Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2009
Randomized Controlled Trial Comparative StudyPre-emptive intra-articular administration of local anaesthetics/opiates versus postoperative local anaesthetics/opiates or local anaesthetics in arthroscopic surgery of the knee joint: a prospective randomized trial.
Arthroscopic surgery on the knee joint is increasingly being performed as day-case surgery. This necessitates adequate postoperative pain therapy. We performed a study to compare three different intra-articular regimens of pain treatment. The hypothesis was that preoperative intra-articular pain management is superior to postoperative procedures. ⋯ This study demonstrated the superiority of the preoperative intra-articular administration of a combination of fentanyl and local anaesthetic over postoperative fentanyl and local anaesthetic or postoperative local anaesthetic alone.
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Traumatic anterior shoulder dislocation in toddlers and pediatric patients is a very rare injury pattern. The treatment and the recurrence rate are mostly extrapolated from adult and adolescent data. ⋯ The 2.5-year-follow-up demonstrated a stable shoulder with free range of motion while still having a Hill-Sachs-lesion. Shoulder dislocation in toddlers maybe addressed less aggressively after closed reduction than in adults due to an unknown recurrence rate.
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Arch Orthop Trauma Surg · Mar 2009
Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation?
Immobilization in external rotation after a first-time traumatic anterior shoulder dislocation has been shown to improve the position of the labroligamentous lesion relative to the glenoid rim. The purpose of the present study was to evaluate the effect of the external rotation position of the shoulder on different types of labroligamentous lesions in patients with first-time traumatic anterior shoulder dislocation by using MRI. ⋯ Placing the shoulder in external rotation after a first-time traumatic shoulder dislocation, significantly improves the position of the labroligamentous lesion on the glenoid rim. Perthes lesions that showed a low grade of plastic deformation displayed better reduction in external rotation and then compared to Bankart or other lesions that showed a high grade of plastic deformation. In conclusion, immobilization of the shoulder after a first-time traumatic shoulder dislocation is most effective in patients with Perthes lesions that show low grade plastic deformation.
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Arch Orthop Trauma Surg · Mar 2009
Rotational instability of the knee: internal tibial rotation under a simulated pivot shift test.
Recently, several publications investigated the rotational instability of the human knee joint under pivot shift examinations and reported the internal tibial rotation as measurement for instrumented knee laxity measurements. We hypothesize that ACL deficiency leads to increased internal tibial rotation under a simulated pivot shift test. Furthermore, it was hypothesized that anatomic single bundle ACL reconstruction significantly reduces the internal tibial rotation under a simulated pivot shift test when compared to the ACL-deficient knee. ⋯ In conclusion, ACL deficiency does not increase the internal tibial rotation under a simulated pivot shift test. For objective measurements of the rotational instability of the knee using instrumented knee laxity devices under pivot shift mechanisms, the anterior tibial translation should be rather evaluated than the internal tibial rotation.
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Arch Orthop Trauma Surg · Mar 2009
Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft.
Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described that address reconstruction of the medial patellofemoral complex. We present a technique, where the MPFL is reconstructed anatomically to restore physiological kinematics and stability, using a free gracilis tendon autograft.