Abstract:

The past decade has seen a dramatic increase in the use of intramedullary nailing for fracture management. Increased availability of new techniques and instrumentation have contributed to the continuing expansion of applications for intramedullary nailing. The introduction and availability of image intensifiers into American hospitals has also led to the popularization of closed intramedullary nailing techniques, and locking nails have expanded the indications of closed intramedullary nailing to unstable long bone fractures of the femur, tibia, and humerus. New classes of nails such as the second generation Reconstruction Nail have expanded the use of intramedullary nailing for more proximal femoral fractures. In addition, advances in biomechanical and locking designs have recently led to the use of intramedullary nailing in distal femur fractures and forearm fractures. There is continuing evolution of specialized nails including a self-guiding nail, nails for use in femoral lengthening, and nails used in conjunction with intramedullary osteotomies.

Authors:

Jeffrey E. Rosen, M.D., Kenneth J. Koval, M.D., Hospital for Joint Diseases Orthopaedic Institute; Victor H. Frankel, M.D., Ph.D., Hospital for Joint Diseases Orthopaedic Institute, New York University, New York, NY

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Abstract:

The first hip replacements of the modern era were performed by Sir John Charnley in 1959, using polytetrafluoroethylene for the acetabulum and polymethylmethacrylate cement to secure the stainless steel femoral component. These initial operations were not a success due to excessive wear of the PTFE bearing surface. The operation was not acknowledged to be the success it is today until 1962when Charnley switched to using high-density polyethylene for the acetabular component and the "low-friction arthroplasty" was introduced. This prosthesis has remained the "gold standard" until the present day with relatively few changes to the original concept, and with considerable success with published results in excess of 20 years.

Authors:

Jonathan C. Gardiner, M.B.B.S., F.R.C.S., Bert J. Thomas, M.D., UCLA School of Medicine, Los Angeles, CA

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Abstract:

The most common carpal instability is the scapholunate dissociation (carpal instability dissociative: C.I.D.) with dorsal intercalated segment instability (D.I.S.I.), with the most significant element being the flexion of the scaphoid bone (rotary subluxation). Rupture of the scapholunate ligament was formerly believed to be the prerequisite for the dissociation. However, three findings contradict this theory.

Authors:

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

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Abstract:

Deep vein thrombosis and pulmonary embolism are important clinical disorders that affect patients in many medical and surgical specialties. In North America, deep vein thrombosis results in hospitalization of up to 600,000patients per year. Pulmonary embolism is also a serious problem that occurs in more than 500,000 patients per year, of whom approximately 200,000 will die. Almost half of those patients who die will be terminally ill or suffer an incurable disease, but the remainder of the deaths occur in patients who otherwise could have recovered completely.

Authors:

Alexander G. G. Turpie, M.D., F.R.C.P., F.A.C.P, F.A.C.C., F.R.C.P.C., McMaster University, Hamilton, Ontario, Canada

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Abstract:

Deep vein thrombosis and pulmonary embolus are known complications of orthopaedic procedures, particularly about the hip and knee. Spinal surgery has been associated with few thrombotic complications historically. Widespread use of instrumentation in adult patients has lead to a rise in complexity of adult spinal surgery. Length of operative procedures, level of difficulty, and bulk of instrumentation have all increased. We have noted an occasional pulmonary embolus in our center, as well as a small incidence of pulmonary embolus in recent reports of adult spine instrumented cases. A consensus conference through the National Institute of Health has estimated that between 300,000and 600,000 hospitalized patients develop deep vein thrombosis each year with as many as 50,000 deaths per year occurring secondary to pulmonary embolus. The incidence of thromboembolic disease appears to increase with age as well as with immobilization. Prolonged rest and prone positioning on frames with compression of femoral veins and iliac veins have been indicated as possible risk factors during spinal surgery.

Authors:

James L. West III, M.D., Tosh Atkins, M.D. University of South Alabama Medical Center, Mobile, AL; Lisa Helms, R.N., Orthopaedic Associates of Mobile, P.A., Mobile AL

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Abstract:

The use of cold therapy postoperatively in orthopaedics has been the topic of a long-standing discussion. How cold is applied, (i.e., ice vs. machine), the length of time of cold exposure, and frequency of application has been the subject of debate for years, and there is still no clear-cut answer or standard which is uniformly followed. The use of cold has been shown by both Cohn and McCoy to decrease the need for pain medication postoperatively. Masten used cold therapy in the laboratory to demonstrate that post-traumatic swelling was controlled with cold applications. McMaster and Liddle showed a relationship with decreased edema and early application of ice. We attempted to look at the application of cold therapy in postoperative spine patients to see if there was significant benefit to our patients. In our study patients were randomly chosen to receive cold therapy postoperatively. Patient groups were normalized as to sex, age, and surgery. Both groups were homogenous when looked at overall. The Hot/Ice System™ (Incare Medical Products, Hollister Inc., Hollister, Calif.] was chosen as the method of cold delivery for three reasons: (1) ease of use, (2) limited need for nursing intervention, and (3) delivery of consistent cold temperatures.

Authors:

Arthur D. Steffee, M.D., John W. Booher, P.A./C., B.S., Robert S. Biscup, D.O., M.S., Fairview Health System, Cleveland, OH

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