Outcome of Subtalar Arthrodesis After Calcaneal Fracture--Patricia Kolodziej, MD, James A. Nunley, MD
Between 1983 and 1995, we used subtalar arthrodesis to treat 16 consecutive patients for continued pain after an intra-articular calcaneal fracture. Average time to union was 3 months (2 to 4 months). Complications were minor in 4 patients, and major in 4 others. Length of follow-up in 14 patients was 55 months (range, 12 to 112 months). Hindfoot scores (clinical rating system of the American Orthopaedic Foot and Ankle Society) improved from 38 (range, 28 to 62) to 67 (range, 39 to 94). Results of medical outcome surveys indicate that patients had low scores in areas related to physical conditioning, physical role functioning, and bodily pain. We conclude that the majority of patients can have improvement with surgical reconstruction that addresses a specific problem, but pain relief is usually not complete.
Patient Self-Testing of Prothrombin Time After Hip Arthroplasty--C. Anderson Engh, Jr., William J. Culpepper II, Patricia A. Charette, and Rachel Brown, RN
We determined whether total hip arthroplasty (THA) patients could test their own prothrombin time reliably over 6 weeks of anticoagulation prophylaxis with a portable device that measures prothrombin time and whether selftesting would improve or maintain the quality of care at a lower cost than our standard procedure. Forty-six THA patients participated in the study and were compared with a matched group managed with our standard protocol using a home health-care nurse. Seven patients (15%) could not be trained to obtain the blood sample, and others required multiple finger sticks to obtain valid results. However, the results from the 29 patients completing the study showed high reliability when compared with results obtained through standard protocol. Self-testing saved about $260 per patient over the cost of venipuncture. Patient self-testing of prothrombin time using the device in this study is reliable and cost-effective for monitoring the anticoagulation status after THA in a select group of elderly patients.
Ulnar Artery Thrombosis: A 6-Year Experience--Stephen J. Troum, Waldo E. Floyd III, and John Sapp, MD
Thrombosis of the ulnar artery can be a cause of significant morbidity. Most often a consequence of blunt trauma to the hypothenar eminence of the hand, it may be attributable to one traumatic event or to repetitive insults. Surgery is often required. We reviewed the presentation and diagnosis of ulnar artery thrombosis and evaluated the effectiveness of treatment by ulnar artery excision with interposition vein grafting. Retrospective chart analysis from 1989 to 1995 at the Medical Center of Central Georgia showed that nine patients (eight male, one female) were treated for ulnar artery thrombosis. Three had associated ulnar artery aneurysms. Eight of the nine were treated with artery excision and interposition vein grafting. Four also received stellate ganglion blocks before surgery. One was treated with stellate ganglion blocks alone. All patients had symptomatic relief and resolution of physical findings. We conclude that ulnar artery thrombosis can be managed with ulnar artery excision and interposition vein grafting when conservative measures fail.
Thromboembolism After Total Knee Arthroplasty: Intermittent Pneumatic Compression and Aspirin Prophylaxis--Christopher M. Larson, Douglas P. MacMillan, and Paul F. Lachiewicz, MD
This is a study of two consecutive antithromboembolism regimens after total knee arthroplasty. In group 1, 131 patients were given aspirin prophylaxis alone (650 mg by mouth twice a day). In group 2, 123 patients were treated with aspirin, knee-high compression stockings, and intermittent knee-high pneumatic compression devices, which were started intraoperatively. The prevalence of deep vein thrombosis in group 1 was 15.9% (21 of 131 patients). One patient had a possible symptomatic nonfatal pulmonary embolism, and one patient had a symptomatic calf thrombus. Asymptomatic thrombi were detected in calf veins in 9 patients, popliteal vein in 6 patients, and femoral vein in 5 patients. In Group 2, the prevalence was 7.4% (9 of 123 patients). Asymptomatic thrombi were located in calf veins in 6 patients, popliteal vein in 1 patient, and femoral vein in 2 patients. There was a significant difference in the prevalence of deep vein thrombosis between the two groups. A history of previous thromboembolism was a significant risk factor for a new thrombus. The prevalence after bilateral one-stage knee arthroplasty was 24.3% for group 1 and 12.5% for group 2. Aspirin and knee-high intermittent pneumatic compression together are more effective than aspirin alone for prevention of deep vein thrombosis after primary and revision knee arthroplasty.
Isthmic Spondylolisthesis and Spondylolysis--Steven M. Theiss, MD
Isthmic spondylolisthesis, or spondylolisthesis due to a lesion of the pars interarticularis, is a common source of pain and disability in both the pediatric and adult population. This review examines the current diagnostic and treatment options for patients with this condition. It also reviews the results of the various interventions to facilitate the surgeon in choosing the appropriate treatment option for any given patient.
Nerve Repair and Grafting in the Upper Extremity*--S. Houston Payne, Jr., MD
The diagnosis and treatment of injury to the peripheral nervous system is one of the greatest challenges in orthopaedic surgery. These common injuries with potentially devastating results provide ongoing stimulus for researchers striving for improved understanding of peripheral nerve biology and its application to nerve repair. A basic understanding of peripheral nerve biology, particularly as it relates to the process of nerve degeneration and regeneration, is critical to patient care. This knowledge, coupled with a thorough understanding of clinical anatomy, provides the clinician with the necessary tools for initial evaluation of the nerve-injured patient. To construct an appropriate plan of management, the physician treatment alternatives for specific nerve injuries. A reconstructive plan can then be formulated with realistic expectations based on reported clinical results.