The Journal of Bone & Joint Surgery最新文献

{"title":"Instability After Shoulder Arthroplasty: Results of Surgical Treatment","authors":"J. Sánchez-Sotelo, J. Sperling, C. Rowland, R. Cofield","doi":"10.2106/00004623-200304000-00006","DOIUrl":"https://doi.org/10.2106/00004623-200304000-00006","url":null,"abstract":"Background: Currently, there is little available information regarding the surgical treatment of instability following shoulder arthroplasty. The purpose of the present study was to review the results of revision surgery performed for the treatment of instability after shoulder arthroplasty to better define the causes of instability and the risk factors for an unsatisfactory outcome.Methods: Between 1985 and 1999, thirty-three shoulders (seven of which had had a hemiarthroplasty and twenty-six of which had had a total shoulder arthroplasty) were treated surgically at our institution for anterior instability (nineteen shoulders) or posterior instability (fourteen shoulders). The primary arthroplasty had been performed for the treatment of degenerative arthritis in sixteen shoulders, arthritis of dislocation in six, acute fracture in four, rheumatoid arthritis in three, and other conditions in four.Results: The instability was attributed to abnormal capsular tension and/or rotator cuff dysfunction in twenty-one shoulders, component malpositioning in one shoulder, and a combination of both in eleven shoulders. One shoulder was treated with removal of the components. In the remaining thirty-two shoulders, each of the elements that was contributing to the instability was specifically addressed at the time of surgery. Revision surgery restored stability in nine of the thirty-two shoulders. Anterior instability was associated with a higher failure rate than posterior instability was (p = 0.04). Although eleven shoulders had additional surgery for the treatment of recurrent instability, only fourteen of the thirty-three shoulders were stable at the time of the final follow-up. According to the Neer rating system, there were four excellent, six satisfactory, and twenty-three unsatisfactory results.Conclusions: Soft-tissue imbalance is present in most cases of instability following shoulder arthroplasty, and component malpositioning plays an additional role in some cases. More than one-half of the shoulders in the present study remained unstable despite attempts at revision. Surgical treatment of instability following arthroplasty is associated with only a modest success rate.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87772335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of Science into Orthopaedic Practice: Implications for Solving the Problem of Articular Cartilage Repair*","authors":"J. Buckwalter","doi":"10.2106/00004623-200300002-00001","DOIUrl":"https://doi.org/10.2106/00004623-200300002-00001","url":null,"abstract":"President Peterson, thank you for the honor of presenting the Fourth International Cartilage Repair Symposium Presidential Guest Lecture. I appreciate the opportunity to address the fascinating subject of integrating science into orthopaedic practice, a subject that should be the primary concern of surgeons and scientists seeking to restore damaged and diseased articular cartilage. It took more than 2000 years for a few thoughtful practitioners of the art of orthopaedics to value and apply principles and observations derived from basic research 1. Yet, in the short time since this occurred, the understanding that optimal patient care depends on science as well as art has transformed orthopaedic practice from a disparate array of manipulations and operations, best characterized as well-intentioned savagery, to a range of treatments that, in many instances, can be considered civilized. Equally important, we live in a time when the integration of knowledge from new basic research into orthopaedic practice has the potential to solve the most daunting clinical problems, including the pain and loss of mobility caused by the limited capacity of human joints to repair themselves.\u0000\u0000Individuals with varying experience and qualifications have practiced orthopaedics for more than twenty-five centuries 1,2. It would be reasonable to expect that, over this period of time, orthopaedic treatments would have become generally safe and effective. Yet, only 250 years ago, John Hunter (1728-1793), the individual regarded as the father of scientific surgery 3, noted that \"surgery, namely operations, is like an armed savage that attempts to get by force that which civilized men would get by stratagem.\" 2 Orthopaedic operations in Hunter's day were painful, bloody, brutal, and extremely dangerous: the typical results, for patients who survived the operations, were disappointing and disabling 1. It was a situation that led to Hunter's comment that …","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86850237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histological Assessment of Cartilage Repair: A Report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS)","authors":"P. Mainil-Varlet, T. Aigner, M. Brittberg, P. Bullough, A. Hollander, E. Hunziker, R. Kandel, S. Nehrer, K. Pritzker, S. Roberts, E. Stauffer","doi":"10.2106/00004623-200300002-00007","DOIUrl":"https://doi.org/10.2106/00004623-200300002-00007","url":null,"abstract":"Physical injury frequently causes tissue damage, including laceration. Repair of the damage usually results in the formation of a scar; complete anatomic healing and true regeneration are rare.\u0000\u0000Connective tissues tend to heal naturally and successfully only if the injury is minor. If the damage is more severe, then a good functional result can be achieved only if Nature is assisted by surgical intervention. The efficacy of such measures has been established in the cases of bone and tendon injuries but not in the case of cartilage damage 1. In the latter situation, we are still prejudiced by Hippocrates' opinion that \"ulcerated cartilage is universally allowed to be a troublesome disease.\" 2 In addition, our view is necessarily colored by the scarcity of successful therapeutic modalities 3.\u0000\u0000Articular cartilage is a narrow layer of specialized connective tissue that permits smooth, frictionless movement of diarthrodial joints. It is comprised of a relatively small number of cells (chondrocytes) embedded in an abundant extracellular matrix 4. The latter consists predominantly of type-II collagen, proteoglycans, and water, along with smaller amounts of other collagen types and noncollagenous proteins. Histologically, articular cartilage is divided into three zones, which are distinguished by the shape of the chondrocytes and the arrangement of type-II collagen fibers. The superficial zone is characterized by flattened disc-like chondrocytes, a low proteoglycan content, and densely-packed, horizontally-arranged collagen fibrils of uniform diameter. This layer has been described as a tension-resisting diaphragm 5 by virtue of its tendency to curl when the articular cartilage is released from the subchondral bone 6. In the middle zone, chondrocytes attain a more rounded profile, proteoglycan content increases, and the collagen fibers decussate to provide an oblique transitional network between the superficial tangential zone and the deep radial zone. The deep radial zone is …","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74434085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Acromioplasty: A Comparison Between Workers' Compensation and Non-Workers' Compensation Populations","authors":"G. Nicholson","doi":"10.2106/00004623-200304000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200304000-00015","url":null,"abstract":"Background: The purpose of the present prospective study was to analyze a consecutive series of patients with subacromial impingement syndrome who were managed with arthroscopic acromioplasty by a single surgeon.Methods: A consecutive series of 106 patients (106 shoulders) with a mean age of 44.7 years (range, twenty to seventy years) was analyzed after a mean duration of follow-up of thirty-two months. The Workers' Compensation group included forty patients (twenty-five men and fifteen women) with a mean age of 41.7 years. The non-Workers' Compensation group included sixty-six patients (thirty-two men and thirty-four women) with a mean age of 46.5 years. The work-demand level was categorized according to the Dictionary of Occupational Titles from the United States Department of Labor. Previously unrecognized intra-articular pathological changes were categorized with use of consistent criteria. Workers' Compensation status, the work-demand level, and the presence of associated intra-articular pathological changes were analyzed for their effect on outcome scores and time to return to full-duty work.Results: The mean outcome scores for the entire population showed significant improvement when the preoperative values were compared with the postoperative values; specifically, the American Shoulder and Elbow Surgeons (ASES) score improved from 41.8 to 86.9, the Simple Shoulder Test (SST) score improved from 5.1 to 10.0, and the visual analog scale (VAS) for pain improved from 6.0 to 1.1 (p < 0.05). Postoperatively, there was no significant difference in the mean outcome scores between the Workers' Compensation and non-Workers' Compensation groups or between different work-demand levels. There was, however, a significant difference in the average time to return to full-duty work (13.7 weeks in the Workers' Compensation group compared with 9.1 weeks in the non-Workers' Compensation group; p = 0.0001), with the Workers' Compensation group having relatively heavier work-demand levels. Intra-articular pathological findings did not affect the outcome scores, but pathological findings that changed treatment were associated with a longer time to return to work (p = 0.04).Conclusion: Arthroscopic acromioplasty consistently provided a good surgical outcome and the ability to return to work in both the Workers' Compensation and non-Workers' Compensation populations. The work-demand level had a direct effect on the time to return to full duty, regardless of Workers' Compensation status. Patients, physicians, therapists, and employers may benefit from the knowledge of these expected outcomes and realistic time-frames for return to work.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78376307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Multipractice Investigation of Patients with Full-Thickness Rotator Cuff Tears: The Importance of Comorbidities, Practice, and Other Covariables on Self-Assessed Shoulder Function and Health Status","authors":"D. T. Harryman, C. Hettrich, Kevin L. Smith, B. Campbell, J. Sidles, Frederick A Matsen","doi":"10.2106/00004623-200304000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200304000-00016","url":null,"abstract":"Background: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.Methods: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.Results: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.Conclusions: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91144346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial Osteotomy for the Treatment of Varus Gonarthrosis: Survival and Failure Analysis to Twenty-two Years","authors":"T. R. Sprenger, J. Doerzbacher","doi":"10.2106/00004623-200303000-00011","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00011","url":null,"abstract":"Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89600582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Total Hip Arthroplasty and Contralateral Bipolar Hemiarthroplasty: A Case Series","authors":"M. Flören, D. Lester","doi":"10.2106/00004623-200311000-00039","DOIUrl":"https://doi.org/10.2106/00004623-200311000-00039","url":null,"abstract":"There is continuing controversy about whether total hip arthroplasty or bipolar hemiarthroplasty should be used for the management of displaced subcapital hip fractures or advanced avascular necrosis of the femoral head, especially in patients with normal-appearing acetabular cartilage. The decision regarding which procedure to perform may be influenced by several factors, including the underlying disease process, perioperative risks 1,2, likelihood of revision 3-5, and economic considerations 6-8. Published reports are difficult to interpret because the series differ with regard to the surgeons performing the operations, surgical approaches, methods of fixation, postoperative protocols, patient mix, and duration of follow-up 3,5,9-18. In our retrospective review, we compared the clinical and radiographic results and patient-reported outcomes of the two procedures in nine patients who had undergone a bipolar hemiarthroplasty on one side and a total hip arthroplasty on the other.\u0000\u0000We conducted a retrospective review of the records on 750 consecutive hip arthroplasties performed between 1988 and 1995, and we identified seventy-five patients (10%) who had undergone bilateral hip replacement. Of these, nine had undergone total hip arthroplasty on one side and bipolar hemiarthroplasty on the other. There were eight women and one man.\u0000\u0000The mean age (and standard deviation) at the time of the bipolar hemiarthroplasty was 74 ± 19 years (range, twenty-eight to eighty-seven years), and the mean age at the time of the total hip arthroplasty was 74 ± 18 years (range, twenty-seven to eighty-seven years). Eight bipolar hemiarthroplasties were performed because of a displaced subcapital hip fracture and one, because of avascular necrosis. Five total hip arthroplasties were performed because of a subcapital hip fracture; two, because of avascular necrosis; and two, because of osteoarthritis.\u0000\u0000All patients underwent staged bilateral hip replacement. A …","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87857787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microcirculation Associated with Degenerative Rotator Cuff Lesions: In Vivo Assessment with Orthogonal Polarization Spectral Imaging During Arthroscopy of the Shoulder","authors":"P. Biberthaler, E. Wiedemann, A. Nerlich, M. Kettler, T. Mussack, S. Deckelmann, W. Mutschler","doi":"10.2106/00004623-200303000-00012","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00012","url":null,"abstract":"Background: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas. Methods: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31. Results: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 ± 13 cm/cm 2 and the mean capillary diameter was 10 ± 0.7 &mgr;m. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 ± 14 cm/cm 2, whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone. Conclusions: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89553950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Anteversion in Children with Cerebral Palsy: Assessment with Two and Three-Dimensional Computed Tomography Scans","authors":"J. Davids, Amanda D. Marshall, E. Blocker, S. Frick, D. Blackhurst, E. Skewes","doi":"10.2106/00004623-200303000-00013","DOIUrl":"https://doi.org/10.2106/00004623-200303000-00013","url":null,"abstract":"Background: Assessment of femoral anteversion in children with cerebral palsy with two or three-dimensional computed tomography scans may be limited by both positional and anatomic variables. Three-dimensional computed tomography techniques are considered to be more accurate than two-dimensional imaging when the femur is not optimally positioned in the gantry or when the neck-shaft angle is increased. Methods: Computed tomography scanning was performed on a series of nine model femora with anteversion ranging from 20° to 60° and neck-shaft angles ranging from 120° to 160°. Each femoral model was scanned in two holding devices, the first of which held the femur in optimal alignment (normal model) and the second of which held the femur in flexion, adduction, and internal rotation (cerebral palsy model) relative to the gantry. Femoral anteversion was calculated for each model from two and three-dimensional computed tomography scans by four examiners on two separate occasions. The intraobserver and interobserver reliability, the accuracy, and the effect of increasing the neck-shaft angle on the accuracy of the measurements made on the two and three-dimensional scans of the normal and cerebral palsy models were then examined. Results: The mean differences in the measurements of femoral anteversion made by the same examiner (intraobserver reliability) were <2° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <4° for the three-dimensional scans of the cerebral palsy models. The mean differences among examiners (interobserver reliability) were <3° for the two-dimensional scans of the normal and cerebral palsy models and the three-dimensional scans of the normal models, and the mean difference was <6° for the three-dimensional scans of the cerebral palsy models. The accuracy of the assessments of femoral anteversion of the normally aligned models was comparable between the two and three-dimensional scans. However, the three-dimensional assessment was significantly more accurate than the two-dimensional assessment for measurement of anteversion of the cerebral palsy models (p = 0.003). Accuracy within 5° was comparable between the two and three-dimensional scans for measurement of the normally aligned models, with 86% of the two-dimensional measurements and 78% of the three-dimensional measurements falling within 5° of the actual measurements. However, the accuracy within 5° was significantly compromised when the models were placed in cerebral palsy alignment. Only 3% of the two-dimensional measurements and 14% of the three-dimensional measurements fell within 5° of the actual measurements, with three-dimensional assessment being significantly better than two-dimensional assessment (p = 0.006). Increasing the neck-shaft angle did not significantly compromise the accuracy of measurement of femoral anteversion with either the two-dimensional or the three-di","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73728337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial Plafond Fractures: How Do These Ankles Function Over Time?","authors":"J. Marsh, Dennis P. Weigel, D. Dirschl","doi":"10.2106/00004623-200302000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200302000-00016","url":null,"abstract":"Background: The intermediate outcome of fractures of the tibial plafond treated with current techniques has not been reported, to our knowledge. The purpose of this study, performed at a minimum of five years after injury, was to determine the effect of these fractures on ankle function, pain, and general health status and to determine which factors predict favorable and unfavorable outcomes.Methods: Fifty-six ankles (fifty-two patients) with a tibial plafond fracture were treated with a uniform technique consisting of application of a monolateral hinged transarticular external fixator coupled with screw fixation of the articular surface. Thirty-one patients with thirty-five involved ankles returned between five and twelve years after the injury for a physical examination, assessment of ankle pain and function with the Iowa Ankle Score and Ankle Osteoarthritis Scale, assessment of general health status with the Short Form-36 (SF-36), and radiographic examination of the ankle.Results: Arthrodesis had been performed on five of the forty ankles for which the outcome was known at a minimum of five years after the injury. Other than removal of prominent screws (two patients), no other surgical procedure had been performed on any patient. The average Iowa Ankle Score was 78 points (range, 28 to 96 points). The scores on the SF-36 and Ankle Osteoarthritis Scale demonstrated a long-term negative effect of the injury on general health and on ankle pain and function when compared with those parameters in age-matched controls. The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.Conclusions: Although tibial plafond fractures have an intermediate-term negative effect on ankle function and pain and on general health, few patients require secondary reconstructive procedures and symptoms tend to decrease for a long time after healing.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84738901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}