Cases reported "Osteochondritis"

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21/31. pseudomonas infection of the sternum and costal cartilages. Report of three cases.

    pseudomonas osteochondritis of the chest wall and sternum has rarely been reported, but when present it has been extremely difficult to eradicate. Multiple operations to debride the involved areas and use of antibiotics have often been inadequate to control this resistant infection. This report describes our experience with three patients who had the late development of pseudomonas osteochondritis of the chest wall. The infection occurred following crush trauma, sternotomy for congenital heart disease, and mastectomy and amputation of the upper extremity for carcinoma of the breast. Antibiotic therapy alone and with limited operations was unsuccessful in controlling the infection in all three instances. Eventually, each patient required extensive regional surgical removal of involved bone and cartilage. Complete healing followed. Our experience favors the early wide removal of bony and cartilaginous tissues in the involved region with preoperative and postoperative coverage by appropriate antibiotics. Operative management is detailed.
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22/31. Use of a hand-carved silicone-rubber spacer for advanced Kienbock's disease.

    We found that the use of a hand-carved silicone-rubber (Silastic) spacer was reasonably effective in relieving symptoms in thirty-six patients with advanced Kienbock's disease, even though there was still some residual postoperative loss of wrist motion and grip strength. Preoperatively all patients had pain and limited motion of the wrist as well as weakness of grip. Roentgenographically all had fragmentation and collapse of the lunate, and 92 per cent had measurable carpal collapse. Most had had symptoms for longer than one year. After removal of the deformed lunate through a dorsal incision, a silicone-rubber spacer was shaped to fit the defect. patients were followed for an average of fifty-four months. Thirty-two patients were followed for at least two years; all but three were improved. This procedure is not recommended when the shape of the lunate is normal or not significantly altered, or when the lunate has not collapsed as measured by precise determinants.
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23/31. Allogeneic deep frozen meniscal graft for repair of osteochondral defects in the knee joint.

    Osteochondral defects in the knee joints of five patients caused by trauma or osteochondritis dissecans were repaired using deep-frozen allogeneic meniscal grafts. Three patients were male and two were female, with a mean age of 26.4 years. The mean follow-up period was 31 months. Postoperative magnetic resonance imaging (MRI) at all periods clearly showed a smooth and congruous articular surface, although the signal intensity of the grafted meniscus was not the same as that of the articular cartilage. Second-look arthroscopy performed approximately 1 year after surgery demonstrated that the grafted meniscus was well bonded to the grafted site, not sunken; there was no gap between the grafted meniscus and the surrounding articular cartilage, indicating that the grafted meniscus functions as a part of the articular surface. Histologic examination revealed that host cells had infiltrated into the meniscus and that cells surrounded by thin collagen fibrils were morphologically similar to fibrochondrocytes. Thus, the acellular grafted meniscus regenerated as meniscal tissue and formed an articular surface, although hyalinization did not occur. Our results suggest that deep-frozen allogeneic meniscal grafting is a useful method to repair osteochondral defects in the knee joint.
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24/31. An arthroplastic salvage procedure for combined radiocarpal and distal radioulnar pathology.

    In a patient with silicone synovitis and degeneration of the distal radioulnar joint after 2 operative procedures for Kienbock's disease, and in a patient with long-standing scapholunate dissociation and distal radioulnar degenerative arthritis, a combined salvage arthroplasty was performed. A proximal row carpectomy with a Sauve Kapandji procedure maintained reasonable function.
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keywords = operative
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25/31. Long-term results of Kienbock's disease treated by triscaphe arthrodesis and excisional arthroplasty with a coiled palmaris longus tendon.

    Fifteen patients with Kienbock's disease were treated with scaphotrapeziotrapezoidal arthrodesis and lunate excisional arthroplasty with a coiled palmaris longus tendon replacement. patients were classified into five groups preoperatively according to Lichtman's classification: stage IIIA, 1 patient; stage IIIB, 11; and stage IV, 3. After an average follow-up period of 57 months, the clinical results were evaluated by the method described by Lichtman et al. Twelve patients were rated as satisfactory, and three patients were rated as unsatisfactory. Clinical results were good with regard to pain relief and grip strength, but poor with regard to range of motion of the wrist. Five patients revealed postoperative progression of osteoarthritic changes at the radioscaphoid joint, and this appeared to be a main factor influencing clinical results. Two of these five patients had subsequent wrist arthrodesis. We conclude that stage IIIB is a specific indication for scaphotrapeziotrapezoidal arthrodesis.
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26/31. External fixation for the treatment of Kienbock's disease.

    With the advent of magnetic resonance imaging, the diagnosis of avascular necrosis of carpal bones can be made early, well before collapse and derangement of carpal mechanics occur. We believe that neutralization of forces early in the course of disease may permit natural healing (revascularization) of the bone. It is questionable whether tubular casts can supply adequate neutralization of force. We recommend the consideration of external fixation, rather than more extensive surgery, as a rational alternative for this purpose. After surgical revascularization, carpal bones go through a resorptive phase that makes them highly susceptible to collapse from compressive forces across the wrist. We advocate the postoperative use of an external fixator to neutralize these forces after a revascularization procedure is performed.
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27/31. candida albicans infection of sternum and costal cartilages: combined operative treatment and drug therapy and 5-fluorocytosine.

    Two patients with candidal sternal osteomyelitis have been successfully treated by operative debridement and adjuvant drug therapy with 5-fluorocytosine. One patient had developed postoperative candidal wound infection after sternotomy, and the other acquired candidal sternal osteomyelitis following Candida fungemia. The diagnosis, suggested by culture, was confirmed by identification of Candida pseudohyphae in debrided tissue. Histological confirmation of candidal sternal osteomyelitis indicates the need for operative debridement and specific systemic antifungal therapy. The drug 5-fluorocytosine appears to provide effective oral therapy in this situation.
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ranking = 3.5
keywords = operative
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28/31. External fixation and cancellous bone grafting for Kienbock's disease: a preliminary report.

    Between 1985 and 1990, 17 patients with histologically proven Kienbock's disease (Lichtman stages I, II, and III) underwent a combination of cancellous bone grafting to the lunate and external fixation across the wrist. All 17 patients were available for review with a minimum follow-up of 2 years (average, 47 years). Based on pain, functional status, range of motion, and grip strength (Mayo wrist score), there were 6 excellent, 6 good, 2 fair, and 3 poor results (2 of whom required further surgery). An overall success rate of 71% (12 of 17) was achieved. Ten patients underwent postoperative magnetic resonance scanning, and in 5, some improvement in signal intensity was demonstrated. The combination of cancellous bone grafting and external fixation is an alternative treatment for Kienbock's disease.
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ranking = 0.5
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29/31. Temporary internal fixation of the scaphotrapezio-trapezoidal joint for the treatment of Kienbock's disease: a preliminary study.

    Temporary scaphotrapezio-trapezoidal (STT) fixation with Kirschner wires (K-wires) has been used in the treatment of 16 cases of Kienbock's disease since 1988. Twelve of these cases with a follow-up of at least 1 year were reviewed. Eight patients were women and 4 were men and the average age at the time of surgery was 44 years (range, 20-67 years). Five cases were treated with temporary STT fixation and vascular bundle implantation (group V), and 7 cases were treated with temporary STT fixation and tendon roll implantation (group T). K-wires were removed between 16 and 26 weeks after surgery (average, 18.6 weeks) in group V, and between 8 and 13 weeks (average, 9.7 weeks) in group T. The follow-up periods ranged from 12 to 92 months (average, 38 months). Postoperative wrist pain disappeared in 7 cases and decreased in 5. The postoperative arc of wrist flexion and extension increased from 97 degrees to 108 degrees in group V and from 85 degrees to 103 degrees in group T. Grip strength improved from 22.2 to 30.6 kg in group V and from 11.4 kg to 17.7 kg in group T. X-ray evaluation revealed that the mean carpal height ratio was 0.488 before surgery, 0.489 during STT fixation, and 0.480 at the final follow-up. The carpal height decreased in 3 cases (2 in group V and 1 in group T). The postoperative radioscaphoid angle improved in all cases during K-wire insertion and regressed after removal of the K-wire, eventually showing a decrease in 4 cases, an increase in 3 cases, and no change in 5 cases.
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ranking = 1.5
keywords = operative
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30/31. Temporary scapho-trapezoidal joint fixation for Kienbock's disease in a 12-year-old girl: a case report.

    Temporary scapho-trapezoidal joint fixation with Kirschner wires was performed for stage IIIB Kienbock's disease in a 12-year-old girl. Preoperative evaluation with radiographs and magnetic resonance imaging confirmed the diagnosis. After 4 months of fixation, wrist range of motion was improved and pain was decreased. Postoperative magnetic resonance imaging revealed revascularization and fracture healing. Temporary scapho-trapezoidal fixation may be useful in the treatment of selected cases of Kienbock's disease in children.
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ranking = 1
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