HSS journal : the musculoskeletal journal of Hospital for Special Surgery
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After two decades as the fifth Surgeon-in-Chief (1935-1955) of The Hospital for Special Surgery (HSS), Philip Duncan Wilson, MD (1886-1969) retired, having implemented, during his administration, major changes in the hospital. The first most important accomplishment was finalizing a formal affiliation with New York Hospital-Cornell Medical Center in 1955 and moving adjacent to the medical campus at 535 East 70th Street. The second was changing the name of the Hospital in 1940 from The Hospital for the Ruptured and Crippled to The Hospital for Special Surgery. ⋯ Because of difficulties over a faculty and staff appointment, Dr. Thompson resigned from the office of Surgeon-in-Chief. He was replaced in1963 by Robert Lee Patterson, Jr., MD (1907-1994), who had first joined the staff of The Hospital for the Ruptured and Crippled in 1936 as a Visiting Surgeon.
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Segmental bone defects of the tibia present a challenging problem, particularly when they are associated with soft tissue injuries or instability. Various techniques have been reported to treat bone loss in the tibia. ⋯ At one and a half year follow-up, the patient was able to walk without any support at home and wore a protective shell for outdoor activities. The outcome of this case study indicates that ipsilateral fibular transport using the Ilizarov method is a valuable technique for limb salvage reconstruction.
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Zygapophysial joint (z-joint) pain has long been suggested to be one of the sources of low back pain. Radiofrequency denervation of the medial branches of the dorsal rami to treat z-joint pain is an outpatient minimally invasive treatment option. There have been many short-term studies to determine the outcome of the procedure, but few long-term studies have been conducted. ⋯ Fifty-two percent of patients reported a successful outcome with improved function at a minimum follow-up period of 2 years (mean 3.5 years, range 2-8.8 years). Patients in the failure group were more likely to be older and have moderate to severe neuroforaminal stenosis (77.8%) compared to patients in the success group (24.2%). Radiofrequency denervation in selected patients with chronic zygapophysial joint-mediated low back pain provides long-term reduction in pain and improved function with minimum morbidity.
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In 1933, for the second time in the history of the Hospital for the Ruptured and Crippled (R & C), a general surgeon, Eugene Hillhouse Pool, MD, was appointed Surgeon-in-Chief by the Board of Managers of the New York Society for the Relief of the Ruptured and Crippled. R & C (whose name was changed to the Hospital for Special Surgery in 1940), then the oldest orthopaedic hospital in the country, was losing ground as the leading orthopaedic center in the nation. The R & C Board charged Dr. ⋯ He established orthopaedic fellowships to support young orthopaedic surgeons interested in conducting research and assisted them with the initiation of their new practices. Recognizing that the treatment of crippling conditions and hernia were becoming separate specialties, one of his first decisions was to restructure the Hernia Department to become the General Surgery Department. His World War I experiences in Europe helped develop his expertise in the fields of fractures, war trauma and amputations, providing a broad foundation in musculoskeletal diseases that was to be beneficial to him in his future role as the leader of R & C.
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Management of acute postoperative pain is challenging, particularly in patients with preexisting narcotic dependency. Ketamine has been used at subanesthetic doses as a N-methyl D-aspartate (NMDA) receptor antagonist to block the processing of nociceptive input in chronic pain syndromes. This prospective randomized study was designed to assess the use of ketamine as an adjunct to acute pain management in narcotic tolerant patients after spinal fusions. ⋯ Three patients in the control group failed PCA pain management and were converted to intravenous ketamine infusions when their pain scores improved. Patients in the ketamine group required less hydromorphone than the control group, but the differences were not significant. Subanesthetic doses of ketamine reduced postoperative pain in narcotic tolerant patients undergoing posterior spine fusions.