Search

This study evaluated 5 currently used periprosthetic femoral shaft fracture fixation techniques to determine which technique provided the greatest fixation stability. Periprosthetic fractures in 30 synthetic femurs were fixed with a plate with cables, plate with proximal cables and distal bicortical screws (Ogden concept), plate with proximal unicortical screws and distal bicortical screws, plate with proximal unicortical screws and cables and distal bicortical screws, or 2 allograft cortical strut grafts with cables. These specimens were then tested in 3 physiologic loading modes. The plate constructs with proximal unicortical screws and distal bicortical screws or with proximal unicortical screws, proximal cables, and distal bicortical screws were significantly more stable in axial compression, lateral bending, and torsional loading than the other fixation constructs studied.

The effects of the anterior and posterior sternoclavicular joint (SCJ) soft tissue structures on joint dislocation strength by sequential sectioning the ligaments and capsule of twenty-eight SCJs were evaluated. The medial clavicle of each specimen was initially loaded in the anterior and posterior directions to provide control values for joint laxity. The anterior or posterior ligaments and capsular structures of the SCJs were then selectively cut and the specimens retested for laxity and then loaded to failure simulating either anterior or posterior dislocation. Testing of intact specimens showed that the posterior ligaments were stiffer than other structures in that it was significantly more difficult to posteriorly displace the SCJ than in any other direction and that the capsule was the important anterior structure affecting joint laxity. Load-to-failure testing showed that it required 50% more force to create a failure by posterior dislocation than by anterior dislocation. The results of this study explain the clinical rarity of posterior sternoclavicular joint dislocations.

A prospective analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogeneous, elderly urban population. Special emphasis was placed on the season of year, time of day, location of fall, and other circumstances in which the fracture occurred. All patients were community dwelling, cognitively intact, previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture. Most fractures occurred at home, particularly in patients who were older, less healthy, and poorer ambulators. More than 75% of fractures resulted from a fall while the patient was standing or walking. Most falls occurred during daylight hours with a peak seen in the afternoon. No seasonal variation in the incidence of hip fractures was observed.

The operative management (open versus arthroscopic) of subacromial impingement was investigated through a search of the English-language literature from 1970 to 1996. Thirty-four clinical studies comprising 1,935 patients met the following selection criteria: a study published in a peer reviewed journal, a valid materials and methods section (describing age, gender, number of subjects, follow-up period, treatment modality, and impingement stage), and acromioplasty without rotator cuff repair. Six hundred and ninety-eight patients had an open decompression (OD) and 1,237 had an arthroscopic subacromial decompression (ASD) for Stage II and III impingement. When possible, only Stage II patients were reviewed. A few studies combined Stage II and III patients in their results; thus, the patients were placed into two groups (OD and ASD) composed of four categories: OD of Stage II impingement (494 patients), OD of Stage II and III impingement (204 patients), ASD of Stage II impingement (727 patients), and ASD of Stage II and III impingement (510 patients). The average duration of symptoms before surgery ranged from 6 months to 43 months in the OD group and 6 months to 61 months in the ASD group. The average age was 41.8 and 42.1 years, clinical follow-up 6 months to 62 months and 12 months to 41 months in the OD and ASD groups, respectively. The objective success rates were 83.3% versus 81.4% and the subjective success rates were 90.0% versus 89.3% for OD versus ASD, respectively. Return to work ranged from 43% to 100% in the OD group and 74% to 100% in the ASD group. Based on our review, the outcome from ASD is similar to OD. For persistent stage II primary impingement, we recommend starting with ASD and reserve OD for surgical failures. ASD allows earlier rehabilitation than OD because complete detachment of the deltoid is not performed, yet ASD is technically more demanding and has a long learning curve.