Abstract:

In prospective, randomized, double-blind, placebo-controlled, multi-center clinical studies, pulsed, lowintensity ultrasound has been proven to be effective in decreasing the time to heal in both fresh diaphyseal (tibia) and metaphyseal (distal radius) fractures. It also decreases the likelihood of a delayed union (>150 days to heal) in tibia fractures and loss of reduction in distal radius fractures. World-wide clinical studies, using pulsed, low-intensity ultrasound for treatment of non-union in a self-paired control study design, have demonstrated a heal rate of 88% with an average treatment time of 4.5 months in non-unions and an average fracture age of 23 months. The therapy is safe and non-invasive, and is used by the patient at home for a 20-minute treatment session per day.

Authors:

Victor H. Frankel, M.D., Ph.D., K.N.O., Kosaku Mizuno, M.D., Ph.D.

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Abstract:

Patients with 75 TRAC (Biomet, Inc., Warsaw, IN) knees have been observed for one year with the fololowing results: average flexion 117 degrees, HSS seore 88.4, Knee Society seores 92.2 (knee), and 76.8 (function). Early results of the TRAC knee appear promising.

Authors:

Lawrence A. Pottenger, M.D., Ph.D., Louis Draganich, Ph.D.

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Abstract:

Articles in the literature about hydroxyapatite-coated hip prostheses show both the clinical and radiologlcal results are extremely satisfactory in the short and medium term. They bear out the reliability, constancy, and durability of bio-active fixation. As in the case of cemented prostheses, results are tempered by the emergence of complications linked with the particles produced by polyethylene wear, a particular cause of osteolysis in the femur or acetabulum. The ABG II HA hip prosthesis was designed with the aim of reducing this type of complication while maintaining the principle of bio-active fixation. Implantation of the system is subject to certain requirements; in particular, a preoperative radiologic assessment is required and the surgical technique must be strictly followed to optimize the biomechanical functioning of the implanted hip.

Authors:

Christian Nourissat, M.D., Jose Adrey, M.D., Daniel Berteaux, M.D., Christian Goalard, M.D., Williamwalter, M.D.

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Abstract:

As the population ages, primary total hip arthroplasty (THA) is becoming one of the most common orthopedic procedures. Therefore, revisions for mechanical loosening after THA should also increase in future years. Loosening is a progressive phenomenon that, along with intracortical granuloma, causes bone destruction. The main concern in total hip revision surgery is the reduced bone stock, which makes it difficult to obtain optimal stability of the femoral stem (Case 1: Figs. 1a, b).

Authors:

Jordi Casas-Sabater, M.D., Marc Cots-Pons, M.D., Félix Castillo-García, M.D., Ernane Dodero Reis, M.D., Joaquim odriguez-Miralles, M.D., Ph.D.

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Abstract:

Fractures of the femoral neck are frequent in the elderly population. The reduced general health status and presence of concomitant diseases, in many cases, make the treatment of these patients demanding. Early mobilization is mandatory to avoid secondary infections, which were often lethal in the past. Surgical intervention has become the standard treatment for these patients. Only a few patients with stable fracture types allow early mobilization without operation.

Authors:

Hans Josef Erli, M.D., Peter Klever, M.D., Othmar Paar, M.D.

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Abstract:

Thrombosis is a common cause of death in the United States. More than two million people die each year from an arterial or venous thrombosis, or the consequences thereof. Approximately an equal number suffer non-fatal thrombosis; for example, deep venous thrombosis (DVT), non-fatal pulmonary embolus (PE), non-fatal cerebrovascular thrombosis (CVT), transient cerebral ischemic attacks (40% of these have a fatal or non-fatal CVT within one year), non-fatal coronary artery thrombosis, retinal vascular thrombosis (RVT), and other non-fatal thrombotic deaths. These numbers emphasize the scope of the problem. By contrast, approximately 550,000 people will die this year in the United States from cancer; thus, fatal thrombosis is approximately four times as prevalent as fatality from malignancy. Thrombosis, therefore, accounts for extraordinary morbidity, mortality, and cost of medical care.

Authors:

Rodger L. Bick, M.D., Ph.D., F.A.C.P.

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Abstract:

In our department, all the patients over 65 years of age with a displaced intracapsular fracture of the upper femur (type III and IV of the Garden's classification') are treated with a femoral hemiarthroplasty (Figs. 1a & 1b). This practice is relatively universal among the European traumatologic centers. Two prospective and randomized trials, published in 2000, reported a high rate of reoperation when treating these fractures with osteosynthesis (36% and 38% of the cases), thus indicating arthroplasty may be preferred.

Authors:

Dominique C.R. Hardy, M.D., Patrick Frayssinet, M.D., Ph.D.

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Abstract:

Venous and arterial thromboses account for some of the most common causes of morbidity and mortality amongst patients in the United States and many other Western societies. Clotting disorders and hypercoagulable states are no longer just treated by hematologists, but by multiple specialties including internal medicine, family practice, critical care physicians and most recently, hospitalists. In more than 75% of cases, the cause of the thrombotic episodes can be identified. More than one-half of the patients with thrombosis harbor either congenital propensity to develop a thrombosis, or have an acquired event that precipitates a pro-thrornbotic state.

Authors:

Dominique C.R. Hardy, M.D., Patrick Frayssinet, M.D., Ph.D.

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Abstract:

Symptomatic chondral lesions in the knee remain a problem for young sportsmen and pose a difficult management issue for or thopedic surgeons and patients alike. Damaged articular cartilage has a Iimited potential for healing and can lead to premature arthritis. Articular defects larger than 2 mm to 4 mm in diameter rarely heal. Neither articular cartilage possesses a lymphatic drainage, a sufficient blood supply, nor neural elements. Also, they are sheltered even from immunological recognition, because of the extracellular matrix surrounding the chondrocyte.

Authors:

Andreas Burkart, M.D., Andreas Balthasar Imhoff, M.D.

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Abstract:

Bone grafts are used in musculoskeletal surgery to restore structural integrity and enhance osteogenic potential. The demand for bone graft for skeletal reconstruetion in bone tumor, revision arthroplasty, and trauma surgery, coupled with recent advances in understanding and application of the biology of bone transplantation, has resulted in an exponential increase in the number of bone-grafting procedures performed over the last decade. It is estimated that 1.5 million bone-grafting procedures are currently performed worldwide each year, compared to a fraction of that number 20 years ago. Major developments also have resulted in the harvesting, storage, and use of bone grafts and production of graft derivatives, substitutes, and bone-inducing agents.

Authors:

Matthew J. W. Hubble, M.B., B.S., F.R.C.S. (Orth)

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Abstract:

Spinal surgeons have long sought to find a procedure of choice by which to treat thoracic disc herniations. The threat of cord inury has stimulated many attempted approaches includig posterior laminectomy (abandoned currently as too likely to result in neurologic loss), costotransversectomy, trans-thoracic trans-pleural, postero-lateral, trans-pedicular and, more recently, transthoracic endoscopic. Commonly, surgery is not contemplated unless significant cord compression and neurologic deficit is present.

Authors:

John C. Chiu, M.D., F.R.C.S., F.A.C.S., Thomas J. Clifford, M.D., Romulo Sison, O.P.A.-C., C.S.T.

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