Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement.

The proximal tibia is a difficult area in which to perform a wide resection of a bone tumor. This difficulty is due to the intimate relationship of tumor in this location to the nerves and blood vessels of the leg, inadequate soft tissue coverage after endoprosthetic reconstruction, and the need to reconstruct the extensor mechanism. Competence of the extensor mechanism is the major determinant of functional outcome of these patients. Between 1980 and 1997, 55 patients underwent proximal tibia resection with endoprosthetic reconstruction for a variety of malignant and benign-aggressive tumors. Reconstruction of the extensor mechanism included reattachment of the patellar tendon to the prosthesis with a Dacron tape, reinforcement with autologous bone-graft, and attachment of an overlying gastrocnemius flap. All patients were followed for a minimum of 2 years; 6 patients (11%) had a transient peroneal nerve palsy, 4 patients (7.2%) had a fasciocutaneous flap necrosis, and 2 patients (3.6%) had a deep wound infection. Full extension to extension lag of 20 degrees was achieved in 44 patients, and 8 patients required secondary reinforcement of the patellar tendon. Function was estimated to be good to excellent in 48 patients (87%). Reattachment of the patellar tendon to the prosthesis and reinforcement with an autologous bone-graft and a gastrocnemius flap are reliable means to restore extension after proximal tibia endoprosthetic reconstruction.

Biopsy of musculoskeletal tumors. Current concepts.

Biopsy is a key step in the diagnosis of bone and soft tissue tumors. An inadequately performed biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Poorly performed biopsy remains a common finding in patients with musculoskeletal tumors who are referred to orthopaedic oncology centers. The principles by which an adequate and safe biopsy of musculoskeletal tumors should be planned and performed are reviewed, and the surgical approach to different anatomic locations is emphasized.

Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: a case report and review of the literature.

Arthroscopic surgery of the elbow was performed in a 14-year-old male athlete for diagnosis and treatment of osteochondritis dissecans of the capitellum. Anterolateral and anteromedial portals were used in accordance with described technique. Postsurgical examination revealed an immediate and complete palsy of the posterior interosseous nerve. This complication was attributed to the manipulation of the arthroscope and instrumentation in close proximity to the radial nerve. Neuromuscular function returned to normal over a 6-month period. This case demonstrates the importance of portal placement and instrument manipulation in arthroscopic evaluation and treatment of the elbow. Further study is necessary to develop technical and procedural improvements to assure safe and effective arthroscopic treatment.

The Shrugged-Off Shoulder: A Comparison of Patients With Recurrent Shoulder Subluxations and Dislocations.

In brief: Patients with recurrent anterior shoulder subluxations and dislocations are compared in terms of recurrences, delays in diagnoses, and treatments. Based on these criteria, the subluxers experienced substantially more disability than the dislocators. Since shoulder instability is such a frequent problem in athletes (sports caused the initial episode in nearly 70% of the patients), professionals who deal with athletic injuries must be aware of the shoulder subluxation syndrome, recognize It early, and quickly initiate appropriate treatments.

Spinal fusion for chronic low back pain.

Results of spinal fusion for chronic low back pain in 46 patients are analyzed, and the authors set forth the clinical circumstances in which the procedure may relieve this common complaint.

Undiagnosed bleeding states and medical treatment.

Relatively little attention has been placed in mild hemophilia in the orthopedic literature even though there are probably an equal number of patients with mild as compared to classic manifestations. Mild hemophilia and similar related conditions frequently are undiagnosed and may represent major problems and if associated with surgery, catastrophic results. Patients with milder bleeding diatheses may not have a diagnosis made until late in life. Mild hemophilia and hemophiloid conditions are defined and typical findings are given. Other causes of intra or postoperative hemorrhagic states are mentioned. Three case reports of mild Factor VIII and Factor XI deficiency, undiagnosed prior to the author's medical treatment, are presented. Knowledge of the typical historical findings, diagnostic methods, and proper treatment of patients seeking medical treatment with mild hemophilia, hemophiloid and similar conditions explaining hemorrhage following trauma and intra and postoperatively will help to prevent undesirable results as well as severe complications.

Vascular and adjacent soft tissue injuries associated with fractures of the pelvis.

One hundred fifty-one patients with fractures of the pelvis and associated injuries have been reviewed. Patients who have these injuries are likely to have uncontrollable, fatal hemorrhage. Of this group, nine died, 11 had exploratory laparotomies, ten had bladder injuries, and two had rectal damage. Blood gas determinations, arterial catheterization, and pulmonary wedge pressure determinations are valuable in making and early diagnosis of pathologic changes resulting from internal hemorrhage.