ⋯ For the diagnosis of tendinosis calcarea and plantar heel spur, castor oil was significantly better than the other two contact media, while for epicondylitis there was no significant difference. Castor oil was found to have an advantage over ultrasound jelly and vaseline in all indications used with regard to application pain. The positive effect of castor oil can be explained by its cavitation-free quality.
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Arch Orthop Trauma Surg · Jan 1999
Comparative Study Clinical TrialWear of alumina ceramics prosthesis.
To investigate the process of wear in the total knee prosthesis consisting of alumina ceramics (Al-ceramics) and ultra-high molecular weight polyethylene (UHMWP) in vivo, we observed the fine structures of the articular surface of the prostheses used for four patients with osteosarcoma of the distal femur. We also examined the wear debris in the surrounding soft tissues. The prostheses were extracted at autopsy between 13 and 48 months after surgery. ⋯ The streaks had similar widths to the Al-ceramics grains. Al-ceramics debris was detected in the soft tissues around the joint mixed with UHMWP debris. We concluded that the wear of UHMWP in Al-ceramics prosthesis was promoted by interposition of Al-ceramics debris.