Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2000
Bipolar hemiarthroplasty for osteonecrosis of the femoral head. A 7- to 18-year followup.
This study evaluated clinical and radiographic results of bipolar hemiarthroplasties for the treatment of osteonecrosis of the femoral head. Forty-eight hips in 35 patients with a mean age of 37 years who underwent primary bipolar hemiarthroplasties were observed for an average of 11.4 years. Osteonecrosis was associated with corticosteroid use (21 patients), alcohol (six patients), idiopathic (four patients), and other conditions (four patients). ⋯ Radiographic proximal migration greater than 4 mm and osteoarthritic signs of the acetabulum indicated a high risk of groin symptoms. The results were inferior to those previously reported for total hip arthroplasty. Thus, for the treatment of osteonecrosis of the femoral head in which necrotic lesions are wide, the authors no longer use this system and currently use total hip arthroplasty.
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Clin. Orthop. Relat. Res. · May 2000
Historical ArticleHospital for special surgery. A brief review of its development and current position.
On May 1, 1999, the Hospital for Special Surgery was 136 years old. To present a history that does adequate justice to the many people, who have been or still are involved in the making of it, is an impossible task. Nevertheless, this document is important because the hospital, first under the name of Ruptured and Crippled and then under that of Special Surgery has played such an important role in the development of orthopaedics and rheumatology in America during the past century. ⋯ The account begins with a description of the hospital's current situation, physical layout and governance. A terse history of the hospital's origin and subsequent development follows, which includes a more specific description of the growth of its orthopaedic surgical services. Finally, separate records of the 112-year-old Postgraduate Orthopaedic Educational Program and 44-year-old Research Division are presented.
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Clin. Orthop. Relat. Res. · Apr 2000
Radial and axillary nerves. Anatomic considerations for humeral fixation.
Because the axillary and radial nerves can be injured during operative exposure and fixation of the humerus, accurate delineation of their location is vital to avoid complications. The authors investigated the relationship of the radial and axillary nerves for radiographically and surgically identifiable bony landmarks. Fifty fresh human cadaveric upper extremities were dissected to identify the nerves as they crossed the lateral intermuscular septum and the humeral surgical neck, respectively. ⋯ Anteroposterior locking screws placed into the proximal humerus endanger the axillary nerve because it lies directly over the posterior cortex as little as 0.7 cm from the surgical neck. As the radial nerve crosses the lateral intermuscular septum more proximal than generally was thought, it is at risk during implant insertion in the distal half of the humerus. Using measurements calculated from preoperative and intraoperative imaging, the approximate position of the nerve could be determined to better plan fixation method and implant location.
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Clin. Orthop. Relat. Res. · Apr 2000
The role of journal clubs in orthopaedic surgery residency programs.
Journal clubs have a long history in graduate medical education; however, their role in orthopaedic surgery residencies has not been analyzed. The 161 orthopaedic residency program directors in the United States and Canada were surveyed to determine the frequency, format, and goals of journal clubs. ⋯ Program directors rate teaching residents how to evaluate a scientific article as the most important goal of a journal club. Although journal clubs are virtually universal in orthopaedic programs, additional study is needed to assess their efficacy and optimal format.
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Clin. Orthop. Relat. Res. · Apr 2000
Review Case ReportsLiposarcoma associated with multiple intramuscular lipomas. A case report.
A 71-year-old slender, previously healthy man was admitted to the authors' institution because of a huge painless mass in his left scapular area. Physical examination revealed a second soft tissue mass in his right scapular region and a third soft tissue mass in the anterior side of his right shoulder. ⋯ A review of the literature showed two cases of retroperitoneal liposarcoma associated with multiple subcutaneous lipomas and two cases of liposarcoma involving an extremity associated with multiple subcutaneous lipomas. There is no previous report in which intramuscular liposarcoma was associated with multiple intramuscular lipomas.