Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2001
Extracorporeal shock-wave therapy for chronic lateral tennis elbow--prediction of outcome by imaging.
Today the clinical use of extracorporeal shockwave application (ESWA) for the treatment of lateral tennis elbow is hampered by the lack of results from randomized controlled trials and of predictive parameters of clinical outcome. The present prospective study aimed to provide the latter by means of magnetic resonance imaging (MRI). Twenty-three female and 19 male patients with unilateral chronic tennis elbow of the dominant site were clinically examined before and after repetitive low-energy ESWA. ⋯ For female patients, MRI scans could be applied for predicting a positive clinical outcome of ESWA. This study reports the first indication of predictability of positive clinical outcome of the treatment of chronic lateral tennis elbow by ESWA using imaging prior to treatment. This may serve as an important step towards overcoming the therapeutic nihilism with respect to the non-operative management of this condition recently in the literature.
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Arch Orthop Trauma Surg · Jul 2001
ReviewNine-year results of Müller cemented titanium Straight Stems in total hip replacement.
At the Orthopaedic Department of the University of Basel, a total of 540 cemented Müller titanium alloy (Ti6Al7Nb) Straight Stems were inserted between 1989 and 1993. A cohort of 120 consecutive patients (66 women, 54 men) with 126 prostheses operated on between March and December 1989 were followed clinically and radiologically in a prospective manner for a mean observation time of 9.1 years. In all cases, the Müller titanium alloy Straight Stem was combined with the senior author's (E. ⋯ Our results do not confirm the high rate of osteolysis and revisions with the Müller titanium alloy Straight Stem presented by some other institutions. The verdict on a specific endoprosthetic implant must be made by combined assessment of the design, the implant surface condition, the material, the cement, the cementing procedure and the operative technique. The statement made in earlier publications that cemented titanium alloy should not be used as a femoral stem prosthesis should be reconsidered.
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Arch Orthop Trauma Surg · Jul 2001
Comparative StudyRadiographic evaluation of cervical spine trauma. Plain radiography and conventional tomography versus computed tomography.
Different imaging modalities are available for the diagnosis of cervical spine injuries. There is a controversial discussion about whether plain radiography (PR), conventional tomography (CTO) or computed tomography (CT) should primarily be used. PR and CTO are more often available and less costly than CT. ⋯ For PR and CTO the detection rates were lower for fractures of the dens than for the rest of the cervical spine. We conclude that the combination of PR and CTO accurately detects fractures of the cervical spine compared with CT. If a fracture of the dens is suspected, the patients should be referred to CT due to its superior accuracy in this region.
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Arch Orthop Trauma Surg · Jul 2001
Recovery after carpal tunnel syndrome operation: the influence of the opposite hand, if operated on in the same session.
In a clinical, retrospectively randomised study, we compared the results of the operation for a carpal tunnel syndrome when one side only or both sides were simultaneously assessed in one session. Of the 125 patients examined, 47.2% had both hands operated on in one session, 52.8% had only one hand operated on in one session or both hands in two sessions. ⋯ These are explained by the necessity of using both hands for daily activities and thus a guaranteed functional follow-up treatment after the bilateral operation. In conclusion, we propose operating on both hands simultaneously whenever possible, even if the opposite hand presents with only a slight CTS, which would otherwise not be considered for operation yet.
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Arch Orthop Trauma Surg · Jul 2001
Comparative StudyOn the impact of calcified deposits within the rotator cuff tendons in shoulders of patients with shoulder pain and dysfunction.
We wanted to prove the hypothesis that calcified deposits within the rotator cuff tendons are merely an epiphenomenon of complex morphological alterations in the shoulders of patients with shoulder pain and dysfunction. The shoulders of 92 patients with calcified deposits within the rotator cuff tendons as noted on plain radiographs were investigated by means of magnetic resonance imaging (MRI; mean age of patient 51.1 years), as well as the shoulders of 28 age- and sex-matched patients with similar clinical symptoms but without any signs of such calcified deposits on plain radiographs. The MRI protocol comprised a coronal, oblique, T1-weighted, spin-echo sequence, a T2-weighted, turbo spin-echo sequence, a sagittal, oblique, T2-weighted, turbo spin-echo sequence, and an axial, T1-weighted, spin-echo sequence. ⋯ The MRI investigations showed no substantial differences between patients with or without calcified deposits within the rotator cuff tendons, but distinct differences between such patients and healthy, asymptomatic volunteers. For patients with shoulder pain, shoulder dysfunction, and calcified deposits within the rotator cuff tendons, these calcified deposits are most probably not the main cause of the clinical symptoms. Rather, it seems to be useful to consider the results of MRI investigations whenever planning therapeutic procedures for patients with shoulder pain and dysfunction, irrespective of whether or not there are signs of calcified deposits within the rotator cuff tendons on plain radiographs.