Adolescent Tibia Vara, Nonossifying Fibroma, and Bipartite Patella in a Nationally Ranked Adolescent Karate Competitor*--Eugene E. Berg, MD

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I describe a case of adolescent tibia vara, a contralateral nonossifying fibroma of the tibia, and bipartite patella, which occurred in an adolescent karate competitor of normal stature. The association of this unusual triad supports the hypothesis that each process has a shared traumatic etiology.

Significance of Cold Intolerance in Upper Extremity Disorders--L. Andrew Koman, MD; Stacey A. Slone, MS; Beth Paterson Smith, PhD; David S. Ruch, MD; Gary G. Poehling, MD

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After upper extremity injury, pain on exposure to cold (cold sensitivity) is a significant problem. This cross-sectional observational study (1) assesses the incidence and prevalence of cold intolerance, (2) evaluates the relationship between functional status and degree of cold intolerance, and (3) correlates health-related quality of life (HRQL) with symptoms of cold intolerance. Patients in a tertiary care center completed questionnaires to document (1) cold sensitivity, (2) upper extremity pain, symptoms, and function, and (3) HRQL. Cold sensitivity was found to be associated with more functional limitations, greater pain, and reduced HRQL. As the severity of cold intolerance increased, functional limitations and pain increased and HRQL decreased. Cold intolerance has a profound effect on HRQL.

Cementless Total Hip Replacement in Patients With Developmental Dysplasia of the Hip*--Michael H. Huo, MD; Andrius Zurauskas, MD; Laurine E. Zatorska, RN; Kristaps J. Keggi, MD

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This study was conducted to evaluate the clinical and radiographic results of 22 total hip replacements done in 17 consecutive patients for coxarthrosis due to developmental dysplasia or dislocation of the hip. All operations were done using an anterior approach without trochanteric osteotomy. Standard cementless prostheses were used in all cases. There was no custom-designed prosthesis used. The acetabular cup was placed in an anatomic position in the true acetabulum in every case. Bulk autograft was necessary to reconstruct the deficient acetabular roof in only 2 hips. The average follow-up was 63 months (range, 40 months to 95 months). The average Harris Hip Score was improved from a preoperative value of 35 (range, 24 to 46), to 96 (range, 79 to 100) at final follow-up. To date, no revision has been done. Three hips showed radiographic evidence suggestive of aseptic loosening (2 stems and 1 cup), but the clinical results remain satisfactory. There is no incidence of dislocation, sciatic nerve palsy, or infection.

Effect of Standard Total Knee Arthroplasty Surgical Dissection on Human Patellar Blood Flow In Vivo: An Investigation Using Laser Doppler Flowmetry*--Steven S. Hughes, MD; Angelo Cammarata, MD; Scott P. Steinmann, MD; Vincent D. Pellegrini, Jr., MD

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We examined the in vivo alterations of human patellar bone blood flow that occur with surgical dissection of the extensor mechanism during total knee arthroplasty. A laser doppler probe was used to measure central patellar blood flow at baseline after quadriceps tenotomy, after partial fat pad excision, after lateral release, and after completion of the lateral release with superolateral geniculate sacrifice. The initial quadriceps tenotomy and medial arthrotomy decreased patellar vascularity to 60.4% of baseline. Fat pad resection initiated another 10.4% decline. The lateral release resulted in a patellar vascularity that was 43.6% of baseline. Finally, the loss of superolateral geniculate inflow reduced the patellar flow to 30.6% of baseline.

Long-term Complications of Snake Bites to the Upper Extremity--David J. Cowin, MD Thomas Wright, MD John A. Cowin, MD

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The purpose of this study was to determine long-term complications of upper-extremity snake envenomations. The records of 73 patients, who were seen for snake bites were obtained; 46 of these patients had bites to the upper extremity, and 27 had bites to the lower extremity. These patients were graded according to the severity of the bite. The snakes involved were eastern diamondback rattlesnake, coral snake, pigmy rattlesnake, water moccasin, and unknown. Fourteen of the 46 patients receiving upper extremity bites were examined by a hand surgeon and an occupational hand therapist 1 to 3.2 years after their bite. Subjective pain data, range-of-motion, intrinsic, extrinsic, finger-flexion tightness, grip strength, pinch strength and objective sensory data were collected. Four patients had continued pain and tissue atrophy at the bite site. There were no long-term sequelae from a missed compartment syndrome.

Natural History of Avascular Necrosis of the Patella Due to Closed Global Patellar Dislocation*--F. Robert Brueckmann, MD

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This 20-year study of avascular necrosis of the patella indicates that the patella can regain its blood supply and normal joint surface over time. Significant changes in the patella and operative treatment are noted.

Modification of the Bankart Reconstruction Using a Suture Anchor*--Steven M. Traina, MD; Jeffrey L. Holtgrewe, MD; Steven King, PA

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A prospective study was done to determine the effectiveness of a suture anchor in doing a Modified Bankart Reconstruction on the traumatic unidirectional Bankart lesion shoulder. From 1989 to 1991, 26 patients encompassing 27 shoulders with recurrent instability had modified Bankart reconstructions. A minimum 18-month follow-up was obtained by examination of 24 patients with telephone interviews done on two patients. The average follow-up was 23.6 months. A 93.1% good-to-excellent result was obtained using the Bankart rating scale. There were no failures or complications. The surgeon involved in the study thought the suture anchor facilitated the attachment of the avulsed capsulolabral complex in doing the Bankart procedure.

Prophylactic Antibiotics for Spine Surgery: Description of a Regimen and Its Rationale--Lee H. Riley III, MD

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Cefazolin, an antibiotic commonly used for surgical prophylaxis, may not adequately penetrate the intervertebral disk or cerebrospinal fluid. The combination of gentamicin and cefuroxime has been found to penetrate both structures in adequate levels and was used in 40 consecutive elective spine cases without a postoperative infection or antibiotic-related complications.

Plate Osteosynthesis of the Distal Femur: Surgical Techniques and Results*--Theodore Miclau, MD; William Holmes, MD; Robert E. Martin, MD; Christian Krettek, MD; Peter Schandelmaier, MD

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Over the past three decades, the techniques for internal fixation of the distal femur have evolved to provide reliably successful results. The improved outcomes of plate osteosynthesis of distal femur fractures are because of better implants, techniques of anatomic reduction and soft tissue handling, and post-fixation stability with early motion. We review the traditional Arbeitsgemeinschaft für Osteosynthesefragen (AO) surgical techniques for plate osteosynthesis of the distal femur and the results reported using these methods.

Lateral Ankle Instability Correction by Translocation of the Intact Peroneus Brevis Tendon: A Prospective Study of 45 Cases*--A. Paul Pieron, MD

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Between November 1982 and November 1991, 45 patients were treated with a new procedure for lateral ankle instability and were available for follow-up. Preoperatively, all patients had a talar tilt of 10° or more and a positive drawer sign. A 9-year follow-up has proven successful in all 45 patients. All patients had increased postoperative stability and returned to their preoperative activities; 70% increased their activities beyond their preoperative level. The rehabilitation time has been shortened by 50%.

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