Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyConservative and operative treatment in cervical burst fractures.
The aim of this study is to compare the results of non-operative and anterior operative treatment of cervical burst and flexion teardrop fractures. Sixty-nine consecutive patients treated during 1980 to 1995 were reviewed retrospectively. Thirty-four of them had been treated with skull traction or halo-vest and 35 with anterior decompression, bone grafting and fixation by an anterior Caspar plate. ⋯ Kyphosis and spinal canal encroachment by retropulsed fragments were measured radiographically. Operatively treated patients recovered more often with at least one Frankel grade (P = 0.027) and presented less narrowing of the spinal canal (P = 0.0006) and kyphotic deformity (P = 0.00003) at the end of the followup. In comparison with the conservative methods, the operative Caspar technique provided superior decompression and fixation as well as promoted the healing of cord injuries caused by burst and flexion teardrop fractures.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyBigger size and defatting of bone chips will increase cup stability.
Morcellised bone allograft in an in vitro model was used to test the tendency towards cup rotation using small or larger fragment sizes of an impacted graft bed and different fat contents. A cup cemented on an impacted graft bed of larger sized bone chips from the Howex bone mill containing natural marrow fat was loaded eccentrically until the cup rotated. ⋯ The smaller sized bone chips from the Tracer bone mill defatted in a similar manner required only 1950 N for cup rotation. The conclusion was that larger sized chips, partly defatted, prevent rotation of a cup cemented on a graft bed.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyHistological and microbiological findings in non-infected and infected revision arthroplasty tissues. The OSIRIS Collaborative Study Group. Oxford Skeletal Infection Research and Intervention Service.
An assessment of clinical and laboratory findings is generally required to distinguish between septic and aseptic loosening of a hip implant. In order to evaluate the diagnostic utility of histological and microbiological investigative techniques to differentiate between these two conditions, we analysed their results in 617 patients with hip implant loosening. Histology and microbiology study confirmed the clinical diagnosis of septic loosening in approximately 98% and 89%. respectively. ⋯ In all but 2 of 81 cases of septic loosening, in which an organism was isolated on microbiological culture, the histological diagnosis of septic loosening was made on the basis of the degree of the acute inflammatory infiltrate (i.e. the presence of 1 or more neutrophil polymorphs per high power field (x 400) on average after examination of at least 10 high power fields) in periprosthetic tissues. In 10 patients for whom there was a strong clinical suspicion of septic loosening but no organisms were isolated on microbiological culture, the histological findings, using the above criteria, were in keeping with the clinical diagnosis of septic loosening. As almost 11% of cases of septic loosening would not have been diagnosed by microbiological investigation alone, our findings indicate that histological examination of periprosthetic tissues should form part of the investigative protocol to distinguish between aseptic and septic loosening.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsRotational acetabular osteotomy for severely dysplastic acetabulum.
The operative procedures chosen for arthrosis with severe acetabular dysplasia vary among orthopaedic surgeons. We operated on 250 hips using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa [8]. In this report, we describe the technique of RAO and the results of this procedure in patients with severely dysplastic hips. ⋯ After acetabular osteotomy with straight and curved osteotomes, smooth inferolateral rotation could be done in all cases. At the latest follow-up symptoms were improved remarkably, especially pain. Radiographically, adequate coverage of the femoral head was achieved and joint congruence improved in all 6 hips.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsOperative treatment of destructive spondyloarthropathy of the lumbar spine in a patient on chronic dialysis.
We present a patient with end-stage renal disease treated by chronic dialysis, in whom progressive destructive spondyloarthropathy of the lumbar spine was successfully managed by fusion with internal fixation, resulting in relief of pain and restoration of activity.