Cases reported "Osteochondritis"

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1/31. An operative procedure for advanced Kienbock's disease. Excision of the lunate and subsequent replacement with a tendon-ball implant.

    Excision of the lunate and subsequent replacement with a tendon implant was performed in 22 patients with Kienbock's disease between 1971 and 1985. This procedure was indicated mainly for those with advanced Kienbock's disease, i.e., stage III or IV according to the Lichtman classification. After the collapsed lunate is removed, a tendon-ball implant, made of the palmaris longus and plantaris tendons is placed in the resultant space in the carpus. A forearm distractor is applied during the operation, and distraction is continued for 4 weeks postoperatively. We report the long-term results in 15 patients, whose average follow-up period was 16 years and 3 months. One patient with infection was excluded from the study because the implanted tendon was removed 2 weeks after the operation, and 6 patients were lost to follow-up. All patients were free of pain after the surgery. The flexion-extension range of the wrist increased by 14.2 degrees, on average, after the surgery. The average grip power of the operated hand was 90.2% of that in the non-operated hand. Calcification and ossification were frequent in the implanted tendons a few months postoperatively. The average carpal height ratio (defined as carpal height/length of the third metacarpal) was 0.53 before the operation and 0.49 at the time of follow-up. According to Dornan's classification of clinical results, 9 of the 15 patients were classified as having excellent results and 6 as good.
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2/31. mafenide acetate allergy presenting as recurrent chondritis.

    Acute chondritis has a strong predilection for recurrence. mafenide acetate has been implicated in causing reactions that mimic this condition; however, these hypersensitivity reactions lack fever, fluctuance, and pain. The authors report a case of mafenide acetate allergy presenting as recurrent chondritis in a patient who had previously been treated successfully for this condition. In this patient, the allergic response resolved within 3 days after cessation of mafenide acetate. If unappreciated, it may have led to unnecessary operative intervention. Therefore, auricular edema and erythema, without fever, fluctuance, and pain, must be recognized by surgeons as a possible mafenide acetate allergy and must be considered in the differential diagnosis for patients who present with recurrent acute suppurative chondritis.
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3/31. Intertrochanteric osteotomy in the treatment of Perthes' disease.

    Intertrochanteric osteotomy has been carried out in 34 children with Perthes' disease. Five weeks after the operation the patients were allowed to move about freely. The average postoperative follow-up period was 27 months. At that time the results seemed to be at least as good as those of Thomas' splint therapy. The varus-derotation osteotomy performed in the initial stage accelerated the process of reossification and seemed to prevent subluxation. According to our findings it is worthwhile correcting the subluxation even in cases with irreversible changes.
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4/31. Kienbock's disease in an eleven-year-old girl. A case report.

    Kienbock's disease occurs most frequently between 20 and 30 years of age (Gillespie, 1961). The youngest patient with Kienbock's disease in literature written in English is a 10-year-old boy (Nakamura et al., 1990). We report the case of an 11-year-old girl with Kienbock's disease whom we treated with radial shortening. Five months after surgery, radiographs showed signs of rapid disappearance of avascular necrosis of the lunate, and the patient had excellent clinical results. Two years postoperatively no recurrence of avascular necrosis of the lunate has occurred.
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keywords = operative
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5/31. Isolated medial cuneiform tuberculosis: a case report.

    Skeletal involvement in extrapulmonary tuberculosis is extremely rare, and foot involvement accounts for less than 10% of osteoarticular tuberculosis. tuberculosis osteomyelitis of the foot can also mimic a wide range of pathology. As a result, this condition is often misdiagnosed, or the true nature of the lesion is identified late in the diagnostic process. This article reports a case of tuberculosis in the medial cuneiform of a 3-year-old girl. Initially misdiagnosed as osteochondrosis, the patient returned 2 years later with a draining sinus on the medial aspect of the left midfoot. New radiographs showed a cystic lesion in the substance of the medial cuneiform. A diagnosis of tuberculosis was established after biopsy and histopathological examination of operative specimen. Antituberculosis treatment was implemented and continued for 16 months. At that time, clinical signs of infection had ceased.
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6/31. X-ray evaluation of radial shortening for Kienbock's disease.

    The effect of inclination of the distal radius to subsequent lunate collapse is controversial. Therefore we evaluated the postoperative x-ray course of 10 patients with stage II, III, or IV Kienbock's disease who were treated only with radial shortening and followed up for an average of 25 months. The three patients who became worse as determined by x-ray evaluation had lunate fossa inclinations of less than 12 degrees after surgery. The four patients who improved had lunate fossa inclinations greater than 12 degrees. Appropriate radial shortening with adjunct wedge osteotomy to increase lunate fossa inclination may prevent further lunate collapse.
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7/31. Treatment of osteochondral lesions of the talus with cryopreserved talar allograft and ankle distraction with external fixation.

    This article presents the results of a retrospective review of six osteochondral lesions on six patients (five men and one woman) treated with transplantation of cryopreserved talar allograft and ankle joint distraction. All patients complained of ankle pain existing for a long time secondary to a traumatic episode confirmed through MRI. Lesions ranged in measurement from 0.8 cm x 0.8 cm to 3.2 cm x 1.8 cm with an average size of 2.1 cm x 1.5 cm. Each patient underwent talar dome transplantation using fresh frozen talar allograft followed by ankle distraction. Distraction was obtained using a three-ring multiplanar external fixation device. All surgeries were performed between 2002 and 2004. All external fixators were removed at 8 weeks and patients remained partial-weight bearing in a removable cast boot for an additional 8 weeks. Serial postoperative radiographs showed complete consolidation of the allograft within 16 weeks. The average follow up time was 24 months, and all patients related a subjective decrease in symptoms and increase in activity levels. patients were also evaluated utilizing the maryland foot Score both pre- and postoperatively. Preoperatively, four patients were graded as fair and two were graded as poor. Postoperatively, two patients related excellent results, three patients related good results, and one patient related fair results. Several patients experienced minor complications such as pin site irritation (five patients), painful talar wire (one patient), and periostitis (one patient). No patients experienced any major complications and none have required additional surgery. We feel that these initial results warrant further investigation of this treatment.
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8/31. osteochondritis dissecans of the distal radioulnar joint.

    To our knowledge there has been no report of osteochondritis dissecans of the distal radioulnar joint. This patient was seen with episodes of painful motion in the left wrist. At operation two free bodies were removed from the distal radioulnar joint. From the clinical, radiographic, operative, and histologic findings, the diagnosis was osteochondritis dissecans of the distal radioulnar joint.
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keywords = operative
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9/31. The results of operative treatment of osteochondritis dissecans of the patella.

    The course of osteochondritis dissecans (OCD) of the patella and the results of operative treatment are analyzed retrospectively in a review of 31 operatively treated cases in 25 patients. Followup was obtained for 21 cases, with an average of 73 months (range, 15 months to 20 years). These 25 patients were predominantly males, and averaged 18 years of age at the time of surgery. A history of trauma was associated with the lesion in 38% of the cases, and the lesion was bilateral in one out of four patients. The most common presenting complaints were subpatellar pain and swelling. The most common initial physical findings were patellofemoral crepitus and joint effusion. Forty-four operations were performed on 31 knees. The most commonly performed procedures were curettage of the patella and removal of loose bodies, in combination or as part of another procedure. A new patellofemoral rating scale was used to evaluate results. Thirty-eight percent of the knees had a good or excellent result, while 62% had a fair or poor result. Persistent pain with restricted function and residual patellofemoral crepitus were common findings. In general, the patients who come to surgery for OCD of the patella have a guarded prognosis for full recovery of knee function.
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keywords = operative
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10/31. Compressive fixation of osteochondritis dissecans fragments with Herbert screws.

    Current methods of fixation of femoral osteochondritic fragments do not provide rigid enough stabilization to allow early postoperative motion. We describe a technique using Herbert screws in a patient to secure a large unstable medial condylar fragment. A second procedure for removal of the screws was not required, and the patient had an excellent clinical result. The Herbert differential pitch bone screw is able to provide compressive fixation, allow early motion, and minimize the potential for complications.
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