Abstract:

An isolated posterior cruciate ligament injury is a difficult clinical and surgical problem. Most authors agree that multidirectional rotatory instability of a knee resulting from either medial or lateral ligamentous laxity in combination with a posterior cruciate ligament (PCL) injury requires surgical stabilization. However, indications for surgical reconstruction of an isolated posterior cruciate ligament injury still remain controversial. This lack of agreement over the surgical indications for this injury appears to stem from a lack of clear understanding of the natural course of PCL-deficient knee, and current limitations in surgical technique to reproduce posterior stability in a predictable fashion.

Authors:

John H. Pak, M.D., Rustic Hills Orthopaedic Association, Colorado Springs, CO; Lonnie E. Paulos, M.D., The Orthopedic Specialty Hospital, Salt Lake City, UT

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Abstract:

Trapezio metacarpal joint (TMJ) arthritis depends on various etiologies including joint laxity, repetitive stresses, hypoplasia of the trapezium bone, and musculotendinous anomalies. The anatomy of the musculotendinous insertions described in textbooks is found very seldom in reality. Only in 2 cases out of 100 hand dissections did we find 1 abductor pollicis longus (APL) tendon. The number of tendons of the first wrist compartment averaged more than four, in different arrangements.

Authors:

Giorgio A. Brunelli, M.D., Brescia University Medical School, Brescia, Italy; Giovanni R. Brunelli, M.D., Spedali Civili di Brescia, Brescia, Italy; Valerio Mattiuzzo, M.D., Brescia University Medical School, Brescia, Italy

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Abstract:

Thromboembolic disease is a potentially fatal complication after high-risk orthopaedic surgery such as total joint arthroplasty and major trauma. Without prophylaxis, pulmonary embolism is known to occur in 1% to 2% of hospitalized patients. Pneumatic foot compression devices have recently been developed to increase lower extremity circulation and, as a result, are effective in thromboembolic disease prophylaxis. Recent studies in total hip and total knee arthroplasty have documented a statistically significant reduction in deep venous thrombosis using these devices. Interestingly, studies utilizing pneumatic foot compression have demonstrated a reduction in lower extremity edema both postoperatively and after significant lower extremity trauma. Pneumatic foot compression appears to be more applicable than the previous mechanical devices, and as a result, compliance appears to have improved.

Authors:

Geoffrey H. Westrich, M.D., Thomas P. Sculco, M.D., The Hospital for Special Surgery, New York, NY

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Abstract:

In the past the evaluation of treatment modalities of calcaneal fractures has been fraught with the lack of well-designed, randomized clinical studies. As a result, surgeons treating these injuries were typically polarized when deciding between a surgical or nonsurgical approach to management. Among the many technical reasons for the frank dichotomy of treatment preferences were the difficulty in anatomical restoration, the relatively poor surgical access to the calcaneus, the limited internal fixation devices available for stabilization, and the difficulty in comprehensive radiographic imaging. Furthermore, the lack of complete understanding of the mechanism of sequential bony failure complicated the surgical exercise. The lack of standardized protocols for surgical treatment also lended to the controversy.

Authors:

John M. Schuberth, D.P.M., F.A.C.F.A.S., Kaiser Foundation Hospital, San Francisco, CA

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Abstract:

Total hip arthroplasty (THA) is now a routine procedure used to relieve pain and restore function. The results of the procedure depend on several factors: implant positioning, bone implant fixation, bone stock, and restoration of a physiological musculo-articular unit. The prosthesis may be cemented or used without cement. In the latter case, mechanical stability relies on implant fit and fill to reduce micromotion and ensure long-term fixation. This fixation is usually enhanced by surface coating of the stem. While the goal of THA is routinely reached in common osteoarthritis, it is often more difficult when the anatomy of the hip is modified. In these cases, fit can be achieved by designing a stem adapted to the modified anatomy to provide optimal stress transfer.

Authors:

Jean-Manuel Aubaniac, M.D., Jean-Noël A. Argenson, M.D., Ph.D., University of Aix-Marseille, Hopital Sainte-Marguerite, Marseille, France

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