Triple arthrodesis in neuromuscular disorders.

Triple arthrodesis, consisting of a fusion of the calcaneo-cuboid, talonavicular, and talocalcaneal joints, is used to correct deformity and replace braces. Indications depend on symptoms. For good results, patients should be at least 12 years old. A review of 25 cases shows that a varus deformity usually does not give good results, a pseudarthrosis always had a poor outcome, and patients are usually more satisfied than the surgeon with the result.

Treatment of nonunion using pulsed electromagnetic fields: a retrospective follow-up study.

Pulsed electromagnetic fields (PEMF) are a useful means of treating cases of fracture nonunion. In 67.7% of nonunions with a disability time of at least 24 months, complete consolidation was obtained. This success rate is increased to 76.6% if we exclude nonunion, that presented contraindications for treatment with PEMF. The disability time had no effect on the success rate. Lesions of the humerus and atrophic nonunion had an unfavorable prognosis.

A new system to produce intraoperatively custom femoral prosthesis from measurements taken during the surgical procedure.

A system has been developed that allows the surgeon to match a prosthesis to any femoral cavity. The surgeon may choose how and where it will preferentially fit. The surgeon does not have to create a cavity to suit a premade prosthesis. The system is based on a novel technique for making a mold of the prepared femoral cavity. This is accurately and thoroughly measured using a laser. An implant is designed and manufactured while the operation is in progress using state-of-the-art computer and machining techniques. All important parameters such as neck length, offset, and anteversion are fully variable intraoperatively. To date, more than 800 consecutive procedures have been carried out. In a limited trial, no subjective difference was found with a cemented Charnley total hip arthroplasty at one year. It currently takes about 40 minutes to manufacture the implant and make it available in the operating room, and this time is being continually reduced. Using a femur first approach, operating time is not greatly extended. In the future, perhaps the operating time will not be extended at all. All data including cavity geometry are centrally recorded for analysis.

Treatment of delayed union and nonunion of the tibia by pulsed electromagnetic fields. A retrospective follow-up.

The results of a clinical follow-up of 57 tibial lesions treated with pulsed electromagnetic fields at least six months after the primary lesion occurred proved that this noninvasive method can be a valuable alternative to other commonly accepted modes of therapy. The overall success rate was 75% but could be improved to 81% when the proper indications were met.

Treatment of chronic osteomyelitis with ciprofloxacin.

The results of the treatment of twenty-one patients (age 22-66 years) with chronic bone or joint infections with ciprofloxacin were evaluated. The osteomyelitis was secondary to trauma in 12 patients, joint replacement in six, previous acute hematogenous infection in two and osteotomy in one. Stafylococcus aureus (11 times) and Pseudomonas aeruginosa (9 times) were most frequently cultured. The duration of ciprofloxacin therapy averaged 76 days. Concomitant antimicrobial drugs were used in one patient only. Fifteen patients were operated during treatment; in most cases the surgical procedure consisted of a thorough debridement. Nineteen patients could be evaluated. The bacteriological results were as follows: eradication 27; marked reduction 1; eradication with recurrence 1. Contamination occurred in five patients and superinfection in two, without much influence on the final outcome. The investigator's assessment at the end of the therapy was as follows: complete success in 14 patients and partial success in seven. During the follow-up (3-13 months) the therapy was judged completely successful in 16, partially successful in four and unsuccessful in one. Two patients had minor gastric complaints during therapy and one showed a temporary slight increase in the liver transaminases.

Adductor tendinitis and musculus rectus abdominis tendopathy.

Groin injuries are becoming more common today in soccer. Conservative treatment consisting of rest, physiotherapy, and medication yields favorable results in only 38% of the long-standing lesions. Operative treatment is indicated in selected cases. Better knowledge of the underlying pathology and a more accurate initial conservative treatment directed to the ethiopathogenesis could solve many of the problems. However, in our experience a simple subcutaneous adductor tenotomy and/or a rectus abdominis tenotomy in combination with a fasciaplasty was done successfully in 75 of 81 patients. There was no loss of power in this group of patients as measured and compared with a control group.

Long-term study of the peroperative infection rate in 1007 total hip replacements using prophylactic cefamandole and other precautions.

Of 1824 primary total hip replacements performed between April 1, 1979, and December 31, 1983, 1007 were reviewed at regular interval and provided sufficiently complete data with special emphasis on pre- and postoperative bacteriological examination and pre- and postoperative determination of the erythrocyte sedimentation rate. All patients with known superficial and deep infections were included. In all cases 2 g of cefamandole q.i.d. were administered within a 24-h period starting with the induction of the anesthesia. All procedures were performed in operating rooms equipped with a vertical laminar air flow. Other precautions included the use of Charnley gowns with a body exhaust system, special draping of the patient, and preoperative culture of the urine. As of June, 1981, gentamicin-loaded polymethylmetacrylate was used routinely. When positive cultures were found in the swabs taken from the tissues during the surgical procedure, appropriate antibiotics were started if the patient was still hospitalized. Follow-up showed two deep (0.2%) and four superficial infections (0.4%). Host factors may play a more important role than suspected, since one patient with a deep infection suffered from severe rheumatoid arthritis and the other from diabetes. Both these patients underwent bilateral hip replacement, the second intervention following the first within 5 weeks. In these two patients the deep infection became apparent 5 and 9 months after the second procedure. Only one of these patients developed a sinus (Staphylococcus aureus).(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro experiments with an injection technique for cup fixation in total hip arthroplasty.

A new technique has been developed to position the cup rigidly into the acetabulum during total hip joint replacement. After positioning the flanged cup on the acetabulum by means of screws, a low-viscosity cement is injected through a hole in the rim of the cup. A comparison with the standard cementing technique was made on the basis of in vitro experiments. For this purpose a mold was constructed to produce castings simulating the human acetabulum. The distribution of the cement, the pressure developed in the acetabulum, and the penetration of the cement are compared for the two cementing techniques.

Recurrent dislocation of the peroneal tendons. Results of rerouting the tendons under the calcaneofibular ligament.

Nine patients (11 cases) with recurrent dislocation of the peroneal tendons who were treated by surgically rerouting the tendons under the calcaneofibular ligament were reviewed. Mean follow-up time was 30.5 months. An excellent or good result was obtained in all cases. This operative technique was previously described in 1975, by Sarmiento and Wolf, in a case report.

Mechanical behaviour of femoral bones in bending loading.

A series of 33 human femoral bones have been subjected to a four point bending test at high strain rates. Two different failure modes were recognized. A Y shaped fracture at the middle region induced by a pure bending moment yielded a zone of non-linearity at the load vs deformation curve and a higher bending force, more deformation of the structure and higher strain energy to fracture compared with the less frequently occurring oblique fracture at the distal third of the structure resulting in a failure without a 'plastic' portion at the load-deformation curve. Estimated values of bending modulus and maximum bending moment based upon a simple uniform beam model showed high correlation coefficients with the experimentally determined values. Scanning electron microscopic examination of the Y fracture showed distortion and void formation of the material at the structural level. This could explain the extensive non-elastic deformation prior to failure.

Partial arthroscopic meniscectomy versus total open meniscectomy.

One hundred sixteen patients who had undergone partial arthroscopic meniscectomy were reviewed in a short-term follow-up study (mean follow-up: 16 months). Their results were compared with those of a group of 402 patients who had been treated previously by conventional open meniscectomy in the same hospital. Average age in the arthroscopic group was 40 years, in the open group 34. Average sick leave was 4 weeks in the arthroscopic group, 10 weeks in the arthrotomy group. In the endoscopic group, there was virtually no sick leave for self-employed people, but 7 weeks if the lesion was sustained at work. Top-class sportsmen resumed competition 5 weeks after arthroscopy, 8 weeks after conventional meniscectomy. Still, most of them complained of prolonged synovial reaction resulting in a period of poor physical condition and performance. Of the patients treated by arthroscopy, 7.5% presented minor problems related to the approach (anteromedial-transpatellar), while 21.5% had similar problems after routine anteromedial incision in the open meniscectomy group. The overall results after arthroscopy were excellent in 49 cases (41.5%), good in 51 (43%), fair in 14 (12%), and poor in four (3.5%). These short-term results are comparable to those of the open meniscectomy group. The short-term results in the older patients confirm our belief that (partial) meniscectomy is useful for the older patient with a history of mechanical meniscal problems, with or without cartilage degeneration, provided one is not dealing with frank osteoarthrosis and secondary varus or valgus deformity.(ABSTRACT TRUNCATED AT 250 WORDS)

Conservative treatment of ipsilateral supracondylar femoral fracture after total knee arthroplasty.

Conservative as well as operative treatment has been proposed for fractures above a knee prosthesis. Three cases are reported and an explanation for the fractures on a mechanical basis is given. Our results shows that closed treatment also leads to satisfactory results, avoiding the risks of extensive surgery.

Chronic leg pain in athletes due to a recurrent compartment syndrome.

A series of 29 patients, all engaged in sports activity on a regular basis, suffering from recurrent compartmental syndrome, is reported. The syndrome is not restricted only to long distance runners but to athletes involved in a variety of sports activities (soccer, volleyball, cycle racing, gymnastics, judo, physical education, and long distance running). Although most patients presented activity-related leg pain, some patients mainly complained of ankle weakness and recurrent ankle distortions at fatigue. The wick catheter technique proved to be most useful to determine which compartments were involved. The severity of clinical symptoms correlated highly with the anomalies of the tissue pressure measurements. The predominance of deep posterior compartment and multiple compartment involvement are in contrast with most previous reports. Conservative treatment was unsuccessful in every patient, whereas surgical decompression of the involved compartments yielded favorable results in those cases where all the involved compartments were released.

Infection of the knee joint with Mycobacterium xenopi.

Mycobacterium xenopi infection of the knee joint occurred in a 71-year-old man. Owing to the failure to recognize the "contaminant" initially as a possible etiologic agent, the joint was destroyed and eventually treated by arthrodesis.

Identification of in-vivo vibration modes of human tibiae by modal analysis.

When attempting to evaluate the mechanical properties of human bones in vivo by mechanical vibration analysis, some essential requirements must be met. A quantitative relation between measured vibration parameters (e.g., natural frequency) and mechanical bone properties must be available, in-vivo vibration modes should correctly be identified and the associated natural frequencies reproducibly and accurately measured, the influence of joints and soft tissues must be known. These problems were addressed by modal analysis (i.e., experimental determination of natural frequencies, mode shapes and damping ratios) of human tibiae in the following situations: 1) dry excised tibiae, 2) fresh excised tibiae, 3) in-vivo tibiae, 4) tibiae in an amputated leg, in different steps of dissection. In the in-vivo measuring conditions used by the authors, the tibia vibration is practically free-free. Two single bending modes (at +/- 270 Hz and +/- 340 Hz, respectively), each of them corresponding with one principal direction for bending, were identified. The difference between the natural frequencies observed in vivo and those of fresh excised tibiae is almost completely caused by the effect of muscles (added mass and damping), whereas joints and skin play only a minor role. Frequency differences between fresh and dry excised tibiae are largely accounted for by the absence of bone marrow in the latter.