Showing papers in "Clinical Orthopaedics and Related Research in 1993"
TL;DR: The need for a standardized system of end result reporting of various surgical alternatives after limb salvaging and ablative procedures for musculoskeletal tumors was clearly recognized during the first International Symposium on Limb Salvage in 1981.
Abstract: The need for a standardized system of end result reporting of various surgical alternatives after limb salvaging and ablative procedures for musculoskeletal tumors was clearly recognized during the first International Symposium on Limb Salvage (ISOLS) in 1981. During the ensuing four biannual symposia, there has been an ongoing developmental experience with a system extensively field tested in 1989 by the Musculoskeletal Tumor Society (MSTS). This system of functional evaluation has been adopted by the MSTS and ISOLS for their joint studies and program presentation. In brief, the system assigns numerical values (0-5) for each of six categories: pain, and function and emotional acceptance in upper and lower extremities; supports, and walking and gait in the lower extremity; and hand positioning, and dexterity and lifting ability in the upper extremity. Demographic information and a patient satisfaction component is included. A numerical score and percent rating is calculated to allow for comparison of results. The system has been field tested in 220 patients with low (+/-) interobserver variability. It was well accepted by the participants, and its usage is recommended by the MSTS to facilitate valid comparative end result studies of musculoskeletal tumor reconstructions.
2,275 citations
TL;DR: Despite an improved outcome for Type II and III fractures with increasing surgical experience, the results of operative intervention in Type IV fractures were no better, even after four years, because the number of articular fragments increase.
Abstract: From January 1987 to September 1990, 132 displaced intraarticular calcaneal fractures were treated operatively using a lateral approach, lag screws, and side plate without bone graft. To evaluate the results, a classification for intraarticular calcaneal fractures was developed, based on standardize
968 citations
TL;DR: The posterior condylar angle, referenced from the surgical epicondylar axis, provides a visual rotational alignment check during primary arthroplasty and may improve alignment of the femoral component at revision.
Abstract: The posterior condylar surfaces of the femur are routinely used as the reference for the rotational orientation of the femoral component during most primary total knee arthroplasties. The purpose of this investigation was to identify a clearly discernible, reproducible secondary anatomic axis useful for determining the rotational orientation of the femoral component when the posterior condylar surfaces cannot be used. Seventy-five embalmed anatomic specimen femurs were studied. A surgical epicondylar axis was defined as the line connecting the lateral epicondylar prominence and the medial sulcus of the medial epicondyle
805 citations
Journal Article•
661 citations
TL;DR: There was a correlation between body weight and the presence of radiolucencies, and patients who weighed more than 80 kg had the lowest survivorship at 15 years: 89.2% clinical survival and 70.6% clinical plus roentgenographic survival.
Abstract: This study reports the 15-year survivorship of 112 consecutive Total Condylar knee arthroplasties that have been followed since 1974. Two endpoints were chosen for survivorship: (1) Revision attributable to septic or aseptic loosening or malalignment. (2) Revision or roentgenographic evidence of component loosening. Life table analysis reveals a 94.1% clinical survivorship at 15 years, with an 90.9% survivorship when roentgenographic failures are included. There were five revisions: one for infection, one for instability, and three for tibial loosening
546 citations
TL;DR: The authors used a mechanical device to locate the FE and the LR axes of six fresh anatomic specimen knees, and images in planes perpendicular to the FE axis showed a circular profile for the femoral condyles.
Abstract: Knee motion is believed to occur about a variable flexion–extension (FE) axis perpendicular to the sagittal plane and a longitudinal rotation (LR) axis. The authors used a mechanical device to locate the FE and the LR axes of six fresh anatomic specimen knees. The motion of points on the LR axis pro
515 citations
TL;DR: The results of this study show that operative treatment of complex intraarticular fractures of the distal tibia remain fraught with difficulty and that the complication rates and need for further reconstructive surgery remains high.
Abstract: In a retrospective study, 58 patients with 60 tibial plafond fractures were treated by internal fixation and reviewed over an average follow-up period of 2.5 years. There were three Reudi Type I, 27 Reudi Type II, and 30 Reudi Type III fractures. Twelve fractures were open, and 60% of the fractures were the result of high-energy trauma. Results were evaluated based on a subjective and objective rating system. There were 15 good and excellent (25%), 15 fair (25%), and 30 poor results (50%). The deep infection rate in Reudi Types I and II fractures was 0%, and in Type III fractures it was 37%. The deep infection rate statistically correlated with the presence of a postoperative wound dehiscence or skin slough but not with the presence of an open fracture. Overall clinical rating correlated with the Reudi classification, quality of reduction, and the presence of a postoperative wound infection. The ankle fusion rate for Reudi Types I and II fractures was 10%, whereas that in Reudi Type III fractures was 26%. The results of this study show that operative treatment of complex intraarticular fractures of the distal tibia remain fraught with difficulty and that the complication rates and need for further reconstructive surgery remains high. If anatomic reduction without soft-tissue complications cannot be predicted preoperatively, consideration should be given to alternative types of treatment.
459 citations
TL;DR: Two important stabilizing mechanisms, concavity compression and scapulohumeral balance, were described in conjunction with recent in vitro studies, and clinical correlation of these mechanisms contributes to the understanding of glenohueral instability.
Abstract: The biomechanics of glenohumeral stability involve several static and dynamic mechanisms to achieve the intricate balance between shoulder mobility and stability. In conjunction with recent in vitro studies, two important stabilizing mechanisms, concavity compression and scapulohumeral balance, were described. Concavity compression refers to the stability obtained by compressing the humeral head into the concave glenoid fossa. Increasing the magnitude of the compressive load, as provided by dynamic muscle contraction, and the depth of the glenoid concavity, which varies from the asymmetric geometry, enhance concavity compression stabilization. The related scapulohumeral balance refers to the dynamic positioning of the glenohumeral joint so that the joint reaction force is balanced within the glenoid fossa. The greater the arc provided by the glenoid, the larger the range of joint force angles acting through the humeral head that may be stabilized. The presence of an intact glenoid labrum is important to both mechanisms. Concavity compression and scapulohumeral balance may be of particular importance to glenohumeral joint stability in the midrange of motion where the capsuloligamentous constraints are lax. Clinical correlation of these mechanisms contributes to the understanding of glenohumeral instability.
434 citations
Journal Article•
398 citations
TL;DR: The objective of treatment of tibial plateau fractures is precise reconstruction of the articular surfaces, stable fragment fixation allowing early motion, and repair of all concomitant lesions in specific fracture types.
Abstract: The objective of treatment of tibial plateau fractures is precise reconstruction of the articular surfaces, stable fragment fixation allowing early motion, and repair of all concomitant lesions. A classification scheme is employed to include the high incidence of concomitant lesions in specific fracture types. The term "complex trauma" is used for extensive injuries involving multiple structural elements of the knee joint. Exact grading of the soft-tissue injury is crucial for the treatment plan. The authors suggest a four-grade classification system of closed and open soft-tissue injury. Preferred treatment is open reduction and internal fixation (ORIF) in all displaced and unstable tibial plateau fractures. A stepwise approach is used in complex knee trauma. Primary treatment includes closed reduction, wound debridement, if necessary, and external fixation of the femur and lower leg ("transfixation"). Open reduction and internal fixation and complex bone and soft-tissue reconstructions are performed in a second operation after recovery of the soft tissues. A follow-up study of 190 of 244 cases of tibial plateau fractures treated in the authors' institution from 1981 to 1987 showed good results after operative treatment, even in extensive fractures, with a tolerable complication rate. The functional recovery was relatively impaired in multiple injured patients and in complex knee trauma.
398 citations
TL;DR: Four fresh-frozen anatomic knee specimens were tested for knee stability, patellar tracking, and patellofemoral contact points with the femoral component positioned in 5 degrees internal, 5 degrees external, or neutral axial rotational alignment of the Femoral component referenced on the posterior femoral condyles.
Abstract: Four fresh-frozen anatomic knee specimens were tested for knee stability, patellar tracking, and patellofemoral contact points with the femoral component positioned in 5 degrees internal, 5 degrees external, or neutral axial rotational alignment of the femoral component referenced on the posterior femoral condyles. The externally rotated specimens had varus-valgus stability of the knee that was closest to the normal control. The internally rotated specimens shifted into valgus alignment with flexion. Patellar tracking also was closest to normal in the externally rotated specimens. Patellofemoral contact was more evenly distributed between the medial and lateral contact areas in the externally rotated specimens than in the internally rotated or in the neutral specimens. Internal rotation of the femoral component in the knee with perpendicular resection of the tibia causes undesirable changes in knee stability, patellar tracking, and patellofemoral contact points. Neutral positioning produces similar but less negative effects on knee stability and patellar kinematics. External rotation improves both patellar tracking and knee stability characteristics.
TL;DR: In this article, the most common gait abnormalities of the knee in patients with cerebral palsy occur in the sagittal plane, and the most commonly common etiologies and the consequences for gait of each disorder are also considered.
Abstract: Gait abnormalities in children with cerebral palsy are the consequence of contractures across joints, muscle spasticity, and phasically inappropriate muscle action. Though abnormalities involving one of the major joints of the lower extremity will usually have consequences on the function of the other joints, it is possible to recognize certain primary disorders at each joint. The most common gait abnormalities of the knee in patients with cerebral palsy occur in the sagittal plane. Based on the experience gained from performing gait analysis on more than 588 patients with cerebral palsy, four primary gait abnormalities of the knee have been identified: jump knee, crouch knee, stiff knee, and recurvatum knee. In this review, each abnormality is described by its motion analysis laboratory profile (physical examination, motion parameters, electromyography [EMG] data, and force plate data). The most common etiologies and the consequences for gait of each disorder are also considered. Appreciation of the most common pathologic patterns of gait should facilitate accurate and detailed analysis of the individual patient with gait abnormalities.
TL;DR: The operative treatment of intraarticular calcaneal fractures has three principal aims: restoration of height, length, and width of the calcaneus, reconstruction of the subtalar and calcaneocuboid joint surfaces, and stable osteosynthesis using an H-plate or screws.
Abstract: The operative treatment of intraarticular calcaneal fractures has three principal aims: restoration of height, length, and width of the calcaneus, reconstruction of the subtalar and calcaneocuboid joint surfaces, and stable osteosynthesis using an H-plate or screws. In 68% of the cases, the sustentacular fragment was the key to open reduction, making the medial approach mandatory. In complex fractures, a lateral approach is added. In "blow-out" fractures or cases with comminution of the sustentacular fragment, an extended lateral approach only is used. For precise preoperative planning of roentgenograms in three planes, four Broden's views and axial plus coroneal or three-dimensional computed tomography scans are required. From July 1983 to July 1990, 157 intraarticular calcaneal fractures were treated by open reduction. The results in 123 cases are 61% good or excellent, 32.5% satisfactory, and 6.5% poor. The following early complications occurred: superficial wound edge necrosis (8.3%), hematoma (2.5%), nonunion (1.3%), and infection (1.9%). Four patients (3.3%) in the follow-up group have developed degenerative changes severe enough to require subtalar fusion. To facilitate the comparison of results, new fracture classification and follow-up scoring systems have been devised.
Journal Article•
TL;DR: Intensive study of this tumor by Rous and by other investigators led to a greater understanding of the nature of the many factors that influence tumor growth, and find important applications today when clinicians are vitally interested in the relationship between the Kaposi sarcoma and the AIDS virus.
TL;DR: New bone formation in the defect sites treated with rhBMP-2 first appeared one month after implantation and had a mean bending strength of 91% +/- 59% and a lack of bony union in the negative-control groups treated with no implant and inactive bone matrix without BMP.
Abstract: A middiaphyseal, 2.5-cm osteoperiosteal segmental defect stabilized by plate fixation was created in the right femur of 17 sheep. Four treatment groups were included: Group I, no implant; Group II, inactive bone matrix; Group III, recombinant human bone morphogenetic protein (rhBMP-2) mixed with inactive bone matrix; and Group IV, autogeneic bone graft. Three animals had early failure of fixation, and the remaining 14 were evaluated at three months after implantation. Radiographs showed bony union of all defects treated with rhBMP-2 (six) and a lack of bony union in the negative-control groups treated with no implant (three) and inactive bone matrix without BMP (three). Both defects treated with autograft healed. New bone formation in the defect sites treated with rhBMP-2 first appeared one month after implantation and had a mean bending strength (expressed as a percentage of the contralateral femur) of 91% +/- 59% (mean +/- standard deviation) for defects treated with BMP-2, 77% +/- 34% for autograft, 9% +/- 8% for no implant, and 11% +/- 7% for inactive matrix without BMP. Three sheep treated with rhBMP-2 had their fixation plates removed at four months and were followed for one year. Their bone defect sites remained solidly healed one year after the initial operation.
Journal Article•
TL;DR: Using an extensile lateral approach, rigid internal fixation, and early motion, more than 100 calcaneal fractures have been treated at the authors' institution between 1985 and 1989, and preliminary results demonstrate lower morbidity and improved outcome.
Abstract: Periodic cycles of enthusiasm for surgical management characterize the history of fractures of the calcaneus of the past century. After each period of advocacy for aggressive surgical therapy, there has been a trend toward nonoperative treatment. Morbidity and disappointing results were reported by those whose early attempts at open reduction were more difficult than expected. With the emergence of a subspecialty within orthopedic surgery devoted to fracture care, the pendulum has again swung toward operative treatment. A clearer understanding of fracture patterns from cross-sectional imaging, concentration of the injuries in the care of experienced fracture surgeons, periopsrative antibiotics, rigid internal fixation, and early rehabilitation represent the latest attempts to improve the outcome from the vexing injury
TL;DR: More than 100 calcaneal fractures have been treated at the institution between 1985 and 1989 as mentioned in this paper, using an extensile lateral approach, rigid internal fixation, and early motion.
Abstract: Periodic cycles of enthusiasm for surgical management characterize the history of fractures of the calcaneus of the past century. After each period of advocacy for aggressive surgical therapy, there has been a trend toward nonoperative treatment. Morbidity and disappointing results were reported by those whose early attempts at open reduction were more difficult than expected. With the emergence of a subspecialty within orthopedic surgery devoted to fracture care, the pendulum has again swung toward operative treatment. A clearer understanding of fracture patterns from cross-sectional imaging, concentration of the injuries in the care of experienced fracture surgeons, perioperative antibiotics, rigid internal fixation, and early rehabilitation represent the latest attempts to improve the outcome from this vexing injury. Using an extensile lateral approach, rigid internal fixation, and early motion, more than 100 calcaneal fractures have been treated at the authors' institution between 1985 and 1989. Compared with published reports, the preliminary results demonstrate lower morbidity and improved outcome.
TL;DR: The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis, and an experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.
Abstract: The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). There were 39 simple and 156 complex associated fracture patterns. There were two large groups of associated fractures: anterior column posterior hemitransverse (39 fractures) and both column fractures (98 cases). Of these fracture patterns stabilized through the ilioinguinal approach, there was a rate of perfect reduction of 85% and 73%, respectively. Of 70 fractures involving the anterior column, anterior wall, and anterior column posterior hemitransverse, there were 61 perfect reductions (87%). The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.
Journal Article•
TL;DR: This paper showed that mice with inherited osteopetrosis can recover bone and calcified cartilage by intravenous administration of cell suspensions prepared from spleen and bone marrow of normal littermates.
Abstract: Capacity to resorb bone and calcified cartilage was restored permanently in mice with inherited osteopetrosis by the intravenous administration of cell suspensions prepared from spleen and bone marrow of normal littermates. Beginning near active growth plates as early as 2 weeks after transplantation, replacement of the abnormal spongiosa continued until medullary cavitites were fully expanded.
TL;DR: In the sacrum, an approach through the S1 facet produced significantly higher axial pullout forces and transverse bending stiffness than the approach described by Harrington and Dickson.
Abstract: This study investigated (1) the effect of screw diameter and insertion technique in lumbar vertebrae, and insertion site in the sacrum, on the axial pullout force and transverse bending stiffness of pedicle screws, and (2) the effect of bone cement augmentation using polymethylmethacrylate (PMMA) and the biodegradable composite, poly(propylene glycol-fumarate) on axial pullout force and transverse bending stiffness of pedicle screws inserted into lumbar vertebrae. The axial pullout force and transverse bending stiffness of a 6.25-mm Steffee screw and a 6-mm Kluger screw did not differ significantly in vertebral bodies of similar equivalent bone mineral density. The axial pullout force of Schanz screws was significantly increased with a 1-mm increase in screw diameter. However, there was no significant increase in transverse bending stiffness. In the sacrum, an approach through the S1 facet produced significantly higher axial pullout forces and transverse bending stiffness than the approach described by Harrington and Dickson. PMMA and a biodegradable composite bone cement poly(propylene glycol-fumarate) both increased the axial pullout force. PMMA also increased the transverse bending stiffness.
TL;DR: The width and configuration of the subacromial space was studied in retraction and protraction of the shoulder girdle in four healthy subjects by magnetic resonance imaging.
Abstract: The width and configuration of the subacromial space was studied in retraction and protraction of the shoulder girdle in four healthy subjects by magnetic resonance imaging. The anterior opening of the subacromial space narrowed as the shoulder moved from a retracted to a protracted position.
TL;DR: The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows; most patients showed improvement with regard to their ability to perform activities of daily living.
Abstract: The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows. Patients were treated with nonsteroidal antiinflammatory medication, stretching, strengthening, and occasional steroid injections. Average age at presentation was 62.2 years. Patients were evaluated at an average of 7.6 years. Forty patients were male, and the dominant limb was involved in 40 cases. Thirty-four patients were reviewed by questionnaire and physical examination, whereas 19 patients were evaluated by telephone interview only. In 40 patients, the onset of symptoms was associated with an injury. In 12 patients, workmen's compensation was involved. At follow-up evaluation, the 34 shoulders that were available for examination were evaluated for pain, range of motion, strength, and function. Thirty-nine of the 53 patients (74%) assessed subjectively had only slight or no shoulder discomfort. Of the 28 shoulders presenting within three months of injury, 24 (86%) were rated as satisfactory at the time of latest evaluation. Of the 16 patients who initially had had shoulder pain for over 6 months, only nine (56%) were rated as satisfactory. Most patients showed improvement with regard to their ability to perform activities of daily living. Average active total elevation was 149 degrees compared with 121 degrees at initial presentation. Thirty-two of the 34 patients examined (94%) had evidence of weakness on muscle testing and 19 (56%) had demonstrable muscle atrophy.
TL;DR: The ROM and outcomes of the severely comminuted or open fractures of the distal intraarticular tibia were very good and range of motion at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two.
Abstract: We are indebted to Ruedi and Allgower for their early work and recommendations for the management of intra-articular distal tibia fractures (pilon fracture). Their classification and guidelines for stable internal fixation with early mobilization have improved the outcome of these severe injuries. It is important to appreciate, though, their particular patient population and type of injury: The majority of their patients had fairly low-energy skiing injuries. Their articular reconstructions and final outcome were excellent [5–7]. Similar results have not been obtained, however, in injuries from high-energy falls or road traffic accidents that involve severe comminution of the intra-articular plafond and distal tibia, especially when these injuries were open [3]. Because of this, an alternative method of stabilization of severely comminuted and/or open pilon fractures has been used at the Erie County Medical Center of the State University of New York at Buffalo over the past 2½ years. This consists of reduction and stabilization of the intra-articular component with screws or small plate fixation and the use of an external fixator across the ankle joint as an external neutralization device.
TL;DR: A significant correlation was found between PF problems and female gender, positive congruence angle, preoperative PF crepitation, rehabilitation difficulties, flexion loss greater than 10 degrees, extension loss more than 5 degrees, and variation in the height of the patella.
Abstract: A series of 226 anterior cruciate ligament (ACL) reconstructions were reviewed to determine the incidence of patellofemoral (PF) problems and the associated prognostic factors. Patients were divided into four groups according to the type of injury (acute or chronic) and operation (through an arthrotomy or arthroscopic assisted). The average follow-up period was 39 months. Overall there was a 5% incidence of PF crepitus with pain and/or swelling, and a further 20% of clear PF crepitus without pain. The change from open surgery and cast to arthroscopic surgery and early motion allowed a decrease of PF problems from 40% to 21% in acute injuries, but the difference was less marked in chronic knees. A deficit greater than 10% at the one-leg hop test was present in 75% of the knees with PF crepitus and pain. The height of the patella was increased in 5% and decreased in 17% of the knees. Patients with rehabilitation difficulties had the largest decrease in patella height, whereas a patella alta was more frequent after patellar tendon reconstruction. A significant correlation was found between PF problems and female gender, positive congruence angle, preoperative PF crepitation, rehabilitation difficulties, flexion loss greater than 10 degrees, extension loss greater than 5 degrees, and variation in the height of the patella. The importance of avoiding immobilization, rehabilitation difficulties, and permanent flexion or extension loss is emphasized.
TL;DR: In this article, the effects of the rigidity of the selected fixation device, the fracture configuration, the accuracy of fracture reduction, and the amount and type of stresses occurring at the bone ends dictated by functional activity and loading at the fracture gap were investigated.
Abstract: The major factors determining the mechanical milieu of a healing fracture are the rigidity of the selected fixation device, the fracture configuration, the accuracy of fracture reduction, and the amount and type of stresses occurring at the bone ends dictated by functional activity and loading at the fracture gap. Of the effects of these factors on fracture healing and remodeling in the canine tibia under unilateral external fixation, the two most significant factors in promoting periosteal callus formation were the amount of physiologic loading as dictated by the body weight and the presence of a significant fracture gap. Uniform axial loading and motion, performed at two or four weeks, did not increase callus formation but did reduce the existing fracture gap. The time-related diminution of periosteal callus (external remodeling) was related to the progress of cortical healing. Cortical reconstruction was fast in stable transverse fractures and delayed in unstable oblique fractures. Motion with loading tended to promote external callus maturation in secondary bone healing. Intracortical new bone formation and porosity were related to the healing pattern and not to the loading magnitude. Endosteal new bone formation showed a strong correlation with the presence of a fracture gap. In terms of torsional strength and energy absorption at failure, the fractures healing through a combination of primary and secondary bone union mechanisms showed the mechanical strength of the healing bone closest to intact bone.
Journal Article•
TL;DR: Gait analysis has been used in the treatment of cerebral palsy and has been shown to be useful in identifying specific pathologies of the patient and providing an accurate assessment of outcome as discussed by the authors.
Abstract: Gait analysis has radically changed the treatment of cerebral palsy. Preoperatively, it allows critical assessment of the specific pathologies of the patient. Postoperatively, it provides an accurate assessment of outcome. This assessment of outcome has in turn allowed the accurate critique of surgeries and has made it possible to discard treatments that are not useful or are perhaps even injurious. As a result of this continual reassessment of surgical techniques, several principles and insights regarding the treatment of cerebral palsy have been learned
TL;DR: Stable internal fixation allows early active and passive mobilization of the subtalar and ankle joints, and if this is not achieved, the functional outcome will be poor.
Abstract: Displaced intraarticular fractures of the calcaneus require operative intervention to restore the anatomy of the bone, which in turn is the requirement for recovery of subtalar joint mobility. Surgery through a lateral incision, without opening the sheath of the peroneal tendons, and the use of lag screws and a "Y-plate," must restore not only the respective positions of the "three poles" of the calcaneus but also the respective orientations of the articular surfaces. Stable internal fixation allows early active and passive mobilization of the subtalar and ankle joints. If this is not achieved, the functional outcome will be poor.
TL;DR: The principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals for displaced intraarticular fractures.
Abstract: Bicondylar intraarticular fractures of the distal humerus, because of their rarity and often associated significant displacement, comminution, and osteopenia, present the orthopedist with a difficult injury to reliably treat successfully. As with any displaced intraarticular fracture, the principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals. To obtain reproducible results, an established treatment protocol is required and is described in detail here. The average excellent-to-good results with surgical treatment for Type C fractures ("T" or "Y" bicondylar fractures) is 75% (range, 65-100%). Complications include heterotopic ossification (4%), infection (4%), ulnar nerve palsy (7%), failure of fixation (5%), and non-union (2%).
TL;DR: Supine Phase I exercises should be considered in the early postoperative period after shoulder surgery to achieve maximum motion while minimizing shoulder muscle activity.
Abstract: The role of shoulder muscles during passive, active, and resistive phases of shoulder rehabilitation exercises was investigated in ten normal subjects with no history of shoulder pathology. Using the scapular plane as a reference, three-dimensional motion of the shoulder was recorded with a computer-aided motion analysis system (VICON) to determine total shoulder elevation. Simultaneously, electromyographic data were acquired on nine shoulder muscles while performing the three phases of shoulder rehabilitation exercises as described by Neer. Fine wire intramuscular electrodes were placed in the following muscles: trapezius, serratus anterior, deltoid (anterior, middle, and posterior separately), supraspinatus, infraspinatus, biceps, and latissimus dorsi. Phase I (passive) exercises performed in the supine position showed the least electromyography (EMG) activity. There was a gradation of EMG activity as one progressed from Phase I (passive) to Phase II (active) to Phase III (resistive) shoulder exercises. Isometric exercises and Phase III resistive exercises showed high levels of activity in the rotator cuff and deltoid muscles. Supine Phase I exercises should be considered in the early postoperative period after shoulder surgery to achieve maximum motion while minimizing shoulder muscle activity. Progression to Phase II and Phase III exercises may proceed as soft tissue and bony healing permit. Phase III exercises performed with an elastic band should provide a satisfactory method to strengthen these muscles.
TL;DR: During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture, and there was no significant difference between genders or among fracture types.
Abstract: During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contralateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72% of the trochanteric fractures were preceded by a contralateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men.