Total articular replacement arthroplasty.

Surface replacement, popularized in the early 1970s has fallen into disfavor by much of the orthopedic community. To date, the authors' experience with 29 cemented total articular replacement arthroplasties (TARAs) in 25 patients has been quite favorable. Factors associated with these favorable results include: a physiologic age less than 60, good bone quality, viability of the remaining femoral head, and preservation of the acetabular subchondral plate. The mean age of cases in this study was 52 years, with patient follow up ranging between 3.5 and 7 years; there were two failures. Today, although conventional cementless total hip arthroplasty seems to be in vogue, real and potential problems exist. These concerns, in conjunction with the good results reported in this series, should encourage the orthopedic surgeon to take a second look at resurfacing arthroplasty, especially in the select group of patients defined in this article. Pending the long-term results of non-cemented prostheses the surgeon may even consider using cementless TARA components.

Diabetic arthropathy of the first metatarsal cuneiform joint. Introduction of a new surgical fusion technique.

This paper describes the surgical treatment of advanced arthropathy of the first metatarsal cuneiform joint in the diabetic patient. A new surgical procedure is described as performed on a 59-year-old black diabetic woman with advanced arthropathy of the first metatarsal cuneiform joint. A brief review of diabetic arthropathy is presented, with special emphasis on the first metatarsal cuneiform joint involvement. The authors believe that with early diagnosis and surgical fusion, the process of rapid tarsal disintegration can be prevented.

Hook of the hamate fractures in athletes.

Five patients have been treated for six hook of the hamate fractures over the past 8 years by the authors. Of these, four patients were professional baseball players and one patient was an accountant. All fractures occurred while playing baseball; four while swinging a bat, and two secondary to a fall on an outstretched hand. Roentgenographic diagnosis was made by carpal tunnel view alone in two, oblique and carpal tunnel view in one, bone scan and subsequent carpal tunnel view in two, and computerized tomography in one fracture. Five of the fractures were through the base of the hook, while one was toward the tip. All patients ultimately underwent hook resection, four early and two late. The patient who sustained the tip of the hook fracture underwent resection of the fracture only to refracture the same hook at its base 6 months later. All patients returned to their previous level of activity in 6 to 8 weeks after surgery without loss of function. Hence, it is the authors' opinion that the entire hook should be resected to the base of the hamate as the primary form of treatment in hook of the hamate fractures.

Injury to the eleventh cranial nerve in a high school wrestler.

Injury to the 11th cranial nerve is not uncommon and is usually associated with surgical procedures in the posterior triangle of the neck. Although palsy resultant from external trauma has been described, there have been no cases reported of this injury occurring in a wrestler. This paper reports on such a case and reviews both the anatomic and the clinical aspects of 11th-nerve palsy.

Chondroma within the flexor hallucis longus tendon sheath. A case report and literature review.

Chondromas in tendon sheaths are a rare entity proviously reported in the flexor sheaths on the hand and possibly the foot. This is the first reported case of condroma of the flexor hallucis longus tendon sheath at the ankle region. A literature review with regard to pathogenesis, classification, and recurrence has been presented.