Division Of Orthopedic Surgery Research Articles

Intraoperative dislocation of the trial femoral head into the pelvis during total hip arthroplasty: a case report.

O. Batouk, MD; M. Gilbart, MD; Division of Orthopaedic Surgery, University of Toronto, 30 Bond Street, Room 5013, Bond Wing, Toronto, ON M5B 1W8, Canada. E-mail address for O. Batouk: [email protected] E-mail address for M. Gilbart: [email protected] R. Jain, MD, FRCSC; 895 Don Mills Road, Two Park Centre, Suite 108, Toronto, ON M3C 1W3, Canada

Orthopedic Manpower

Orthopedic Manpower

Prolonged Coma after Unreamed, Locked Nailing of Femoral Shaft Fracture

USING transesophageal echocardiography, echogenic material can be shown in the right ventricle during many orthopedic procedures. 1 Recently, transcranial Doppler-recorded microembolic signals have been described during femoral fracture fixation, suggesting that medullary pressurization may be associated with systemic microembolism and pulmonary fat and marrow emboli. 2 Although reamed, locked intramedullary nailing is the procedure of choice for most femoral shaft fractures, some investigators advocate the use of small-diameter, locking, unreamed nails to decrease the risk of fat emboli. 3,4 We report a case of severe intraoperative fat embolism after an unreamed locked intramedullary nailing.

Editorial Comment

Editorial Comment

Myocardial Abscess With Perforation of the Heart Following Staphylococcal Pyemia

J. Robert Gladden (Fig 1) was born in Charlottesville, NC, and raised in East St. Louis. He obtained his undergraduate degree from Long Island University where he played on the basketball team. He then attended Meharry Medical College in Nashville from which he graduated with honors in 1938. After interning at the Freedmen's Hospital in Washington, DC, he became the first orthopaedic resident in a new orthopaedic program at that hospital directed by Dr. Julius Neviaser. After the completion of his training, Dr. Gladden joined the orthopaedic staff of the College of Medicine of Howard University.1 In 1950 he succeeded Dr. Neviaser as chief of the Division of Orthopaedic Surgery. In this capacity he established the orthopaedic residency program at the District of Columbia General Hospital. In January 1945 The American Board of Orthopaedic Surgery granted its certificate to Dr. Gladden, the first African American to be certified by the Board. In 1951 he became the first African American member of the American Academy of Orthopaedic Surgeons. He also became a member of the American College of Surgeons. In addition to his medical activities, Dr. Gladden was active in the affairs of his community, serving on numerous boards and committees. The following paper relates in some detail the course of a staphylococcal infection initiated by a puncture wound about the knee. It should remind us of the problems that can occur in cases of infection with antibiotic resistant organisms.

Orthopedics.

Division of Orthopedic Surgery, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, MS #69, Los Angeles, CA 90027, USA

Denervation Atrophy Caused by Suprascapular Nerve Injury: MR Findings

From the Department of Radiology (J. S. Yu) and Division of Orthopedic Surgery, Department of Surgery (R. A. Fischer), Ohio State University Medical Center, 450 W. Tenth Ave., Columbus, OH 43210, U.S.A. Address correspondence and reprint requests to Dr. J. S. Yu.

Wear Particles in Bilateral Internal Iliac Lymph Nodes After Loosening of a Painless Unilateral Cemented Total Hip Arthroplasty

Accepted for publication April 19, 1996. * Requests for reprints: Division of Orthopaedic Surgery, Duke exceeds local encapsulation. We report particulate wear debris in bilateral internal iliac lymph nodes in a patient undergoing radical cystoprostatectomy who also had a loose but painless unilateral total hip arthroplasty. Our case illustrates that disseminated particle wear debris should be University Medical School, P.O. Box 3332, Durham, North Carolina added to the Of nodes in patients with an endoprosthesis.2 ~

Periprosthetic Osteolysis in Total Hip Arthroplasty

Palo Alto Medical Clinic, 300 Homer Avenue, Palo Alto, California 94301 Division of Orthopaedic Surgery, R144, Stanford University Medical School, 300 Pasteur Drive, Stanford, California 94305

20 years of microsurgery in Greece.

The beginning of microsurgery in Greece is rooted at Duke University Medical Center in Durham, NC, where between 1970 and 1974 I was a Clinical and Research Fellow under Dr. James Urbaniak at the Department of Surgery, Division of Orthopaedic Surgery at Duke University Medical Center. It is there that I first learned the three “Ms” of microsurgery, the operating microscope, micro-instruments and micro-sutures, for the suturing of small vessels. At that time and even today, Microsurgery has a solid foundation in the laboratory where surgeons have the opportunity to practice microsurgical techniques and solve problems on experimental models. While at Duke, I had the opportunity to work in a laboratory which was located in the VA hospital. There, experimental models included the femoral and brachial arteries of cats and rabbits, the aorta of rats and the radius and radial artery of dogs and reflected a continuous research effort related to the evaluation of various methods for suturing small vessels and to t...

ANAEROBIC OSTEOMYELITIS FOLLOWING A HORSE BITE

Departments of Medicine (RGN) and Surgery (TN), Division of Orthopedic Surgery, Somerset Medical Center, and the Department of Medicine, Division of Infectious Diseases, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School (RGN), New Brunswick, New Jersey

Polyethylene wear in knee arthroplasty. A review.

Division of Orthopedics. Stanford University Medical Center, Stanford, California, USA and *Department of Orthopedics, University Hospital, Lund, Sweden Correspondence: Stuart Goodman, MD, Stanford University School of Medicine, Division of Orthopedic Surgery, 300 Pasteur Drive, Room R 171, Stanford, CA 94305-5326, USA. Tel + l a 1 5 723 7072. Fax + 1 4 5 723 9805 Submitted 92-04-04. Accepted 92-04-08

Method of tendon labeling in forearm injuries

From the University of California, San Diego Medical Center, Division of Orthopaedic Surgery and Rehabilitation, San Diego, Calif. Received for publication Jan. 24, 1990; accepted in revised form July 23, 1990. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Michael J. Botte, MD, Division of Orthopaedic Surgery and Rehabilitation, H-894, University of California San Diego Medical Center, 225 Dickinson St., San Diego, CA 92103. 311125442 Fig. 1. A sterile adhesive tape attached to a hemostat serves as a label to tag the tendon. A sterile marking pen is used to write the name of the tendon on the tape.

Surgical Malpractice in the Renaissance and Today

Presented by invitation at the Columbia-Presbyterian Medical Center, Division of Plastic Surgery, Department of Surgery, Division of Orthopedic Surgery, and the Health Sciences Library, February of 1986, at the Columbia Division of Pediatric Surgery, April of 1986, and at the Samuel Kernel Lecture of Phi Lambda Kappa Medical Fraternity, Miami, Florida, March of 1987.

Anterior Kostuik-Harrington Distraction Systems for the Treatment of Kyphotic Deformities

Based on the biomechanical principles of anterior distractive forces combined with instrumentation to decrease sagittal bending moments, an anterior system using a modification of Harrington instrumentation has been developed for the correction of kyphotic deformities. It has been used in the treatment of acute burst fractures in 100 cases, posttraumatic kyphosis in 45 cases, Scheuermann's kyphosis in 36 cases, rigid round backs in three cases, acute rigid kyphosis (congenital) in four cases, postlaminectomy in 21 cases, flat back syndrome in 56 cases, kyphosis secondary to tumor in ten cases, and kyphosis secondary to osteoporosis with fracture in four cases. A total of 279 cases have been treated with anterior instrumentation. Complications include breakage of 35 screws and four rods. There have been no early or late vascular or neurologic sequelae related to instrumentation. The biomechanical basis for the treatment of kyphotic deformities includes an anterior distractive force to resist compressive loads and, where possible, segmental fixation to decrease sagittal bending moments combined with bone grafts far from the neutral axis. This system provides these benefits with minimal risk and morbidity.

Cross-sectional imaging in the evaluation of osteogenic sarcoma: MRI and CT

Cross-sectional Imaging in the Evaluation Osteogenic Sarcoma: MRI and CT By Leanne L. Seeger, Jeffrey J. Eckardt, B EFORE the advent of cross-sectional scan- ning techniques, imaging of malignant bone tumors was confined to plain radiography and radionuclide bone scanning. While radiography remains the primary imaging modality for differ- ential diagnosis, magnetic resonance imaging (MRI) and computed tomography (CT) have had a profound impact on the preoperative stag- ing evaluation of bone tumors and their response to therapy. In this article we will define the role of MRI and CT in the work-up of the patient with known osteogenic sarcoma (OGS), stressing imaging strategies that optimize information available to the clinician and assist in therapy planning. In order to achieve these optimal factors, communi- cation with the referring physician and review of available radiographs and radionuclide bone scans before MRI or CT image acquisition is often essential. PREOPERATIVE EVALUATION Under usual circumstances, the diagnosis of OGS should be made with radiographs and confirmed by biopsy, and the detection of skip lesions and distant metastases should be accom- plished with radionuclide bone scanning. The role of MRI and CT scanning, therefore, is not for diagnostic purposes but rather to supply information that is otherwise inapparent or un- available. This basic concept is often forgotten when cross-sectional images are obtained, result- ing in studies that provide “pretty pictures,” but add little or no additional useful information to the clinician who will ultimately be responsible From the Department of Radiological Sciences. Muscu- loskeletal Section, and the Department of Surgery, Division of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles. Leanne L. Seeger: Assistant Professor of Radiological Sciences; Jeffrey J. Eckardt: Associate Professor of Ortho- paedic Surgery; Lawrence W. Bassett: Professor of Radiolog- ical Sciences, UCLA School of Medicine. Los Angeles. Address reprint requests to L.L. Seeger, MD, UCLA School of Medicine. Department of Radiological Sciences, 10833 Le Conte Ave. Los Angeles, CA 90024. 0 I989 by W.B. Saunders Company. 0037-I 98X~89/2403-0003$5.00/0 and Lawrence W. of Bassett for treatment. Magnetic resonance imaging and CT image acquisition should address specific issues that are important to the surgeon and should be tailored according to tumor location and proposed surgical treatment, whether it be amputation or resection with limb salvage proce- dure. The following discussion reflects the scanning principles and techniques we use for evaluating patients with OGS both preoperatively and post- operatively. This was derived from both our own experience and the experience of others as re- ported in the literature. ‘-’ Regional differences in the management of patients with malignant bone tumors may alter this procedure. To become familiar with local treatment protocols, commu- nicate directly with the surgeon who will ulti- mately be responsible for treatment. The goals of cross-sectional imaging of pa- tients with OGS include: (1) determining both the marrow and soft-tissue extent of tumor; (2) defining the relationship of tumor to major neu- ral and vascular structures; (3) evaluating adja- cent joints for intraarticular tumor and/or syn- ovial infiltration; (4) detecting skip lesions; and (5) providing measurements needed for the antic- ipated surgical procedure. It is prudent to image the involved bone in its entirety with MRI or CT. This will do the following: (1) allow evaluation of any additional suspicious-looking lesions on bone scan; (2) allow detection of unsuspected metastases that were not evident on the bone scan; and (3) provide reference points for measurements that aid in surgical planning. Tumor resectability in the extremities will be in part determined by the ability to leave major neural and vascular bundles intact; therefore, limb salvage is not appropriate when tumor has encased or infiltrated these structures. Tumor that is either intraarticular or has extensively involved the synovial barrier also precludes limb salvage. Skip lesions will significantly alter surgi- cal margins for OGS of the extremity. For primary pelvic tumors of the ilium or sacrum, preoperative imaging must identify infiltration into abdominal or pelvic soft tissues and the Seminsrs in Roentgenology, Vol XXIV, No 3 (July), pp 174-

Cerebrovascular accident complicating Klippel-Feil syndrome. A case report.

Division of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson School of Medicine, Camden 08103.

Stress fractures associated with osteoarthritis of the knee. A report of three cases.

Division of Orthopaedic Surgery, University of Western Ontario, University Hospital, London, Canada.

USE OF SOMATOSENSORY EVOKED RESPONSES FOR DETECTION AND PREVENTION OF NERVE INJURY DURING TOTAL HIP ARTHROPLASTY

Department of Anesthesiology and Division of Orthopedic Surgery, University of Kansas School of Medicine, Kansas City, Kansas 66103

Dural ectasia associated with spontaneous dislocation of the upper part of the thoracic spine in neurofibromatosis. A case report and review of the literature.

Division of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.