Southern orthopaedic association residents and fellows' conference abstracts, presented in conjunction with soa's fall meeting and sma's section on orthopaedic and trauma surgery.TIBIOTALOCALCANEAL ARTHRODESIS arthrodesis /ar·thro·de·sis/ (-de´sis) the surgical fixation of a joint by a procedure designed to accomplish fusion of the joint surfaces by promoting the proliferation of bone cells; called also artificial ankylosis. WITH A RETROGRADE INTRAMEDULLARY NAIL: A PATIENT SERIES USING A MODIFICATION OF THE STANDARD TECHNIQUE. Matt Hammit, MD, and Thorn A. Tarquinio, MD. The University of Mississippi Medical Center University of Mississippi Medical Center (UMC) is the health sciences campus of the University of Mississippi (Ole Miss). Located in Jackson, Mississippi (USA), it houses the Schools of Medicine, Dentistry, Nursing, Health Related Professions, and Graduate Studies in the Health , Jackson, Miss.
This is a retrospective study of retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis. This study will describe the surgical approach and retrograde nailing technique used at our institution, which is a modification of the approach and technique originally described for this procedure. Our early results and complications encountered in treating patients with this potentially devastating pathology are presented as well. The preoperative diagnoses were post-traumatic avascular necrosis of the talus talus (tā`ləs), deposit of rock fragments detached from cliffs or mountain slopes by weathering and piled up at their bases. A talus is a common geologic feature in regions of high cliffs. with resultant ankle and subtalar degenerative joint disease degenerative joint disease
n. Abbr. DJD
degenerative joint disease Osteoarthritis, see there in 14 patients, severe neuropathic (Charcot) arthropathy arthropathy /ar·throp·a·thy/ (ahr-throp´ah-the) any joint disease.arthropath´ic
Charcot's arthropathy neuropathic a. in 10 patients, rheumatoid arthritis in one patient, and congenital tibial pseudarthrosis in one patient. 26 procedures were performed on 25 patients from December 1996-January 2001. Complications include one superficial wound eschar eschar /es·char/ (es´kahr)
1. a slough produced by a thermal burn, by a corrosive application, or by gangrene.
2. tache noire.
n. , which resolved without treatment; two deep venous thromboses; three patients with painful hardware; and one patient with a stress fracture at the proxima l interlocking screw site. There were no nonunions, amputations, infections, or wound necroses. This study will demonstrate that tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail is an effective salvage procedure for patients with extensive ankle and subtalar joint disease; and that the common complication of wound necrosis can potentially be avoided by an alternative surgical exposure.
A COMPARISON OF WEAR DEBRIS INDUCED OSTEOLYSIS osteolysis /os·te·ol·y·sis/ (os?te-ol´i-sis) dissolution of bone; applied especially to the removal or loss of the calcium of bone.osteolyt´ic
n. ALONG A CEMENTED AND CEMENTLESS INTERFACE: AN ANIMAL MODEL IN THE RABBIT. Jason A. Bergandi, MD. Pennsylvania State University Pennsylvania State University, main campus at University Park, State College; land-grant and state supported; coeducational; chartered 1855, opened 1859 as Farmers' High School. Musculoskeletal Research Laboratory, Hershey, Pa.
By compromising bone structure, periprosthetic osteolysis may increase the risk of fracture and/or aseptic loosening of components leading to revision surgery. Our purpose was to develop a reproducible rabbit model of periprosthetic osteolysis and observe the effects of implant type and fixation on the latency to onset and size of the osteolytic lesions. Thirty-seven New Zealand white rabbits (71 knees) underwent knee arthrotomy ar·throt·o·my
Incision into a joint. Also called synosteotomy.
incision of a joint. and placement of cylindrical intramedullary stainless steel or polymethylmethacrylate (PMMA PMMA polymethyl methacrylate. ) implants. Each knee contained both a metallic and PMMA implant in either the femur or tibia that communicated with a common synovial synovial /sy·no·vi·al/ (-al)
1. pertaining to a synovial membrane.
2. pertaining to or secreting synovia.
of, pertaining to, or secreting synovia. space. A suspension of polyethylene particles (size [less than] 4.5 mm and concentration of 1-5 x 106 particles/ml) was injected into each knee at two-week intervals for ten weeks to induce osteolysis. Serial radiographs were taken at 4, 8, 14, 18, and 22 weeks postoperatively to document the progression of osteolysis. Statistical analysis was performed utilizing a two-tailed, unpaired t test and a Mantel-Cox test with the level of significance set a P [less than] .05. Radiographic radiographic (rā´dēōgraf´ik),
adj relating to the process of radiography, the finished product, or its use. analysis revealed that 96.9% of the stainless steel implants had evidence of osteolysis by 22 weeks compared to 22.9% of the PMMA implants. The earliest onset of lesions in the metal implant group occurred at 4 weeks compared to 14 weeks in the PMMA group. We also found the area and volume of the osteolytic lesions to be significantly larger in the metal implants when compared to the implants composed of PMMA. Onset of osteolysis around metal implants occurred in a significantly shorter period of time and more frequently when compared to implants composed of PMMA. Also, the area and volume of the osteolytic lesions around the metal implants was found to be significantly larger than those of the PMMA. We concluded that relative material effects on osteoclast osteoclast /os·teo·clast/ (os´te-o-klast?)
1. a large multinuclear cell associated with absorption and removal of bone.
2. an instrument used for osteoclasis. induced bone resorption and differences in ease of transport of particulate debris along metallic compared to PMMA surfaces may accoun t for observed differences in frequency and severity of osteolytic lesions.
LONG TERM FOLLOW-UP FOR ANTEGRADE DRILLING FOR OSTEOCHONDRITIS DESSICANS OF THE KNEE. Rena R. Amro, MD, Wudbhav Sanakar, BS, Theodore Ganley, MD, and John Gregg, MD. The Children's Hospital of Philadelphia The Children's Hospital of Philadelphia is one of the largest and oldest children's hospitals in the world. "CHOP" has been ranked as the best children's hospital in the United States by U.S. News & World Report and Child Magazine in recent years. , The University of Pennsylvania Health System The University of Pennsylvania Health System is a diverse research and clinical care organization in Philadelphia, Pennsylvania that operates under the direction and auspices of the University of Pennsylvania, its umbrella organization Penn Medicine and the University of , Philadelphia, Pa.
The purpose of this study is to review the long-term results of 70 knees with osteochondritis dessicans of the femoral condyles or patella patella (pətĕl`ə): see kneecap. that failed a conservative program and were treated with antegrade drilling. To our knowledge, this study represents the largest reported series using this technique. Between 1986 and 2001, 66 patients had antegrade drilling of 70 lesions of the femoral condyles or patella after failing conservative treatment. Postoperative evaluation included rating by the International Knee Documentation Committee (IKDC) form for osteochondritis dessicans as well as radiographic evaluation. In this group of patients, the average age at the time of surgery was 15 years. Forty-one patients had open physes and twenty-six were skeletally mature. The average follow-up was 30 months. These lesions were drilled in 49 medial femoral condyle condyle /con·dyle/ (kon´dil) a rounded projection on a bone, usually for articulation with another bone.con´dylar
n. lesions, 9 lateral femoral condyle lesions, 7 trochlea trochlea /troch·lea/ (trok´le-ah) pl. troch´leae [L.] a pulley-shaped part or structure; used in anatomic nomenclature to designate a bony or fibrous structure through which a tendon passes or with which other structures lesions, and 9 patella lesions. According to the criteria of the IKDC form, 36 were normal, 29 nearly normal, and 5 abnormal. In the skeletally mature patients, 8 had normal results, 17 had nearly normal results, and 2 had abnormal results. In the skeletally immature population, 27 had normal results, 12 had nearly normal results and 3 had abnormal results. Lesions that were drilled in the patella or trochlea had lower scores than lesions drilled in the lateral or medical femoral condyles. In both groups, IKDC scores were lower in patients who had other surgical procedures on the knee subsequent to the drilling of the osteochondritis dessicans lesion. After failure of conservative therapy, antegrade drilling is an effective treatment for osteochondritis dessicans of the knee that occurs in skeletally immature patients. In comparison, this procedure is not as successful in skeletally mature patients. Consequently, other surgical methods should be considered for skeletally mature patients with osteochondritis dessicans lesions. Further studies need to be completed to determine alternative treatment modalities f or skeletally mature patients with osteochondritis dessicans lesions of the knee.
SUCTION INSTRUMENTATION DECREASES INTRAMEDULLARY PRESSURE AND PULMONARY EMOBLISM DURING TOTAL KNEE ARTHROPLASTY. Rena R. Amro, MD, Matthew Kelly, MD, David G. Nazarian, MD, and Robert E. Booth, MD. The Pennsylvania Hospital, The University of Pennsylvania Health System, Philadelphia, Pa.
The risk of pulmonary embolism as a grave consequence of lower extremity total joint arthroplasty total joint arthroplasty
Arthroplasty in which both joint surfaces are replaced with artificial materials, usually metal and high-density plastic. is well documented. Increased intramedullary pressure created during femoral instrumentation has been positively correlated with increased marrow particle content embolization. The purpose of this two-part study is to demonstrate that the use of suction devices during femoral canal instrumentation during total knee arthroplasty decreases femoral intramedullary pressure and the amount of marrow content embolized to the pulmonary circulation. Three of six fresh frozen complete cadaveric femurs were instrumented with a standard intramedullary knee alignment guide and three femurs were instrumented with the same alignment rod, which was placed inside of a cannulated can·nu·late also can·u·late
tr.v. can·nu·lat·ed, can·nu·lat·ing, can·nu·lates
To insert a cannula into (a bodily cavity, duct, or vessel), as for the drainage of fluid or the administration of medication.
adj. suction sleeve connected to wall suction (-22 in Hg). Intramedullary pressure was monitored with specialized transducers attached at multiple sites along the specimens. The second phase of the study included 24 patients who undenvent unilateral cemented t otal knee arthroplasty. Twelve randomly selected patients were instrumented with the standard intramedullary guide and twelve patients were instrumented with the suction adapted guide. Transesophageal echocardiography and a computerized pixel counter were used to record and quantify embolic activity intraoperatively in both groups. The average intramedullary pressures (in Torr) monitored in the cadaveric specimens were 107.8 with the standard equipment and -248.2 with the suction device. The group of 12 patients who underwent femoral preparation with the standard equipment exhibited an average of 89 embolic particles registered upon tourniquet tourniquet (tr`nĭkĕt, –kā, tûr`–), compression device used to cut off the flow of blood to a part of the body, most often an arm or leg. release. The average particle count was 31 when the suction equipment was used. Postoperatively, patients in the standard group exhibited transient confusion. The knee scores were 91 in both groups and then was no notable radiographic difference at an average of 1 year follow up. Although compliance and pressures are different in the cadaver than in vivo, the intramedul lary pressures in the distal femurs were consistently reduced when using the suction device. The device also decreased thc number of embolic particles by 65% during knee arthro-plasty with no increase in operative time. This data supports the use of these devices to decrease femoral pressure and embolic matter in the pulmonary circulation.
CLINICAL OUTCOME EVALUATIONS OF AN ALTERNTIVE THROMBOEMBOLIC thromboembolic
pertaining to or emanating from thromboembolism.
see thromboembolic colic. DISEASE PROPHYLACTIC PROTOCOL IN TOTAL JOINT REPLACEMENT. Patrick B. Leach, MD, J. Kevin Brooks, MD, Scott S. Corpe, MD, Timothy R. Young Timothy Roberts Young (November 19 1811 - May 12 1898) was a U.S. Representative from Illinois.
Born in Dover, New Hampshire, Young completed preparatory studies. He attended Phillips Exeter Academy and was graduated from Bowdoin College, Brunswick, Maine, in 1835. , DO, and Thomas L. Bradbury, MD. Medical College of Georgia In 1828, it was chartered by the state of Georgia as the Medical Academy of Georgia, with plans to offer a single course of lectures leading to a bachelor's degree. It opened the following year on October 1st at the Augusta hospital. , Section of Orthopaedic Surgery, Augusta, Ga.
Thromboembolic disease (TED) prevention conventionally uses chemical prophylaxis. Recently, we initiated a TED prophylaxis protocol including a regime of early ambulation, mechanical foot pumps, compression stockings, and enteric-coated aspirin (ECASA). The purpose of this study was to examine the clinical outcomes of this regimen and to compare these results to literature controls. One thousand-sixteen (1,016) consecutive patients who underwent primary or revision THR Thr threonine.
threonine. or TKR from 1995-1999 were treated by our prophylaxis protocol. A retrospective investigation was completed with clinical outcomes noted for fatal and non-fatal PE; DVTs, which were clinically evident as documented by duplex US and/or venography Venography Definition
Venography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot. ; infection; and hemorrhagic Hemorrhagic
A condition resulting in massive, difficult-to-control bleeding.
Mentioned in: Hantavirus Infections
pertaining to or characterized by hemorrhage. complications. The review of the patient clinical course was limited to the first six weeks postoperatively. Demographic data of the 1,016 cases (594 THR and 422 TKR) showed that THR were performed on 313 female and 256 male patients, and that TKR were performed on 281 female and 166 male patients.
Results disclosed 3 PEs (0.3%) [1 nonfatal and 2 fatal]; 11 DVTs (1.1%), and 8 deep wound infections (0.8%). There were no hemorrhagic complications. These results are comparable to published series of TED prophylaxis using coumadin or heparin derivatives as chemical prophylactics against TED. We suggest that these results support the use of the aforementioned TED prophylaxis protocol as an effective alternative to other protocols. Advantages to this protocol include low cost, ease of administration, no need for laboratory monitoring of coagulation coagulation (kōăg'ylā`shən), the collecting into a mass of minute particles of a solid dispersed throughout a liquid (a sol), usually followed by the precipitation or parameters, low risk of bleeding complications and excellent patient compliance.
EVALUATION OF CALCIUM SULFATE AUGMENTATION IN PEDICLE pedicle /ped·i·cle/ (ped´i-k'l) a footlike, stemlike, or narrow basal part or structure.
1. A constricted portion or stalk.
2. SCREW PULLOUT TESTS. Michael T. Rohmiller, MD, Dugan Schwalm, MS, R. Chris Glattes, MD, Tarek G. Elalayli, MD, and Dan M. Spengler, MD. Vanderbilt University, Department of Orthopaedics and Rehabilitation, Nashville, Tenn.
Lumbar vertebrae implanted with pedicle screws were subjected to axial pullout tests. The force required to cause implant failure was measured and compared for three methods of fixation. To determine the strength of a new calcium sulfate cement in terms of pedicle screw augmentation. The purpose was to evaluate calcium sulfate versus polymethylmethacrylate in terms of pullout strength. PMMA was considered the gold standard in terms of strength for this experiment. Many authors have evaluated the components responsible for ultimate pullout strength of pedicle screws. In these studies, one important variable has been the screw fixation. Since pedicle screw fixation has increased in popularity over recent years, so has the need to augment difficult situations. PMMA has been established as the gold standard in terms of strength of fixation but has the potential for severe complications when applied in spine surgery. Calcium sulfate represents an alternative to PMMA since calcium sulfate lacks the exothermic exothermic /exo·ther·mic/ (-ther´mik) marked or accompanied by evolution of heat; liberating heat or energy.
ex·o·ther·mic or ex·o·ther·mal
1. react ion, is osteoconductive, and is resorbed by the body in thirty to sixty days. Lumbar vertebrae were harvested from five cadavers and implanted with pedicle screws. These screws were either placed in native bone or augmented with either calcium sulfate paste or PMMA. In those pedicles that had augmentation, the material was permitted to set for a minimum of 24 hours. Axial pullout tests were then performed using an MTS testing machine. The screws were pulled out over a distance of up to 6 mm at 0.25 mm/sec. This rate and distance assured failure in each case. The load to failure was recorded for each pedicle. Calcium sulfate augmentation improved pedicle screw pullout strength significantly when compared to native bone (P[less than].0006). This represented an average increase of 170% over the native bone. Likewise PMMA improved the pullout strength significantly over native bone (P[less than].0001) for an average increase of 205%. There were no significant differences between the calcium sulfate and PMMA augme ntations although the PMMA averaged 121% of the strength of calcium sulfate. Although PMMA is considered the gold standard in terms of bone fixation strength, its use around the spine has been limited due to concern over complications. The calcium sulfate hone paste tested in this study demonstrated similar strength to PMMA without the major risks. In addition, the calcium sulfate paste may allow for possible osteoconduction to aid in spinal fusion. Further study is needed to determine the applicability of this calcium sulfate paste in the clinical setting of spine surgery.
WOUND COMPLICATIONS USING A MODIFIED SURGICAL APPROACH TO OPEN REDUCTION OF TIBIAL PLAFOND pla·fond
An anatomical part or surface that is farthest from the midline of the body, especially the articular surface of the distal end of the tibia. FRACTURES. Leo Chen, MD, Kevin O'Shea, MD, and John Early, MD. UT Southwestern Medical Center, Dallas, Tex.
Fractures of the tibial plafond are often extremely difficult to manage because joint reduction must be achieved while maintaining the soft tissue envelope. The argument for closed treatment of tibial plateau fractures centers on the risk of wound complications from surgery. With an anterior longitudinal approach, wound complication rates as high as 37% have been reported. By modifying the approach for open reduction, joint visualization is improved and wound complications reduced. Between 1994 and 1999, 65 tibial plafond fractures in 64 patients underwent open reduction and internal fixation using a standard staged protocol except for modification of the surgical approach. Initially, the fractures were stabilized and reduced provisionally with an ankle spanning AO/ASIF external fixator. Once the soft tissue swelling subsided, open reconstruction of all fractures were accessed through combined medial and lateral incisions for joint reduction and internal fixation. All fractures were AO type 43, with 28 type B (2 open) and 37 types C (7 open). Sixty tibial plafond fractures in 59 patients were available for follow up. The complication rate due to the surgical wounds was 7% (5 patients) overall and 11% (4 patients) for AO type 43 C fractures. Complications included wound dehiscence dehiscence /de·his·cence/ (de-his´ins) a splitting open.
wound dehiscence separation of the layers of a surgical wound.
n. (2), superficial infection (1), and deep infection (2, with one requiring surgical debridement and hardware removal). No amputations, joint infections, or free soft tissue transfers occurred due to the surgical approach. All surgical wounds healed. Historically, wound complications after immediate open reduction and internal fixation of tibial plafond fractures are well documented. However, later studies have revealed that a staged approach to these injuries can reduce the complication rates. After the soft tissues allow, open reduction has been performed with a standard anterior incision. In our study, the use of a combined medial and lateral approac h to open reduction and internal fixation of the tibial plafond is a safe alternative to the anterior approach.
LUMBAR SPINE SURGERY IN OBESE PATIENTS. Paul Fuchs, DO, Allen Goodrich, MD, and Kevin Brooks, MD. Medical College of Georgia, Section of Orthopaedic Surgery, Augusta, Ga.
Lumbar surgery in obese patients is challenging. Our experience with lumbar spine surgery in obese patients has been without any appreciable increase in peri-operative complications compared to a non-obese population. A retrospective study of 60 consecutive patients who underwent lumbar spine with a minimum of 2 years follow-up was conducted. Patients were grouped as obese versus non-obese based on obesity defined as a body mass index (kg/ht) greater than 30. Data reviewed for each group included procedure duration, estimated blood loss, length of hospital stay, complications (perioperative perioperative /peri·op·er·a·tive/ (-op´er-ah-tiv) pertaining to the period extending from the time of hospitalization for surgery to the time of discharge.
adj. and late) based on matched procedures, and functional assessment. Statistical analyses included paired t tests and descriptive statistics. Of the parameters examined, estimated blood loss and operative time were significantly increased in the obese group compared to the non-obese group. There was no appreciable difference in complications or surgical outcomes between the obese and non-obese groups. The majority of informat ion regarding perioperative data and the obese patient is in the total joint arthroplasty population. The information in the spine literature regarding perioperative outcomes in obese patients undergoing lumbar spine surgery is limited and controversial. In our review, we found increased blood loss and longer operative times in the obese group; however, there was no difference in complication rates or functional outcomes between the two study groups.
PREFABRICATION prefabrication, in architectural construction, a technique whereby large units of a building are produced in factories to be assembled, ready-made, on the building site. The technique permits the speedy erection of very large structures. OF A VASCULARIZED BONE GRAFT USING A CORAL TEMPLATE. Barry S. Callahan, MD, Thomas Dovan, MD, and Roger A. Summerlin, MD. Vanderbilt University Medical Center The Vanderbilt University Medical Center (VUMC) is a collection of several hospitals and clinics associated with Vanderbilt University in Nashville, Tennessee. It comprises the following units:
The purpose of this study was to investigate the potential of creating a vascularized bone graft from an inorganic template. The template used was a 3 x 5 mm cylinder of calcium phospate coral placed in a segment of silicone tubing with a 1 mm hole drilled centrally for placement of a vascular pedicle. Twenty adult Spraque-Dawley rats were divided into two groups (I & II). Each group had the template implanted in the subcutaneous inguinal region, with microsurgical insertion of the superficial epigastric artery The superficial epigastric artery arises from the front of the femoral artery about 1 cm below the inguinal ligament, and, passing through the femoral sheath and the fascia cribrosa, turns upward in front of the inguinal ligament, and ascends between the two layers of the into the central hole of the template. In group II, 0.1 cc of bone marrow aspirate as·pi·rate
To take in or remove by aspiration.
A substance removed by aspiration.
The removal by suction of a fluid from a body cavity using a needle. was added to the matrix. A non-vascularized control group was not utilized because the main purpose of the study was to explore the potential of creating a vacularized graft. Two animals from each group were sacrificed at six, eight, ten, twelve and fourteen weeks. Gross appearance and pedicle patency were recorded prior to animal termination. All templates were embedded in paraffin, sectioned and stained with hematoxyli n and eosin. The six-week specimens from both groups demonstrated capillary ingrowth ingrowth /in·growth/ (-groth) an inward growth; something that grows inward or into.
Something that grows inward or into a part of the body. with scattered multinucleated multinucleated
characterized by having more than one nucleus per cell.
multinucleated giant cell
see giant cell. giant cells amongst a fibrous stroma stroma /stro·ma/ (stro´mah) pl. stro´mata [Gr.] the matrix or supporting tissue of an organ.stro´malstromat´ic
n. pl. stro·ma·ta
1. . Osteoid osteoid /os·te·oid/ (os´te-oid)
1. resembling bone.
2. the organic matrix of bone; young bone that has not undergone calcification.
Resembling bone. formation was present in Group II at eight weeks with mature trabecular bone and marrow elements at 14 weeks. Group I did not show osteoid until ten weeks, however, at 14 weeks had similar trabecular bone and morrow formation as group II. On retrieval, all pedicles had pulsatile pulsatile /pul·sa·tile/ (pul´sah-til) characterized by a rhythmic pulsation.
characterized by a rhythmic pulsation. flow to the template. This study demonstrates that a vascularized osseous osseous /os·se·ous/ (os´e-us) of the nature or quality of bone; bony.
Composed of, containing, or resembling bone; bony. graft can be prefabricated pre·fab·ri·cate
tr.v. pre·fab·ri·cat·ed, pre·fab·ri·cat·ing, pre·fab·ri·cates
1. To manufacture (a building or section of a building, for example) in advance, especially in standard sections that can be easily shipped and from an inorganic template without the use of any host elements. The addition of autologous bone marrow did decrease the time to osteoid formation, however it did not appear to effect the time to trabecular bone formation. Although we did not show its clinical feasibility, the ability to create a vascularized bone graft has many clinical applications and would help avoid donor site morbidity commonly associated with these types of autografts.
VASCULARIZED FIBULAR GRAFTS FOR MASSIVE SEGMENTAL BONE LOSS IN THE FOREARM. Thomas T. Dovan, MD, and Douglas R. Weikert. Vanderbilt University Medical Center, Nashville, Tenn.
Massive segmental bony defects of the forearm are a challenging problem with long term outcomes typically associated with multiple complications and functional loss. Treatment options include amputation amputation (ăm'pyətā`shən), removal of all or part of a limb or other body part. Although amputation has been practiced for centuries, the development of sophisticated techniques for treatment and prevention of infection has greatly , creation of a one-bone forearm or reconstruction. Reconstruction can be accomplished with vascularized or non-vascularized grafts. Avascular avascular /avas·cu·lar/ (a-vas´ku-ler) not vascular; bloodless.
Not associated with or supplied by blood vessels. cortical grafts have prolonged healing times secondary to creeping substitution. In addition, there is a greater risk of infection when placed in a relatively avascular bed. Vascularized grafts maintain their size and structure and have the ability to hypertrophy and remodel under stress. Since they are biologic, they do not require resorption prior to incorporation and are more resistant to the potentially poor conditions of the recipient bed. This study is a retrospective review of six cases involving massive ([greater than]6cm) segmental defects of forearm reconstructed with a vascularized diaphyseal diaphyseal /di·a·phy·se·al/ (-fiz´e-al) pertaining to or affecting the shaft of a long bone (diaphysis).
pertaining to or affecting the shaft of a long bone (diaphysis). fibular autograft autograft: see transplantation, medical. . Six patients were treated for diaphyseal segmenta l bone defects in the radius or ulna ulna: see arm. . The average follow up was 13 months (4-21 months). There were three males and three females, ages ranging from 32-41 years old. All defects were diaphyseal (4 radius, 2 ulna) ranging in size from 9-14 cm. Five patients had primary compression plating of an associated radius or ulna fracture; one was converted to a one-bone forearm. There were four defects secondary to blunt trauma or osteomyelitis, one from a GSW GSW
gunshot wound , and one from a pathologic fracture. The fibula was harvested with its periosteal periosteal /peri·os·te·al/ (-os´te-al) pertaining to the periosteum.
pertaining to or emanating from the periosteum. blood supply and the peroneal artery and vein. The donor vessels were the radial artery in five and the ulnar artery in one. The graft was secured with plate fixation. All patients were immobilized postoperatively. Osseous union was confirmed radiographically in all patients. The average time to union was 7.5 months ranging from 4-12 months. There was one fixation failure requiring conversion from simple screw fixation to plate fixation and one infected donor site requiring local wo und care. For patients with a two-bone forearm, pronation pronation /pro·na·tion/ (-na´shun) the act of assuming the prone position, or the state of being prone. Applied to the hand, the act of turning the palm backward (posteriorly) or downward, performed by medial rotation of the forearm. averaged 68[degrees] (20-90) and supination supination /su·pi·na·tion/ (soo?pi-na´shun) [L. supinatio ] the act of assuming the supine position, or the state of being supine. averaged 44[degrees] (20-90). All patients were satisfied with their results postoperatively despite having some residual functional limitations. The development of microsurgical techniques has allowed the use of vascularized bone in the management of massive skeletal defects. Vascularized fibular grafts are biomechanically, biologically and anatomically suited for management of massive segmental defects in the forearm. Bony union of the graft allows for the preservation of forearm rotation thus improving functional outcomes and patient satisfaction.
CHANGES IN CAROTID ARTERY BLOOD FLOW DURING ANTERIOR CERVICAL SPINE SURGERY. Matthew E. Pollard, MD, and Tricia Little, MEd. Department of Orthopaedics & Vascular Lab, Atlanta Medical Center, Atlanta, Ga.
Adequate surgical exposure for Anterior Cervical Discectomy and Fusion Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine in order to stabilize the corresponding vertebrae. (ACDF) necessitates prolonged retraction of the carotid artery. The perioperative effects of retraction on carotid artery flow dynamics. Carotid artery blood flow was measured in 15 patients undergoing anterior cervical spine surgery. Duplex ultrasonic measurements of common carotid artery flow velocity were made in 15 patients undergoing ACDF. Measurements were recorded preoperatively, intra-operatively after exposure was obtained and self-retaining retractors placed, intra-operatively at the end of the procedure just prior to release of retraction, postoperatively in the recovery room, and on postoperative day one. Using flow velocity data, the changes in cross sectional area were calculated at each time interval and expressed as a percentage change in area from baseline measurements. The parameters of patient age, pre-existing atherosclerotic vascular disease atherosclerotic vascular disease Atherosclerosis, see there , and prolonged intra-operative retraction were analyzed to determine if they w ere associated with the observed changes. Vessel cross sectional area decreased an average of 14% with the initial placement of self-retaining retractors, and further decreased to 70% of baseline by the end of the case. Flow remained laminar at all times and flow velocities returned to normal in the recovery room. These changes were more pronounced in the younger patients studied, but were unrelated to mild pre-existing atherosclerotic vascular disease or prolonged retraction. Intra-operative retraction during anterior cervical spine surgery alters common carotid artery flow dynamics by causing a significant reduction in vessel cromss sectional area. These changes are most pronounced in young patients. Atherosclerotic disease is a common finding in patients being evaluated for ACDF.
THE NATURAL HISTORY OF HIP DISLOCATION IN PATIENTS WITH SPINAL MUSCULAR ATROPHY Spinal Muscular Atrophy (SMA) is a term applied to a number of different disorders, all having in common a genetic cause and the manifestation of weakness due to loss of the motor neurons of the spinal cord and brainstem. . Scott M. Sporer, MD. Dartmouth Hitchcock Medical Center, Lebanon, NH.
The purpose of this study was to follow a cohort of patients with a diagnosis of type II (independent sitting) or type III (independent standing) spinal muscular atrophy. The natural history of hip disclocation as well as the incidence of pain and functional difficulties (positioning, skin and perineal perineal /peri·ne·al/ (-ne´al) pertaining to the perineum.
The diamond-shaped region of the body between the pubic arch and the anus. care) was determined. In addition, the effect of scoliosis and pelvic obliquity obliquity /obliq·ui·ty/ (ob-lik´wit-e) the state of being inclined or slanting.oblique´
Litzmann's obliquity on the timing of hip migration was evaluated in both patient groups. Database retrieval of patients diagnosed with Spinal Muscular Atrophy types II and III at Connecticut Children's Medical Center between 1934 and 1998 were included in the study. A minimum of two year follow-up was required. The prevalence of hip dislocation or subluxation subluxation /sub·lux·a·tion/ (sub?luk-sa´shun)
1. incomplete or partial dislocation.
2. in chiropractic, any mechanical impediment to nerve function; originally, a vertebral displacement believed to impair nerve was determined utilizing retrospective serial radiographic review. Hips were graded radiographically using Reimer's index of coverage: normal ([less than] 25% uncovered), subluxed (25-75% uncovered) and dislocated dis·lo·cate
tr.v. dis·lo·cat·ed, dis·lo·cat·ing, dis·lo·cates
1. To put out of usual or proper place, position, or relationship.
2. ([greater than] 75% uncovered). Pain as well as functional limitations were assessed via phone or by clinical questionnaire. 41 patients (82 hips) with spinal muscular atrophy (24 patients with Type II and 17 patients with Type III) with a mean age at follow up of 18.2 years (range 2-62 years) were identified. 15 hips in 12 type II patients were dislocated; an additional 15 hips in eight additional patients were subluxed. 21 patients had significant (greater than 1 cm) pelvic obliguity. Two of the 25 patients experienced hip pain, one patient had difficulty with seating and no patients had difficulty with perineal care. Two hips in the type III patients were dislocated, 5 hips were subluxed, and five of the patients had significant pelvic obliguity. None of the 17 patients experienced hip pain, had difficulty with seating, or had problems with perineal care. Hip subluxation and/or dislocation with associated pelvic obliquity is very prevalent in patients with type II spinal muscular atrophy, while it is much less common in the ambulatory type III patients. Despite the presence of hip disloca tion, patients will seldom have associated pain or functional problems. Hip dislocation in type II patients tends to occur at an early age and is frequently accompanied by the temporal relationship of pelvic obliquity.
THE INTERNET AS A COMMUNICATION TOOL FOR U.S. ACADEMIC ORTHOPAEDIC SURGERY DEPARTMENTS. Tamara D. Rozental, MD, Jess H. Lonner, MD, and Selene G. Parekh, MD, MBA. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania (body, education) University of Pennsylvania - The home of ENIAC and Machiavelli.
Address: Philadelphia, PA, USA. , University of Pennsylvania School of Medicine The University of Pennsylvania's School of Medicine, presently located in the University City section of Philadelphia, Pennsylvania, was the United States's first school of medicine, founded at the College of Philadelphia, as the University was then called. , Philadelphia, Pa; Wharton Business School, Small Business Development Center, University of Pennsylvania, Philadelphia, Pa.
The Internet's appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based healthcare companies have proliferated and many medical centers have established individual web sites. The purpose of this study was to evaluate U. S. academic orthopaedic surgery departments with respect to Internet visibility and content. We reviewed existing web sites for the 154 departments or divisions of orthopaedic surgery currently accredited accredited
recognition by an appropriate authority that the performance of a particular institution has satisfied a prestated set of criteria.
cattle herds which have achieved a low level of reactors to, e.g. for resident education by the Accreditation Council for Graduate Medical Education The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for the accreditation for postgraduate medical training programs (i.e., internships and residencies) for medical doctors in the United States. . Each web site was assessed for its informational value in the categories of clinical services, resident education and physician recruitment. In addition, three commonly employed browsing engines were used to search for individual web sites and determine their ease of accessibility. In the category of clinical services, 65 sites (57.5%) provided faculty listings and 49 (43.4%) provided office telep hone numbers and locations. Only 13 sites provided information on common orthopaedic conditions and five had links to other patient education sites. In the category of resident education, 24 sites (21.2%) had online academic schedules but only two (1.7%) provided access to complete conferences or teaching files. In the category of physician recruitment, 91 provided a description of their residency program and 54 had information on the application process, but only 26 (23%) web pages offered detailed departmental statistics. In terms of accessibility, 53 (46.9%) programs were identified by one of three popular search engines, 17 (15%) were identified by more than one search engine and two (1.7%) were identified by all three. The Internet is severely underutilized by U. S. academic orthopaedic surgery departments as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access using popular search engines. U.S. academic orthopaedic surgery departments are thu s missing a valuable opportunity to promote awareness of their institution and become an educational resource for the community.