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1: Osteoporos Int. 2003 Nov 5 [Epub ahead of print].

The fracture iaison service: success of a pro!ra" for the evauation and
"ana!e"ent of patients #ith osteoporotic fracture.
$c%ean &'( )aacher *+( ,raser $( $c-uiian ..
/estern Infir"ar0( )as!o#( 12.
Introduction: ,racture care often represents the first opportunit0 for
"ana!e"ent of osteoporosis3 ho#ever( "an0 patients do not receive an0
after a fracture. In )as!o#( *cotand( fe#er than 104 of fracture patients
under#ent bone "inera densit0 56$78 testin!. In an effort to better "eet the
needs of fracture patients b0 providin! routine assess"ent and( #here
treat"ent for osteoporosis after their fracture( a nove service 5The ,racture
%iaison *ervice8 #as desi!ned and i"pe"ented in t#o separate Nationa 9eath
*ervice trusts in )as!o#. $ethods: &n a!reed:upon standard of care for "en
#o"en 50; 0ears of a!e #ith fractures #as estabished in coaboration #ith
orthopedic sur!eons and pri"ar0 care ph0sicians. The ,racture %iaison *ervice
assu"es responsibiit0 for fracture case:findin! and for assessin! and
perfor"in! dia!nostic evauations 5incudin! a<ia 7=&8( and "a>in! specific
treat"ent reco""endations for the secondar0 prevention of osteoporotic
fractures. 'esuts: 7urin! the first 1? "onths of operation( "ore than @(A00
patients #ith fractures of the hip( #rist( hu"erus( an>e( foot( hand( and
sites #ere seen b0 the ,racture %iaison *erviceBs osteoporosis speciaist
nurses. Near0 three Cuarters of these patients #ere considered for 6$7
treat"ent #as reco""ended for appro<i"ate0 204 of the patients #ithout need
6$7 testin!. Overa( ?2.34 of patients #ho had 6$7 testin! #ere found to be
osteopenic or osteoporotic at the hip or spine. .oncusions: The ,racture
%iaison *ervice has successfu0 identified and evauated "ost patients #ith
fractures. On0 those patients #ho decined #ere not evauated. The uti"ate
success of the pro!ra" #i be "easured b0 the subseCuent fracture e<perience
these patients( but cear i"prove"ents in dia!nosin! and treatin! o# bone
"inera densit0 in patients #ith fracture have aread0 been de"onstrated.
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2: Osteoporos Int. 2003 Nov @ [Epub ahead of print].
'adiocaciu" absorption is reduced in post"enopausa #o"en #ith vertebra and
"ost t0pes of periphera fractures.
Nordin 6E( OB%ou!hin D7( Need &)( 9oro#itE $( $orris 9&.
7ivision of .inica 6ioche"istr0( Institute of $edica and Feterinar0
,ro"e 'oad( 5000( &deaide( *outh &ustraia( &ustraia.
Intestina caciu" absorption accounts for A04 of the variance in caciu"
baance and is therefore a potentia0 ver0 i"portant deter"inant of bone
status. /hether "easured b0 the baance techniCue or #ith radiocaciu"( it is
>no#n to be si!nificant0 reduced in post"enopausa #o"en #ith vertebra and
fractures. 60 contrast( there is ver0 itte infor"ation about caciu"
absorption in other t0pes of post"enopausa fracture. /e no# report a series
5@G untreated( .aucasian post"enopausa #o"en in #ho" #e recorded prevaent
fractures( "easured radiocaciu" absorption( and obtained radio!raphs of the
atera thoracic and u"bar spine. Of these #o"en( 1H2 had no prevaent
fractures( sho#ed nor"a spine radio!raphs( and served as contros3 H2 had one
or "ore periphera fractures but nor"a spine radio!raphs3 1@H had one or "ore
#ed!ed or crushed vertebrae but no periphera fractures3 and 15? had a histor0
of periphera fracture and one or "ore fractured vertebrae. &!e:adIusted
radiocaciu" absorption #as si!nificant0 o#er in the t#o !roups #ith spina
fractures than in the contros 5 DJ0.0018 but not in the !roup #ith periphera
fractures on0. It #as aso o#er in the cases #ith "ore than t#o spina
fractures than in those #ith t#o or ess 5 DJ0.0018. In respect of periphera
fractures( the !reatest a!e:adIusted absorption deficit #as found in fractures
of the hu"erus 53548 foo#ed b0 hip 53248( spine 52148( #rist 51G48( and rib
1H4 5a si!nificant but not si!nificant0 different fro" each other8. %esser
deficits in tibia( an>e and foot fractures #ere not si!nificant but t0pe 2
errors coud not be e<cuded. /e concude that i"paired caciu" absorption is
particuar0 associated #ith those fractures for #hich osteoporosis is a
si!nificant ris> factor.
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3: ,oot &n>e Int. 2003 Oct32@5108:HH1:@.
Investi!ation of incidence of superficia peronea nerve inIur0 foo#in!
'edfern 7+( *auve D*( *a>eariou &.
,ri"e0 Dar> 9ospita N9* Trust( Dorts"outh 'oad( ,ri"e0( *urre0( 12."
The ai" of this stud0 #as to investi!ate the incidence of superficia peronea
nerve 5*DN8 inIur0 foo#in! an>e fracture and to estabish #hether this
differed bet#een those treated b0 open reduction and interna fi<ation 5O'I,8
and those treated nonoperative0 in a cast. T#o hundred ei!ht0 patients #ho
been treated for an an>e fracture either sur!ica0 5O'I, !roup8 or
nonoperative0 5cast !roup8 #ere identified. Datients #ere invited for revie#(
assessed usin! the &O,&* scorin! s0ste"( and e<a"ined for an0 evidence of *DN
inIur0. The sur!ica approach #as docu"ented and a fractures #ere cassified
accordin! to the /eber cassification. & tota of 120 patients returned for
revie#3 5A patients fro" the O'I, !roup and A@ patients fro" the cast !roup.
"ean ti"e fro" inIur0 to revie# #as 2 0ears 5ran!e( 12:3A "onths8. Overa( 1?
patients 51548 had a s0"pto"atic *DN inIur0 and these patients had a
si!nificant0 o#er &O,&* score. In the cast !roup( G4 of patients had painfu
s0"pto"s fro" an *DN inIur0( co"pared to 214 of patients in the O'I, !roup 5p
.058. No evidence of *DN inIur0 #as found in those #ho had a posteroatera
approach to the an>e. *ur!eons shoud be a#are that the *DN is at ris> durin!
atera approach to the fibua and that inIur0 to this nerve can freCuent0 be
identified as a cause of chronic an>e pain.
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@: &cta Orthop Trau"ato Turc. 200333H5@8:2GG:303.
[Treat"ent of tri"aeoar fractures. Is osteos0nthesis needed in posterior
"aeoar fractures "easurin! ess than 254 of the Ioint surfaceL]
[&rtice in Tur>ish]
2atioE 9( 6o"baci 9( )or!ec $.
7epart"ent of Orthopedics and Trau"atoo!0 5Ortopedi ve Trav"atooIi 2ini!i8(
9a0darpasa Nu"une Trainin! and 'esearch 9ospita( 1s>udar( Istanbu( Tur>e0.
O6+E.TIFE*: /e evauated the effect of posterior "aeoar fractures( #hich
"easured ess than 254 of the Ioint surface( on the resuts of an>e
$ET9O7*: The stud0 incuded @@ patients 521 fe"aes( 23 "aes3 "ean a!e @@
0ears3 ran!e 1H to HA 0ears8 #ho under#ent sur!ica treat"ent for /eber t0pes
or . an>e fractures. ,ibua fractures #ere associated #ith detoid i!a"ent
ruptures in 12 patients( and #ith "edia "aeoar fractures in 32 patients.
*i<teen patients and 2? patients #ith and #ithout posterior "aeoar
respective0( #ere evauated as separate !roups accordin! to the DhiipsB
criteria for co"parison of cinica( anato"ica( and arthritic scores. The
foo#:up #as 2G.5 "onths 5ran!e 1? to A@ "onths8. 'E*1%T*: There #ere no
si!nificant differences bet#een the t#o !roups #ith re!ard to cinica and
anato"ica scores. &thou!h the "ean arthritic score #as hi!her in patients
a posterior "aeoar fracture( it did not reach si!nificance 5pM0.058.
.ON.%1*ION: Our data sho# that satisfactor0 resuts can be achieved in
"aeoar fractures "easurin! ess than 254 of the Ioint surface #hen an
acceptabe reduction is perfor"ed even #ithout osteos0nthesis.
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5: + 6one +oint *ur! &". 2003 Oct3?5:&5108:1?G3:G00.
Outco"es after treat"ent of hi!h:ener!0 tibia pafond fractures.
Doa> &N( $c.arth0 $%( 6ess '*( &!e +( *#iont>o#s>i $,.
7epart"ent of Orthopaedics( 1niversit0 of $ar0and *choo of $edicine(
21201( 1*&. apoa>Ku"oa.u"".edu
6&.2)'O1N7: &thou!h a nu"ber of investi!ators have docu"ented cinica
and co"pications associated #ith tibia pafond( or pion( fractures( ver0
have e<a"ined functiona and !enera heath outco"es associated #ith these
fractures. Our purpose #as to assess "idter" heath( function( and i"pair"ent
after pion fractures and to e<a"ine patient( inIur0( and treat"ent
characteristics that infuence outco"e. $ET9O7*: & retrospective cohort
of pion fractures treated at t#o centers bet#een 1GG@ and 1GG5 #as conducted.
Datient( inIur0( and treat"ent characteristics #ere recorded fro" patient
intervie#s and "edica record abstraction. *tud0 participants returned to the
initia treat"ent centers for a co"prehensive evauation of their heath
The pri"ar0 outco"es that #ere "easured incuded !enera heath( #a>in!
abiit0( i"itation of ran!e of "otion( pain( and stair:ci"bin! abiit0. &
secondar0 outco"e "easure #as e"po0"ent status. 'E*1%T*: Ei!ht0 5H?48 of 103
ei!ibe patients #ere evauated at a "ean of 3.2 0ears after inIur0. )enera
heath( as "easured #ith the *hort ,or":3A 5*,:3A8( #as si!nificant0 poorer
than a!e and !ender:"atched nor"s. Thirt0:five percent of the patients
substantia an>e stiffness3 2G4( persistent s#ein!3 and 334( on!oin! pain.
si<t0:five participants #ho had been e"po0ed before the inIur0( t#ent0:ei!ht
5@348 #ere not e"po0ed at the ti"e of foo#:up3 nineteen 5A?48 of the
t#ent0:ei!ht reported that the pion fracture prevented the" fro" #or>in!.
$utivariate ana0ses reveaed that presence of t#o or "ore co"orbidities(
"arried( havin! an annua persona inco"e of ess than 25(000 1* doars( not
havin! attained a hi!h:schoo dipo"a( and havin! been treated #ith e<terna
fi<ation #ith or #ithout i"ited interna fi<ation #ere si!nificant0 reated
poorer resuts as refected b0 at east t#o of the five pri"ar0 outco"e
"easures. .ON.%1*ION*: &t "ore than three 0ears after the inIur0( pion
fractures can have persistent and devastatin! conseCuences on patientsB heath
and #e:bein!. .ertain socia( de"o!raphic( and treat"ent variabes see" to
contribute to these poor outco"es.
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A: Nhon!!uo =iu ,u .hon! +ian /ai 2e Na Nhi. 2003 *ep31H558:3AH:G.
[Operative treat"ent of dispaced taar nec> fractures #ith absorbabe a!
[&rtice in .hinese]
%iu %,( .ai +,( %ian! +.
Trau"atic Orthopedic 7epart"ent( )enera 9ospita of +inan $iitar0 .o""and(
+inan( *handon!( D. '. .hina 250031.
O6+E.TIFE: To stud0 a ne# >ind of operation for dispaced taar nec>
$ET9O7*: ,ro" &pri 1GGA to $arch 2001( G taar nec> fractures #ere treated b0
interna fi<ation of absorbabe a! scre# #ith a "edia approach and cut of
"edia "aeous to e<pose the fractures. & non:#ei!ht:bearin! beo#:>nee cast
#as appied for A to 12 #ee>s after operation. Once union of the fracture site
is apparent( the patient shoud re"ain non:#ei!ht bearin! in a re"ovabe
short:e! and >eep e<ercise ever0 da0. 'E*1%T*: & the patients received
foo#:up fro" 15 to A0 "onths #ith an avera!e of 2? "onths. The fractures
heaed fro" 20 to @2 #ee>s. The e<ceent and !ood rate of function #as HH.?4
5HOG8 accordin! to &"erican Orthopedic ,oot and &n>e *ociet0 *core5&O,&*8.
case had the co"pication of superficia infection of #ound and s>in ed!e
necrosis after operation( #hich #as 9a#>ins t0pe III. %ate co"pication
t#o cases of avascuar necrosis5&FN8. &"on! the"( one &FN of 9a#>ins t0pe II
caused b0 ear0 #ei!ht:bearin! five #ee>s after operation and !ained the fair
score. The other &FN of 9a#>ins t0pe III #as inefficient to conservative
and proceeded an>e fusion in the end. The &O,&* of the patient #as bad.
.ON.%1*ION: Treat"ent of taar nec> fractures b0 interna fi<ation of
a! scre# #ith a "edia approach is an idea "ethod. It can !ain a
resut b0 the operation( strict postoperative care and rehabiitation.
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H: ,oot &n>e Int. 2003 *ep32@5G8:H2@3 author rep0 H2@:A.
'E: $ethod for "anua reduction of dispaced intra:articuar fracture of the
cacaneus: techniCue( indications and i"itations( O"oto 9( Na>a"ura 2( ,oot
&n>e Int. 225118:?H@:?HG( 2001.
2i" 79( 6er>o#itE $+.
Dubication T0pes:
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?: + 'econstr $icrosur!. 2003 +u31G558:2G5:?.
)raciis "usce spit into t#o free faps.
*choeer T( $eirer '( )urunuo!u '( DiEa:2atEer 9( /echseber!er ).
1niversit0 9ospita Innsbruc>( %eopod:,ranEens 1niversit0( Innsbruc>(
& case is presented in #hich the !raciis "usce #as transverse0 spit into
free faps for covera!e of t#o separate defects in a patient #ith a
"uti:se!"ent fracture of the "etatarsa bones and the an>e Ioint.
D$I7: 1@50A5HA [Dub$ed : in process]
G: + Orthop Trau"a. 2003 *ep31H5?8:5@G:5@.
.orrection of tibia "aunion and nonunion #ith si<:a<is ana0sis defor"it0
correction usin! the Ta0or *patia ,ra"e.
,ed"an 7*( *hin **( $adan *( 2ova 2+.
7epart"ent of Orthopaedic *ur!er0( NP1:9ospita for +oint 7iseases( 301 East
1Hth *treet( Ne# Por>( NP 10003( 1*&. david.fed"anK"
O6+E.TIFE: To deter"ine the effectiveness of si<:a<is ana0sis defor"it0
correction usin! the Ta0or *patia ,ra"e for the treat"ent of posttrau"atic
tibia "aunions and nonunions. 7E*I)N: 'etrospective0 revie#ed( consecutive
series. $ean duration of foo#:up #as 3.2 0ears 5ran!e 2:@.2 0ears8. *ETTIN):
Tertiar0 referra center for defor"it0 correction. D&TIENT*OD&'TI.ID&NT*:
Ei!hteen patients #ere incuded in the stud0 511 "aunions and H nonunions8.
defor"ities #ere posttrau"atic in nature. The "ean nu"ber of operations before
the appication of the spatia fra"e #as 2.A 5ran!e 1:A operations8. &
patients co"peted the stud0. INTE'FENTION: *i<:a<is ana0sis defor"it0
correction usin! the Ta0or *patia ,ra"e 5*"ith Q Nephe#( $e"phis( TN8 #as
for correction of posttrau"atic tibia "aunion or nonunion. Nine patients had
bone !raftin! at the ti"e of fra"e appication. One patient #ith a tibia
pafond fracture si"utaneous0 had defor"it0 correction and an an>e fusion
a "obie atrophic nonunion. T#o patients had infected tibia nonunions that
treated #ith "utipe debride"ents( antibiotic beads( and bone !raftin! at the
ti"e of spatia fra"e appication. & rotationa !astrocne"ius fap #as used to
cover a pro<i"a third tibia defect in one patient. The avera!e en!th of
the spatia fra"e #as #orn( ti"e to heain!( #as 1?.5 #ee>s 5ran!e 12:32
$&IN O1T.O$E $E&*1'E$ENT*: &ssess"ent of defor"it0 correction in si< a<es(
and an>e ran!e of "otion( incidence of infection( and return to preinIur0
activities. 'E*1%T*: Of the 1? patients treated #ith the Ta0or *patia ,ra"e(
#ith adIunctive bone !raft as necessar0( 1H achieved union and si!nificant
correction of their defor"ities in si< a<es 5ie( corona an!uation and
transation( sa!itta an!uation and transation( rotation( and shortenin!8.
,ifteen patients returned to their preinIur0 activities at ast foo#:up.
.ON.%1*ION: *i<:a<is ana0sis defor"it0 correction usin! the Ta0or *patia
,ra"e is an effective techniCue to treat posttrau"atic "aunions and nonunions
of the tibia( #ith severa advanta!es over previous0 used devices.
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10: Orthop .in North &". 2003 +u33@538:@@5:5G.
&n>e and foot disorders in s>eeta0 i""ature athetes.
.ha"bers 9).
7epart"ent of Orthopedic *ur!er0( 1niversit0 of .aifornia at *an 7ie!o( *an
7ie!o( .&( 1*&. hcha"bersKchsd.or!
&s one of the "ost co""on0 inIured areas in the i""ature athete( the foot
an>e has "an0 disorders. 2no#ed!e of con!enita and deveop"enta
abnor"aities and possibe inIur0 patterns enabes the cinician to correct0
dia!nose these disorders. Dh0sica e<a"ination and appropriate use of i"a!in!
technoo!0 provide confir"ation of the initia i"pression. &s chidren and
adoescents participate in sports #ith !reater intensit0( there is a hi!her
incidence of overuse inIuries that "a0 have on!:ter" i"pications.
Dubication T0pes:
'evie#( Tutoria
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11: &rthroscop0. 2003 *ep31G5H8:E?:11.
&rthroscopic resection of an e<tra:articuar tenos0novia !iant ce tu"or
the an>e re!ion.
*pahn )( 6ousseIot ,( *chuE 9+( 6auer T.
.inic of &rthroscop0 and +oint *ur!er0( Eisenach( )er"an0.
This report describes the case of a 31:0ear:od "an #ith a tenos0novia !iant
ce tu"or in the eft an>e re!ion. The tu"or deveoped over a period of 5
"onths. & conservative0 treated fracture of the e! in the patientBs histor0
#as i"portant. The presur!ica "a!netic resonance i"a!in! 5$'I8 e<a"ination
ao#ed a specific dia!nosis and the e<cusion of infitrative properties of
tu"or. The tu"or #as e<cised usin! an e<cusive0 arthroscopic techniCue. The
procedure incuded treat"ent of intra:articuar pathoo!ies and the re"ova of
oose bodies. The e<cision #as co"pete and no recurrence or co"pication #as
seen in 5 "onthsB foo#:up. In vie# of the possibe recurrence 5in about 504
patients8 and the un>no#n deveop"ent of "ai!nant tu"ors( arthroscopic
can be advanta!eous. This procedure incudes s"a scars and o#er ris>s of
infection and necrosis. Therefore( arthroscopic treat"ent of soft tissue
near the an>e Ioint "a0 b0 an aternative to open e<cision.
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12: .in Orthop. 2003 *ep35@1@8:3H:@@.
Open an>e fractures in patients #ith diabetes "eitus.
/hite .6( Turner N*( %ee ).( 9aidu>e#0ch )+.
$a0o .inic( 'ochester( $N 55G05( 1*&.
.o"pications after sur!ica treat"ent of cosed an>e fractures in patients
#ith diabetes previous0 have been #e docu"ented. The purpose of this stud0
#as to evauate the union rate( infection rate( and soft tissue co"pication
rate in open an>e fractures in patients #ith diabetes. 6et#een +anuar0 1(
and 7ece"ber 31( 2000( 1@ open an>e fractures in 13 patients #ith diabetes
treated. The "ean foo#up #as 1G "onths 5ran!e( A:?@ "onths8. & patients
foo#ed up unti union( a"putation( or for at east A "onths. Nine of 1@
e<tre"ities 5A@48 had #ound heain! co"pications. 1ti"ate0( five patients
5si< e<tre"ities3 @248 had beo# the >nee a"putation. On0 three of 1@
in three patients heaed #ithout co"pications. Open an>e fractures in
#ith diabetes are i"b:threatenin! inIuries #ith hi!h a"putation and infection
rates despite conte"porar0 techniCues of open reduction and interna fi<ation(
intravenous antibiotics( and e"er!ent irri!ation and debride"ent.
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13: 'ofo ,ortschr )eb 'ont!enstr Neuen 6id!eb Ferfahr. 2003 *ep31H55G8:11G3:
'apid "uscuos>eeta "a!netic resonance i"a!in! usin! inte!rated parae
acCuisition techniCues 5ID&T8::initia e<periences.
'o"aneehsen 6( OberhoEer 2( $uer %D( 2reitner 2,.
2ini> und Doi>ini> fur 'adioo!ie( +ohannes )utenber!:1niversitat $ainE.
D1'DO*E: To investi!ate the feasibiit0 of usin! "utipe receiver coi
for ti"e savin! inte!rated parae i"a!in! techniCues 5iD&T8 in trau"atic
"uscuos>eeta disorders. $&TE'I&% &N7 $ET9O7*: A patients #ith trau"atic
deran!e"ents of the >nee( an>e and hip under#ent $' i"a!in! at 1.5 T. ,or
si!na detection of the >nee and an>e( #e used a A:channe bod0 arra0 coi
#as paced around the Ioints( for hip i"a!in! t#o @:channe bod0 arra0 cois
t#o ee"ents of the spine arra0 coi #ere co"bined for si!na detection. &
patients #ere investi!ated #ith a standard i"a!in! protoco that "ain0
consisted of different turbo spin:echo seCuences 5D7:( T 528:#ei!hted T*E #ith
and #ithout fat suppression( *TI'8. & seCuences #ere repeated #ith an
inte!rated parae acCuisition techniCue 5iD&T8 usin! a "odified sensitivit0
encodin! 5"*EN*E8 techniCue #ith an acceeration factor of 2. Overa i"a!e
Cuait0 #as subIective0 assessed usin! a five:point scae as #e as the
abiit0 for detection of pathoo!ic findin!s. 'E*1%T*: 'e!ardin! overa i"a!e
Cuait0( there #ere no si!nificant differences bet#een standard i"a!in! and
i"a!in! usin! "*EN*E. & pathoo!ies 5occut fracture( "enisca tear( torn
interpositioned 9offaBs ceft( cartia!e da"a!e8 #ere detected b0 both
techniCues. iD&T ed to a @? 4 reduction of acCuisition ti"e co"pared #ith
standard techniCue. &dditiona0( ti"e savin!s #ith iD&T ed to a decrease of
pain:induced "otion artifacts in t#o cases. .ON.%1*ION: In ti"es of increasin!
cost pressure( iD&T usin! "utipe coi ee"ents see"s to be an efficient and
econo"ic too for fast "uscuos>eeta i"a!in! #ith dia!nostic perfor"ance
co"parabe to conventiona techniCues.
Dubication T0pes:
Evauation *tudies
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1@: &" + Orthop. 2002 +an33151 *upp8:1?:21.
The bioresorbabe s0ndes"otic scre#: appication of po0"er technoo!0 in
$ier *7( .ars '+.
7epart"ent of Orthopaedic *ur!er0( The 1nion $e"oria 9ospita( 6ati"ore(
$ar0and( 1*&.
& bioresorbabe s0ndes"otic scre# #as used successfu0 for fi<ation in @
patients( 3 #ith a bi"aeoar /eber t0pe:. an>e fracture and 1 #ith a
$aisonneuve:t0pe inIur0. The 5:"" scre# consisted of a po0!0coic
acidOpo0actic acid copo0"er paced in standard fashion at the ti"e of open
reduction and interna fi<ation. The patients heaed #ithout difficut0( and
foo#:up radio!raphs sho#ed anato"ic "aintenance of the s0ndes"otic space.
There #ere no resorption probe"s. *i!ns of "ini"a irritation #ere noted at
scre#:head site in 2 patients at 3 to @ "onths after sur!er0( but the
did not ha"per activit0 or rehabiitation. The scre#s "aintained ai!n"ent.
Drei"inar0 resuts su!!est that a ar!er stud0 to further evauate the effect
of this scre# is appropriate.
D$I7: 12GA22@5 [Dub$ed : inde<ed for $E7%INE]
15: &" + Orthop. 2002 +an33151 *upp8:H:10.
$ana!e"ent of ipsiatera dista tibia and an>e fractures.
9enr0 *%.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of 2entuc>0 *choo of $edicine(
%e<in!ton( 2entuc>0( 1*&.
This stud0 revie#s 2@ patients #ith ipsiatera fractures of the dista tibia
"etaph0sis and an>e Ioint. & fractures #ere evauated and cate!oriEed b0
"echanis" of inIur0::that is( bendin! force versus torsion. &::tibia
fractures in this series #ere "ana!ed b0 a statica0 oc>ed intra"eduar0
#ith appropriate stabiiEation of the an>e inIur0 as indicated b0 the
or inIur0 pattern. This treat"ent protoco resuted in an e<ceent cinica
resut #ith on0 3 patients reCuirin! a secondar0 procedure: 2 d0na"iEations
1 e<chan!ed intra"eduar0 nai. The resuts indicate that fibuar fractures
invovin! disruption of the s0ndes"osis or "ini"a0 dispaced dista fibuar
fractures "a0 be treated nonoperative0. .onservative "ana!e"ent or "ini"a
interna fi<ation "a0 be reco""ended for "ini"a0 dispaced fractures of the
"edia "aeous or tibia pafond. 7ispaced fractures of the "edia
or dista fibua or fractures in #hich the s0ndes"osis has been disrupted are
best treated #ith standard open reduction and interna fi<ation foo#in!
pace"ent of the intra"eduar0 nai.
D$I7: 12GA22@3 [Dub$ed : inde<ed for $E7%INE]
1A: ,oot &n>e Int. 2003 &u!32@5?8:A@2:G.
Dseudo os tri!onu" si!n: "issed postero"edia taar facet fracture.
)iuffrida &P( %in **( &bidi N( 6erberian /( 6er>"an &( 6ehrens ,,.
7epart"ent of Orthopaedics( 1$7N+:Ne# +erse0 $edica *choo( Ne#ar>( N+ 0H103(
6&.2)'O1N7: Dostero"edia taar facet fracture 5D$T,,8 is a rare inIur0(
sparse0 reported in the iterature. This artice proposes that D$T,, is often
eft undia!nosed b0 orthopaedic sur!eons and su!!ests the routine appication
advanced radio!raphic studies 5i.e.( .T scan8 in the reco!nition of D$T,,. It
aso evauates nonoperative "ana!e"ent of D$T,,. $ET9O7*: &fter obtainin!
Institutiona 'evie# 6oard approva( the "edica records over a 5:0ear period
51GGH:20018 #ere retrospective0 revie#ed fro" the foot and an>e service of a
eve 1 trau"a center( identif0in! a cases of D$T,,. .harts #ere revie#ed
reevant data. 'esuts of treat"ent #ere assessed durin! foo#:up ph0sica
e<a"ination. 'E*1%T*: *i< cases of D$T,, #ere identified over a 5:0ear period.
& inIuries #ere associated #ith "edia subtaar Ioint disocation. ,our of
5AA48 patients #ere not initia0 dia!nosed #ith D$T,,( but instead
as an os tri!onu". The re"ainin! t#o patients had an estabished dia!nosis of
D$T,, at the ti"e of initia treat"ent. & had short e! cast i""obiiEation
for "edia subtaar disocation. .T evauation 0ieded additiona dia!noses in
a si< patients. & si< patients sho#ed a D$T,,. ,ive patients 5?348
persistent subtaar Ioint subu<ation. ,ive of si< 5?348 patients reCuired at
east one additiona procedure as a resut of an undia!nosed or nonoperative0
treated D$T,,. ,our patients under#ent subtaar Ioint fusion( and one patient
under#ent tibiotaar cacanea fusion secondar0 to conco"itant an>eOsubtaar
arthritis. The patient #ho did not under!o reco""ended fusion continued to be
s0"pto"atic. .ON.%1*ION*: 7ia!nosis of D$T,, necessitates a hei!htened
suspicion( especia0 #hen a "edia subtaar Ioint disocation is present.
Droper i"a!in! studies( such as corona .T scan( shoud be perfor"ed after an0
subtaar disocation. Ti"e0 treat"ent( in the for" of open reduction and
interna fi<ation for ar!e fra!"ents invovin! the articuar surface or
sur!ica e<cision for s"aer fra!"ents( is reco""ended in order to restore
proper anato"0 and function of the subtaar Ioint. This stud0 verifies the
si!nificant "orbidit0 associated #ith an undia!nosed or nonoperative0 treated
D$I7: 12G5A5H2 [Dub$ed : in process]
1H: *in!apore $ed +. 2003 $ar3@@538:155:G.
.inics in dia!nostic i"a!in! 5?38. Occut tibia cond0ar fracture.
*in!h 2( Deh /..
7epart"ent of 7ia!nostic 'adioo!0( *in!apore )enera 9ospita( Outra" 'oad(
*in!apore 1AGA0?.
& 3G:0ear:od "an #ho presented #ith ri!ht >nee pain foo#in! trau"a #as
to have a radio!raphica0:occut fracture of the atera tibia cond0e on
"a!netic resonance 5$'8 i"a!in!. The intra:articuar fracture #as seen as a
curviinear area of h0pointensit0 on both T1: and T2: #ei!hted $' i"a!es( #ith
surroundin! bone bruisin!. The $' appearances of occut fractures and bone
bruisin!( and the roe of $' i"a!in! in the detection of these inIuries in
various other re!ions( such as the an>e( hip( ebo# and #rist( are discussed.
D$I7: 12G53H33 [Dub$ed : inde<ed for $E7%INE]
1?: + &th Train. 2002 7ec33H5@8:@A3:@AA.
%on!itudina *pit of the Deroneus 6revis Tendon and %atera &n>e
Treat"ent of .onco"itant %esions.
2arsson +( /i!er D.
*ah!rens>a 1niversit0 9ospita( )otebor!( *#eden.
O6+E.TIFE: To describe the cinica picture( pathoph0sioo!0( and treat"ent of
conco"itant esions of the peroneus brevis tendon and atera i!a"ent
to the an>e. 6&.2)'O1N7: In so"e cases( chronic atera an>e instabiit0 is
associated #ith a on!itudina partia tear in the peroneus brevis tendon.
Datients #ho suffer fro" this esion usua0 have at0pica posteroatera
pain co"bined #ith si!ns of recurrent i!a"ent instabiit0 5R!ivin! #a0R8. The
tendon inIur0 is often overoo>ed because it is co"bined #ith the i!a"ent
inIur0( and the inIur0 "echanis"s are si"iar. 7E*.'IDTION: Tears or a<it0 in
the superior peronea retinacuu" ao# the anterior part of the inIured
peroneus brevis tendon to ride over the sharp posterior ed!e of the fibua(
eadin! to a on!itudina tear in the tendon. This co"bined inIur0 shoud be
suspected in patients #ith recurrent !ivin! #a0 of the an>e Ioint and
retro"aeoar pain. The dia!nosis can be estabished usin! either
utrasono!raph0 or "a!netic resonance i"a!in!. 7I,,E'ENTI&% 7I&)NO*I*:
inIur0( tenos0novitis( peroneus on!us tendon esion( os peroneu" fracture(
dista peroneus brevis tendon tear( or ano"aous peroneus tertius tendon.
T'E&T$ENT: The tendon inIur0 and the i!a"ent insufficienc0 shoud be repaired
at the sa"e ti"e. .ON.%1*ION*: /e reco""end reconstruction of the superior
peronea retinacuu"( co"bined #ith repair of the tendon( usin! side:to:side
sutures and anato"ica reconstruction of the atera an>e i!a"ents.
D$I7: 12G3H5A? [Dub$ed : as suppied b0 pubisher]
1G: ,oot &n>e Int. 2003 +u32@5H8:5A1:A.
Dosition of the dista fibuar fra!"ent in pronation and supination an>e
fractures: a .T evauation.
Tan! ./( 'oidis N( Faishnav *( Date &( Thordarson 76.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of *outhern .aifornia( %os
&n!ees( .& G0033( 1*&.
6&.2)'O1N7: &thou!h cassica0 the fibua has been reported to be in
rotation after supination:e<terna rotation 5*E'8 or pronation:e<terna
5DE'8 an>e fractures( a previous .T stud0 de"onstrated that #hat had
traditiona0 been interpreted as e<terna rotation of the dista fibuar
fracture fra!"ent is actua0 interna rotation of the pro<i"a fibuar
fra!"ent. The purpose of this stud0 #as to evauate a series of .T scans in
patients #ho have suffered t0pe IF *E' or DE' an>e fractures to assess the
rotationa defor"it0 of the fibuar fra!"ent. $&TE'I&%* &N7 $ET9O7*: .T scans
the inIured and uninIured e<tre"ities #ere perfor"ed on 30 e<tre"ities #hich
sustained either *E' 5218 or DE' 5G8 inIuries. The rotationa reationship
bet#een the tibia and fibua #as deter"ined b0 a "easured rotationa ratio. &
Cuaitative assess"ent of the rotationa reationship bet#een the tibia and
fibua above( at( and beo# the fracture site at the eve of the "ortise #as
aso perfor"ed. The difference in the ratio 5cacuated b0 subtractin! the
rotation ratio of the nor"a side fro" the fracture side8 de"onstrated #hether
the fractured fibua is e<terna0 or interna0 rotated co"pared to the
uninIured side. 'E*1%T*: The avera!e rotationa ratio difference above the
fracture co"pared to beo# the fracture for the *E' !roup de"onstrated
si!nificant e<terna rotation 5p J .0018. The DE' fracture aso de"onstrated
e<terna rotation of the dista fra!"ent co"pared to the pro<i"a fra!"ent 5p
.0028. &dditiona0( Cuaitative assess"ent of the reationship de"onstrated
obvious chan!e in the rotationa reationship in an0 patient above the
site e<cept one #here "id interna rotation of the pro<i"a fra!"ent #as
9o#ever( at the eve of the "ortise( a had a nor"a taofibuar rotationa
reationship #hie 2@ of 30 had #idenin! of the "edia cear space #ith
rotation cear0 evident on 15 of these 2@ scans. .ON.%1*ION: Our stud0
de"onstrated that the dista fibuar fra!"ent in both *E' and DE' fractures is
e<terna0 rotated reative to both the contraatera nor"a side and co"pared
to the pro<i"a fibuar fra!"ent.
D$I7: 12G213A3 [Dub$ed : inde<ed for $E7%INE]
20: Osteoporos Int. 2003 &u! 12 [Epub ahead of print].
The association bet#een osteoporotic fractures and heath:reated Cuait0 of
ife as "easured b0 the 9eath 1tiities Inde< in the .anadian $uticentre
Osteoporosis *tud0 5.a$os8.
&dachi +7( Ioannidis )( Dic>ard %( 6er!er .( Drior +.( +oseph %( 9ane0 7&(
OsE0ns>i /D( $urra0 T$( &nastassiades T( 9op"an /( 6ro#n +D( 2ir>and *(
.( Dapaioannou &( DoiCuin *( Tenenhouse &( Dapadi"itropouos E&.
7epart"ent of $edicine( *t. +osephBs 9ospita( $c$aster 1niversit0( .harton
&venue East( *uite 501( %? N 1P2( 9a"iton( Ontario( .anada.
Osteoporotic fractures can be a "aIor cause of "orbidit0. It is i"portant to
deter"ine the i"pact of fractures on heath:reated Cuait0 of ife 59'-%8. &
tota of 3(3G@ #o"en and 1(122 "en 50 0ears of a!e and oder( #ho #ere
for the .anadian $uticentre Osteoporosis *tud0 5.a$os8( participated in this
cross:sectiona stud0. $ini"a trau"a fractures of the hip( pevis( spine(
bod0 5incuded upper and o#er e!( >nee( an>e( and foot8( upper bod0
ar"( ebo#( sternu"( shouder( and cavice8( #rist and hand 5incuded
hand( and fin!er8( and ribs #ere studied. Darticipants #ith subcinica
vertebra defor"ities #ere aso e<a"ined. The 9eath 1tiities Inde< $ar> II
III *0ste"s #ere used to assess 9'-%. Dast osteoporotic fractures varied in
prevaence fro" 1.24 5pevis8 to 2H.?4 5o#er bod08 in #o"en and 0.34 5pevis8
to 2G.34 5#rist8 in "en. $utivariate inear re!ression ana0ses [para"eter
esti"ates and correspondin! G54 confidence intervas 5.I8] indicated that
"ini"a trau"a fractures #ere ne!ative0 associated #ith 9'-% and that this
reationship depends on fracture t0pe and !ender. The "uti:attribute scores
the $ar> II s0ste" #ere ne!ative0 reated to hip 5:0.053 G54 .I: :0.0G(
o#er bod0 5:0.023 G54 .I: :0.03( :0.0008( and subcinica vertebra fractures
5:0.023 G54 .I: :0.03( :0.008 for #o"en. The "uti:attribute scores for the
III s0ste" #ere ne!ative0 reated to hip 5:0.0G3 G54 .I: :0.1@( :0.038 and
fractures 5:0.0A3 G54 .I: :0.11( :0.008 for #o"en( and rib fractures 5:0.0A3
.I: :0.12( :0.008 for "en. In concusion( this stud0 de"onstrates a ne!ative
association bet#een osteoporotic fractures and Cuait0 of ife in both #o"en
D$I7: 12G2050H [Dub$ed : as suppied b0 pubisher]
21: Eur + Fasc Endovasc *ur!. 2003 &u!32A528:1HA:?.
& co"parison of patients #ho deveoped venous e! uceration before and after
their 50th birthda0.
$ac2enEie '2( 6ro#n 7&( &an D%( 6radbur0 &/( 'uc>e0 .F.
Fascuar *ur!er0 1nit( 'o0a Infir"ar0( Edinbur!h( *cotand( 12.
6&.2)'O1N7: athou!h chronic venous uceration 5.F18 is often vie#ed pri"ari0
as a disease of the eder0( recent epide"ioo!ica data su!!est that a
si!nificant proportion of patients first deveop .F1 before "idde a!e. *uch
patients "a0 represent a distinct !roup in ter"s of aetioo!0( natura
pro!nosis and therapeutic options. &I$: to co"pare patients #ho deveoped .F1
before 5)roup 18 and after 5)roup 28 their 50th birthda0. $ET9O7*: one hundred
and ei!hteen consecutive patients #ith RpureR .F1 under#ent histor0 and
e<a"ination( "easure"ent of an>e:brachia pressure inde< 5&6DI8 and dupe<
utrasound e<a"ination of the affected i"b. Dure venous ucers #ere defined
those of M@ #ee>s duration in the presence of venous refu< 5M0.58 and in
association #ith an an>e: brachia pressure inde< of M0.?. 'E*1%T*: patients
)roup 1 5n S 5@( @A48 #ere "ore i>e0 to be "ae 532O5@ [5G4] vs 1@OA@ [234](
J 0.001 chi5288( to have a hi!her "edian 5interCuartie [I-']8 bod0 "ass inde<
532 [2H:3G] vs 2H [23:3@]( p S 0.003( $ann:/hitne0 1 [$/1]8( to have a histor0
of deep venous thro"bosis 523O5@ [@34] vs 1AOA@ [254]( p S 0.0@ chi5288 and of
ipsiatera on! bone fracture 513O5@ [2@4] vs 5OA@ [?4]( p S 0.01( chi5288(
have previous0 under!one venous sur!er0 52HO5@ [504] vs 1GOA@ [304] a "edian
5I-'8 of 11.5 5A.5:1G8 and 10 52:208 0ears earier respective0( and to have
#orse disease in ter"s of the duration of present ucer 512 5A:3A8 vs ?.5 [3:
"onths( p S 0.035 $/18( the tota duration of ucer disease 521A [H2:3A0] vs
[12:120] "onths( p J 0.001 $/18( and the nu"ber of episodes of uceration 53
[2:H] vs 1 [1:3]( p S 0.002 $/18. There #as no si!nificant difference bet#een
the t#o !roups in the pattern and severit0 of venous refu< #ith @AO5@ 5?548
)roup 1 and 5@OA@ 5?@48 of )roup 2 patients havin! sur!ica0 correctabe
superficia venous refu<. .ON.%1*ION: patients #ho deveop .F1 before their
50th birthda0 appear to represent a distinct !roup in ter"s of aetioo!0(
natura histor0 and pro!nosis. The i"portance of thro"bo:e"boic proph0a<is
the prevention( and the detection and correction of superficia venous refu<
the treat"ent( of such ucers is re:e"phasised.
D$I7: 12G1H?3@ [Dub$ed : in process]
22: $a!n 'eson I"a!in! .in N &". 2003 $a0311528:311:21.
/inter sports inIuries. The 2002 /inter O0"pics e<perience and a revie# of
.ri" +'.
7epart"ent of 'adioo!0( 1niversit0 9ospita and .inics( 1niversit0 of 1tah
9eath *ciences .enter( 50 North $edica 7rive( *at %a>e .it0( 1T ?@132( 1*&.
InIur0 patterns at the 2002 /inter O0"pics #ere si"iar to those in
recreationa #inter athetes( athou!h inIur0 rates #ere hi!her. The hi!h
of inIur0 co"pared #ith reported rates in recreationa athetes refect the
intensit0 of the co"petition and the hi!h speeds of the athetes. In addition(
rates are artificia0 eevated because #e #ere not abe to count the nu"ber
practice runs b0 each athete( on0 the nu"ber of races. The hi!hest rates of
inIuries resutin! in positive $' i"a!in! or pain radio!raphs #ere in
sno#boarders 52?O1000 races8( foo#ed b0 apine s>iers 520O10008. In a of
#inter sports( the "ost co""on0 inIured Ioint #as the >nee 53H inIuries8( and
the "ost co""on >nee inIur0 #as the &.% tear. InIuries to the foot and an>e
#ere second in freCuenc0 515 inIuries8. It is interestin! that three of the
an>e inIuries #ere s0ndes"osis sprains3 this "a0 be an underreported inIur0
#inter sports. There #ere 12 inIuries to the upper e<tre"it0( a but t#o to
shouder. 6ac> co"paints #ere freCuent( but on0 seven patients had
i"a!in! abnor"aities found in the u"bar spine: t#o stress fractures of the
pedices( one acute pedice fracture( one spond0o0sis( and four disc
D$I7: 12G1A?G3 [Dub$ed : in process]
23: ,oot &n>e .in. 2003 +un3?528:3A1:H3( <i.
1se of ao!rafts in the "ana!e"ent of an>e arthritis.
TontE /% +r( 6u!bee /7( 6ra!e $E.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of .aifornia( *an 7ie!o( 200
&rbor 7rive T??G@( *an 7ie!o( .& G2103( 1*&.
'econstruction of articuar cartia!e defects of the tibiotaar Ioint re"ains
chaen!e. &thou!h arthrodesis and tota an>e arthropast0 are treat"ent
options( #e present fresh tibiotaar ao!raftin! as an aternative techniCue.
The avera!e a!e of 12 patients #ho under#ent tibiotaar ao!raftin! #as @3
0ears. The avera!e foo#:up #as 21 "onths. & !rafts heaed at the
interface. .o"pications incuded intraoperative fracture in one patient and
!raft coapse that reCuired revision ao!raftin! in another. $ost patients
#ere reieved of preoperative pain and #ere satisfied #ith the procedure.
Dostoperative function #as aso si!nificant0 i"proved( based on Cuestionnaire
and ph0sician assess"ent. ,resh tibiotaar ao!raftin! is an e<citin! and
pro"isin! techniCue in the treat"ent of articuar cartia!e defects in 0oun!(
active patients.
D$I7: 12G112@H [Dub$ed : inde<ed for $E7%INE]
2@: ,oot &n>e .in. 2003 +un3?528:31H:33.
*upra"aeoar osteoto"0: indications and techniCue.
*ta"atis E7( $0erson $*.
7epart"ent of Orthopaedic *ur!er0( The 1nion $e"oria 9ospita( 3333 North
.avert *treet( T@00( 6ati"ore( $7 2121?( 1*&.
The dista tibia 5supra"aeoar8 osteoto"0 for the treat"ent of pathoo!ic
entities of the adut dista tibia and foot and an>e has received i"ited
attention in the iterature. It is technica0 de"andin! and reCuires an
e<tensive and carefu preoperative pannin!. In our e<perience( it has been a
usefu too in the sur!ica ar"a"entariu" to reconstruct the nor"a "echanica
environ"ent in "aunion preventin! an0 on!:ter" deeterious effects( and to
shift and redistribute oads in the an>e Ioint to protect the articuar
cartia!e fro" further de!eneration.
Dubication T0pes:
'evie# %iterature
D$I7: 12G112@@ [Dub$ed : inde<ed for $E7%INE]
25: + Orthop Trau"a. 2003 &u!31H5H8:53@:5.
&chies tendon rupture associated #ith inIur0 of the cacaneofibuar
*u!i"oto 2( 2asana"i '( I#ai $( Ta>a>ura P( 2a#ate 2.
7epart"ent of Orthopaedic *ur!er0( *aisei>ai Nara 9ospita( Nara( +apan.
& @G:0ear:od "an coided a!ainst an infieder #hen he sid into second base
durin! a recreationa baseba !a"e. 9e #as unabe to continue in the !a"e due
to diffuse pain and s#ein! of his hindfoot. & rupture of the &chies tendon
#as dia!nosed incidenta0 on papation and observation of a positive
sCueeEe test. *ubcutaneous he"orrha!e at the atera aspect of the hee and a
s"a bone fra!"ent under the atera "aeous on an anteroposterior pain
radio!raph indicated a fracture of the cacanea #a. &t sur!er0( a co"pete
rupture of the &chies tendon and an avusion of the cacaneofibuar i!a"ent
fro" the cacanea #a #ere seen. 6oth inIuries #ere sur!ica0 repaired( and
the patient subseCuent0 did #e. The "echanis" of inIur0 #as thou!ht to be
i"pact h0perdorsife<ion of the an>e #ith rupture of the &chies tendon
acco"panied b0 an inversion inIur0. 1sin! a iterature search( it #as found
this co"bination of inIuries has not been previous0 reported.
D$I7: 12G02HG5 [Dub$ed : in process]
2A: Dh0siother 'es Int. 20033?528:AG:?2.
Derfor"ance after sur!ica treat"ent of patients #ith an>e fractures::1@:
Nisson )( N0ber! D( E>dah .( Eneroth $.
'esearch 7epart"ent( %und 1niversit0 9ospita( 7epart"ent of Dh0sica Therap0(
%und 1niversit0( *#eden. !ertrud.".nissonKs>
6&.2)'O1N7 &N7 D1'DO*E: ,e# studies have been pubished that e<tensive0
evauate ph0sica outco"e after an>e fractures. In addition( there is a ac>
>no#ed!e of ho# ph0sica outco"e correates #ith subIective assess"ents of
s0"pto"s and function after an>e fracture. The purpose of the present stud0
to investi!ate outco"e after sur!ica treat"ent of patients #ith an>e
and to stud0 ho# #e the e<perience of s0"pto"s and function correated #ith
the resuts of cinica ph0sica tests. $ET9O7: The stud0 used a retrospective
cross:sectiona stud0 desi!n. ,ift0:four patients( a!ed 1H:A@ 0ears( #ere
evauated 1@ "onths post:operative0. Evauation incuded a Cuestionnaire
containin! the Oerud:$oander &n>e *core 5O$&*8 5Oerud and $oander( 1G?@8
and so"e additiona Cuestions. Datients #ere aso caed for a ph0sica and
radio!raphic e<a"ination. 'E*1%T*: The "edian O$&* obtained #as H5 5ran!e
10:1008. On0 10 51G48 of the patients reported co"pete recover0 and 1A 53048
scored M or S G0( indicatin! !ood function. The resuts of the foo#in!
cinica tests #ere correated #ith O$&*: oaded dorsa e<tension3 an>e
circu"ference3 nu"ber of toe and hee rises3 and sin!e:i"b stance. Those #ho
sho#ed poorer resuts in ph0sica outco"e on the affected side had o#er O$&*.
No an>es #ith cear "echanica instabiit0 #ere found( athou!h a"ost haf
patients e<perienced functiona instabiit0 that( in turn( #as associated #ith
decreased tota O$&*. .ON.%1*ION*: 6oth subIective0 scored function and
ph0sica perfor"ance after sur!ica0 treated an>e fractures indicated poor
resuts. One reason for this "i!ht be insufficient rehabiitation.
D$I7: 12?HGH2G [Dub$ed : in process]
2H: + &" Dodiatr $ed &ssoc. 2003 +u:&u!3G35@8:33A:G.
*0ndes"otic rupture #ithout an>e fracture. & report of t#o cases in
professiona footba pa0ers.
Endean T( 2in! /( $artin 9'.
7epart"ent of *ports $edicine( Dao &to $edica ,oundation( Dao &to( .&
G@301( 1*&.
T#o patients #ith s0ndes"otic rupture #ithout fracture are presented to
de"onstrate that i!a"entous inIur0 to the dista s0ndes"osis can occur as an
isoated inIur0. In both cases dia!nosis #as dea0ed o#in! to a ne!ative
radio!raph on the da0 of inIur0. .o"prehensive foo#:up is i"perative to
correct0 dia!nose this inIur0 pattern.
D$I7: 12?AGA0A [Dub$ed : inde<ed for $E7%INE]
2?: + &" Dodiatr $ed &ssoc. 2003 +u:&u!3G35@8:2G2:H.
$edia "aeoar stress fractures. %iterature revie#( dia!nosis( and
2or &( *atE"an &T( /e"pe D7.
2aiser Der"anente( Te"pe 9is( $7 20H@?:255H( 1*&.
$edia "aeoar stress fractures are reative0 unco""on inIuries that can be
Cuite debiitatin! and disabin!. This artice discusses the s0"pto"s(
dia!nostic aids( patho"echanics( and "ana!e"ent of "edia "aeoar stress
fractures. 1sin! three cases( the authors iustrate nonoperative versus
operative treat"ents in an athete and the infuence of an in:season versus an
off:season inIur0. & percutaneous cannuated scre# fi<ation procedure is
described that ao#ed an athete to return to co"petition 2@ da0s after
sustainin! a dispaced "edia "aeoar stress fracture.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12?AG5G? [Dub$ed : inde<ed for $E7%INE]
2G: )0neco Obstet ,erti. 2003 +un3315A8:5@3:5.
['efe< s0"pathetic d0stroph0 invovin! the an>e in pre!nanc0:
and therapeutic "ana!e"ent]
[&rtice in ,rench]
*er!ent ,( $ouro>o 7( *ea" '( $arpeau %.
.iniCue !0necoo!iCue et obstetricae( hopita .hares:Nicoe( .91 de 'ouen(
1( rue de )er"ont( HA031 'ouen cede<( ,rance. ,abrice.*er!
/e report the case of a "uti!ravida presentin! in the first tri"ester of
pre!nanc0 #ith refe< s0"pathetic d0stroph0 invovin! both an>es.
ocation of refe< s0"pathetic d0stroph0 in pre!nanc0 is cassica0 the hip
ti"es out of 108. *0"pto"s deveop "ost0 #ith pri"ipara in the third
of pre!nanc0 or in post:partu". ,racture is the "aIor ris> of refe<
d0stroph0. Decuiarities of refe< s0"pathetic d0stroph0Bs treat"ent in the
course of pre!nanc0 are evo>ed. The end of the pre!nanc0 can be shortened #ith
the ai" of stabiiEin! disease even to activate its heain!. Dathoph0sioo!ic
"echanis"s of refe< s0"pathetic d0stroph0 in pre!nanc0 see" "utipe and
co"pe<. Our observation( b0 its at0pica characteristics( recas it.
D$I7: 12?A51G@ [Dub$ed : inde<ed for $E7%INE]
30: &" + *ports $ed. 2003 +u:&u!3315@8:511:H.
The incidence of inIuries in eite Iunior fi!ure s>aters.
7ubravcic:*i"unIa> *( Decina $( 2uipers 9( $oran +( 9asp $.
7epart"ent of Dh0sica $edicine and 'ehabiitation( *veti 7uh )enera
Na!reb( .roatia.
6&.2)'O1N7: There has been rapid !ro#th in the technica and ph0sioo!ic
"ade on s>aters #ho perfor" "ore and "ore difficut Iu"ps( spins( ifts(
and free s>atin! "ove"ents. D1'DO*E: To investi!ate the freCuenc0 of inIuries
and overuse s0ndro"es in eite Iunior s>aters. *T17P 7E*I)N: -uestionnaire.
$ET9O7*: 7urin! four consecutive +unior /ord ,i!ure *>atin! .ha"pionships and
the .roatia .up( #e intervie#ed 23A fe"ae and 233 "ae s>aters b0
to deter"ine the freCuenc0 of inIuries and overuse s0ndro"es. 'E*1%T*:
,ift0:nine of the fe"ae s>aters 52548 and A5 of the "ae s>aters 52H.G48
reported sustainin! acute inIuries3 101 fe"ae 5@2.?48 and 10A "ae 5@5.548
s>aters reported overuse s0ndro"es. %o# bac> pain #as reported b0 1G fe"ae
23 "ae s>aters. The "ost freCuent acute inIur0 #as an>e sprain. In sin!es
fe"ae s>aters( the "ost freCuent overuse inIur0 #as stress fracture 51G.?48(
foo#ed b0 Iu"perBs >nee 51@.G48. In sin!es "ae s>aters( Iu"perBs >nee
51A.148 #as the "ost freCuent inIur0( foo#ed b0 Os!ood:*chatter disease
51@.248. $ore than 504 of inIuries in 0oun! sin!es fi!ure s>aters invoved
overuse s0ndro"es. Dairs s>aters and ice dance s>aters had a hi!her ris> of
acute inIur0 than overuse s0ndro"e because of fas fro" ifts and thro#
.ON.%1*ION*: Dro!ra"s to i"prove postura ai!n"ent( fe<ibiit0( and
especia0 durin! the as0nchronous period of bone and soft tissue deveop"ent(
shoud be instituted to prevent and reduce overuse s0ndro"es.
D$I7: 12?A053H [Dub$ed : in process]
31: + 6one +oint *ur! &". 2003 +u3?5:&5H8:1321:G.
1nce"ented *T&' tota an>e prostheses. Three to ei!ht:0ear foo#:up of
fift0:one consecutive an>es.
&nderson T( $ont!o"er0 ,( .arsson &.
7epart"ent of Orthopaedics( $a"o 1niversit0 9ospita( *#eden.
6&.2)'O1N7: The feasibiit0 of repacin! the an>e Ioint has been a "atter of
specuation for a on! ti"e. In recent 0ears( the desi!ns of an>e prostheses
have been i"proved( and three desi!ns( a used #ithout bone ce"ent( current0
do"inate the "ar>et. 9o#ever( docu"entation of the cinica resuts of the use
of these prostheses is sparse. /e revie#ed the inter"ediate:ter" resuts of
fift0:one consecutive *candinavian Tota &n>e 'epace"ents 5*T&'8. $ET9O7*:
6et#een 1GG3 and 1GGG( fift0:one consecutive an>es #ere repaced #ith an
unce"ented( h0dro<0apatite:coated *T&' tota an>e prosthesis. .inica
e<a"ination for the present stud0 #as perfor"ed b0 one sur!eon #ho had not
part in the operations. *tandardiEed radio!raphs #ere used. .o"pications and
faiures #ere recorded( and patient satisfaction and functiona outco"e scores
#ere deter"ined for a patients #ith an unrevised i"pant. 'E*1%T*: T#eve
an>es had to be revised. *even #ere revised because of oosenin! of at east
one of the co"ponents3 t#o( because of fracture of the "eniscus3 and three(
other reasons. & co"ponent #as e<chan!ed in seven of the t#eve revisions(
#hereas the an>e #as successfu0 fused in the other five. &n additiona
an>es had radio!raphic si!ns of oosenin!. The thirt0:nine unrevised an>es
5thirt0:seven patients8 #ere e<a"ined after thirt0:si< to ninet0:seven "onths
5"edian( fift0:t#o "onths8. The patient #as satisfied #ith the resut after
thirt0:one of the an>e repace"ents( so"e#hat satisfied after t#o( and not
satisfied after si<. The "edian 2ofoed score increased fro" 3G points before
sur!er0 to H0 points at the ti"e of the foo#:up e<a"ination. & "edian
foo#:up score of H@ points #as recorded #hen the s0ste" described b0 $aEur
a. and the &O,&* 5&"erican Orthopaedic ,oot and &n>e *ociet08 s0ste" #ere
used. The "edian ran!e of "otion #as appro<i"ate0 the sa"e preoperative0 and
postoperative0. The esti"ated five:0ear surviva rate( #ith revision for an0
reason as the end point( #as 0.H0. /hen radio!raphic oosenin! of either
co"ponent #as used as the end point( the esti"ated five:0ear radio!raphic
surviva rate #as si!nificant0 better for the ast thirt0:one an>es treated
the series 5p S 0.0328. .ON.%1*ION*: Tota an>e repace"ent "a0 be a
aternative to arthrodesis( provided that the co"ponents are correct0
positioned and are of the correct siEe. 9o#ever( the ris>s of oosenin! and
faiure are sti hi!her than are such ris>s after tota hip or tota >nee
D$I7: 12?5135? [Dub$ed : inde<ed for $E7%INE]
32: + 6one +oint *ur! &". 2003 +u3?5:&5H8:11?5:G.
%o#er:e<tre"it0 function for drivin! an auto"obie after operative treat"ent
an>e fracture.
E!o 2&( *hei>haEadeh &( $o!atederi *( 6arnett &( 2ova 2+.
7epart"ent of Orthopaedic *ur!er0( Ne# Por> 1niversit0:9ospita for +oint
7iseases( Ne# Por> 10003( 1*&. Ie!
6&.2)'O1N7: The purpose of this stud0 #as to deter"ine #hen patients recover
abiit0 to safe0 operate the bra>es of an auto"obie foo#in! operative
of an an>e fracture. $ET9O7*: & co"puteriEed drivin! si"uator #as deveoped
and tested. Eeven heath0 vounteers #ere tested once to estabish nor"a
vaues 5)roup I8( and a !roup of thirt0:one vounteers #ith a fracture of the
ri!ht an>e #ere tested at si<( nine( and t#eve #ee>s foo#in! operative
repair 5)roup II8. The subIects #ere tested #ith a series of drivin! scenarios
5cit0( suburban( and hi!h#a08. *cores on the *hort ,or" $uscuos>eeta
&ssess"ent #ere recorded at si<( nine( and t#eve #ee>s and #ere co"pared #ith
the resuts of the drivin! test. /e investi!ated the effect of the ti"e of the
visit and of the testin! condition on the bra>in! ti"es. 'E*1%T*: The tota
bra>in! ti"e #as 10HG "sec for )roup I and 1330( 11H2( and 11A0 "sec for )roup
II at si<( nine( and t#eve #ee>s( respective0( postoperative0 5p S 0.00G@8.
The tota bra>in! ti"e consistent0 i"proved for each of the drivin! scenarios
at each successive data point 5p S 0.058. The increase in the tota bra>in!
at si< #ee>s "eant an increase in the distance traveed b0 the auto"obie
bra>in! of 22 ft 5A.H "8 at A0 "ph 5GA.A >"Ohr8( and the increase at nine
"eant an increase of ? ft 52.@ "8 at A0 "ph. The functiona outco"e i"proved
each successive visit( athou!h no si!nificant association #as found bet#een
functiona scores and nor"aiEation of tota bra>in! ti"e. .ON.%1*ION: 60 nine
#ee>s( the tota bra>in! ti"e of patients #ho have under!one fi<ation of a
dispaced ri!ht an>e fracture returns to the nor"a( baseine vaue.
D$I7: 12?513@0 [Dub$ed : inde<ed for $E7%INE]
33: + Orthop Trau"a. 2003 +u31H5A8:@21:G.
9i!h:veocit0 !unshot #ounds of the tibia pafond "ana!ed #ith IiEarov
e<terna fi<ation: a report of 13 cases.
PidiE .( &tesap &*( 7e"irap 6( )ur E.
O6+E.TIFE: To report the resuts of usin! IiEarov fi<ation for the treat"ent
open tibia pafond fractures caused b0 hi!h:veocit0 !unshot inIuries.7E*I)N
'etrospective revie# of consecutive patients. *ETTIN): $iitar0 acade"ic
hospita. D&TIENT*: 1sin! the &O cassification( three t0pe .1( five t0pe .2(
and five t0pe .3 open tibia pafond fractures due to hi!h:veocit0 !unshot
inIuries #ere treated #ith irri!ation( debride"ent( pri"ar0 cosure( and
IiEarov fi<ation. Eeven of the fractures #ere t0pe III&( and the re"ainin!
#ere t0pe III6 accordin! to the )ustio:&nderson cassification. There #ere
"utipe trau"as in one case. $ET9O7*: Dafond fractures #ere treated b0
IiEarov techniCue in a 13 cases. In three of the cases( additiona osseous
transport to ei"inate a s>eeta defect #as perfor"ed. $&IN O1T.O$E $E&*1'E*:
'esuts #ere evauated accordin! to 6oneBs cinica !radin! s0ste". 'E*1%T*:
&vera!e foo#:up #as 3?.@ "onths 5ran!e 2A to 50 "onths8. .aus be!an to
in 21 to 35 da0s 5avera!e 2H.G da0s8. The fractures united in 12A to 15@ da0s
5avera!e 13H.A da0s8( and the apparatus #as re"oved fro" the i"b at that
There #ere si< !ood( three fair( and four poor resuts. $ini"a s>in necrosis
around the #ound #as seen in four cases( #ound infection and puruent
#ere seen in t#o cases( and an!uar defor"it0 #as seen in t#o cases. 7ea0ed
union and refe< s0"pathetic d0stroph0 #ere not seen in an0 cases. &thou!h
tibiotaar narro#in! #as seen in four cases( no cases reCuired tibiotaar
arthrodesis or subseCuent bon0 reconstruction at the ti"e of their "ost recent
foo#:up. The avera!e residua an>e ran!e of "otion #as pantar fe<ion 1?.5
de!rees and dorsife<ion 11.5 de!rees. .ON.%1*ION*: Ear0 a!!ressive
of nonviabe tissues( stabiiEation #ith an IiEarov e<terna fi<ator( and
either pri"ar0 or dea0ed pri"ar0 cosure foo#ed b0 ear0 an>e ran!e of
"otion and #ei!ht bearin! is an aternative treat"ent "ethod of these
D$I7: 12?@3H2H [Dub$ed : inde<ed for $E7%INE]
3@: .in Orthop. 2003 +u35@128:131:?.
Outco"e after sin!e techniCue an>e arthrodesis in patients #ith rheu"atoid
2enned0 +)( 9art0 +&( .ase0 2( +an /( -uinan /6.
7epart"ent of Orthopaedics( 9ospita for *pecia *ur!er0( Ne# Por>( NP 10021(
1*&. I!>Khot""
The estabished treat"ent for severe rheu"atoid arthritis in the an>e is
arthrodesis. Nu"erous reports in the iterature describe outco"es in patients
#ith de!enerative and posttrau"atic arthrosis and rheu"atoid disease. This has
ed to resuts that are difficut to interpret. In addition( in the fe#
that have evauated patients #ith rheu"atoid disease "an0 techniCues of
arthrodesis are reported( further confoundin! assess"ent of one fusion "ethod.
One techniCue of 20 an>e fusions in patients #ith rheu"atoid disease #as
evauated. & "odified /a!ner arthrodesis #as used throu!h a transfibuar
approach usin! parae co"pression scre#s. The scorin! s0ste"s of $aEur et
$oran et a( and the *hort:,or":3A #ere used to evauate the outco"e. The "ean
ti"e to foo#up #as 3 0ears 10 "onths. Ei!hteen of 20 fusions obtained a
taocrura union 5G048. No correation #as found bet#een the scores of $aEur
a and $oran et a. .orreation #as achieved bet#een the scores for the *hort
,or":3A and $oran et a. The "odified /a!ner an>e arthrodesis is a si"pe(
reiabe( reproducibe techniCue #ith a G04 union rate. The vaue of the
techniCue has been confir"ed in patients #ith rheu"atoid arthritis b0
the outco"e usin! a scorin! s0ste" that is vaidated and reevant to this
Dubication T0pes:
.inica Tria
D$I7: 12?3?0A3 [Dub$ed : inde<ed for $E7%INE]
35: 1us Trav"a 7er!. 2003 &pr3G528:1@5:?.
$ana!e"ent of %isfrancBs fracture:disocation.
Dehivan O( &>"aE I( *oa>o!u .( 'odop O.
)uhane $iitar0 $edica &cade"0( 9a0darpasa Trainin! 9ospita( 7epart"ent of
Orthopaedics and Trau"atoo!0( Istanbu( Tur>e0. oEipehKe:>
%isfrancBs Ioint inIuries are rare and co"pe<. & car driver #ho sustained a
traffic accident( #as ad"itted because of partia dorsoatera
fracture:disocation of the %isfrancBs Ioint. The dia!nosis #as "ade b0
e<a"ination and radio!raphs. 'eduction and pin fi<ation #ere perfor"ed under
!enera anesthesia. &t the end of the ninth "onth( ran!e of "otion of the foot
and an>e #as fu( #ith no pain on dai0 activities.
D$I7: 12?3A115 [Dub$ed : inde<ed for $E7%INE]
3A: .urr *ports $ed 'ep. 2003 +un32538:125:35.
*ideine "ana!e"ent of fractures.
9utchinson $( Tanse0 +.
1niversit0 of Iinois at .hica!o( 7epart"ent of Orthopedics( *ports $edicine
*ervices( 20G $edica *ciences *outh( G01 *outh /ocott( .hica!o( I% A0A12(
&thetes have the potentia to sustain a "0riad of inIuries( ran!in! fro"
strains and overuse to fractures and disocations. The tea" ph0sician and
sideine "edica professionas "ust be >een0 a#are of the ris> potentia( and
have an e"er!enc0 pan in pace to address an0 potentia inIuries. 6one inIur0
can ran!e fro" unstabe( open fractures to overuse and stress fractures.
and pa0ers "a0 chaen!e reco""endations re!ardin! not on0 treat"ent( but
return:to:pa0 issues. The funda"enta !uideine "ust a#a0s be #hat is safe
the athete. 7ecisions "ust be individuaiEed for each athete( anato"ic site(
and inIur0. If the athete is not at si!nificant ris> to hi"sef( the fracture
is heaed or can be protected( and the athete can function at his previous
eve #ith a protective device( he "a0 be abe to return to sport.
D$I7: 12?31A51 [Dub$ed : inde<ed for $E7%INE]
3H: 'ev Esp &nestesio 'eani". 2003 &pr3505@8:1G2:A.
[Du"onar0 e"bois" after pace"ent of an Es"arch banda!e for an>e sur!er0]
[&rtice in *panish]
DaeE 9ospita $( 9errero )ento E( 6uisan )arrido ,.
*ervicio de &nestesioo!ia( 'eani"acion 0 Terapeutica de 7oor( 9ospita
.inico 1niversitario de Faadoid( &vd. 'a"on 0 .aIa( 3 @H005 Faadoid.
/e report the case of a #o"an schedued for sur!ica fi<ation of an an>e
fracture #ho deveoped a pu"onar0 e"bois" durin! appication of an Es"arch
co"pression banda!e for e<san!uination of the i"b. Trachea intubation and
"echanica ventiation #ere needed to reani"ate the patient and sur!er0 had to
be postponed 15 da0s. Orthopedic sur!er0( pneu"atic tourniCuets for providin!
boodess fied and other ris> factors contribute to the deveop"ent of
pu"onar0 e"bois"( #hich is often fata. &ccurate dia!nosis b0 pas"a 7:di"er
deter"ination and i"a!in! 5perfusion scinti!raph0( vascuar 7opper
echocardio!raph0 and pu"onar0 an!io!raph08 is discussed( aon! #ith
approaches to consider #hen "ana!in! pu"onar0 e"bois".
D$I7: 12?2530? [Dub$ed : inde<ed for $E7%INE]
3?: &coho &coho. 2003 +u:&u!33?5@8:35H:G.
.ase report: "ana!in! fractures in non:co"piant acohoic patients::a
chaen!in! tas>.
.haraa"bous .D( Nipitis .*( 2u"ar '( 9irst D( Dau &*.
7epart"ent of Trau"a and Orthopaedics( $anchester 'o0a Infir"ar0( $anchester(
&I$*: To investi!ate #hether there are e<tractabe concusions for i"b
"ana!e"ent in dependent acohoics. $ET9O7*: /e discuss four cases of
acohoics #ho presented in our depart"ent over a 12:"onth period( and #ho
deveoped si!nificant co"pications o#in! to non:co"piance #ith treat"ent.
'E*1%T*: Initia treat"ent( athou!h appropriate( faied because of
non:co"piance. This ed to further ad"issions( #ound infections and sur!er0
enabe cure. .ON.%1*ION*: Our case reports indicate that for upper i"b
fractures of the "idde third of the hu"erus( non:operative treat"ent or
interna fi<ation #ith out:patient deto<ification is appropriate. %o#er i"b
fractures( on the other hand( shoud be deat #ith b0 e<terna fi<ation and
in:patient deto<ification. It is i"perative that the acoho dependence is
addressed if #e are to decrease non:co"piance.
D$I7: 12?1@G0@ [Dub$ed : inde<ed for $E7%INE]
3G: ,oot &n>e Int. 2003 $a032@558:3G2:H.
Deroneus on!us i!a"entopast0 for chronic instabiit0 of the dista
tibiofibuar s0ndes"osis.
)rass '( 'a""et *( 6ie#ener &( N#ipp 9.
2ini> fur 1nfa:und /iederhersteun!schirur!ie( 1niversitats>ini>u" .. ).
.arus der Technischen 1niversitat 7resden( ,etscherstr. H@( 7:0130H 7resden(
)er"an0. r!
The dista tibiofibuar s0ndes"os"otic i!a"ent co"pe< is i"portant for
stabiit0 and con!ruenc0 of the an>e Ioint. *0ndes"otic esions in the an>e
fracture:disocations are #e reco!niEed and cassified s0ste"atica0.
insufficienc0 of the s0ndes"osis eads to a atera shift of the taus and
eversion stress per"its a pathoo!ica rotation of the taus. There is aso
retroversion of the dista fibua representin! a painfu defor"it0. %itte
e<perience e<ists #ith sur!ica reconstruction of the s0ndes"osis. This
describes a ne# i!a"entopast0 #ith a spit peroneus on!us tendon !raft that
"i"ics the nor"a anato"ic conditions of the s0ndes"otic co"pe< in 1A
#ith s0"pto"atic chronic s0ndes"otic insufficienc0 after pronation:e<terna
rotation and pronation abduction inIuries to the an>e Ioint. Dostoperative0(
no infections or he"ato"as #ere seen. One patient had as0"pto"atic brea>a!e of
the s0ndes"osis scre#3 one patient had a 10 de!ree decrease of dorsife<ion at
the an>e because of a partia anterior tibiofibuar s0nostosis. ,ifteen of 1A
patients had pain reief at a "ean foo#:up period of 1A.@ "onths 5ran!e( 13:
"onths83 a patients had reief of the chronic s#ein! of the an>e and the
!ivin! #a0. The "ean 2arsson score at foo#:up #as ?? 5ran!e( H0:1008
It "a0 be concuded that peroneus on!us i!a"entopast0 in a prei"inar0
resuted in reiabe an>e stabiit0 and considerabe pain reief in patients
#ith chronic s0ndes"otic instabiit0.
D$I7: 12?011G@ [Dub$ed : inde<ed for $E7%INE]
@0: + 1trasound $ed. 2003 +un3225A8:A35:@0.
*ono!raphic dia!nosis of taar atera process fracture.
.opercini $( 6onvin ,( $artinoi .( 6ianchi *.
7eparte"ent de 'adioo!ie( 7ivision de 'adiodia!nostic et de 'adioo!ie
Interventionnee( 9opita .antona 1niversitaire de )eneve( )eneva(
The freCuenc0 of fractures of the atera process of the taus 5%DT8 has
"ar>ed0 increased because of the e<pansion of sno#board activit0. These
are difficut to dia!nose( because the0 have aspecific si!ns( and standard
radio!raphs do not sho# the fractures in 504 of cases. *ono!raph0 is used "ore
and "ore in the assess"ent of an>e trau"a( but it is rare0 perfor"ed for
detection of bone fractures. /e report a case of a patient in #hich sono!raph0
direct0 sho#ed an %DT fracture.
D$I7: 12HG55A0 [Dub$ed : in process]
@1: Dast 'econstr *ur!. 2003 +un31115H8:2223:G.
6one reconstruction of the o#er e<tre"it0: co"pications and outco"es.
Deissier D( 6oireau D( $artin 7( 6audet +.
*ervice de .hirur!ie DastiCue( 9opita Dee!rin:Tondu( 6ordeau<( ,rance.
& stud0 #as perfor"ed to ana0Ee the resuts and fina outco"es of bone
reconstruction of the o#er e<tre"it0. T#ent0:si< patients presented #ith t0pe
III6 open fractures( nine #ith t0pe III. open fractures( and 15 #ith chronic
osteo"0eitis. *even patients under#ent pri"ar0 a"putation( and reconstruction
#as atte"pted for @3 patients. The "ean bone defect siEe #as H.H c" 5ran!e( 3
20 c"8. 6one reconstruction #as achieved #ith conventiona bone !rafts in 1A
cases( in association #ith either oca 513 cases8 or free 5three cases8
FascuariEed bone transfer #as perfor"ed in 2@ cases( #ith either
!roin faps 510 cases8( soeus:fibua faps 512 cases8( or osteocutaneous
atera ar" faps 5t#o cases8. ,or three patients( bone reconstruction #as
perfor"ed #ith a techniCue that co"bines the induction of a "e"brane around a
ce"ent spacer #ith the use of an autoo!ous canceous bone !raft. Infections
#ere observed to be responsibe for proon!ed hospita sta0s and treat"ent
faiures. The cu"uative rates of sepsis #ere @.A percent at 1 #ee> after
and A2.? percent at 2 "onths. Fascuar co"pications #ere aso reated to
infections and #ere responsibe for four secondar0 a"putations. One patient
as>ed for secondar0 a"putation because of a painfu nonfunctiona o#er i"b.
6one heain! occurred in 3H of @3 cases( and the avera!e ti"e to union #as G.5
"onths( #ith an avera!e of ?.H procedures. The "ean en!ths of sta0 #ere @G
for conventiona bone !rafts and A2 da0s for vascuariEed bone !rafts. & of
the 50 patients #ere abe to #a>( #ith an avera!e ti"e of 1@ "onths. & of
patients #ith a"putations under#ent prosthetic rehabiitation. Datients "ost0
co"pained about the reconstructed i"b 5A2.? percent8. +oint stiffness #as
present in @0 percent of the cases. Other on!:ter" co"pications #ere pain
5nine cases8( ac> of sensation 5five cases8( infection 5five cases8( and
pseudarthrosis 5one case8. 9o#ever( a of the patients #ith successfu
reconstructions preferred their sava!ed e! to an a"putation. Of @1 patients
#ho #ere #or>in! before the inIur0( 2A returned to #or>.
Dubication T0pes:
Evauation *tudies
D$I7: 12HG@@A3 [Dub$ed : inde<ed for $E7%INE]
@2: Top $a!n 'eson I"a!in!. 2003 &pr31@528:1HG:GH.
$a!netic resonance i"a!in! of sports inIuries of the an>e.
$orrison /6.
7epart"ent of 'adioo!0( Tho"as +efferson 1niversit0 9ospita( Dhiadephia(
Denns0vania 1G10H( 1*&. /iia".$orrisonK"
6asic sports:reated inIuries of the an>e incude i!a"ent tear( tendon
de!eneration and tear( bone bruise( fracture( i"pin!e"ent( osteochondra
and pantar fasciitis. This artice discusses the "a!netic resonance i"a!in!
appearance of these inIuries.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12HHH??G [Dub$ed : inde<ed for $E7%INE]
@3: .in Dodiatr $ed *ur!. 2003 &pr320528:335:5G.
Dro!ressive post:trau"atic an>e arthrosis treated #ith tota an>e Ioint
repace"ent: a case revie#.
+anis %'( /i>e 6( 6ease0 67( Doot E( %a" &T.
)rant Dodiatric *ur!ica 'esidenc0 Dro!ra"( 7epart"ent of $edica Education(
)rant $edica .enter( 111 *. )rant &venue( .ou"bus( O9 @3215( 1*&.
This artice discusses the Ioint de!eneration pro!ression associated #ith
post:trau"atic arthrosis of the an>e. & representative case stud0 of this
debiitatin! condition #as outined( and treat"ent #ith tota an>e Ioint
repace"ent #as presented. &thou!h an>e arthrodesis continues to be a
option foo#in! the pro!ression of severe post:trau"atic osteoarthritis(
an>e repace"ent is "aturin! as a viabe option for this condition.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12HHAG?5 [Dub$ed : inde<ed for $E7%INE]
@@: .in Orthop. 2003 $a035@108:2AH:H3.
$uticentric !iant ce tu"or of bone: a case report and revie# of the
Ta0or 2,( Pin!sa>"on!>o /( .onard 2&( *tanton 'D.
&fred I. duDont Institute( /i"in!ton( 7E( 1*&.
$uticentric !iant ce tu"or of bone is the rare variant of a esion that is
reative0 co""on in a s>eeta0 "ature popuation. &n other#ise heath0
13:0ear:od bo0 presentin! #ith this entit0 #as foo#ed up for A 0ears.
this period( the patient #as dia!nosed #ith and treated for si< individua
esions. One recurrence reCuired resection( IiEarov bone en!thenin!( and
subseCuent an>e arthrodesis. 9e re"ains fu0 active and free of distant
Dubication T0pes:
'evie#( Tutoria
D$I7: 12HH1?3G [Dub$ed : inde<ed for $E7%INE]
@5: InIur0. 2003 +un33@5A8:@5@:G.
.acanea fractures in adoescents. .T cassification and resuts of operative
6uc>in!ha" '( +ac>son $( &t>ins '.
6risto 'o0a Infir"ar0( 6risto( 12. racheKbuc>in!ha".co.u>
The "orphoo!0 of cacanea fractures in G adoescents 5"ean a!e 13.@ 0ears8
#ith 10 fractures #ere cassified usin! pain fi"s and co"puted to"o!raph0
scans. The patterns #ere found to be si"iar to those in aduts.& e<cept one
of the fractures 5#hich #as not si!nificant0 dispaced8 #ere treated #ith
reduction and interna fi<ation. In a cases it #as possibe to achieve
anato"ic reduction and ri!id interna fi<ation. *even patients had Be<ceentB
on!:ter" cinica resuts. One patient #ith pendin! iti!ation scored B!oodB(
and one patient #ith an ipsiatera fracture of the taar nec> scored BfairB.
This patient had "id i"itation of an>e "ove"ent( a others had fu an>e
"ove"ent. ,ive had unrestricted subtaar "ove"ent( in t#o it #as "id0
and in three it #as "oderate0 i"ited 550:?048. There #as no evidence of
abnor"ait0 of the ph0ses on foo# up =:ra0s. /e concude that operative
treat"ent of this fracture 0ieds !ood resuts.
D$I7: 12HAHHG3 [Dub$ed : inde<ed for $E7%INE]
@A: Nurs *tand. 2003 $a0 H:1331H53@8:22.
.o""ent on:
Nurs *tand. 2002 Oct 2331H5A8:3H:@A3 CuiE @H:?.
One step at a ti"e.
9a0es +.
*hre#sbur0 *choo.
Dubication T0pes:
D$I7: 12HA@GH2 [Dub$ed : inde<ed for $E7%INE]
@H: &nn E"er! $ed. 2003 +un3@15A8:?5@:?.
,racture of the atera process of the taus associated #ith sno#boardin!.
.han )$( Poshida 7.
7epart"ent of E"er!enc0 $edicine( 6eevue 9ospita .enter( Ne# Por>
*choo of $edicine( Ne# Por>( NP 1001A( 1*&."
*no#boardin! is one of the fastest:!ro#in! #inter sports and is associated
a reative0 hi!h rate of an>e inIuries. Dresented is a patient #ho( after
fain! #hie sno#boardin!( co"pained of atera an>e pain and #as
"isdia!nosed #ith an an>e sprain. ,urther #or>up reveaed a atera process
the taus fracture( an inIur0 that is rare outside of sno#boardin!. & atera
process of the taus fracture shoud be suspected #hen there is a histor0 of
inversion #ith dorsife<ion and there is tenderness over the atera process
the taus. 'esuts of pain fi"s are ne!ative up to @04 of the ti"e( and
therefore a co"puted to"o!raphic scan is the i"a!in! "odait0 of choice.
Treat"ent incudes i""obiiEation and not bearin! #ei!ht for @ to A #ee>s for
nondispaced fractures or open reduction and fi<ation for dispaced fractures.
1p to t#o thirds of patients #ith atera process of the taus fractures
chronic pain. Ear0 reco!nition "a0 decrease this reative0 hi!h rate of
D$I7: 12HA@3@2 [Dub$ed : inde<ed for $E7%INE]
@?: ,oot &n>e .in. 2003 $ar3?518:131:@H( i<.
.o"pications of open reduction and interna fi<ation of an>e fractures.
%e0es $( Torres '( )uien D.
*ection of ,oot and &n>e *ur!er0( .inica .e"tro( $adrid( *pain.
This artice discusses the co"pications after open reduction and interna
fi<ation of an>e fractures. .o"pications are cassified as perioperative
5"areduction( inadeCuate fi<ation( and intra:articuar penetration of
hard#are8( ear0 postoperative 5#ound ed!e dehiscence( necrosis( infection and
co"part"ent s0ndro"e8( and ate 5stiffness( dista tibiofibuar s0nostosis(
de!enerative osteoarthritis( and hard#are reated co"pications8. E"phasis is
paced on preventive "easures to avoid such co"pications.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12HA05?0 [Dub$ed : inde<ed for $E7%INE]
@G: 1nfachirur!. 2003 $a0310A558:35G:AA.
[The roe of the tibiofibuar s0ndes"otic and the detoid i!a"ents in
stabiiEin! /eber 6 t0pe an>e Ioint fractures::an e<peri"enta investi!ation]
[&rtice in )er"an]
'ichter +( *chuEe /( .asbru""e 6( $uhr ).
.hirur!ische 1niversitats>ini>( 6er!"annshei( 6ochu".
The purpose of the present bio"echanica investi!ation #as to chec> the
functiona i"portance of the s0ndes"osis i!a"ents and of the detoid i!a"ent
for an>e fracture t0pe 6 accordin! to the &O:/eber cassification. /e
constructed a specia fi<ation ca"p( #ith 12 fresh and une"ba"ed o#er e!s
bein! tested for atera shift 5""8 and ten for tibiotaar rotation. &
speci"ens #ere e<posed in the sa"e neutra position.Transverse oads 5,5088
varied bet#een 0 and 150 N( a<ia oads 5,5E88 bet#een 0( 300( A00 and 1(000 N
and rotationa oads 5,5r88 bet#een 2.@ and @.G N". & series #ere repeated
accordin! to supination:eversion 5*E8 inIur0 patterns of the %au!e:9ansen
cassification. *0ndes"otic i!a"ents and the fibua #ere incre"enta0
sectioned fro" anterior to posterior. T0pe *E I consisted of an isoated
incision of the anterior s0ndes"osis i!a"ent. T0pe *E II had an additiona
obiCue fracture of the fibua at the hei!ht of the tibiofibuar s0ndes"osis.
t0pe *E III inIuries( in addition to the fibuar fracture( a co"pete rupture
the s0ndes"osis i!a"ents #as present( and for t0pe *E IF esions the detoid
i!a"ents #ere incised.The transverse oad:dispace"ent curve #as s:shaped in
a uninIured Ioints(#ith the hi!hest !radient bet#een 10 and 20 N #ith no
co"pression. /ithout a<ia co"pression in cases of ,508S25 N transverse oads(
the "ean taus transation #as 0.51 "". ,oo#in! t0pe II inIuries( the
taus transation #as 0.A? "" 5not si!nificant8 and rose to an avera!e of 0.G5
"" 5 D J0.018 in t0pe III inIuries. &fter additiona incision of the detoid
i!a"ents( the an>e Ioint subu<ed per"anent0 #hen "ore than 5:10 N
oads #ere appied. &<ia oads of 300 N or "ore resuted in a considerabe
reduction in taus transations( indicatin! increased stabiit0 and con!ruenc0
#ithin the Ioint co"pe<. In this #a0( the vertica oadin! of the an>e
a#a0s contributed to Ioint stabiit0. The avera!e interna tibiotaar
reached #ith a torCue of 2.@ N" #as 3.52 de!rees and #ith @.G N" 5.15 de!rees
#hen no a<ia co"pression #as appied.E<terna rotation "easured :A.3A de!rees
and :?.A2 de!rees( respective0. ,oo#in! the e<peri"enta protoco(
si!nificant increases #ere noted for e<terna rotation at *E II de!rees
5 D S0.0038 and for interna rotation at *E III de!rees 5 D S0.038 inIuries.
data support the proposition that the detoid i!a"ents and the posterior
s0ndes"osis pa0 a >e0 roe in the stabiit0 of an>e fractures for
supination:eversion inIuries. If these structures re"ain intact( conservative
and ear0 functiona treat"ent are reco""ended in patients #ith "ini"a 5J2
or no fracture dispace"ent. This concept is confir"ed b0 the iterature
#ith cinica "id: and on!:ter" foo#:up studies.
D$I7: 12H50?0? [Dub$ed : in process]
50: ,oot &n>e Int. 2003 &pr32@5@8:3A?:H1.
Dri"ar0 fusion as sava!e foo#in! taar nec> fracture: a case report.
Tho"as '9( 7anies T'.
*t. $ichaeBs 9ospita( Toronto( Ontario( .anada.
,or a 2G:0ear:od "an #ith a three:#ee>:od 9a#>ins T0pe IF taar nec>
intra:operative reduction and fi<ation #ere not possibe due to soft tissue
contractures and severe co""inution. & pri"ar0 taonavicuar and subtaar
arthrodesis #ith the use of iiac crest bone !raft #as perfor"ed.
foo#:up at 1A "onths de"onstrated soid fusions( no avascuar necrosis of
taus and a functiona ran!e of "otion at the an>e. 9e #as not capabe of
returnin! to his Iob of roof "aintenance.
D$I7: 12H353?3 [Dub$ed : inde<ed for $E7%INE]
51: ,oot &n>e Int. 2003 &pr32@5@8:33?:@@.
$aunion foo#in! tri"aeoar fracture #ith posteroatera subu<ation of
taus::reconstruction incudin! the posterior "aeous.
/eber $( )anE '.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of 6ern( Insespita( 3010 6ern(
*#itEerand. "
$aunion after a "aeoar fracture can incude a dispaced posterior
#ith associated posteroatera subu<ation of the taus. .orrective osteoto"0
incudin! the posterior "aeous #as perfor"ed in four patients. +oint
con!ruit0 #as obtained in ever0 case. The patients #ere foo#ed for @A to ?0
"onths postoperative0. The0 a e<perienced an i"prove"ent in pain and three
four patients #ere uni"ited in their #a>in! capacit0. $id to "oderate
residua s0"pto"s #ere freCuent. The s0"pto"s #ere attributed to the da"a!e of
the cartia!e and soft:tissues both fro" the initia inIur0 and fro"
#ei!htbearin! on the incon!ruous Ioint. 7iscrete( non:pro!ressive osteoph0tes
#ere seen in a patients. 7ea0 in reconstruction did not precude a !ood
resut( athou!h ear0 reoperation is fet to be preferabe.
D$I7: 12H353HH [Dub$ed : inde<ed for $E7%INE]
52: $ed + $aa0sia. 2002 7ec35H5@8:@2A:32.
Fascuar trau"a in Denan! and 2uaa %u"pur 9ospitas.
%a>h#ani $N( )ooi 69( 6arras .7.
Denan! &dventist 9ospita( Denan!.
O6+E.TIFE*: The nature of vascuar trau"a varies !reat0 bet#een continents
across ti"e. The ai" of this stud0 #as to prospective0 ana0se the
de"o!raphics( pathoo!0( "ana!e"ent and cinica outco"es of vascuar inIuries
in t#o urban $aa0sian hospitas and revie# of internationa iterature on
vascuar trau"a. ,ro" this infor"ation( prei"inar0 "ana!e"ent and preventive
i"pications #i be described. $ET9O7*: Ei!ht0:four consecutive cases of
reCuirin! vascuar sur!er0 #ere prospective0 ana0sed over three 0ears at
9ospita 2uaa %u"pur and 9ospita Duau Dinan!( $aa0sia. E<tensive patient
de"o!raphic and inIur0 data( incudin! the "echanis" of inIur0( associated
inIuries( an!io!raphic findin!s( operative detais and post:operative
co"pications( #ere s0ste"atica0 !athered. 'E*1%T*: $ost vascuar inIuries
#ere incurred b0 "aes 5HAO?@8( #ith 3H4 52?OHA8 of the" a!ed bet#een 21 and
0ears. $aa0s #ere "ost freCuent0 inIured 5n S 3A8 foo#ed b0 .hinese and
Indians. 'oad traffic accidents 5n S @G8 substantia0 outnu"bered a other
causes of inIur0. %o#er i"b inIuries 5n S 5H8 occurred "ore than t#ice as
as upper i"b inIuries 5n S 2H8. .o"pete arteria transections 5n S @38 and
inti"a inIuries 5n S 2H8 #ere "ore co""on than arteria acerations 5n S 108
and pseudoaneur0s"s 5n S @8. The "ost freCuent0 da"a!ed vesses #ere the
popiteaOtibioperonea trun> 5n S 338. & patients received ur!ent 7opper
utrasound assess"ent and( #here possibe( an>e:brachia s0stoic inde<
"easure"ent. Of a patients( @0 received an an!io!ra"( hae"od0na"ic
"a>in! this investi!ation i"practica in others. Dri"ar0 arteria repair #as
"ost freCuent0 e"po0ed sur!ica procedure 5n S 5@8 foo#ed b0 auto!enous
reverse on! saphenous vein 5%*F8 interposition !raft 5n S 1@8( e"boecto"0 5n
58 and DT,E interposition !raft 5n S 38. The "ost co""on post:operative
co"pication #as #ound infection 5n S 118. &"putation( as a ast resort( #as
reCuired in 13 cases foo#in! either pri"ar0 or auto!enous reverse %*F repair
co"picated b0 sepsis or critica ischae"ia. .ON.%1*ION*: Fascuar trau"a(
especia0 in conIunction #ith severe soft tissue( nerve or orthopaedic inIur0
carries coossa ph0sica( ps0choo!ica( financia and socia costs.
nerve and venous inIur0 portended poor outco"e in this stud0. /hist
trau"a #as a co""on association( the concurrence of occut vascuar trau"a and
soft tissue inIur0 #ithout fracture e"phasises the crucia i"portance of
thorou!h and rapid cinica vascuar assess"ent( investi!ation and sur!ica
intervention. ,ascioto"0( especia0 for the o#er i"b( is i"portant for the
prevention of co"part"ent s0ndro"e and its( i"b:threatenin! seCueae. Dri"ar0
preventive road safet0 pro"otion and interventions( #ith attention to hi!h:
!roups 50oun! "aes and "otorc0cists8( is ur!ent0 reCuired.
D$I7: 12H331AH [Dub$ed : inde<ed for $E7%INE]
53: + 6one +oint *ur! 6r. 2003 &pr3?5538:@31:@.
E<tra:articuar e<trusion of an osteochondra fra!"ent of the taar do"e.
9erscovici 7 +r( Infante &, +r( *caduto +$.
Orthopaedic Trau"a *ervice( Ta"pa )enera 9ospita( Ta"pa( ,orida( 1*&.
Osteochondra fractures of the taus are unco""on. The0 are cassified
to 6erndt and 9art0( as pro!ressin! in severit0 throu!h four sta!es. This
cassification( ho#ever( does not address e<tra:articuar e<trusion of the
osteochondra fra!"ent. /e report an osteochondra esion of the taar do"e
#hich presented as an e<truded e<tra:articuar fra!"ent in a cosed inIur0 of
the an>e. This t0pe of esion "a0 offer a continuation to the four ori!ina
sta!es. .inicians shoud be a#are that this pattern of fracture can occur(
thus ao# a "ore accurate dia!nosis and the provision of so"e aid in the
treat"ent of these inIuries.
D$I7: 12H2G12@ [Dub$ed : inde<ed for $E7%INE]
5@: + 6one +oint *ur! 6r. 2003 &pr3?5538:33@:@1.
Tota an>e repace"ent. The resuts in 200 an>es.
/ood D%( 7ea>in *.
/ri!htin!ton 9ospita for +oint 7isease( /i!an( En!and( 12.
6et#een 1GG3 and 2000 #e i"panted 200 ce"entess( "obie:bearin! *T&' tota
an>e repace"ents. None #as ost to foo#:up for reasons other than the
of a patient. The "ean foo#:up #as for @A "onths 52@ to 1018. & co"pication
reCuirin! further sur!er0 deveoped in ei!ht an>es and 1@ #ere revised or
fused. The cu"uative surviva rate at five 0ears #as G2.H4 5G54 .I ?A.A to
G?.?8 #ith ti"e to decision to revision or fusion as an endpoint. The "ost
freCuent co"pications #ere dea0ed #ound heain! and fracture of a "aeous.
These beca"e ess co""on #ith e<perience of the operation. The radioo!ica
appearance of the interface of the tibia i"pant #as si!nificant0 reated to
its operative fit and to the t0pe of bioactive coatin!.
D$I7: 12H2G10@ [Dub$ed : inde<ed for $E7%INE]
55: + 6one +oint *ur! &". 2003 $a03?5:&558:?20:@.
,oot and an>e fractures in eder0 #hite #o"en. Incidence and ris> factors.
9asse"an .T( Fo!t $T( *tone 2%( .aue0 +&( .onti *,.
1niversit0 of Dittsbur!h( Denns0vania( 1*&.
6&.2)'O1N7: &thou!h foot and an>e fractures are a"on! the "ost co""on
nonspina fractures occurrin! in oder #o"en( itte is >no#n about their
epide"ioo!0. This stud0 #as desi!ned to deter"ine the incidence of and ris>
factors for foot and an>e fractures in a cohort of GH0@ eder0( nonbac>
enroed in the "uticenter *tud0 of Osteoporotic ,ractures. $ET9O7*: &t their
first cinic visit( bet#een 1G?A and 1G??( the #o"en provided infor"ation
re!ardin! ifest0e( subIective heath( and function. 6one "inera densit0 #as
"easured in the pro<i"a and dista parts of the radius and in the cacaneus.
The #o"en #ere foo#ed for a "ean of 10.2 0ears( durin! #hich ti"e 301 of
had a foot fracture and 2G1 had an an>e fracture. The fractures #ere
#ith use of a "odification of the Orthopaedic Trau"a &ssociationBs !uideines.
'E*1%T*: The incidence of foot fractures #as 3.1 per 1000 #o"an:0ears( and the
incidence of an>e fractures #as 3.0 per 1000 #o"an:0ears. The "ost co""on
fracture #as an isoated fibuar fracture 5prevaence( 5H.A48( and the "ost
co""on foot fracture #as a fracture of the fifth "etatarsa 55A.G48. /o"en #ho
sustained an an>e fracture had been si!ht0 0oun!er at the ti"e of stud0
enro"ent than the #o"en #ho did not sustain such a fracture 5H1.0 co"pared
#ith H1.H 0ears8( the0 had a hi!her bod0 "ass inde< 52H.A co"pared #ith 2A.58(
and the0 #ere "ore i>e0 to have faen #ithin the t#eve "onths prior to
fiin! out the ori!ina Cuestionnaire 53?.14 co"pared #ith 2G.H48. The
appendicuar bone "inera densit0 #as not si!nificant0 different bet#een
t#o !roups of subIects. /o"en #ho sustained a foot fracture had a o#er bone
"inera densit0 in the dista part of the radius 50.3@5 !Oc" 528 co"pared #ith
0.3A3 !Oc" 528 8 and a o#er cacanea bone "inera densit0 50.3G@ !Oc" 528
co"pared #ith 0.@0@ !Oc" 528 8 than the #o"en #ithout a foot fracture( the0
ess i>e0 to be ph0sica0 active 5A2.34 co"pared #ith AH.?48( and the0 #ere
"ore i>e0 to have had a previous fracture after the a!e of fift0 5@5.54
co"pared #ith 3A.?48 and to be usin! either on! or short:actin!
benEodiaEepines. .ON.%1*ION*: Overa( foot fractures appeared to be t0pica
osteoporotic fractures( #hereas an>e fractures occurred in 0oun!er #o"en #ith
reative0 hi!h bod0 "ass inde<.
Dubication T0pes:
$uticenter *tud0
D$I7: 12H2?031 [Dub$ed : inde<ed for $E7%INE]
5A: Orthopedics. 2003 &pr32A5@8:@15:?.
7iabetic neuroarthropath0 5.harcot Ioints8: the i"portance of reco!niEin!
chronic sensor0 deficits in the treat"ent of acute foot and an>e fractures in
diabetic patients.
)raves $( TarCuinio T&.
7epart"ent of Orthopedic *ur!er0 and 'ehabiitation( 1niversit0 of $ississippi
$edica .enter( 2500 N *tate *t( +ac>son( $* 3G21A( 1*&.
Datients #ith diabetic neuropath0 are at a hi!her ris> of deveopin!
co"pications( especia0 .harcot arthropath0. Ear0 dia!nosis and
is the >e0 to opti"iEin! outco"e. Therefore( diabetic patients #ith a o#er
e<tre"it0 inIur0 shoud be screened #ith sensor0 testin! usin! a 5.0H
D$I7: 12H22G1@ [Dub$ed : inde<ed for $E7%INE]
5H: &" ,a" Dh0sician. 2003 &pr 13AH5H8:1@3?.
.o""ent on:
&" ,a" Dh0sician. 2002 *ep 13AA558:H?5:G@.
7ifferentiatin! foot fractures fro" an>e sprains.
9atch '%.
Dubication T0pes:
D$I7: 12H22?@3 [Dub$ed : inde<ed for $E7%INE]
5?: 6r + Dast *ur!. 2003 +an35A518:AA:G.
1se of Inte!ra to resurface a atissi"us dorsi free fap.
$oore .( %ee *( 9art &( /atson *.
7epart"ent of 6urns and Dastic *ur!er0( )as!o# 'o0a Infir"ar0( )as!o#( 12.
The successfu use of Inte!ra to cover a "usce fap as a secondar0
reconstructive procedure is presented.
D$I7: 12H0A1A0 [Dub$ed : inde<ed for $E7%INE]
5G: &cta Orthop Trau"ato Turc. 200333H528:133:H.
[.inica resuts of tibia pion fractures treated b0 open reduction and
interna fi<ation]
[&rtice in Tur>ish]
2aenderer O( )unes O( OEcaabi IT( OEu> *.
IE"ir **2 Tepeci> E!iti" 9astanesi II. Ortopedi ve Trav"atooIi 2ini!i.
O6+E.TIFE*: /e evauated the resuts of pion fractures treated b0 open
reduction and interna fi<ation. $ET9O7*: The stud0 incuded 1? patients 5"ean
a!e 3A 0ears3 ran!e 1G to 5A 0ears8 #ith pion fractures. &ccordin! to the
and &!o#erBs cassification( there #ere three t0pe I( nine t0pe II( and si<
t0pe III fractures. ,ive fractures #ere open incudin! three of )ustio:
t0pe II( and t#o fractures of t0pe III. The resuts #ere assessed usin! the
6ur#e:.harne0 criteria. The "ean foo#:up #as 5@ "onths 5ran!e G to ?A
"onths8. 'E*1%T*: &ccordin! to the 6ur#e:.harne0 criteria( the resuts #ere
!ood in 12 patients 5AA48( fair in three patients 51H48( and poor in three
patients 51H48. The "ost co""on co"pication #as posttrau"atic de!enerative
arthritis( foo#ed b0 #ound infection 52248( *udec> atroph0 52248( dea0ed
union 51H48( and an!uation 51148. .ON.%1*ION: Ear0 anato"ica reduction( a
stabe fi<ation( ear0 "obiiEation( and dea0ed #ei!ht:bearin! see" to
on!:ter" resuts of treat"ent in pion fractures caused b0 hi!h ener!0
Dubication T0pes:
Evauation *tudies
D$I7: 12H0@252 [Dub$ed : inde<ed for $E7%INE]
A0: + ,oot &n>e *ur!. 2003 $ar:&pr3@2528:GG:10@.
Ear0 #ei!ht bearin! after posterior "aeoar fractures: &n e<peri"enta and
prospective cinica stud0.
Dapachristou )( Efstathopouos N( %evidiotis .( .hronopouos E.
*econd 7epart"ent of Orthopaedics( Nationa and 2apodistrian 1niversit0( *t
9ospita( N. Ionia( &thens( )reece.
The distribution of a<ia oad to the o#er end of the tibia at different
positions of the an>e Ioint for the anterior( "idde( and posterior part of
Ioint #as studied in both photoeastic "odes and fractured an>e Ioints in
cadaveric speci"ens. *0nthetic "odes #ere used to si"uate both nor"a an>e
Ioints and an>es #ith fractures of the posterior ip of the tibia. Tests #ere
perfor"ed #ith the an>e at dorsife<ed( neutra:fe<ed( and pantarfe<ed
positions of the an>e Ioint. The cinica portion of the stud0 evauated 15
patients #ith fracture of the posterior "aeous that co"prised 04 to 334 of
the articuar surface. & patients had open reduction and interna fi<ation
throu!h a posteroatera or postero"edia approach( and #ere ao#ed fu
bearin! in a cast #ithin H da0s of sur!er0. In the si"uated "odes( the
posterior one fourth of the an>e Ioint re"ains unoaded in the "aIorit0 of
cases. The stresses are !reat0 increased #hen the oad is doubed and are
"ain0 distributed to the 2 centra Cuadrants. /ith additiona a<ia oad( the
fourth Cuadrant sustained itte increase in the oad bearin!. & patients
had an uneventfu recover0. 60 the second postoperative "onth( the0 #ere abe
#a> nor"a0 and had a painess ran!e of "otion of the an>e. 60 the third
"onth( a patients #ere abe to underta>e their dai0 activities( and a
fractures #ere consoidated. The cinica reevance of this stud0 is ear0
#ei!ht bearin!( after open reduction interna fi<ation of posterior "aeoar
fracture of the an>e Ioint( faciitates recover0( pro"otes fracture union(
ao#s the patient to assu"e nor"a activit0 b0 the third "onth after sur!er0.
5The +ourna of ,oot Q &n>e *ur!er0 @2528:GG:10@( 20038
D$I7: 12H010HG [Dub$ed : in process]
A1: Int Orthop. 200332H528:G?:102. Epub 2002 7ec 11.
%isfranc inIuries: patient: and ph0sician:based functiona outco"es.
OB.onnor D&( Peap *( Noe +( 2ha00at )( 2enned0 +)( &rivindan *( $c)uinness
7epart"ent of Orthopaedic *ur!er0( .or> 1niversit0 9ospita( /iton( Ireand.
The purpose of this stud0 #as to assess functiona outco"e of patients #ith a
%isfranc fracture disocation of the foot b0 app0in! vaidated patient: and
ph0sician:based scorin! s0ste"s and to co"pare these outco"e toos. Of 25
inIuries sustained b0 2@ patients treated in our institution bet#een +anuar0
1GG5 and +une 2001( 1A #ere avaiabe for revie# #ith a "ean foo#:up period
3A 510:H@8 "onths. InIuries #ere cassified accordin! to $0erson. Outco"e
instru"ents used #ere: 5a8 $edica Outco"es *tud0 3A:Ite" *hort ,or" 9eath
*urve0 5*,:3A8( 5b8 6ati"ore Dainfu ,oot score 5D,*8 and 5c8 &"erican
Orthopedic ,oot and &n>e *ociet0 5&O,&*8 "id:foot scorin! scae. ,our
had an e<ceent outco"e on the D,* scae( seven #ere cassified as !ood(
fair and t#o poor. There #as a statistica0 si!nificant correation bet#een
D,* and 'oe Dh0sica 5'D8 ee"ent of the *,:3A.
D$I7: 12H00G33 [Dub$ed : inde<ed for $E7%INE]
A2: Instr .ourse %ect. 2003352:A@H:5G.
The sur!ica "ana!e"ent of pediatric fractures of the o#er e<tre"it0.
,0nn +$( *>a!!s 7%( *ponseer D7( )ane0 T+( 2a0 '$( %eitch 22.
.hidrenBs 9ospita of Dhiadephia( 1niversit0 of Denns0vania( Dhiadephia(
Denns0vania( 1*&.
The "aIorit0 of pediatric fractures of the o#er e<tre"it0 can and shoud be
treated #ith cosed reduction( i""obiiEation( and cose foo#:up. 9o#ever(
there is an on!oin! debate in the orthopaedic co""unit0 re!ardin! the e<act
of sur!ica "ana!e"ent in the treat"ent of pediatric fractures. In the past 2
decades( sur!ica "ana!e"ent of certain fractures provided "ar>ed0 better
resuts than cosed "ana!e"ent. In certain cases( such as those reCuirin!
anato"ic reai!n"ent of the ph0sis or articuar surface( there are cear
indications for sur!ica "ana!e"ent. Increasin!0( ho#ever( sur!ica
is bein! used to "aintain opti"a ai!n"ent( to ao# ear0 "otion( or to
faciitate "obiiEation of chidren #ith a o#er e<tre"it0 fracture. ,or "an0
t0pes of fractures( both nonsur!ica and sur!ica "ethods have 0ieded !ood
resuts and have voca advocates. .ertain technica advances( such as the use
fe<ibe intra"eduar0 fi<ation and bioreabsorbabe i"pants( have further
increased enthusias" for sur!ica "ana!e"ent of pediatric fractures of the
Dubication T0pes:
'evie#( Tutoria
D$I7: 12AG0??G [Dub$ed : inde<ed for $E7%INE]
A3: %iver Transp. 2003 &pr3G5@8:3H3:A.
The safet0 and outco"e of Ioint repace"ent sur!er0 in iver transpant
%evits>0 +( Te 9*( .ohen *$.
.enter for %iver 7iseases( )astroenteroo!0 7ivision( 1niversit0 of .hica!o
9ospitas( .hica!o( I%.
& s"a !roup of patients "a0 reCuire tota hip arthropast0( tota >nee
arthropast0( or other Ioint repace"ent sur!er0 after O%T for osteoporotic
fractures( osteonecrosis( and osteoarthritis. &thou!h arthropast0 is safe in
the !enera popuation( its safet0 in iver transpant recipients is uncear.
The ai" of the stud0 #as to deter"ine the safet0 and outco"e of Ioint
repace"ent sur!er0 in our iver transpant recipients. & retrospective
#as perfor"ed on a iver transpant recipients #ho had tota Ioint
arthropast0 at a sin!e teachin! institution bet#een 1G?A and 2002. 7ata
re!ardin! "aIor intraoperative and postoperative co"pications #as obtained
the "edica charts and a hospita:based co"puter s0ste". Of over 1(200 iver
transpant recipients( #e identified H patients #ho under#ent 12 tota
arthropasties 5? >nee( 3 hip( 1 an>e8. +oint repace"ents #ere perfor"ed
eective0 for osteonecrosis 55 of 128 and osteoarthritis 55 of 128( #hereas
hip arthropasties #ere perfor"ed e"er!ent0 for fractures. & patients #ith
osteonecrosis or hip fracture had been treated #ith proon!ed corticosteroids.
There #ere no deaths or "aIor co"pications in the intraoperative and
postoperative periods. On on!:ter" foo#:up( no patients have had pain(
disocation( or infection in the postsur!ica Ioint. No Ioint revision sur!er0
has been reCuired. In concusion( a s"a nu"ber of stabe iver transpant
recipients at our institution under#ent Ioint repace"ent sur!er0 #ithout
short:ter" or on!:ter" co"pications. Our stud0 su!!ests that Ioint
sur!er0 "a0 be safe0 and successfu0 perfor"ed in this popuation( athou!h
ar!er( rando"iEed( prospective trias are needed to confir" our findin!s.
D$I7: 12A?2??G [Dub$ed : in process]
A@: *in!apore $ed +. 2002 Nov3@35118:5AA:G.
'idin! "otorc0ces: is it a o#er i"b haEardL
%ateef ,.
7epart"ent of E"er!enc0 $edicine( *in!apore )enera 9ospita( 1 9ospita
Outra" 'oad( *in!apore 1AGA0?. !aefaKs!".s!
The "orbidit0 and "ortait0 a"on! "otorc0cists invoved in road traffic
accidents 5'T&8 in *in!apore is hi!h. 7ue to their reative0 s"a siEe( the0
represent a vunerabe !roup of road:users. $an0 reports fro" studies
overseas have sho#n that both o#er i"b and head inIuries appear to be co""on
a"on! "otorc0cists. O6+E.TIFE*: To stud0 the characteristics of o#er i"b
inIuries a"on! "otorc0cists invoved in 'T&( #ho present to the 7epart"ent of
E"er!enc0 $edicine of an urban( tertiar0( teachin! hospita for treat"ent.
$ET9O7*: The stud0 #as conducted prospective0 fro" 1 +u0 2000 to 30 +une
7e"o!raphic data #as coected to!ether #ith detais of the t0pe of inIuries(
"echanis" invoved( "ana!e"ent and disposition. *D** 5.hica!o( Inc.8 #as
utiised for data "ana!e"ent and statistica ana0sis. 'E*1%T*: Of the 1(?0G
"otorc0cists studied( 1(05A 55?.348 sustained o#er i"b inIuries( 32?
had head inIuries and 25A 51@.248( sustained facia inIuries. The "ean a!e #as
2A.@ ;O: H.2 0ears and "aes "ade up the "aIorit0 of the patients 51(H33(
G5.?48. 9e"et usa!e #as 1004.The co""onest t0pe of o#er i"b inIur0 #as
fractures 5531( 50.348.The "ost co""on t0pe of fracture #as that of the shaft
the tibia and fibua 5231( @3.548( foo#ed b0 fractures around the an>e
35.048. ,or those #ith "ore than one bod0 re!ion inIured( head inIur0 #as
to be not co""on0 associated #ith o#er i"b inIuries. The co""onest
of inIur0 #as coision #ith another vehice( #hie approachin! a turn 5HAG(
@2.548.There #ere GA "otorc0cists 55.348 #ho had cinica evidence of acoho
consu"ption on their breath at presentation. There #ere 533 52G.548 patients
#ere ad"itted for in:patient "ana!e"ent and the "ean duration of sta0 #as @.?
;O: @.5 da0s.&"on!st those #ith o#er i"b inIuries( the ad"ission rate #as
30.54 5322 of 1(05A8 and the "ean duration of hospitaisation #as 5.3 ;O: 3.G
da0s. .ON.%1*ION: %o#er i"b inIuries represent the co""onest for" of inIur0
a"on! "otorc0cists invoved in 'T&. I"proved trainin! via "otorc0ce rider
education( better desi!n of future "otorc0ces and protective foot#ear "a0
to reduce this probe".
D$I7: 12A?0525 [Dub$ed : inde<ed for $E7%INE]
A5: + Orthop Trau"a. 2003 &pr31H5@8:2@1:G.
.o"pications foo#in! "ana!e"ent of dispaced intra:articuar cacanea
fractures: a prospective rando"iEed tria co"parin! open reduction interna
fi<ation #ith nonoperative "ana!e"ent.
9o#ard +%( 6uc>e0 '( $c.or"ac> '( Date )( %ei!hton '( Detrie 7( )apin '.
.anadian Orthopedic Trau"a *ociet0( .a!ar0( &berta( .anada.
O6+E.TIFE: To report on a co"pications e<perienced b0 patients #ith
intra:articuar cacanea fractures 57I&.,s8 foo#in! nonoperative "ana!e"ent
or open reduction interna fi<ation 5O'I,8. 7E*I)N: Drospective( rando"iEed(
"uticenter stud0. *ETTIN): ,our eve I trau"a centers. D&TIENT*: The patient
popuation consisted of consecutive patients( a!e 1H to A5 at the ti"e of
inIur0( presentin! to 1 of the centers #ith 7I&.,s bet#een &pri 1GG1 and
7ece"ber 1GG?. INTE'FENTION*: Datients #ere rando"iEed to the nonoperative
treat"ent !roup or to operative reduction usin! a atera approach to the
cacaneus. $&IN O1T.O$E $E&*1'E$ENT*: ,oo#:up for patients #as at 2 #ee>s( A
#ee>s( 3 "onths( 12 "onths( 2@ "onths( and once !reater than 2@ "onths
inIur0. &t each foo#:up interva( patients #ere assessed for the deveop"ent
of "aIor and "inor co"pications. &fter a "ini"u" of 2:0ear foo#:up(
#ere as>ed to fi out a vaidated visua anao!ue scae Cuestionnaire 5F&*8
a !enera heath revie# 5*,:3A8. 'E*1%T*: There #ere 22A 7I&.,s 520A patients8
in the O'I, !roup #ith 5H of 22A 52548 fractures 55H of 20A patients [2?4]8
havin! at east 1 "aIor co"pication. Of 233 fractures 521? patients8
nonoperative0 "ana!ed( @2 51?48 5@2 of 21? patients [1G4]8 deveoped at east
"aIor co"pication 5indirect0 resutin! in sur!er08. .ON.%1*ION:
occur re!ardess of the "ana!e"ent strate!0 chosen for 7I&.,s and despite
"ana!e"ent b0 e<perienced sur!eons. .o"pications are a cause of si!nificant
"orbidit0 for patients. Outco"e scores in this stud0 tend to support O'I, for
cacanea fractures. 9o#ever( O'I, patients are "ore i>e0 to deveop
co"pications. .ertain patient popuations 5/.6 and *anders t0pe IF8 deveoped
hi!h incidence of co"pications re!ardess of the "ana!e"ent strate!0 chosen.
Dubication T0pes:
.inica Tria
$uticenter *tud0
'ando"iEed .ontroed Tria
D$I7: 12AHGA?3 [Dub$ed : inde<ed for $E7%INE]
AA: E"er! $ed 5,re"ante8. 2003 &pr315528:12A:32.
Faidation of the Otta#a &n>e 'ues in &ustraia.
6roo"head &( *tuart D.
E"er!enc0 7epart"ent( %0e $cE#in 9eath *ervice( &deaide(
O6+E.TIFE: This stud0 #as a prospective vaidation of the Otta#a &n>e 'ues
5O&'8 in &ustraia foo#in! appropriate education in the use of the rues.
$ET9O7*: The O&' #ere appied to consecutive patients 1? 0ears and over
presentin! #ith acute an>e and foot inIuries to the E7 of an urban teachin!
hospita. 'E*1%T*: Three hundred and thirt0:three patients had 3AA inIuries.
There #ere @3 fractures in 2A5 an>e inIuries and 1@ fractures in 101 foot
inIuries. *ensitivit0 #as 1004 for an>e 5G54 confidence interva 5.I8: G2:
and "idfoot fractures 5G54 .I: HH:1008. *pecificit0 #as 15.?4 5G54 .I: 11:218
for an>e fractures and 20.H4 5G54 .I: 13:318 for "idfoot fractures.
The O&' had a sensitivit0 of 1004 for an>e and "idfoot fractures #hen used b0
both Iunior and senior ph0sicians.
Dubication T0pes:
Faidation *tudies
D$I7: 12AH5A22 [Dub$ed : inde<ed for $E7%INE]
AH: + 6one +oint *ur! &". 2003 &pr3?5:&5@8:A0@:?.
Effect of fibuar pate fi<ation on rotationa stabiit0 of si"uated dista
tibia fractures treated #ith intra"eduar0 naiin!.
2u"ar &( .harebois *+( .ain E%( *"ith '&( 7anies &1( .rates +$.
1niversit0 of Tennessee:.a"pbe .inic( $e"phis( Tennessee 3?10@( 1*&.
6&.2)'O1N7: The effect of an intact fibua on rotationa stabiit0 after a
dista tibia fracture has( to the best of our >no#ed!e( not been cear0
defined. /e desi!ned a cadaver stud0 to carif0 our cinica i"pression that
fi<ation of the fibua #ith a pate increases rotationa stabiit0 of dista
tibia fractures fi<ed #ith a 'usse:Ta0or intra"eduar0 nai. $ET9O7*:
"atched pairs of e"ba"ed hu"an cadaveric e!s and si<teen fresh:froEen hu"an
cadaveric e!s( incudin! one "atched pair( #ere tested. To si"uate
5:"" transverse se!"enta defects #ere created at the sa"e eve in the tibia
and fibua( H c" pro<i"a to the an>e Ioint in each bone. The tibia #as
stabiiEed #ith a G:"" 'usse:Ta0or intra"eduar0 nai that #as statica0
oc>ed #ith t#o pro<i"a and t#o dista scre#s. Each speci"en #as tested
fibuar fi<ation as #e as #ith fibuar fi<ation #ith a si<:hoe se"itubuar
pate. & bia<ia "echanica testin! "achine #as used in torCue contro "ode
an initia a<ia oad of 53 to H1 N appied to the tibia cond0e. &n!uar
dispace"ent #as "easured in 0.5A:N:" torCue incre"ents to a "a<i"a torCue of
@.52 N:" 5@0 in:b8. 'E*1%T*: Initia0( si!nificant0 ess dispace"ent 5p J
S 0.058 #as produced in the speci"ens #ith fibuar pate fi<ation than in
#ithout fibuar pate fi<ation. The difference in an!uar dispace"ent bet#een
the speci"ens treated #ith and #ithout pate fi<ation #as estabished at the
first torCue data point "easured but did not increase as the torCue #as
increased. No si!nificant difference in the rotationa stiffness #as found
bet#een the speci"ens treated #ith and #ithout pate fi<ation after
of the second torCue data point 5bet#een 1.A? and @.@? N:"8. .ON.%1*ION*:
,ibuar pate fi<ation increased the initia rotationa stabiit0 after dista
tibia fracture co"pared #ith that provided b0 tibia intra"eduar0 naiin!
aone. 9o#ever( there #as no difference in rotationa structura stiffness
bet#een the speci"ens treated #ith and #ithout pate fi<ation as appied
#as increased.
D$I7: 12AH2?33 [Dub$ed : inde<ed for $E7%INE]
A?: .in Orthop. 2003 &pr35@0G8:2A0:H.
*0ndes"otic disruption in o# fibuar fractures associated #ith detoid
Ebrahei" N&( E!af0 9( Dadania" T.
7epart"ent of Orthopaedic *ur!er0( $edica .oe!e of Ohio( 7o#in! 9a 30A5
&rin!ton &venue( Toedo( O9 @3A1@:5?0H( 1*&. nebrahei"K"
%o# fibuar fractures that #ere associated #ith detoid i!a"ent disruption
inferior tibiofibuar s0ndes"otic disruption #ere studied. & of the patients
had a T0pe 6 /eber fibuar fracture associated #ith a detoid i!a"ent inIur0.
It #as difficut to detect the s0ndes"osis disruption on the initia
of the anteroposterior and "ortise radio!raphs obtained preoperative0 because
there #as no obvious taar shift on the pain radio!raph. .arefu evauation
the pain radio!raph and deter"ination of a the reco""ended "easure"ents
necessar0 to dia!nose the s0ndes"otic disruption. 9o#ever( the s0ndes"otic
disruption #as easi0 reco!niEabe on a<ia co"puted to"o!raph0 scans #hen
co"parin! the inIured and the noninIured sides. &<ia co"puted to"o!raph0
aso sho#ed a shao# incisura fibuaris in a patients and in three cases it
reveaed anterior fibuar subu<ation that #as not appreciated on the pain
radio!raphs obtained preoperative0. On the basis of the current stud0 usin!
eve of the fibuar fracture as a !uideine for appication of the
scre# as su!!ested b0 so"e authors "a0 not be accurate. There are severa
factors that shoud be considered incudin! the depth of the incisura
posterior "aeous fractures( detoid i!a"ent inIur0( and subu<ation of the
fibua. The sur!eonBs i"pression in the operatin! roo" of s0ndes"osis
shoud be considered as the best !uideine in the appication of s0ndes"osis
fi<ation rather than dependin! on the eve of the fibuar fracture.
D$I7: 12AH1510 [Dub$ed : inde<ed for $E7%INE]
AG: .in Orthop. 2003 &pr35@0G8:2@1:G.
*ava!e of dista tibia "etaph0sea nonunions #ith the G0 de!rees cannuated
bade pate.
.hin 2'( Na!ar>atti 7)( $iranda $&( *antoro F$( 6au"!aertner $'( +upiter +6.
7epart"ent of Orthopaedics( $assachusetts )enera 9ospita and 9arvard $edica
*choo( 6oston( $&( 1*&. >in!se0chinKhot""
Nonunion of dista tibia "etaph0sea fractures after trau"a is a "aIor
Treatin! these nonunions is "ade "ore chaen!in! b0 the presence of
ipsiatera tibiotaar arthrosis. The current stud0 e<a"ined the use of the G0
de!rees cannuated bade pate as an aternative "ethod of stabe interna
fi<ation for 13 dista tibia "etaph0sea nonunions and si"utaneous fusion of
three arthritic tibiotaar Ioints in 13 patients 5seven "aes and si< fe"aes8
#ith an avera!e a!e of @2.@ 0ears 5ran!e( 21:H3 0ears8. Each patient had an
avera!e of three prior procedures 5ran!e( 2:A8. Datients #ere foo#ed up for
avera!e of 3@.2 "onths 5ran!e( 2@:55 "onths8. & 13 patients achieved
radio!raphic and cinica union an avera!e of 15.A #ee>s 5ran!e( 12:20 #ee>s8
fro" the date of the definitive procedure. There #ere t#o bro>en scre#s( but
secondar0 procedures #ere reCuired to obtain fusion. & patients #ere
a"buator0 #ithout support at the ast foo#up. The i"pant proved effective
for stabe interna fi<ation of dista tibia "etaph0sea nonunions aone or
si"utaneous fusion of the tibiotaar Ioint.
D$I7: 12AH150? [Dub$ed : inde<ed for $E7%INE]
H0: &cta Orthop 6e!. 20033AG518:@2:?.
Tibiocacanea $archetti:FicenEi naiin! in revision arthrodesis for
posttrau"atic pseudarthrosis of the an>e.
7e *"et 2( 7e 6rau#er F( 6urssens D( Fan Ovost E( Ferdon> '.
7epart"ent of Orthopaedic *ur!er0( )hent 1niversit0 9ospita( 7e Dinteaan
6:G000 )ent( 6e!iu". >oen.des"etKs>
The authors conducted a retrospective stud0 of H patients treated #ith
tibiotaocacanea $archetti:FicenEi naiin! 5one antero!rade and si<
nais8. & these patients had deveoped pseudarthrosis after previous
arthrodesis for posttrau"atic an>e fractures. The resuts #ere evauated
cinica0 and radio!raphica0 at a "edian ti"e of four 0ears. ,usion
in three patients( in one of the" on0 after re"ova of the pro<i"a oc>in!
scre#. Of the re"ainin! four patients( one achieved consoidation after
repace"ent of the $archetti:FicenEi nai b0 another intra"eduar0 nai( t#o
#ere ost to foo#:up after repace"ent b0 e<terna or interna fi<ation( and
the ast patient deveoped pseudarthrosis a!ain. &t east nine additiona
interventions #ere necessar0 in si< patients( incudin! one a"putation for
intractabe pain and severe soft:tissue da"a!e due to the trau"a. None of the
patients had e<ceent or !ood resuts. The "aIorit0 #as unsatisfied #ith this
t0pe of intra"eduar0 naiin!. Therefore our stud0 #as ter"inated
'evision an>e fusion for nonunion or "aunion after e<terna or interna
fi<ation has a hi!h co"pication rate. ,urther stud0 is "andator0 to prevent
resove re"ainin! probe"s.
D$I7: 12AAA2G0 [Dub$ed : inde<ed for $E7%INE]
H1: + Orthop *ci. 20033?528:23A:?.
,racture of the dista end of the fibua throu!h a persistent ph0sis in an
#ith fracture of the "edia "aeous.
Pa"a"oto N( Na!o0a *( Obata $( Pa"ashita T.
7epart"ent of Orthopaedic *ur!er0( *apporo $edica 1niversit0 *choo of
$edicine( $ina"i 1:Io( Nishi 1A:cho"e( .huo:>u( *apporo 0A0:?5@3( +apan.
& 2A:0ear:od #o"an #as inIured in a "otor vehice accident and sustained a
bi"aeoar fracture of the ri!ht an>e. 'adio!raphs reveaed a shearin!
fracture of the "edia "aeous and a !ap in the dista end of the ri!ht
that rese"bed epiph0sio0sis in chidren. ,racture of the dista end of the
fibua throu!h a persistent ph0sis #as suspected. 9istoo!ica e<a"ination of
"ateria obtained fro" the fracture site durin! sur!er0 reveaed re"nants of
h0aine cartia!e. /e beieve that the fracture occurred at a persistent
of the dista end of the fibua.
D$I7: 12AA5GA@ [Dub$ed : inde<ed for $E7%INE]
H2: + Orthop *ci. 20033?528:1AA:G.
Dercutaneous patin! for unstabe tibia fractures.
Oh ./( Dar> 6.( 20un! 9*( 2i" *+( 2i" 9*( %ee *$( Ihn +..
7epart"ent of Orthopedic *ur!er0( 20un!poo> Nationa 1niversit0 9ospita( 50(
2:)a( *a"7o>:7on!( .hun!:)u( 7ae!u( 2orea H00:H21.
T#ent0:four unstabe tibia fractures #ere stabiiEed #ith a narro# i"ited
contact:d0na"ic co"pression pate inserted usin! a percutaneous patin!
techniCue under fuoroscopic !uidance. The "aIor indication for this techniCue
#as a tibia fracture for #hich intra"eduar0 naiin! #oud be difficut.
#ere 1A pro<i"a or dista "etaph0sea fractures and 5 se!"enta fractures in
aduts and 3 "id:shaft fractures in adoescents #ho sti had an open ph0sis.
the 2@ fractures( 22 heaed #ithout a second procedure3 the t#o faiures
incuded one that reCuired an ear0 bone !raft for severe co""inution and
another #ith a superficia infection that heaed after ear0 re"ova of the
pate. There #ere no other infections. There #ere three cases of scre#
but the0 did not reCuire a further procedure. &t the fina foo#:up( one
patient had heaed #ith 5 de!rees varus ai!n"ent and another #ith 10 de!rees
e<terna rotation. & the patients had !ood >nee or an>e function. /e are
confident that the percutaneous patin! techniCue to treat unstabe tibia
fractures for #hich intra"eduar0 naiin! #oud be difficut #i prove to be
an aternative stabiiEation "ethod( as it avoids the ris> of infection or
tissue co"pro"ise.
D$I7: 12AA5G52 [Dub$ed : inde<ed for $E7%INE]
H3: 2nee *ur! *ports Trau"ato &rthrosc. 2003 $ar311528:112:5. Epub 2003 +an
&rthroscop0:assisted reduction and percutaneous fi<ation of a "utipe !enoid
)i!ante &( $arinei $( Ferdenei &( %upetti E( )reco ,.
Istituto di Datoo!ia e .inica deB&pparato %oco"otore( Doo
7idattico:*cientifico( Fia Tronto( 10( A0020 Torrette( Ita0. a!i!
)enoid fractures are rare. The traditiona "ethod for treatin! the" is open
reduction and interna fi<ation in arthroto"0. &rthroscopic reduction #ith
percutaneous fi<ation is used in seected fractures 5of tibia pateau( an>e(
dista radius8. /e describe the sur!ica techniCue adopted to treat a
P:shaped articuar !enoid fracture usin! arthroscop0 and percutaneous
D$I7: 12AA@20@ [Dub$ed : inde<ed for $E7%INE]
H@: *#iss *ur!. 20033G518:1G:25.
[2irschner #ire transfi<ation of s0ndes"osis rupture::an aternative treat"ent
of t0pe 6 and . "aeoar fractures]
[&rtice in )er"an]
$issbach:2ro &( $eier %( $e0er D( 6urc>hardt &( Eisner %.
.hirur!ische 2ini>( 'atisches 2antons: und 'e!ionaspita .hur( %oestrasse
.9:H000 .hur.
&fter co"petin! O'I, of the atera "aeous( the standard techniCue for
fi<ation of the s0ndes"osis invoves pace"ent of a 3.5 "" oc>in! scre#
the fibua to the tibia. &ternative there is a possibiit0 to "a>e the
transfi<ation #ith t#o 1.A "" 2irschner #ires introduced obiCue0 across the
dista tibiofibuar s0ndes"osis. No ear0 re"ovin! of the i"pant is
This retrospective stud0 #as conducted on a tota of 50 cases of /eber t0pe 6
. "aeoar fractures #ith s0ndes"otic rupture bet#een 1G?? and 1GGA. In @5
patients 5G048 there is no co"pication seen for the transfi<ation( but in
patients a 2irschner #ire disocation #as observed. /e #ere abe to revie# 3A
these patients after a "edian foo#:up of ?.3 0ears 5ran!e 5:12 0ears8. The
resuts #ere evauated usin! obIective( subIective and roent!eno!raphic
criteria. *ubIective ratin! had 2G patients 5?148 #ith ver0 !ood or !ood
resuts. )ood radioo!ica resuts #ere found in 2G patients 5?148. .oncudin!
of this resuts the 2irschner #ires transfi<ation is a technica si"pe "ethod
#ith !ood or ver0 !ood resuts.
Dubication T0pes:
Evauation *tudies
D$I7: 12AA1@2? [Dub$ed : inde<ed for $E7%INE]
H5: &cta Orthop Trau"ato Turc. 200333H518:G:1?.
['esuts of the IiEarov "ethod in the treat"ent of pseudoarthrosis of the
[&rtice in Tur>ish]
OEtur>"en P( 7o!ru .( 2ari $.
**2 Istanbu E!iti" 9astanesi 1. Ortopedi ve Trav"atooIi 2ini!i( Istanbu.
O6+E.TIFE*: /e evauated the resuts of the IiEarov "ethod in the treat"ent
pseudoarthrosis of the o#er e<tre"ities. $ET9O7*: ,ort0:si< patients 53@ "en(
12 #o"en3 "ean a!e 3?.A 0ears3 ran!e 2? to AG 0ears8 #ere treated b0 the
IiEarov "ethod for fe"ora 5nS?( 1H48 and tibia 5nS3?( ?348 pseudoarthrosis.
The "ean duration of the disease #as 1.A 0ears 5ran!e A "onths to @.? 0ears8.
Dseudoarthrosis #as h0pertrophic in seven patients 51A48 and atrophic in 3G
patients 5?@48. The "ean nu"ber of previous operations #as 1.@ 5ran!e 0 to @83
the "ean bone oss #as H.@ c" 5ran!e 3 to 12 c"83 the "ean shortenin! #as A.?
5ran!e 0 to 12 c"83 the "ean siEe of the defect #as 5.2 c" 5ran!e 3 to 12 c"8.
&ppications #ere "onofoca in 30 patients 5AA48 and bifoca in 1A patients
53@48. The "ean foo#:up #as 22.A "onths 5ran!e G to 5@ "onths8. 'E*1%T*:
occurred in a patients 5G248 but four 52 "onofoca( 2 bifoca8. The fi<ator
#as appied for a "ean of 20? da0s 5ran!e G3 to H50 da0s8( #hich #as 1A2 da0s
5ran!e G? to 2GA da0s8 for "onofoca( and 2?A da0s 5ran!e 1@0 to @GA da0s8 for
bifoca appications. &ccordin! to the Dae0Bs criteria( the resuts for bone
heain! and function #ere e<ceent in 2A and 25 patients( !ood in 12 and 1@
patients( fair in four and three patients( and poor in four patients(
respective0. Din tract infections deveoped in 2? patients( and refe<
s0"pathetic d0stroph0 in three patients. 'efracture occurred after the re"ova
of the fra"e in three patients #ho received bifoca treat"ent. One patient
deveoped transient peronea nerve pas0 #ith drop foot. ECuinus ri!idit0 of
an>e #as seen in four patients. .anceous bone !raftin! #as perfor"ed in
patients 52548 in #ho" dea0ed heain! #as observed at the tar!et site
se!"enta bone transport. Three patients had union #ith a residua defor"it0
"ore than H de!rees. In the "onofoca !roup( none of the patients had a
shortenin! of "ore than 1 c". ,oo#in! bifoca appications( no bone defects
#ere observed3 the "ean residua en!th discrepanc0 #as 1. 5 c" 5ran!e 0 to @
c"8( and the heain! inde< #as 52 da0sOc". .ON.%1*ION: The IiEarov techniCue
"a0 si"utaneous0 be successfu in the treat"ent of Ioint contractures(
an!uar( rotationa( and transationa defor"ities( shortenin!( and bone
Dubication T0pes:
Evauation *tudies
D$I7: 12A551G0 [Dub$ed : inde<ed for $E7%INE]
HA: ,oot &n>e Int. 2003 ,eb32@528:1H2:5.
&vusion fractures of the "edia tuberce of the posterior process of the
2i" 79( 6er>o#itE $+( Dress"an 7N.
7epart"ent of Orthopedics( 7enver( .O ?0205( 1*&. david.h.>i"K>p.or!
&vusion fracture of the "edia tuberce of the posterior process of the taus
occurs after forcefu dorsife<ion:pronation of the an>e. /e evauated five
patients #ho had sustained this fracture #hie participatin! in sportin!
activities. T#o patients #ere correct0 dia!nosed acute0 and treated #ith
i""obiiEation and i"ited #ei!htbearin!. &vusion fractures in the re"ainin!
three patients #ent undia!nosed acute0. This !roup #as treated #ith dea0ed
operative e<cision for persistent postero"edia an>e pain. The patients #ere
evauated at a "ean foo#:up of 35 "onths usin! the &O,&* &n>e:9indfoot
The t#o patients dia!nosed and treated acute0 achieved e<ceent resuts. The
three patients #ith "issed fractures did poor0( 0et achieved co"parabe
after ate e<cision. Our resuts su!!est that pro"pt dia!nosis and appropriate
"ana!e"ent 0ieds reiab0 !ood outco"es. 1ntreated avusion fractures
predictab0 do poor0. ,or these patients( ate e<cision can provide
functiona and s0"pto"atic i"prove"ent.
D$I7: 12A2HA2H [Dub$ed : inde<ed for $E7%INE]
HH: ,oot &n>e Int. 2003 ,eb32@528:15?:A3.
InIur0 characteristics and the cinica outco"e of subtaar disocations: a
cinica and radio!raphic ana0sis of 25 cases.
6ibbo .( &nderson '6( 7avis /9.
7epart"ent of Orthopaedic *ur!er0( $arshfied .inic( $arshfied( /I 5@@@G(
The obIective of this stud0 #as to deter"ine the "echanis"s of inIur0 and
pattern of associated foot and an>e inIuries and s0ste"ic inIuries associated
#ith subtaar disocations( and( correate these data #ith the radio!raphic
cinicaOfunctiona outco"e of patients after subtaar disocation. 'E*1%T*:
T#ent0:five patients #ith a subtaar disocation #ere identified over a seven
0ear period. The "ean patient a!e #as 3? 0ears. $aes 5nS1G8 co"prised HA4 of
patients( #ith a "ean a!e of 3A 0ears. 9i!h ener!0 "echanis"s 5"otor vehice
accidents( fas8 accounted for A?4 of subtaar disocations. &thou!h hi!h
ener!0 "echanis"s sho#ed a stron! trend to#ard open subtaar disocations( the
association #as not statistica0 si!nificant 5pS0.05H3( ,isherBs e<act test8.
.osed disocations predo"inated 5H548. %eft and ri!ht:sided disocations #ere
near0 eCua0 distributed( even a"on! "otor vehice accidents. $edia
disocations predo"inated 5A548: these #ere not infuenced b0 "echanis" of
inIur0 and did not resut in statistica0 o#er &O,&* an>eOhindfoot scores.
*ubtaar disocation #as irreducibe 5reCuirin! open reduction8 in 324( #ith
hi!her ener!0 "echanis"s of inIur0 bein! statistica0 associated #ith an
irreducibe subtaar disocation 5pS0.02A1( ,isherBs e<act test8. 6oc> to
reduction #as even0 distributed a"on! soft tissue ee"ents 5posterior tibia
tendon( fe<or haucis on!us tendon( capsue( e<tensor retinacuu"8 and
osseous ee"ents. Ei!ht0:ei!ht percent of patients incurred conco"itant
to the foot and an>e 5G54 of #hich #ere cosed inIuries8( na"e0( the an>e
taus. *0ste"ic inIuries occurred in ??4 of patients. &t a "ean foo#:up of
five 0ears( the "ean &O,&* score of the subtaar disocation side #as
si!nificant0 o#er 5"eanSH1 vs. G3( pS0.000H( unpaired *tudentBs t:test8. No
statistica reation #as found bet#een the nu"ber of associated e<tre"it0
inIuries and &O,&* score 5*pear"an correation coefficient( rS5:80.23A(
pS0.3318. 'adio!raphic foo#:up de"onstrated ?G4 of an>es #ith radio!raphic
chan!es 5314 s0"pto"atic83 ho#ever( the "aIorit0 of these patients 5A148 had
associated an>e inIur0. The subtaar Ioint de"onstrated radio!raphic chan!es
?G4 of patients( #ith A34 bein! s0"pto"atic3 H54 of patients #ith subtaar
chan!es incurred a fracture about the subtaar Ioint at the ti"e of
,our patients #ent on to subtaar fusion at an avera!e of ?.? "onths
post:disocation. The "idfoot sho#ed radio!raphic chan!es in H24 of patients(
#ith on0 154 of these patients bein! s0"pto"atic. & patients #ith "idfoot
s0"pto"s #ere #e controed b0 nonsur!ica "easures.
D$I7: 12A2HA2@ [Dub$ed : inde<ed for $E7%INE]
H?: 1nfachirur!. 2003 ,eb310A528:1A1:5.
[*i"utaneous rei"pantation of both o#er e!s::5:0ear foo#:up 5case
[&rtice in )er"an]
*ch"idha""er '( 7ornin!er %( 9uber /( 9aer 9( 2ropf &.
1nfa>ran>enhaus der &1F&( %inE( &ustria.
/e are reportin! the case of a 2G 0ear od "ae in #ho" #e perfor"ed
rei"pantaton of both o#er e!s foo#in! trau"a inficted b0 a rairoad
bo<car. ,ive 0ears after this accident( the patientBs #a> is a"ost nor"a
both deep sensitivit0 and t#o point discri"ination on the soes of his feet
sufficient.The patient can #a>( run and stand ver0 #e on one e!( both on
even and on uneven !round.9e returned to his Iob #ith the rairoad ? "onths
after his accident. Ori!ina0 the patient #as e"po0ed as a rairoad #or>"an(
and is no# an office e"po0ee. 9is private ife is nor"a and he enIo0s hi>in!
and dancin!. In our opinion( sufficient function of the tibia nerve in the
reconstructed e<tre"it0 is i"portant for cinica0 satisfactor0 on!:ter"
resuts. 6oth the $an!ed E<tre"it0 *everit0 *core 5$E**8 and the NI***& are
hepfu in "a>in! the decision on #hether to pri"ari0 a"putate or reconstruct
)ustio III. cases. )ood on!:ter" resuts as #e as !enera cost reduction
are achievabe foo#in! reconstruction of e<tre"ities.&"putation of an
e<tre"it0 can be predicted #ith 1004 certaint0 #hen $E** is G or "ore.Dri"ar0
shortenin! and secondar0 en!thenin! of an e<tre"it0 is a !ood "ethod of
treatin! )ustio III . fractures.
D$I7: 12A2@A?G [Dub$ed : inde<ed for $E7%INE]
HG: .in Orthop. 2003 $ar35@0?8:2?A:G1.
7ista tibia "etaph0sea fractures treated b0 percutaneous pate
Oh ./( 20un! 9*( Dar> I9( 2i" DT( Ihn +..
20un!poo> Nationa 1niversit0 9ospita( Tae!u( 2orea. c#ohK>>r
T#ent0:one patients #ith fractures of the dista tibia "etaph0sis( so"e #ith
"ini"a dispace"ent in the an>e( #ere treated b0 percutaneous pate
osteos0nthesis #ith a narro# i"ited contact:d0na"ic co"pression pate. 1sin!
the cassification b0 the &rbeits!e"einschaft fur Osteos0nthesefra!en and
Orthopaedic Trau"a &ssociation( 1H fractures had no articuar invove"ent(
#hereas four incuded intraarticuar e<tension. &t fina foo#up 5"ean( 20
"onths8( a the fractures heaed #ithout second procedures and the "ean union
ti"e #as 15.2 #ee>s. One patient had "aai!n"ent of the i"b #ith 10 de!rees
interna rotation( but there #ere no an!uar defor"ities !reater than 5
or an0 shortenin! !reater than 1 c". & patients had e<ceent or
an>e function. There #ere no infections or an0 soft tissue co"pro"ise.
Dercutaneous pate osteos0nthesis is a safe and #orth#hie "ethod of "ana!in!
such fractures( #hich avoids so"e of the co"pications associated #ith
conventiona open patin! "ethods.
D$I7: 12A1A0H2 [Dub$ed : inde<ed for $E7%INE]
?0: .in Orthop. 2003 $ar35@0?8:?2:5.
&ntibiotic therap0 in !unshot #ound inIuries.
*i"pson 6$( /ison '9( )rant 'E.
7ivision of Orthopaedic *ur!er0( 9o#ard 1niversit0 9ospita( /ashin!ton( 7.(
1*&. r!"
Drotocos for antibiotic proph0a<is in the treat"ent of fractures caused b0
!unshots have not been deineated cear0 in the iterature to date. The
revie# of the iterature reveas that antibiotic therap0 for treat"ent of
fractures is predicated on the "uEEe veocit0 of the #eapon used to infict
fracture. )enera consensus has been reached re!ardin! the reCuire"ent of at
east 2@ hours of intravenous antibiotic treat"ent in fractures caused b0
hi!h:veocit0 #eapons in conIunction #ith the appropriate #ound and fracture
care. *i"iar0( in fractures caused b0 shot!uns( thorou!h #ound debride"ent
2@: to @?:hour ad"inistration of intravenous antibiotics is necessar0.
in fractures caused b0 o#:veocit0 #eapons( there is not a preponderance of
evidence sho#in! that there is a distinct advanta!e to usin! antibiotic
proph0a<is in these inIuries. *pecia cinica consideration "ust be !iven
re!ardin! the use of antibiotics in fractures caused b0 !unshots that are
intraarticuar and those about the hand( foot( and an>e.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12A1A0@2 [Dub$ed : inde<ed for $E7%INE]
?1: *pina .ord. 2003 $ar3@1538:1H2:H.
1se of the rin! fi<ator in the treat"ent of fractures of the o#er e<tre"it0
on!:ter" parape!ic and tetrape!ic patients.
$einers T( 2ei $( ,ie!er '( &be '.
*pina .ord .enter( /erner /ic>er .inic( 3@53H 6ad /idun!en( )er"an0.
*T17P 7E*I)N: 'etrospective stud0. O6+E.TIFE*: To e<a"ine the vaue of
fracture stabiiEation b0 "eans of the rin! fi<ator in fractures of the o#er
e<tre"it0 in the presence of chronic para0sis caused b0 transverse esions of
the spina cord. *ETTIN): & speciaist center for the treat"ent of spina cord
inIuries in )er"an0. $ET9O7*: .inica e<a"ination of the o#er e<tre"ities
side:for:side co"parison( radioo!ica investi!ation of the fractures( patient
surve0. D&TIENT*: In 21 patients #ith chronic spina cord esions( 22
of the o#er e<tre"ities #ere treated #ith the rin! fi<ator. 'E*1%T*: &t
foo#:up a "ean of @1.5 "onths after fracture heain! it coud be sho#n that
"ove"ent in the >nee and an>e Ioints on the sa"e side as the fracture #as not
restricted b0 "ore than 10 de!rees in an0 of our patients. No osses affectin!
activities of dai0 ivin! #ere reported( and 1G of the 21 patients #ere
satisfied #ith the resut achieved #ith this techniCue. &fter four of the 22
operations there #ere co"pications. $aai!n"ents #ere visibe radioo!ica0
foo#in! five of the fractures. .ON.%1*ION*: In osteoporosis:induced
of the o#er e<tre"ities in chronica0 parape!ic and tetrape!ic patients(
fracture stabiiEation #ith the rin! fi<ator( #ith fe#er co"pications and
better resuts in ter"s of Ioint "obiit0( is superior to the conservative
treat"ent so far !iven preference in the iterature. It shoud be offered as
aternative to conservative treat"ent in the case of pathoo!ica fractures.
D$I7: 12A12A20 [Dub$ed : inde<ed for $E7%INE]
?2: Dfe!e N. 2001 Nov35@5118:?2G:30.
[%earnin! in nursin! care: support in a crisis]
[&rtice in )er"an]
2ea N( 2ea D.
D$I7: 12A0H@5G [Dub$ed : inde<ed for $E7%INE]
?3: &" + ,orensic $ed Datho. 2003 $ar32@518:51:@.
& variant of incapretta"ento 5ritua i!ature stran!uation8 in East Ti"or.
Doanen $*.
,orensic Dathoo!0 1nit( Office of the .hief .oroner( and the 7epart"ent of
Dathobioo!0 and %aborator0 $edicine( 1niversit0 of Toronto( Toronto( Ontario(
Incapretta"ento is a rituaiEed for" of i!ature stran!uation often
#ith the Itaian $afia. The ha"ar>s incude i!ature stran!uation and
of the bod0 in a hi!h0 stereot0ped fashion. The bindin!s incude t0in! the
#rists and an>es to!ether( #ith the bod0 in the prone position 5si"iar to
Rho!t0in!R8( and an additiona i!ature encircin! the nec> and attached to
bindin!s of the e<tre"ities. The bindin! of the bod0 "a0 be perfor"ed after
death is inficted b0 i!ature stran!uation( or it "a0 be associated #ith
sef:stran!uation( as sho#n b0 the arran!e"ent of i!atures and the position
the bod0. & case #ith !reat si"iarities to incapretta"ento( in #hich the bod0
#as e<hu"ed fro" a !rave in East Ti"or( is described in detai. 9o#ever( in
addition to prone:position bindin! and a h0oid fracture( choppin! #ounds of a
>nee and bunt trau"a to the posterior torso #ere found. The i"pication of
these #ounds is discussed in reation to incapretta"ento.
D$I7: 12A0@GGG [Dub$ed : inde<ed for $E7%INE]
?@: Orthopedics. 2003 ,eb32A528:1313 author rep0 131.
.o""ent on:
Orthopedics. 2002 &pr3255@8:@2H:30.
&n>e fi<ation.
)eor!e '..
Dubication T0pes:
D$I7: 125GH21@ [Dub$ed : inde<ed for $E7%INE]
?5: + 6io"ech En!. 2002 7ec312@5A8:H50:H.
The a<ia inIur0 toerance of the hu"an footOan>e co"pe< and the effect of
&chies tension.
,un> +'( .randa +'( Tourret %+( $ac$ahon .6( 6ass .'( Datrie +T( 2hae#pon!
Eppin!er '9.
&uto"obie *afet0 %aborator0( 7epart"ent of $echanica( &erospace( and Nucear
En!ineerin!( 1niversit0 of Fir!inia( 1011 %inden &venue( .harottesvie( F&
22G02( 1*&. Ifun>"
&<ia oadin! of the footOan>e co"pe< is an i"portant inIur0 "echanis" in
vehicuar trau"a that is responsibe for severe inIuries such as cacanea and
tibia pion fractures. &<ia oadin! "a0 be appied to the e! e<terna0( b0
the toepan andOor pedas( as #e as interna0( b0 active "usce tension
appied throu!h the &chies tendon durin! pre:i"pact bracin!. The obIectives
this stud0 #ere to investi!ate the effect of &chies tension on fracture "ode
and to e"pirica0 "ode the a<ia oadin! toerance of the footOan>e
6unt a<ia i"pact tests #ere perfor"ed on fort0:three 5@38 isoated o#er
e<tre"ities #ith and #ithout e<peri"enta0 si"uated &chies tension. The
pri"ar0 fracture "ode #as cacanea fracture in both !roups. 9o#ever( fracture
initiated at the dista tibia "ore freCuent0 #ith the addition of &chies
tension 5p J 0.058. &coustic sensors "ounted to the bone de"onstrated that
fracture initiated at the ti"e of pea> oca a<ia force. & surviva ana0sis
#as perfor"ed on the inIur0 data set usin! a /eibu re!ression "ode #ith
speci"en a!e( !ender( bod0 "ass( and pea> &chies tension as predictor
variabes 5'2 S 0.G08. & cosed:for" survivor function #as deveoped to
the ris> of fracture to the footOan>e co"pe< in ter"s of a<ia tibia force.
The a<ia tibia force associated #ith a 504 ris> of inIur0 ran!ed fro" 3.H >N
for a A5 0ear:od 5th percentie fe"ae to ?.3 >N for a @5 0ear:od 50th
percentie "ae( assu"in! no &chies tension. The survivor function presented
here "a0 be used to esti"ate the ris> of footOan>e fracture that a bunt
i"pact #oud pose to a hu"an based on the pea> tibia a<ia force "easured b0
anthropo"orphic test device.
D$I7: 125GAA@@ [Dub$ed : inde<ed for $E7%INE]
?A: 6$+. 2003 ,eb 22332A5H3?A8:@1H.
.o""ent in:
6$+. 2003 ,eb 22332A5H3?A8:@05:A.
6$+. 2003 $a0 2@332A5H3GG8:11@H3 author rep0 11@H.
&ccurac0 of Otta#a an>e rues to e<cude fractures of the an>e and "id:foot:
s0ste"atic revie#.
6ach"ann %$( 2ob E( 2oer $T( *teurer +( ter 'iet ).
9orten .entre( Nurich 1niversit0( Dostfach Nord( .9:?0G1 Nurich( *#itEerand.
O6+E.TIFE: To su""arise the evidence on accurac0 of the Otta#a an>e rues( a
decision aid for e<cudin! fractures of the an>e and "id:foot. 7E*I)N:
*0ste"atic revie#. 7&T& *O1'.E*: Eectronic databases( reference ists of
incuded studies( and e<perts. 'EFIE/ $ET9O7*: 7ata #ere e<tracted on the
popuation( the t0pe of Otta#a an>e rues used( and "ethods. *ensitivities(
not specificities( #ere pooed usin! the bootstrap after inspection of the
receiver operatin! characteristics pot. Ne!ative i>eihood ratios #ere
for severa sub!roups( correctin! for four "ain "ethodoo!ica threats to
vaidit0. 'E*1%T*: 32 studies "et the incusion criteria and 2H studies
reportin! on 15 5?1 patients #ere used for "eta:ana0sis. The pooed ne!ative
i>eihood ratios for the an>e and "id:foot #ere 0.0? 5G54 confidence
0.03 to 0.1?8 and 0.0? 50.03 to 0.208( respective0. The pooed ne!ative
i>eihood ratio for both re!ions in chidren #as 0.0H 50.03 to 0.1?8.
these ratios to a 154 prevaence of fracture !ave a ess than 1.@4 probabiit0
of actua fracture in these sub!roups. .ON.%1*ION*: Evidence supports the
an>e rues as an accurate instru"ent for e<cudin! fractures of the an>e and
"id:foot. The instru"ent has a sensitivit0 of a"ost 1004 and a "odest
specificit0( and its use shoud reduce the nu"ber of unnecessar0 radio!raphs
Dubication T0pes:
'evie#( &cade"ic
D$I7: 125G53H? [Dub$ed : inde<ed for $E7%INE]
?H: Dediatr E"er! .are. 2003 ,eb31G518:A:G.
$idfoot inIur0 in chidren reated to "ini scooters.
6ibbo .( 7avis /9( &nderson '6.
7epart"ent of Orthopaedic *ur!er0( $arshfied .inic( /isconsin( 1*&.
The re"ar>abe rise in popuarit0 of "ini scooters has been acco"panied b0 an
increase in the nu"ber of foot and an>e inIuries. /e have observed uniCue
pediatric foot inIuries reated to the use of "ini scooters. &n association
be present in>in! the desi!n of the "ini scooter and the ridin! practices of
chidren. /e report on t#o uniCue "idfoot inIuries in chidren occurrin! #ith
"ini scooter use and discuss ho# these foot inIuries "a0 be reated to scooter
desi!n and chidrenBs ridin! practices. *afet0 !uideines ai"ed at the
prevention of foot and an>e inIuries #hie ridin! "ini scooters are outined.
D$I7: 125G2105 [Dub$ed : inde<ed for $E7%INE]
??: Int Orthop. 200332H518:30:5. Epub 2002 *ep 05.
,racture disocations of %isfrancBs Ioint treated #ith cosed reduction and
percutaneous fi<ation.
Deru!ia 7( 6asie &( 6atta!ia &( *topponi $( 7e *i"eonibus &1.
1niversita Tor Fer!ata( Fia ).&. Dana( 13( 001GH( 'o"e( Ita0.
/e revie#ed @2 patients 5"ean a!e 3H.H;O:1@.2 0ears8 #ith cosed fracture
disocations of %isfrancBs Ioint treated #ith percutaneous scre# fi<ation.
foo#:up #as 5?.@;O:1H.3 "onths. The ai" #as to co"pare disocations in #hich
perfect anato"ica reduction had been reached #ith disocations in #hich
reduction #as on0 near anato"ica. The "ean &"erican Orthopaedic ,oot and
*ociet0 score for a patients #as ?1.0;O:13.5. There #ere no si!nificant
differences in outco"e scores bet#een patients #ith perfect anato"ica
and patients #ith near anato"ica reduction. 9o#ever( patients #ith co"bined
fracture disocations obtained statistica0 better scores than patients #ith
pure disocations.
D$I7: 125?2?0A [Dub$ed : inde<ed for $E7%INE]
?G: &" + Orthop. 2003 +an332518:@A:?.
1se of a vertica transarticuar pin for stabiiEation of severe an>e
*cioscia TN( Niran 69.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of Dittsbur!h( Dittsbur!h(
Denns0vania( 1*&.
Transarticuar pin fi<ation has been used successfu0 to stabiiEe severe
fractures. This techniCue is "ost co""on0 used as provisiona fi<ation unti
interna fi<ation is appropriate. In addition( transarticuar pin fi<ation can
be a suppe"ent in cases invovin! persistent tibiotaar instabiit0 after
interna fi<ation and can provide soe definitive fi<ation of arthritic and
osteoporotic an>es. In this artice( #e describe the sur!ica techniCue(
resuts( and revie# #hen transarticuar pin fi<ation "a0 be appropriate. /e
beieve that a orthopedic sur!eons shoud >no# this techniCue::especia0
those treatin! cases of co"pe< orthopedic trau"a.
D$I7: 125?0352 [Dub$ed : inde<ed for $E7%INE]
G0: &" + Orthop. 2003 +an332518:35:H.
Dantar !an!ion c0st associated #ith stress fracture of the third "etatarsa.
$c&ister 7'( 2oh +( 6er!fed +&.
7epart"ent of Orthopaedic *ur!er0( .enter for 9eath *ciences( 1niversit0 of
.aifornia( %os &n!ees( .aifornia( 1*&.
)an!ion c0sts of the foot and an>e occur reative0 infreCuent0. $etatarsa
stress fractures occur in a variet0 of athetes #ho subIect their o#er
e<tre"ities to repetitive oadin!. In this artice( #e report the case of a
professiona footba pa0er #ith a pantar forefoot !an!ion c0st associated
#ith a stress fracture of the third "etatarsa. &fter the c0st resoved #ith
aspiration( the stress fracture heaed #ith conservative( nonsur!ica
D$I7: 125?03@G [Dub$ed : inde<ed for $E7%INE]
G1: + Trau"a. 2003 ,eb35@528:3HG:G0.
The orthopastic approach for "ana!e"ent of the severe0 trau"atiEed foot and
9eit"ann .( %evin %*.
7ivision of Dastic( 'econstructive( $a<iofacia and Ora *ur!er0( 7u>e
1niversit0 $edica .enter( 7urha" 2HH10( 1*&.
Dubication T0pes:
'evie#( Tutoria
D$I7: 125HG0H1 [Dub$ed : inde<ed for $E7%INE]
G2: Osteoporos Int. 2003 +an31@518:AG:HA.
7isabiit0 after cinica fracture in post"enopausa #o"en #ith o# bone
densit0: the fracture intervention tria 5,IT8.
,in> 9&( Ensrud 2E( Neson 76( 2erani 'D( *chreiner D+( Nhao P( .u""in!s *'(
Nevitt $..
$7( $D9( F& $edica .enter( One Feterans 7rive( 6o< 11)( $inneapois( $N
1*&. ho#ard.fin>K"!ov
'eative0 itte is >no#n about outco"es foo#in! cinica osteoporotic
fractures at nonhip( nonvertebra s>eeta sites. To address this issue( #e
prospective0 assessed post:fracture disabiit0 at "utipe s>eeta sites in
popuation of G0G oder 5a!ed 55:?1 0ears8( co""unit0:d#ein! #o"en #ith o#
fe"ora nec> bone "inera densit0 #ho had e<perienced a fracture #hie
in the ,racture Intervention Tria 5,IT8. ,IT is a rando"iEed( doube:"as>ed(
pacebo:controed tria that #as desi!ned to deter"ine the effect of
aendronate on fracture incidence( and the current stud0 #as conducted as a
secondar0 ana0sis of ,IT data. ,oo#in! incident cinica fractures( ,IT
participants #ere foo#ed prospective0 for assess"ent of site:specific(
fracture:reated disabiit0. $easures of disabiit0 #ere sef:reported da0s
hospitaiEed or confined to bed because of the fracture 5Bbed da0sB8 and da0s
reduced usua activities because of the fracture 5Bi"ited activit0 da0sB8. Of
fracture t0pes evauated( those of the hip resuted in the hi!hest percenta!e
subIects #ith an0 bed da0s or i"ited activit0 da0s after fracture 5G@4 #ith
bed da0s and 1004 #ith an0 i"ited activit0 da0s8( thou!h the "ean nu"ber of
da0s and i"ited activit0 da0s appeared hi!hest after u"bar vertebra
525.? "ean bed da0s and 15?.5 "ean i"ited activit0 da0s8. *ubstantia
disabiit0 aso #as reported after fractures of thoracic vertebrae( hu"erus(
dista forear"( an>e and foot. /ithin fracture t0pes( post:fracture
#as hi!h0 variabe( ran!in! fro" none to "ore than A "onths.
D$I7: 125HH1?H [Dub$ed : inde<ed for $E7%INE]
G3: + 6one +oint *ur! &". 2003 ,eb3?5:&528:2?H:G5.
Tibia pafond fractures. 9o# do these an>es function over ti"eL
$arsh +%( /ei!e 7D( 7irsch 7'.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of Io#a 9ospitas and .inics(
.oe!e of $edicine( Io#a .it0 522@2( 1*&. I:"
6&.2)'O1N7: The inter"ediate outco"e of fractures of the tibia pafond
#ith current techniCues has not been reported( to our >no#ed!e. The purpose
this stud0( perfor"ed at a "ini"u" of five 0ears after inIur0( #as to
the effect of these fractures on an>e function( pain( and !enera heath
and to deter"ine #hich factors predict favorabe and unfavorabe outco"es.
$ET9O7*: ,ift0:si< an>es 5fift0:t#o patients8 #ith a tibia pafond fracture
#ere treated #ith a unifor" techniCue consistin! of appication of a
hin!ed transarticuar e<terna fi<ator couped #ith scre# fi<ation of the
articuar surface. Thirt0:one patients #ith thirt0:five invoved an>es
bet#een five and t#eve 0ears after the inIur0 for a ph0sica e<a"ination(
assess"ent of an>e pain and function #ith the Io#a &n>e *core and &n>e
Osteoarthritis *cae( assess"ent of !enera heath status #ith the *hort ,or":
5*,:3A8( and radio!raphic e<a"ination of the an>e. 'E*1%T*: &rthrodesis had
been perfor"ed on five of the fort0 an>es for #hich the outco"e #as >no#n at
"ini"u" of five 0ears after the inIur0. Other than re"ova of pro"inent scre#s
5t#o patients8( no other sur!ica procedure had been perfor"ed on an0 patient.
The avera!e Io#a &n>e *core #as H? points 5ran!e( 2? to GA points8. The
on the *,:3A and &n>e Osteoarthritis *cae de"onstrated a on!:ter" ne!ative
effect of the inIur0 on !enera heath and on an>e pain and function #hen
co"pared #ith those para"eters in a!e:"atched contros. The de!ree of
osteoarthrosis #as !rade 0 in three an>es( !rade 1 in si<( !rade 2 in t#ent0(
and !rade 3 in si<. The "aIorit0 of patients had so"e i"itation #ith re!ard
recreationa activities( #ith an inabiit0 to run bein! the "ost co""on
co"paint 5t#ent0:seven of the thirt0:one patients8. ,ourteen patients chan!ed
Iobs because of the an>e inIur0. ,ifteen an>es #ere rated b0 the patient as
e<ceent3 ten( as !ood3 seven( as fair3 and one( as poor. Nine patients #ith
previous0 recorded an>e scores had better scores after the on!er foo#:up
interva. The patients perceived that their condition had i"proved for an
avera!e of 2.@ 0ears after the inIur0. .ON.%1*ION*: &thou!h tibia pafond
fractures have an inter"ediate:ter" ne!ative effect on an>e function and pain
and on !enera heath( fe# patients reCuire secondar0 reconstructive
and s0"pto"s tend to decrease for a on! ti"e after heain!.
D$I7: 125H130H [Dub$ed : inde<ed for $E7%INE]
G@: + 6one +oint *ur! &". 2003 ,eb3?5:&528:205:11.
1se of a cast co"pared #ith a functiona an>e brace after operative treat"ent
of an an>e fracture. & prospective( rando"iEed stud0.
%ehtonen 9( +arvinen T%( 9on>onen *( N0"an $( Fihtonen 2( +arvinen $.
$edica *choo( 1niversit0 of Ta"pere( ,inand.
6&.2)'O1N7: .ontrovers0 continues #ith re!ard to the opti"a postoperative
after open reduction and interna fi<ation of an an>e fracture. The
of this stud0 #as that postoperative treat"ent of an an>e fracture #ith a
that ao#s active and passive ran!e:of:"otion e<ercises #oud i"prove the
functiona recover0 of patients co"pared #ith that after conventiona
#ith a cast. Thus( the purpose of this prospective( rando"iEed stud0 #as to
co"pare the on!:ter" subIective( obIective( and functiona outco"e after
conventiona treat"ent #ith a cast and that after use of functiona bracin! in
the first si< #ee>s foo#in! interna fi<ation of an an>e fracture. $ET9O7*:
One hundred patients #ith an unstabe andOor dispaced /eber t0pe:& or 6 an>e
fracture #ere treated operative0 and then #ere rando"0 aocated to t#o
!roups: i""obiiEation in a beo#:the:>nee cast 5fift0 patients8 or ear0
"obiiEation in a functiona an>e brace 5fift0 patients8 for the first si<
postoperative #ee>s. The foo#:up e<a"inations( #hich consisted of subIective
and obIective 5cinica( radio!raphic( and functiona8 evauations( #ere
perfor"ed at t#o( si<( t#eve( and fift0:t#o #ee>s and at t#o 0ears
postoperative0. 'E*1%T*: There #ere no perioperative co"pications in either
stud0 !roup( but ei!ht patients #ho #ere "ana!ed #ith a cast and thirt0:three
patients #ho #ere "ana!ed #ith a brace had postoperative co"pications( #hich
#ere "ain0 reated to #ound:heain!. T#o patients in the !roup treated #ith a
cast had deep:vein thro"bosis. & fractures heaed #e in both !roups. The
difference bet#een the t#o !roups #ith respect to the co"pication rate #as
si!nificant 5p S 0.00058. No si!nificant differences bet#een the stud0 !roups
#ere observed in the fina subIective or obIective 5cinica8 evauation. &t
t#o:0ear foo#:up e<a"ination( the avera!e score 5and standard deviation8
accordin! to the an>e:ratin! scae of 2ai>>onen et a. #as ?5 ;O: G points
the !roup treated #ith a cast and ?3 ;O: 10 points for the !roup treated #ith
brace( and the avera!e an>e score accordin! to the s0ste" of Oerud and
$oander #as ?H ;O: ? points and ?H ;O: G points( respective0. .ON.%1*ION*:
on!:ter" functiona outco"e after postoperative treat"ent of an an>e
#ith a cast and that after use of a functiona brace are si"iar. &thou!h
"obiiEation #ith use of a functiona an>e brace "a0 have so"e theoretica
beneficia effects( the ris> of postoperative #ound co"pications associated
#ith this treat"ent approach is considerab0 increased co"pared #ith that
conventiona cast treat"ent. Thus( the postoperative protoco of treat"ent
a functiona brace reCuires refine"ent before it can be !enera0 advocated
use after operative treat"ent of an an>e fracture.
Dubication T0pes:
.inica Tria
'ando"iEed .ontroed Tria
D$I7: 125H12G5 [Dub$ed : inde<ed for $E7%INE]
G5: Nhon!!uo =iu ,u .hon! +ian /ai 2e Na Nhi. 2002 $a031A538:20G:11.
[Orthopaedic appications for biode!radabe and absorbabe interna fi<ation
[&rtice in .hinese]
%iu +)( $a /9( =u ==.
7epart"ent of Orthopaedics( ,irst .inica 9ospita of +iin 1niversit0(
.han!chun +iin( D. '. .hina 130021. I!
O6+E.TIFE: To iustrate the effect and co"pication of orthopedic
for biode!radabe and absorbabe interna fi<ation of fractures( and to
the e<istent probe" and research aspect current0. $ET9O7*: The recent
iteratures on orthopedic appications and stud0 of biode!radabe and
interna fi<ation for fractures #ere revie#ed. The effect of biode!radabe
"aterias on bone heain! #as su""ariEed. 'E*1%T*: It is !ood for the
of fracture fi<ation and resut of treat"ent. The biode!radabe and absorbabe
interna fi<ation fractures had no adverse effect on bone heain!. .ON.%1*ION:
There #i be "ore #idespread appication for biode!radabe and absorbabe
"aterias in orthopedics( but the intensive research shoud be carried out to
prevent its co"pication.
Dubication T0pes:
'evie#( Tutoria
D$I7: 125AGH01 [Dub$ed : inde<ed for $E7%INE]
GA: + ,oot &n>e *ur!. 2003 +an:,eb3@2518:@5:H.
'ecurrent an>e sprains secondar0 to nonunion of a atera "aeous fracture.
,araI &&( &cei> I.
Orthopaedic *ur!er0 7epart"ent( &iredae )enera 9ospita( *teeton( /est
Por>shire( En!and.
& case of an adut "an #ith s0"pto"s of chronic recurrent an>e sprains
secondar0 to nonunion of a fracture of the tip of the atera "aeous is
presented. The nonunion #as debrided( bone !rafted( and interna0 fi<ed b0
usin! the tension band #ire techniCue. The fracture heaed and the patient
e<perienced no further episodes of an>e sprain.
D$I7: 125AH3A? [Dub$ed : inde<ed for $E7%INE]
GH: $ed Drinc Dract. 2003 +an:$ar312518:@H:50.
Dri"ar0 an>e fusion usin! bair techniCue for severe0 co""inuted fracture of
the taus.
9antira 9( & *a0ed 9( 6ar!hash I.
&:'aEi Orthopaedic 9ospita( *afat( 2u#ait."
O6+E.TIFE: /e report a case of a severe0 co""inuted fracture of the bod0 of
taus treated b0 pri"ar0 6air tibiotaar fusion. .%INI.&% D'E*ENT&TION &N7
INTE'FENTION: & ver0 severe0 co""inuted open fracture of the bod0 of the
#as treated on the sa"e da0 of inIur0 b0 debride"ent and tibiotaar fusion
the 6air fusion techniCue. .ON.%1*ION: 6air fusion "a0 be indicated in cases
of severe0 co""inuted fractures of the taar bod0. It has the advanta!e of
!ivin! a near:nor"a appearance to the foot( producin! ess shortenin! and
ao#in! "otion to re"ain at the taonavicuar and anterior subtaar Ioints.
.op0ri!ht 2003 *. 2ar!er &)( 6ase
D$I7: 125AAGAG [Dub$ed : inde<ed for $E7%INE]
G?: + Orthop *ci. 20033?518:20:5.
&n>e arthrodesis co"bined #ith tibia en!thenin! usin! the IiEarov
*a>ura>ichi 2( Tsuchi0a 9( 1ehara 2( 2abata T( Pa"ashiro T( To"ita 2.
7epart"ent of Orthopaedic *ur!er0( *choo of $edicine( 2anaEa#a 1niversit0(
Ta>ara:"achi( 2anaEa#a G20:?A@1( +apan.
/e report our e<perience usin! the IiEarov "ethod to perfor" co"bined an>e
arthrodesis and tibia en!thenin! in si< patients 5"ean a!e @H 0ears3 ran!e
25:AA 0ears8. The avera!e distraction en!th #as @.1 c" 5ran!e 1.1:A.? c"8(
the "ean period of foo#:up #as 3A "onths 5ran!e 2A:@@ "onths8. Three
had active infection of the an>e. ,our patients had under!one previous
t#o of #hich #ere pri"ar0 an>e arthrodeses. /e perfor"ed
co"pression:distraction in three patients and bone transport in three. In the
co"pression:distraction !roup( the "ean en!th !ained #as 1.G c"( the "ean
e<terna fi<ation inde< 5E,I8 #as 1@@ da0sOc"( and the "ean e<terna fi<ation
ti"e #as 2@A da0s. In the bone transport !roup( the "ean en!th !ained #as A.2
c"( the "ean E,I #as 35.@ da0sOc"( and the "ean e<terna fi<ation ti"e #as 233
da0s. & cases achieved a !ood cinica resut #ith a soid an>e arthrodesis
and no infection( defor"it0( or need for additiona support. The IiEarov
"a0 be practica0 appied for an>e arthrodesis( especia0 in co"picated
cases. The E,I and e<terna fi<ation ti"e tended to increase for patients #ith
en!th !ain of 3 c" or ess.
D$I7: 125A0??1 [Dub$ed : inde<ed for $E7%INE]
GG: 2nee *ur! *ports Trau"ato &rthrosc. 2003 +an311518:@A:G. Epub 2002 Nov
I"prove"ent in techniCue for arthroscopic an>e fusion: resuts in 15
2ats +( van 2a"pen &( de /aa:$aefiIt $..
7epart"ent of Orthopedics( 1niversit0 9ospita NiI"e!en( Dostbo< G101( A500 96
NiI"e!en( The Netherands.
/e retrospective0 assessed ti"e unti consoidation( co"pications( and
functiona resuts accordin! to $or!an fro" the cinica charts and
of 15 arthroscopic an>e fusions. In 11 patients uniatera distraction and
crossed scre# pace"ent over the fusion area throu!h tibia and fibua #ere
5!roup &83 in @ patients a techniCue of biatera distraction and parae
pace"ent fro" the dorsa side of the tibia into the nec> of the taus #as
5!roup 68. In !roup & there #ere t#o cases of insufficient co"pression at the
arthrodesis site( three cases of subopti"a co"pression( and five cases of
"aposition of the scre#s. In a cases in !roup 6 !ood co"pression and
#as achieved( and no case of "apositionin! of scre#s occurred. There #as
nonunion in 3 of 11 patients in !roup & and in none of the four patients in
!roup 6. Ti"e unti fusion #as 23.3 in !roup & and 12.5 #ee>s in !roup 6.
,unctiona resuts #ere better in !roup 6. The initia e<periences #ith our
techniCue of biatera distraction and parae scre# pace"ent are therefore
pro"isin!. *cre# pace"ent is easier and opti"a co"pression and fi<ation are
achieved. /e fee that this techniCue shoud be considered #hen perfor"in! an
arthroscopic an>e fusion.
D$I7: 125@?@51 [Dub$ed : inde<ed for $E7%INE]
100: &ust + Dh0siother. 20023@?5@8:320.
Otta#a &n>e 'ues are "ore sensitive than 7utch in detectin! si!nificant
Dope '.
D$I7: 125@203G [Dub$ed : as suppied b0 pubisher]
101: &NN + *ur!. 2002 Oct3H25108:H2@:30.
.o""ent in:
&NN + *ur!. 2002 Nov3H25118:HH5:A.
&n>e fractures: functiona and ifest0e outco"es at 2 0ears.
%ash N( 9orne )( ,ieden +( 7evane D.
7epart"ent of *ur!er0( /ein!ton *choo of $edicine( Ota!o 1niversit0(
/ein!ton( Ne# Neaand.
6&.2)'O1N7: &n>e fractures for" a hi!h proportion of the tota nu"ber of
fractures treated in Ne# Neaand. Internationa studies sho# that there are
"i<ed functiona outco"es #ith differin! fracture t0pes and subseCuent0
differin! ifest0e outco"es. $ET9O7*: ,racture cinic records and orthopaedic
ad"issions boo>s for /ein!ton Dubic 9ospita( .apita .oast 9eath(
:/ein!ton( #ere retrospective0 revie#ed to !ain a popuation of patients
sustained an>e fractures for the period +anuar0::7ece"ber 1GG?. These
#ere as>ed to fi in posta Cuestionnaires detaiin! their current an>e
function and ifest0e( t#o 0ears after fracturin! their an>e. The patientsB
radio!raphs #ere revie#ed to cassif0 the t0pes of an>e fractures sustained.
'E*1%T*: Of 1@1 patients that sustained an>e fractures( H@ #ere foo#ed up 2
0ears after their an>e fracture. & fracture t0pes avera!ed Oerud:$oander
an>e scores of H1.1. /eber & fractures avera!ed an>e function scores of G0(
/eber 6 fractures ?0( and /eber . fractures H?. ,our patients 5548 achieved
BpoorB resuts( 12 51A48 patients achieved a BfairB resut( 30 5@148 patients
!ained a B!oodB resut( 2H 53A48 patients attained Be<ceentB resuts.
%ifest0e outco"es #ere refected in the patientBs an>e function outco"es 5D
0.058. .ON.%1*ION: Datients #ho sustain an>e fractures can be e<pected to be
sti e<periencin! functiona difficuties t#o 0ears post:treat"ent.
D$I7: 1253@3?@ [Dub$ed : inde<ed for $E7%INE]
102: E"er! $ed +. 2003 +an320518:E2.
,racture of atera process of the taus presentin! as an>e pain.
*har"a *.
Fictoria Infir"ar0( *outh )as!o# 1niversit0 9ospitas N9* Trust( )as!o#( 12.
The case is presented of a 2H 0ear od #o"an #ith atera an>e pain after an
inversion inIur0 sustained #hie dancin!. &thou!h initia radio!raphs faied
identif0 the fracture( radio!raphs of the an>e at si< #ee>s sho#ed an
unsuspected fracture of the atera process of the taus. The fracture #as
treated #ith cast i""obiisation for si< #ee>s and the patient is current0
under!oin! a!!ressive ph0siotherap0. & iterature revie# reveaed that
of the atera process of the taus are freCuent0 overoo>ed and shoud be
considered in the differentia dia!nosis of patients #ith acute and chronic
an>e pain as an ear0 dia!nosis and treat"ent prevent on! ter"
D$I7: 125333G@ [Dub$ed : in process]
103: E"er! $ed +. 2003 +an320518:E1.
.o""inuted fracture of the taus not visibe on the initia radio!raph.
6urton T( *oan +.
7epart"ent of &ccident and E"er!enc0 $edicine( )enera Infir"ar0( %eeds( 12.
&1T9O':e:"ai address pease ,ractures of the taus are rare inIuries and
fractures of the bod0 of the taus are particuar0 rare. 7ia!nosis of these
fractures is aso difficut as initia radio!raphs "a0 be nor"a( particuar0
#ith osteochondra taar do"e fractures. %on! ter" "orbidit0 is co""on after
fractures of the taus. & case is presented of a patient #ith a co""inuted
fracture of the bod0 of the taus #ith non:dia!nostic initia standard an>e
radio!raphs. &ccident and e"er!enc0 doctors shoud be a#are of this inIur0(
be suspicious that patients #ith an appropriate "echanis" of inIur0 and
pronounced pain "a0 reCuire further investi!ation despite nor"a standard
radio!raphs( as an occut fracture of the taus "a0 be present.
D$I7: 125333G3 [Dub$ed : in process]
10@: .in 6io"ech 56risto( &von8. 2003 +an31?518:1G:2H.
*e"i:ri!id vs ri!id !ass fibre castin!: a bio"echanica assess"ent.
/hite '( *churen +( 2onn 7'.
7epart"ent of Orthopaedics( )ra"pian )ait and $ove"ent &na0sis .entre(
1niversit0 of &berdeenO)ra"pian 1niversit0 9ospitas Trust( *cotand(
O6+E.TIFE*: To deter"ine if se"i:ri!id s0nthetic casts provide an0 "easurabe
advanta!es co"pared to ri!id s0nthetic casts. 6&.2)'O1N7: )ass fibre banda!es
are no# co""on0 appied i""ediate0 post:inIur0 to provide ri!id
of the i"b( for both #ei!ht bearin! and non:#ei!ht bearin! casts. 9o#ever(
co"posite casts that have inherent fe<ibiit0 are aso avaiabe and it is
cai"ed the0 provide so"e functionait0. $ET9O7*: ,ive "e"bers of the
orthopaedic depart"ent each appied a ri!id and a se"i:ri!id beo# ebo#
5.oes8 and a beo# >nee #a>in! cast to a sin!e vounteer subIect. +oint
i""obiisation and functiona "ove"ent #as assessed usin! eectro!onio"etr0
i"b support usin! pressure transducers. 'E*1%T*: *e"i:ri!id .oes casts
provided si!ht0 !reater i""obiisation at the #rist #hie ao#in! fu
function and !reater support to the forear" durin! hand "ove"ents. *i"iar0(
se"i:ri!id beo# >nee #a>in! casts produced !reater i""obiisation at the
#hie ao#in! "ore forefoot "ove"ent and #ere ess of an i"pedi"ent to
.ON.%1*ION*: *e"i:ri!id castin! techniCues have "easurabe advanta!es co"pared
to ri!id s0nthetic casts and represent a further deveop"ent in the
"ana!e"ent of fractures and soft tissue inIuries. 'E%EF&N.E: *e"i:ri!id
is a reative0 ne# techniCue that can reduce so"e of the probe"s of ri!id
i""obiisation and coud potentia0 shorten the rehabiitation phase
inIur0. Infor"ation about the perfor"ance of these casts to assess their vaue
in specific appications is ver0 i"ited.
Dubication T0pes:
Evauation *tudies
D$I7: 1252H2@3 [Dub$ed : inde<ed for $E7%INE]
105: *#iss *ur!. 20023?5A8:2?5:H.
[Drevention of thro"boe"bois" in conservative a"buator0 fracture treat"ent.
Ferification of an out:of:court ,$9 5,ederation $ediation 9evetica8 e<pert
[&rtice in )er"an]
9ohendorff 6( 6urc>hardt &.
2ini> fur Orthopadische .hirur!ie( 2antonsspita Oten( Oten.
In an e<tra Iudicia assess"ent for the $edica &ssess"ent .entre of the ,$9
5,ederation $ediation 9evetica8 a cinica case of a fe"ae patient #ho had
suffered fro" deep vein thro"bosis #as revie#ed. The patient had been treated
conservative0 for a "aeoar fracture and had not received an0
thro"bosis proph0a<is. The Cuestion of fase treat"ent had to be discussed.
fina concusion of the Iudicia assess"ent is that the "edica treat"ent #ith
ph0sica thro"bosis proph0a<is of the patient #as correct. 7ue to the various
controversia Iud!e"ents found in the iterature concernin! the thro"bosis
proph0a<is( a certain insecurit0 re"ains for the treatin! ph0sician. Ta>in!
into account the different ris> factors( the indication for a proph0a<is "ust
therefore sti be decided on an individua basis.
D$I7: 12520?50 [Dub$ed : inde<ed for $E7%INE]
10A: ,oot &n>e .in. 2002 7ec3H5@8:H55:A@( vii.
E<perience #ith the *T&' an>e arthropast0 at /ri!htin!ton 9ospita( 12.
/ood D%.
/ri!htin!ton( /i!an and %ei!h N9* Trust( /i!an %ancashire( 12."
The *T&' prosthesis has been used at /ri!htin!ton 9ospita since Nove"ber
and fro" then unti +une 2002( 2?0 repace"ents have been carried out. The
opinions e<pressed in this artice are based on an on!oin! audit of these
Dubication T0pes:
'evie#( Tutoria
D$I7: 1251AH32 [Dub$ed : inde<ed for $E7%INE]
10H: ,oot &n>e .in. 2002 *ep3H538:551:A5( i<.
*0ndes"osis inIuries: acute( chronic( ne# techniCues for faied "ana!e"ent.
$osier:%a.air *( Di>e 9( Do"ero0 ).
,a"i0 Orthopedic &ssociates( @@AA /est 6risto 'oad( ,int( $I @?50H( 1*&.
& s0ndes"otic inIur0 occurs throu!h tearin!( rupture( or bon0 avusion of the
s0ndes"otic i!a"ent co"pe<. The s0ndes"otic i!a"ent co"pe< consists of the
anterior tibiofibuar( the posterior tibiofibuar( the transverse tibiofibuar
and the interosseous i!a"ents. /ithout these i!a"entous restraints the
tibiofibuar Ioint 57T,+8 #idens and can resut in an as0""etric an>e
$an0 cadaveric studies have been perfor"ed to evauate the force reCuired and
a"ount of 7T,+ dispace"ent #ith pro!ressive sectionin! of the s0ndes"otic
Dubication T0pes:
'evie# %iterature
D$I7: 12512@0G [Dub$ed : inde<ed for $E7%INE]
10?: ,oot &n>e .in. 2002 *ep3H538:@G5:G.
&bsorbabe i"pants in fracture "ana!e"ent.
*troud ...
7epart"ent of Orthopaedic *ur!er0( 1nion $e"oria 9ospita( 3333 North .avert
*treet( 6ati"ore( $7 2121?( 1*&. 0ncKhei<.or!
The use of absorbabe i"pants has been studied e<tensive0 in the cinic and
the aborator0. The i"itations of absorbabe i"pants are no# #e:>no#n and
incude a finite ife span and stren!th profie( the possibe deveop"ent of
infa""ator0 response( and their i"itation to use in fractures that do not
reCuire traditiona co"pression techniCues. &dvanta!es of these i"pants
the ac> of necessit0 for re"ova at a ater date( #hich has cost savin!s
potentia( their ease of use( and their stren!th( #hich "a0 be sufficient for
heain! in certain situations. The "ost i>e0 scenarios for the use of these
i"pants in fracture "ana!e"ent of the foot and an>e incude s0ndes"otic
disruptions( disocations about the "idfoot( and fractures of the "edia
Dubication T0pes:
'evie# %iterature
D$I7: 12512@05 [Dub$ed : inde<ed for $E7%INE]
10G: &cta Orthop Trau"ato Turc. 200233A538:2@2:H.
[The resuts of sur!ica treat"ent in an>e fractures]
[&rtice in Tur>ish]
Pi"aE E( 2ara>urt %( *erin E( 6uut $.
7epart"ent of Orthopedics and Trau"atoo!0 5Ortopedi ve Trav"atooIi &nabii"
7ai8( $edicine ,acut0 of ,irat 1niversit0( 23200 EaEi!( Tur>e0.
O6+E.TIFE*: /e evauated the resuts of sur!ica treat"ent for an>e fractures
and the factors that pa0 a roe in these resuts. $ET9O7*: The stud0 incuded
31 patients 520 "en( 11 #o"en( "ean a!e 3?.2 0ears8 #ho under#ent sur!ica
treat"ent for an>e fractures and had an adeCuate foo#:up. &ccordin! to the
%au!e:9ansen cassification( the "echanis" of occurrence #as supination:
rotation in 13 5@248( pronation:e<terna rotation in t#o 52A48(
pronation:abduction in four 51348( and supination:abduction in four patients
51348. In t#o patients 5A48( the fractures coud not be cassified. $ost of
fractures occurred #ith fain! in #inter "onths. The "aIorit0 of fractures
55548 #as of bi"aeoar t0pe. The "ean foo#:up #as 2A "onths. 'E*1%T*:
#as obtained in a fractures. &ccordin! to the obIective criteria( the
#ere !ood( "oderate( and poor in 1? 55?48( ei!ht 52A48( and five 51A48
respective0. *ubIective evauation 0ieded !ood( "oderate( and poor resuts
1H 55548( ei!ht 52A48( and si< 51G48 patients( respective0. The resuts #ere
poor especia0 in pronation:e<terna rotation and fracture:disocation t0pe
fractures. T#o patients 5A48 deveoped de!enerative arthritis. .ON.%1*ION: In
our opinion( the best anato"ica reduction "a0 be achieved b0 sur!ica
of an>e fractures that present #ith a taar tit( fibuar shortenin!( and
inIur0 to the s0ndes"osis.
Dubication T0pes:
Evauation *tudies
D$I7: 125100?2 [Dub$ed : inde<ed for $E7%INE]
110: $i $ed. 2002 7ec31AH5128:10@@.
E<posive ordinance disposa tea" eCuip"ent and its use in dia!nosin!
$ida )*( $c)ranahan $E.
Operation Endurin! ,reedo"( Tas> ,orce 'a>>asan( 99.:2:1?H( &DO &E 0G355.
& 31:0ear:od "an presented to the 'a>>asan battaion aid station( ocated at
the -andahar &irport( &f!hanistan( #ith co"paints and ph0sica findin!s
consistent #ith those that #oud either support a !rade III an>e sprain or
fracture. The battaion aid station is an echeon I eve of care. This
does not have radio!raphic capabiities. /ith the cosest radioo!0 faciit0
ocated in *eeb( O"an the H10th E<posive Ordinance 7isposa tea"( #hich #as
operatin! in the area( #as contacted. This unit #as abe to perfor"
in a ti"e0 "anner to hep aid in correct0 dia!nosin! the inIur0.
D$I7: 125021?2 [Dub$ed : inde<ed for $E7%INE]
111: + ,oot &n>e *ur!. 2002 Nov:7ec3@15A8:3HG:??.
$echanica characteristics of an absorbabe copo0"er interna fi<ation pin.
DietrEa> /*( .a"inear 7*( Derns *F.
6io"et( Inc.( D.O. 6o< 5?H( /arsa#( IN @A5?1( 1*&.
&bsorbabe interna fi<ation is !ainin! acceptance a"on! foot and an>e
sur!eons. /hie absorbabe pins "ade of po0:%:actic acid( po0!0coic acid(
or po0:p:dio<anone are !enera0 effective as appied in the foot( their
stren!th oss profies and de!radation characteristics "a0 not be opti"a0
"atched to the heain! process. This stud0 investi!ated a nove absorbabe
oriented copo0"er pin( #ith uniCue absorption characteristics( "ade of ?24
po0:%:actic acid and 1?4 po0!0coic acid( to deter"ine its suitabiit0 for
use in fi<ation in the foot. The pins #ere incubated in a 3H de!rees . buffer
bath that si"uated in vivo conditions and #ere "echanica0 tested in
four:point bend and shear at ti"e intervas up to 12 #ee>s. In vitro stren!th
oss profies de"onstrated pea> stren!th retention 5fe<ura and shear8 for
about ? #ee>s( #ith 504 of properties re"ainin! b0 12 #ee>s. The initia
"oduus of the pins #as appro<i"ate0 H )Da. The "athe"atica reationship
bet#een pin stren!th and pin dia"eter #as discussed( providin! the sur!eon
hepfu criteria for "a>in! an i"pant seection. The de!radation ti"e course
these pins appears to co"pi"ent the >no#n heain! d0na"ics of bone( "a>in!
a suitabe choice for use in foot sur!er0.
D$I7: 12500H?G [Dub$ed : inde<ed for $E7%INE]
112: + Dediatr Orthop. 2003 +an:,eb323518:55:G.
Fa!us defor"it0 after fibuar resection in chidren.
)onEaeE:9erranE D( de 'io &( 6ur!os +( %opeE:$ondeIar +&( 'apariE +$.
&caa de 9enares 1niversit0( $adrid( *pain. p!
The authors present a retrospective stud0 of 23 patients in their !ro#in!
#ho under#ent resection of "ore than 2 c" of the fibua. %on!:ter" effects in
the an>e and tibia #ere ana0Eed. The patients #ere radioo!ica0 studied
usin! the contraatera side as contro. 'epresentative radioo!ic findin!s
dista "i!ration of the fibua head in H54 5but #ithout cinica reevance8(
thic>enin! of the e<terna tibia corte< in 204( taar tit in @54( pro<i"a
"i!ration of the atera "aeous in 554( and diaph0sea va!us of the tibia
204 of the cases. Inco"pete re!eneration of fibua #as observed in 5?4 of the
cases. T#o patients suffered a spira diaph0sea fracture and another a so#
ph0sea fracture of the dista tibia. In this stud0( "an0 radioo!ic chan!es
#ere observed after fibua resection. The authors su!!est usin! reconstruction
"ethods after fibua resection #hen it is possibe.
D$I7: 12@GGG@@ [Dub$ed : inde<ed for $E7%INE]
113: Nhon!hua /ai 2e Na Nhi. 2002 Nov3@05118:?55:H.
1niatera e<terna fi<ator co"bined #ith si"pe interna fi<ation for severe
open tibia:fibuar fracture.
Nhan! P( ,an! /( %ou .( %u 9( *hi )( Nhao +.
7epart"ent of Orthopeadic( NhuIi DeopeBs 9ospita( NheIian! 311?00( .hina.
O6+E.TIFE: To i"prove the treat"ent for severe open tibia:fibuar fracture.
$ET9O7*: ,ro" 1GG@ to 2000( 1@A patients #ith severe open tibia:fibuar
#ere treated. &ccordin! to )ustio cassification( a patients #ere of t0pe
III. &"on! the"( GA patients beon!ed to III &( 3A III 6( and 1? III .. One
hundred and ei!ht patients #ere "ae and 3? fe"ae( a!ed fro" 11 to A? 0ears(
#ith an avera!e of 31. & patients #ere treated #ith uniatera e<terna
fi<ator co"bined #ith si"pe interna fi<ation 5!enera scre# or 2irschner
#ire8. Thirt0 patients #ere treated #ith secondar0 fap operation. &"on! the"(
1G patients received pedice !astrocne"ius "usce faps( G free vastus
"usce faps( and 2 free atissi"us dorsi "usce faps. 'E*1%T*: Three
of t0pe III6 #ere subIected to a"putation because of advanced a!e and
cerebra or thoraco:abdo"ina inIur0. ,ive patients of t0pe III . had
because of insufficient postoperative bood supp0 and necrosis. The rupture
other 13? patients #as #e reduced( and fir"0 fi<ed. The0 #ere foo#ed up
A "onths:A 0ears( #ith an avera!e of 2.5 0ears. The avera!e ti"e of
fracture:union #as 2H #ee>s( and the avera!e ti"e for re"ova of fi<tors #as
#ee>s. The "otion of >nee Ioint ran!ed fro" 0 to 120 de!ree in 110 patients3
fro" 0 to 100 de!rees in 25( and fro" 0 to G0 de!rees. The "otion of an>e
#as appro<i"ate0 nor"a. .ON.%1*ION*: ,or patients #ith severe open
tibia:fibuar fracture( co"prehensive ana0sis shoud be "ade for preservation
of the #ounded i"b or a"putation as for eder0 patients #ith vesse:nerve
inIur0 or #ith cerebra: thoracoabdo"ina inIur0( e"er!enc0 a"putation shoud
done. 1niatera e<terna fi<ator co"bined #ith si"pe interna fi<ation
5!enera scre# or 2irschner #ire8 for severe open tibia:fibuar fracture is
advanta!eous for a si"pe and reiabe fi<ation. It is ess trau"atic.
D$I7: 12@?H?A@ [Dub$ed : inde<ed for $E7%INE]
11@: 1nfachirur!. 2002 7ec31055128:1115:313 CuiE 131:2.
[Dion tibia fractures]
[&rtice in )er"an]
9ahn $D( Thies +/.
2ini> fur 1nfa: und /iederhersteun!schirur!ie Nentra>ran>enhaus
*an>t:+ur!en:*trasse( 6re"en. $ichae:Dau.9ahnKE>h:bre"en:"
D$I7: 12@?A5?0 [Dub$ed : inde<ed for $E7%INE]
115: + Orthop *ci. 20023H5A8:AG@:H.
.harcot Ioint:i>e chan!es foo#in! an>e fracture in a patient #ith no
under0in! disease: report of a rare case.
2u"a!ai $( Po>ota 2( Endoh T( Ta>e"oto 9( Na!ata 2.
7epart"ent of Orthopaedic *ur!er0( 2uru"e 1niversit0 *choo of $edicine( AH
&sahi:"achi( 2uru"e( ,u>uo>a ?30:0011( +apan.
.harcot Ioint is a disease that often occurs in patients #ith diabetes
tabes dorsais( s0rin!o"0eia( chronic acohois"( epros0( trau"a( or
after fractures and disocations. The treat"ent for .harcot Ioint has various
co"pications( such as s>in esions( infections( and dea0ed union. /e present
our e<perience #ith a "ae patient #ho deveoped .harcot Ioint:i>e chan!es
#ithout diabetes "eitus or an0 other disease after an an>e fracture due to
"inor trau"a.
D$I7: 12@?A@H5 [Dub$ed : inde<ed for $E7%INE]
11A: &rch Orthop Trau"a *ur!. 2002 7ec31225G:108:5@1:3. Epub 2002 Nov 0H.
$edia peritaar disocation.
Dehivan O( &>"aE I( *oa>o!u .( 'odop O.
)uhane $iitar0 $edica &cade"0( 9a0darpasa Trainin! 9ospita( 7epart"ent of
Orthopaedics and Trau"atoo!0( Istanbu( Tur>e0. oEipehKe:>
In this paper( a case of cosed "edia subtaar disocation and acco"pan0in!
taar head fracture in a 22:0ear:od "an #hich occurred #hie #a>in! on a
do#nhi road is reported. .osed reduction under !enera anesthesia #as
unsuccessfu. The obstace for cosed reduction #as deter"ined at sur!er0 for
open reduction and interna fi<ation as buttonhoin! of the taar head throu!h
the e<tensor retinacuu". &t the 2A:"onth foo#:up( he #as pain:free in his
dai0 activities.
D$I7: 12@?33@0 [Dub$ed : inde<ed for $E7%INE]
11H: + Trau"a. 2002 7ec3535A8:10G@:1013 discussion 1102.
Is there a reiabe outco"e "easure"ent for dispaced intra:articuar
2inner 6+( 6est '( ,a> 2( Thon 2D.
7epart"ent of *ur!er0( 'obert:6osch:2ran>enhaus( *tutt!art( )er"an0.
6&.2)'O1N7: The treat"ent of dispaced intra:articuar cacanea fractures
re"ains controversia( because of difficuties in assessin! the outco"e. The
!oa of this stud0( therefore( #as to co"pare different outco"e "easure"ents
#ith !ait ana0sis( usin! d0na"ic pedo!raph0. $ET9O7*: T#ent0 patients #ith
operative0 treated dispaced intra:articuar cacanea fractures #ere
up cinica0 and radio!raphica0. In addition( foot pressure #as "easured
usin! d0na"ic pedo!raph0. 'E*1%T*: No si!nificant difference #as found bet#een
the t#o cinica outco"e scores used 5p S 0.0?83 both reveaed !ood resuts.
70na"ic pedo!raph0( ho#ever( sho#ed a shift of the "a<i"u" i"pact and ro:off
of the foot to the atera side( as #e as a #idenin! of these Eones in the
hee and on the soe in 1@ of 20 patients. .ON.%1*ION: These resuts indicate
that traditiona outco"e "easure"ents underesti"ate functiona deficits in our
patients. $onitorin! pantar pressure distribution "i!ht therefore be a usefu
too for assessin! foot function in these patients.
Dubication T0pes:
Evauation *tudies
D$I7: 12@H?03@ [Dub$ed : inde<ed for $E7%INE]
11?: *ports $ed. 2003333518:H5:?1.
Overvie# of inIuries in the 0oun! athete.
&diri" T&( .hen! T%.
7ivision of E"er!enc0 $edicine( .hidrenBs Nationa $edica .enter(
7. 20010( 1*&. tadiri"Kcn"c.or!
It is esti"ated that 30 "iion chidren in the 1* participate in or!anised
sports pro!ra""es. &s "ore and "ore chidren participate in sports and
recreationa activities( there has been an increase in acute and overuse
inIuries. E"er!enc0 depart"ent visits are hi!hest a"on! the schoo:a!e to
adut popuation. Over one:third of schoo:a!e chidren #i sustain an inIur0
severe enou!h to be treated b0 a doctor or nurse. The 0ear0 costs have been
esti"ated to be as hi!h as 1.? biion 1* doars. There are ph0sica and
ph0sioo!ica differences bet#een chidren and aduts that "a0 cause chidren
be "ore vunerabe to inIur0. ,actors that contribute to this difference in
vunerabiit0 incude: chidren have a ar!er surface area to "ass ratio(
chidren have ar!er heads proportionate0( chidren "a0 be too s"a for
protective eCuip"ent( !ro#in! cartia!e "a0 be "ore vunerabe to stresses and
chidren "a0 not have the co"pe< "otor s>is needed for certain sports unti
after pubert0. The "ost co""on0 inIured areas of the bod0 incude the an>e
>nee foo#ed b0 the hand( #rist( ebo#( shin and caf( head( nec> and
.ontusions and strains are the "ost co""on inIuries sustained b0 0oun!
In ear0 adoescence( apoph0sitis or strains at the apoph0ses are co""on. The
"ost co""on sites are at the >nee 5Os!ood:*chatter disease8( at the hee
5*everBs disease8 and at the ebo# 5%itte %ea!ue Ebo#8. Non:trau"atic >nee
pain is one of the "ost co""on co"paints in the 0oun! athete. Datear
Dain *0ndro"e 5D,D*8 has a consteation of causes that incude overuse( poor
trac>in! of the patear( "aai!n"ent probe"s of the e!s and foot probe"s(
such as pes panus. In the chid( hip pathoo!0 can present as >nee pain so a
carefu hip e<a" is i"portant in the chid presentin! #ith an insidious onset
>nee pain. Other co""on inIuries in 0oun! athetes discussed incude anterior
cruciate i!a"ent inIuries( an>e sprains and an>e fractures. Drevention of
sports and recreation:reated inIuries is the idea. There are si< potentia
#a0s to prevent inIuries in !enera: 5i8 the pre:season ph0sica e<a"ination3
5ii8 "edica covera!e at sportin! events3 5iii8 proper coachin!3 5iv8 adeCuate
h0dration3 5v8 proper officiatin!3 and 5vi8 proper eCuip"ent and fiedOsurface
pa0in! conditions.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12@HH3HG [Dub$ed : inde<ed for $E7%INE]
11G: + Orthop *ur! 59on! 2on!8. 2001 +un3G518:3G:@3.
,oot and an>e inIuries occurrin! in infatabe rescue boats 5I'68 durin! surf
ifesavin! activities.
&shton %&( )ruIic %.
$ona Fae 9ospita( &ustraia.
Infatabe 'escue 6oats 5I'6s8 are utiised b0 the *urf %ife *avin!
5*%*&8 in &ustraia to perfor" rescue operations and in re!iona co"petitions
bet#een surf cubs. These activities have resuted in a nu"ber of serious foot
and an>e inIuries #hich refect the hi!h i"pact of this activit0 in heav0 and
unpredictabe surf. /e have retrospective0 revie#ed 12 si!nificant inIuries
reatin! to I'6 usa!e presented to our re!iona hospita e"er!enc0 depart"ent
over a 3:0ear period. These incude A %isfranc fracture disocations of the
"idfoot( @ an>e fracture variants( one tibia shaft fracture( and one
rupture of the peronea retinacuu" eadin! to peronea tendon disocation.
&na0sis of I'6 footstraps in current usa!e sho#s the0 are direct0 reated to
the patterns of inIur0 seen. /e have reco""ended "odifications to footstraps
hand!rips current0 in use #ith the ai" of "ini"isin! or preventin! these
D$I7: 12@A??@2 [Dub$ed : as suppied b0 pubisher]
120: Int Orthop. 200232A5A8:3HH:?0. Epub 2002 +u 0A.
Tibia reconstruction usin! a non:vascuarised fibuar transfer.
$orsi E.
,acut0 of $edicine( $enoufia 1niversit0( 25 E"ohtsb *treet( $ohr" 6a>(
&e<andria( E!0pt. esa0edU"orsiKhot""
& non:vascuarised contraatera fibuar transfer #as perfor"ed on seven
patients #ith non:union of the tibia and a scerosed se!"enta bone defect
foo#in! inIur0. The avera!e foo#:up #as 2.H 0ears #ith a "ini"u" of 2
The operation #as successfu in achievin! fracture union in si< patients( #ith
an avera!e ti"e to union of @.5 "onths 5ran!e: 3:A8. *hortenin! of up to 2.@
#as found in t#o patients and "id residua an>e stiffness in one. This
procedure is successfu and si"pe #hen co"pared to "icrovascuar and IiEarov
D$I7: 12@AA?H3 [Dub$ed : inde<ed for $E7%INE]
121: + 6one +oint *ur! 6r. 2002 Nov3?@5?8:113?:@1.
Dercutaneous scre# fi<ation for fractures of the sesa"oid bones of the hau<.
6unde .$( Nichoson D( 6ac>ne0 $/.
Over a period of one 0ear #e treated nine fractures ofhe sesa"oid bones of the
hau<( five of #hich #ere in the "edia sesa"oid. & patients had s0"pto"s
e<ercise( but on0 one had a recent histor0 of inIur0. The "ean a!e of the
patients #as 2H 0ears 51H to @58 and there #ere si< "en. The "ean duration of
s0"pto"s #as nine "onths 51.5 to @?8. The dia!nosis #as based on cinica and
radioo!ica investi!ations. /e describe a ne# sur!ica techniCue for
percutaneous scre# fi<ation for these fractures usin! a 6arou> scre#. & the
patients #ere assessed before and after sur!er0 usin! the &"erican Orthopaedic
,oot and &n>e *ociet0 9au< *core 5&O,&*8. There #as a statistica0
si!nificant i"prove"ent in the "ean score fro" @A.G to ?0.H 5p S 0.00038 after
fi<ation of the fracture #ith a rapid resoution of s0"pto"s. & patients
returned to their previous eve of activit0 b0 three "onths. /e beieve that
this reative0 si"pe techniCue is an e<ceent "ethod of treat"ent in
appropriate0 seected patients.
D$I7: 12@A3A5? [Dub$ed : inde<ed for $E7%INE]
122: ,oot &n>e .in. 2002 +un3H528:323:50.
,oot and an>e fractures in the industria settin!.
.a"pbe +T.
7epart"ent of Orthopaedic *ur!er0( +ohns 9op>ins 1niversit0( +ohns 9op>ins
6a0vie# $edica .enter( @G@0 Eastern &venue( 6ati"ore( $7 2122@:2H?0( 1*&.
,ractures of the an>e and foot are co""on in the #or>er. Droper initia
assess"ent and treat"ent can resut in a functiona recover0 that is pro"pt
co"pete in "an0 cases. $an0 fractures( ho#ever( have a poor on!:ter"
and proon!ed recover0. ,ran> initia discussions #ith the patient and case
"ana!er can hep the s0ste" better "ana!e the patientBs future.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12@A2113 [Dub$ed : inde<ed for $E7%INE]
123: Osteoporos Int. 2002 7ec3135128:G?0:G.
$easure"ent of bone adIacent to tibia shaft fracture.
,inda0 *.( Easte '( In!e 6$.
6one $etabois" )roup( *ection of $edicine( 7ivision of .inica *ciences(
1niversit0 of *heffied( *heffied( 12.
7ea0ed union and non:union are co""on co"pications after fracture of the
tibia shaft. 'esponse of the surroundin! bone as a fracture heas coud be
"onitored usin! techniCues current0 used in the stud0 of osteoporosis. The
of our stud0 #ere to: 518 evauate the decre"ent in bone "easure"ents "ade
to the fracture usin! dua:ener!0 =:ra0 absorptio"etr0 57=&8( Cuantitative
utrasound 5-1*8 and periphera Cuantitative co"puted to"o!raph0 5p-.T83 528
co"pare vaues for fractured versus non:fractured e! to deter"ine the
of decre"ent in bone "easure"ents3 and 538 cacuate short:ter" precision in
7=&( -1* and p-.T in order to cacuate the ratio of decre"ent to precision
5response ratio( ''8 to deter"ine the opti"a test for "onitorin! chan!es
tibia fracture. The bi!!est decre"ent in bone "easure"ents at the ipsiatera
i"b of 2? patients #ith tibia shaft fracture #as observed at the p-.T tibia
trabecuar sites 5dista S 1G4( pJ0.00013 pro<i"a 54 S 214( pJ0.0013 pro<i"a
104 S 2?4( pJ0.0018 and the utradista tibiaOfibua "easured b0 7=& 51G4(
pJ0.00018. /hen co"parin! N:scores( the "a!nitude of decre"ents at the
ipsiatera i"b #as bi!!er for variabes "easured direct0 at the tibia( both
pro<i"a and dista to the fracture. The "a!nitude of the decre"ent in
utradista tibiaOfibua 6$7 decreased as the ti"e since fracture increased
5 r
S 0.558. /hen response ratios are considered( p-.T "easure"ents at the dista
tibia 5'' A:?8 and pro<i"a 54 and 104 trabecuar sites 5'' 5 and G
respective08 #ere found to be the "ost sensitive to chan!e. Therefore( p-.T
the trabecuar re!ions of either the pro<i"a or dista tibia shoud prove the
"ost sensitive "easure"ent for "onitorin! chan!es in bone adIacent to a tibia
shaft fracture.
D$I7: 12@5GG@1 [Dub$ed : inde<ed for $E7%INE]
12@: ,oot &n>e Int. 2002 Nov3235118:GGG:1002.
The roe of pusatie cod co"pression in ede"a resoution foo#in! an>e
fractures: a rando"iEed cinica tria.
$ora *( Naavras .)( /an! %( Thordarson 76.
T#ent0:four patients #ith dispaced an>e fractures a#aitin! sur!er0 #ere
rando"iEed to a stud0 5nS118 or a contro !roup 5nS138. In the stud0 !roup(
patients had a pusatie cod co"pression 5D..8 device appied to their an>e(
and re"ained at bed rest #ith the e<tre"it0 eevated #hie a#aitin! sur!er0.
the contro !roup patients re"ained in a posterior "oded spint instead of
D.. device. 6aseine circu"ferentia "easure"ents of the an>e #ere obtained(
foo#ed b0 "easure"ents at 2@:hour incre"ents to evauate ede"a resoution.
addition( patient satisfaction #ith use of the D.. device #as evauated #ith a
scae ran!in! fro" 1 to @.The "edian decrease of circu"ference in the stud0
!roup co"pared to the contro !roup #as 0.5 c" vs. 0.1 c" at 2@ hours
0.G c" vs. 0.@ c" at @? hours 5pJ0.0018( and 1.2 c" vs. 0.5 c" at H2 hours
5pS0.00G8. The ratio of the decrease in circu"ference reative to the
circu"ference of the nor"a an>e #as si!nificant0 hi!her in the D.. !roup
co"pared to the contro !roup at a ti"e points. & patients in the D..
#ere satisfied #ith the device 5"edian satisfaction score S @8. The D.. device
#as #e toerated and resuted in a si!nificant0 !reater reduction of an>e
circu"ference at 2@( @?( and H2 hours after its appication( co"pared to
spintin! and eevation aone.The D.. device faciitates ede"a resoution
foo#in! an>e fractures.
Dubication T0pes:
.inica Tria
'ando"iEed .ontroed Tria
D$I7: 12@@G@03 [Dub$ed : inde<ed for $E7%INE]
125: ,oot &n>e Int. 2002 Nov3235118:GG2:5.
Evauation of co"pression in intra"eduar0 hindfoot arthrodesis.
6erson %( $c)arve0 /.( .anton TO.
The )reater 9artford Orthopedic )roup( D.( 9artford( .T( 1*&.
.o"pression #as evauated in an intra"eduar0 hindfoot arthrodesis cadaver
"ode usin! an e<terna fi<ator and a Rsecond !enerationR intra"eduar0
co"pression nai. ,our cadaver speci"ens #ere used. ,our trias #ere done #ith
each speci"en. Tria 1: "anua co"pression #ith the 1st !eneration nai. Tria
2: e<terna fi<ator for co"pression #ith the 1st !eneration nai. Tria 3:
e<terna fi<ator for co"pression #ith the 2nd !eneration nai. Tria @:
nai:"ounted co"pression device #ith the 2nd !eneration nai. In Tria 1 it
not possibe to obtain or "aintain co"pression. In Tria 2 ar!e vaues of
co"pression #ere obtained #ith the e<terna fi<ator( ho#ever co"pression #as
"aintained after the first !eneration nais #ere oc>ed and the fi<ator #as
re"oved. In Tria 3 ar!e vaues of co"pression #ere obtained #ith the
fi<ator( but "ini"a co"pression #as "aintained after the second:!eneration
nais #ere oc>ed and the fi<ator #as re"oved. In Tria @ ar!e vaues of
co"pression #ere obtained #ith the co"pression device and !reater than A04 of
the co"pression #as "aintained after the nai #as oc>ed and the co"pression
device #as reeased. The stud0 reveaed that both the e<terna fi<ator and the
co"pression device coud produce co"pression. The e<terna fi<ator is usefu
an aid in the O.'. 9o#ever( in this stud0 si!nificant co"pression #as
on0 #ith utiiEation of the co"pression device.
D$I7: 12@@G@01 [Dub$ed : inde<ed for $E7%INE]
12A: &rch Orthop Trau"a *ur!. 2002 Nov31225?8:@2@:?. Epub 2002 +un 20.
Dercutaneous( arthroscopica0:assisted osteos0nthesis of cacaneus fractures.
)avi> +$( 'a""et *( N#ipp 9.
7epart"ent of Trau"a and 'econstructive *ur!er0( 1niversit0 9ospita .ar
.arus( ,etscherstr. H@( 0130H 7resden( )er"an0.
6&.2)'O1N7: The deveop"ent of "aIor and "inor #ound co"pications is a "aIor
concern in the open reduction and interna fi<ation of dispaced intra:
cacaneus fractures. Dercutaneous( arthroscopica0 assisted scre#
osteos0nthesis #as deveoped to "ini"iEe the sur!ica approach #ithout ris>in!
inadeCuate reduction of the subtaar Ioint. The "ethod #as appied in seected
cases of dispaced intra:articuar cacaneus fractures #ith one fracture ine
crossin! the posterior cacanea facet 5*anders t0pe II fractures8. $ET9O7*:
6et#een $arch 1GG? and +u0 2000( 15 patients #ere treated #ith that "ethod.
Dercutaneous evera!e #as carried out #ith a *chanE scre# introduced into the
tuberosit0 fra!"ent 5the /esthues "aneuver8 under direct arthroscopic and
fuoroscopic contro. &fter anato"ic reduction #as achieved( the fra!"ents
fi<ed #ith three to si< canceous scre#s introduced via stab incisions.
'E*1%T*: The functiona resuts of 10 patients at a "ini"u" of 1 0ear foo#:
are !ood to e<ceent( #ith an avera!e &O,&* an>e:hindfoot score of G3.H
?H:1008 and an avera!e $ar0and ,oot *core of G5.? 5ran!e G3:1008. Overa
patient co"fort and satisfaction #ere superior to open reduction for si"iar
fracture patterns( and the in:hospita ti"e coud be reduced. .ON.%1*ION*:
Dercutaneous( arthroscopica0 assisted osteos0nthesis offers e<act assess"ent
of the articuar surface and ao#s anato"ica reduction #hie adherin! to the
principes of "ini"a0 invasive sur!er0. The short:ter" resuts are
#hie on!:ter" resuts #ith !reater patient cohorts are a#aited.
D$I7: 12@@21HA [Dub$ed : inde<ed for $E7%INE]
12H: .in Orthop. 2002 Nov35@0@8:1GA:202.
Dreoperative hip to an>e radio!raphs in tota >nee arthropast0.
$c)ror0 +E( Trousdae 'T( Da!nano $/( Ni!bur $.
Nava $edica .enter Dorts"outh( Dorts"outh( F&( 1*&.
/hether a preoperative on! e! radio!raph ta>en #ith the patient standin!
the sur!eon reproduce a nor"a "echanica a<is after tota >nee arthropast0
un>no#n. The purpose of the current stud0 #as to evauate #hether a
on! e! radio!raph heps to restore nor"a i"b ai!n"ent after tota >nee
arthropast0. Ninet0:four patients 512@ pri"ar0 tota >nee arthropasties8
rando"iEed to either receive or not receive a preoperative on! e! standin!
radio!raph. Datients #ith previous hip or an>e sur!er0( fe"ora or tibia
fracture( defor"it0 of 15 de!rees or !reater( or those #ho #ere obese 5bod0
#ei!ht inde< M @0 >!O"28 #ere e<cuded. & arthropasties #ere done b0 one
sur!eon. The an!e of dista fe"ora resection varied bet#een 5 de!rees and ?
de!rees 5"ean( A.2 de!rees8 a"on! patients #ith on! e! radio!raphs. In
patients #ithout on! e! radio!raphs( the dista fe"ur #as cut at 5 de!rees.
%on! e! radio!raphs #ere obtained postoperative0 in a patients and the
"echanica a<is #as assessed( first b0 #hether the "echanica a<is fe #ithin
the centra third of the >nee( and second b0 the distance in "ii"eters that
the "echanica a<is fe fro" the >nee center. No si!nificant difference in
postoperative "echanica a<is #as detected bet#een the t#o !roups. Ei!ht0:si<
percent of the patients #ith on! e! preoperative radio!raphs and G24 of the
patients #ithout on! e! preoperative radio!raphs had the "echanica a<is
throu!h the centra 51O38 of the >nee. Dreoperative hip to an>e on! e!
radio!raphs ta>en #ith the patient standin! did not si!nificant0 hep to
a neutra "echanica a<is durin! routine tota >nee arthropast0.
Dubication T0pes:
.inica Tria
'ando"iEed .ontroed Tria
D$I7: 12@3G2A0 [Dub$ed : inde<ed for $E7%INE]
12?: + Orthop Trau"a. 2002 Nov:7ec31A5108:H0G:1A.
Trabecuar bone strain chan!es associated #ith subchondra co""inution of the
dista tibia.
$c2ine0 TO( .aendar D/( 6a0 62.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of Io#a 9ospita and .inics(
.it0( Io#a 522@2( 1*&. todd:"c>
O6+E.TIFE: To "easure trabecuar bone strain chan!es resutin! fro" three
increasin! subchondra bone defects in the dista tibia. 7E*I)N: .adaveric
bio"echanica "ode. *ETTIN): .ontact radio!raphs #ere "ade fro" sa!itta
sections of hu"an cadaveric dista tibia under no oad and oaded to @00 N.
7i!ita i"a!es( "ade fro" contact radio!raphs of unoaded speci"ens( #ere
co"pared to correspondin! di!ita i"a!es of oaded speci"ens usin! custo"
soft#are that "easures trabecuar defor"ation and cacuates trabecuar bone
strain. INTE'FENTION: T#eve speci"ens #ere initia0 oaded intact in
co"pression. Testin! #as repeated after creatin! three increasin! circuar
subchondra bone defects in the center of a sa!itta cross:section of the
tibia. 7efects #ere 104( 204( and 304 of the sa!itta dia"eter of the dista
tibia. $&IN O1T.O$E $E&*1'E*: $a<i"u" shear strain( "a<i"u" principa strain(
and "ini"u" principa strain #ere "easured in si< discrete re!ions in the
trabecuar bone in the dista tibia. 'E*1%T*: *"a defects 51048 caused
strain eevations. *i!nificant increases in trabecuar bone strain #ere
#ith "ediu" 52048 and ar!e 53048 defects. .o"pressive strain increases as
as 1@00 "icrostrain 510 strain8 #ere "easured adIacent to and pro<i"a to the
defects #ith "ediu" and ar!e defects. .ON.%1*ION*: *ubchondra defects cause
siEe:dependent eevations in trabecuar bone strain in the dista tibia.
and ar!e defects caused rapid0 increasin! trabecuar bone defor"ation under
D$I7: 12@3G1G@ [Dub$ed : inde<ed for $E7%INE]
12G: &NN + *ur!. 2002 Nov3H25118:HH5:A.
.o""ent on:
&NN + *ur!. 2002 Oct3H25108:H2@:30.
The i"portance of outco"e.
Nade *.
Dubication T0pes:
D$I7: 12@3HA?5 [Dub$ed : inde<ed for $E7%INE]
130: Nurs *tand. 2002 Oct 2331H5A8:3H:@A3 CuiE @H:?.
.o""ent in:
Nurs *tand. 2003 $a0 H:1331H53@8:22.
&ssess"ent and "ana!e"ent of foot and an>e fractures.
%arsen 7.
&QE 7epart"ent( 6ro"e0 9ospita( 2ent. dorthe.arsenKbro"e0hospitas.nhs.u>
InIuries to the foot and an>e are co""on presentations in &QE( and #hie
are rare0 ife:threatenin!( incorrect dia!nosis and "ana!e"ent can have
conseCuences for patients. This artice discusses the causes( assess"ent and
treat"ent of patients #ith these fractures.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12@3@H@G [Dub$ed : inde<ed for $E7%INE]
131: + 6one +oint *ur! &". 2002 Nov3?@:&5118:2111:G.
/hatBs ne# in orthopaedic trau"a.
/iss 7&.
*outhern .aifornia Orthopaedic Institute( A?15 Nobe &venue( Fan Nu0s( .&
G1@05( 1*&. donorthoKearthin>.net
Dubication T0pes:
'evie#( Tutoria
D$I7: 12@2GH?H [Dub$ed : inde<ed for $E7%INE]
132: + 6one +oint *ur! &". 2002 Nov3?@:&5118:202G:3?.
2ine"atic behavior of the an>e foo#in! "aeoar fracture repair in a
hi!h:fideit0 cadaver "ode.
$icheson +7( 9a"e &+( 6ucEe> ,%( *har>e0 N&.
.enter for %oco"otion *tudies( The Denns0vania *tate 1niversit0( 2G
6uidin!( 1niversit0 Dar>( D& 1A?02( 1*&.
6&.2)'O1N7: Drevious studies invovin! a<ia0 oaded an>e cadaver speci"ens
under!oin! a passive ran!e of "otion after fracture have de"onstrated rotator0
instabiit0 patterns consistin! of e<cessive e<terna rotation durin! pantar
fe<ion. The present stud0 #as desi!ned to e<pand these studies b0 usin! a
in #hich an>e "otion is controed b0 ph0sioo!ica0 accurate "otor forces
!enerated throu!h phasic force:coupes attached to the "usce:tendon units.
$ET9O7*: Ei!ht ri!ht une"ba"ed cadaver feet #ere tested in a d0na"ic !ait
si"uator that reproduces the sa!itta >ine"atics of the tibia #hie app0in!
ph0sioo!ica "usce forces to the tendons of the "aIor e<trinsic "usces of
foot. *i<:de!rees:of:freedo" >ine"atics of the tibia and taus #ere "easured
#ith use of a FI.ON "otion:ana0sis s0ste". The e<peri"enta conditions
a co"binations of atera and "edia inIur0 to reproduce the cinica
cassifications of an>e fracture. *tatistica ana0sis #as perfor"ed #ith
repeated:"easures ana0ses of variance. 'E*1%T*: The taus of the intact
de"onstrated couped e<terna rotation and inversion reative to the tibia as
the an>e pantar fe<ed. Osteoto"0 of the fibua( si"uatin! a atera an>e
fracture( si!ht0 but si!nificant0 increased e<terna rotation and inversion
of the taus 5p J 0.0018( #hereas disruption of either the superficia or the
deep detoid i!a"ent increased taar eversion 5p J 0.0038 and disruption of
deep detoid i!a"ent increased interna rotation 5p J 0.00018. The aberrant
"otions #ere corrected b0 repair of the inIured structure. .ON.%1*ION*: The
predo"inant couped rotation of the taus is e<terna rotation associated #ith
pantar fe<ion. ,oo#in! pro!ressive an>e destabiiEation( taar e<terna
rotation and inversion increased. .inica 'eevance: The cinica
decision:"a>in! process re!ardin! the treat"ent of an>e fractures centers on
deter"ination of #hether the inIur0 is e<pected to resut in abnor"a "otion(
#hich is thou!ht to predispose to the deveop"ent of arthritis. The present
stud0 de"onstrated a re"ar>abe de!ree of an>e stabiit0 durin! stance phase
even #hen there #as severe disruption of "edia and atera structures. This
findin! su!!ests that a "ain deter"inant of cinica outco"e after an>e
fracture "a0 be an>e "otion durin! s#in! phase( #hen an>e stabiit0 is not
au!"ented b0 the co"bination of a<ia oadin! and active "otor contro of
"otion. If s#in!:phase "otion is abnor"a( then the an>e "a0 be in a
position at the point of hee:stri>e.
D$I7: 12@2GHAA [Dub$ed : inde<ed for $E7%INE]
133: 7ev $ed .hid Neuro. 2002 Oct3@@5108:AG5:?.
,racture prevaence in 7uchenne "uscuar d0stroph0.
$c7onad 7)( 2inai $( )aa!her &.( $ercuri E( $untoni ,( 'oper 9( +ardine D(
+ones 79( Di>e $).
O<ford 'adciffe N9* Trust( 12.
The obIective of this stud0 #as to deter"ine the prevaence( circu"stances(
outco"e of fractures in "aes #ith 7uchenne "uscuar d0stroph0 57$78 attendin!
neuro"uscuar cinics. Three hundred and sevent0:ei!ht "aes 5"edian a!e 12
0ears( ran!e 1 to 25 0ears8 attendin! four neuro"uscuar centres #ere studied
case:note revie# suppe"ented b0 )D etter or b0 intervie# at the ti"e of
attendance. *event0:nine 520.G48 of these patients had e<perienced fractures.
,ort0:one percent of fractures #ere in patients a!ed ? to 11 0ears and @?4 in
independent0 a"buant patients. ,ain! #as the "ost co""on "echanis" of
fracture. 1pper:i"b fractures #ere "ost co""on in "aes usin! >nee:an>e:foot
orthoses 5A548 #hie o#er:i"b fractures predo"inated in independent0 "obie
and #heechair dependent "aes 55@4 and A?4 respective08. T#ent0 percent of
a"buant "aes and 2H4 of those usin! orthoses ost "obiit0 per"anent0 as a
resut of the fracture. In a substantia proportion of "aes( the occurrence
a fracture had a si!nificant i"pact on subseCuent "obiit0.
D$I7: 12@1?HG5 [Dub$ed : inde<ed for $E7%INE]
13@: + Dediatr Orthop. 2002 Nov:7ec3225A8:H5@:A0.
Treat"ent of estabished and anticipated nonunion of the tibia in chidhood.
%io# 'P( $ont!o"er0 '+.
$iddebrou!h )enera 9ospita( .eveand( 1nited 2in!do". '"
Nonunion in on! bone fractures is rare in the s>eeta0 i""ature patient.
authors report the outco"e of a series of patients treated for tibia bone
and nonunion at avera!e foo#:up of AA "onths. Nine chidren a!ed 1? "onths
1H 0ears #ere treated. Three patients had estabished nonunion ran!in! fro" H
"onths to A 0ears( three had bone oss 51:A c"8( and three had fractures in
#hich nonunion #as anticipated 5one )ustio IIIb and t#o Tscherne III8.
Treat"ent invoved #ound e<cision for open fractures( debride"ent of
devascuariEed bone( and stabiiEation #ith "onoatera fi<ators 5t#o
and circuar fi<ators 5seven patients8. ,ive patients had unifoca treat"ent
four had "utifoca treat"ent 5three bone transports8. Treat"ent ti"e ran!ed
fro" 3 to 12 "onths and #as not reated to the co"pe<it0 of treat"ent.
,unctiona outco"e #as "easured usin! the *hort $uscuos>eeta ,unctiona
&ssess"ent( a vaidated outco"e assess"ent too. &t the atest foo#:up
5avera!e AA "onths8( the "ean >nee fe<ion #as 13@ de!rees and "ean an>e
#as 12 de!rees dorsife<ion( 31 de!rees pantar fe<ion. Dh0sea arrest #as
present in three chidren 5i"b en!th discrepanc0 2:@ c"8( but #ith no
defor"it0. ,unctiona outco"e reveaed a R70sfunction Inde<R of 04 to 1G4
5avera!e H48 and a R6other Inde<R of 04 to 1A4 5avera!e A48. )ood function can
be obtained foo#in! treat"ent of these severe inIuries.
D$I7: 12@0GG02 [Dub$ed : inde<ed for $E7%INE]
135: Dast 'econstr *ur!. 2002 Nov31105A8:1A13:@.
.oa!en sheets as te"porar0 #ound cover in "aIor open fractures before
definitive fap cover.
Fen>atra"ani 9( *abapath0 *'.
Dubication T0pes:
D$I7: 12@0G?0@ [Dub$ed : inde<ed for $E7%INE]
13A: +6':6T'. 2002 &u!:*ep3?55@8:212:?.
Trau"a of the pediatric an>e and foot.
Fanhoenac>er ,$( 6ernaerts &( )ieen +( *chepens E( 7e *chepper &$.
7epart"ent of 'adioo!0( 1niversit0 9ospita &nt#erp( Ede!e"( 6e!iu".
This artice presents a brief overvie# of the inIuries to the an>e and foot
encountered in chidren and adoescents. Trau"a to the an>e or foot "a0
fro" acute( chronic( or repetitive forces. The roe of the different i"a!in!
"odaities in the assess"ent of an>e and foot trau"a in the !ro#in! patient
discussed. Dain radio!raphs re"ain the "ainsta0 in the dia!nosis of "ost
trau"as( #hereas .T "a0 be hepfu to unrave the co"pe< anato"0 of certain
fractures i>e the tripane or Iuvenie Tiau< fracture. In the evauation of
chronic inIuries( incudin! osteochondrosis dissecans and osteonecrosis( $'I
evovin! as the "odait0 of choice.
D$I7: 12@033G2 [Dub$ed : inde<ed for $E7%INE]
13H: + ,oot &n>e *ur!. 2002 *ep:Oct3@1558:335:H.
IiEarov rin! fi<ator for a difficut case of an>e s0ndes"osis disruption.
'e#ani +( %ahoti O( Ora>#e *.
%e#isha" 1niversit0 9ospita( %ondon( 12.
*0ndes"otic stabiiEation is reco""ended for tibiofibuar diastasis( a
$aisonneuve fracture( or s0ndes"otic instabiit0 after fi<ation of dista
tibia:fibua fractures. In the case presented( a s0ndes"otic stabiiEation #as
perfor"ed #ith a scre# inserted 2 c" above the tibiotaar Ioint *ubseCuent
faiure occurred due to the #ei!ht of the patient and a ac> of co"piance
the necessar0 non#ei!ht bearin! protoco. The IiEarov fra"e #as used to
and "aintain a stabe s0ndes"osis #ith a si"pe t#o:rin! construct #hich
the patient to bear #ei!ht on the inIured i"b #hie his s0ndes"osis heaed.
This is not reco""end as a routine "ethod of treat"ent( but is presented as an
e<tended indication of the IiEarov fra"e for difficut cases.
D$I7: 12@00H1G [Dub$ed : inde<ed for $E7%INE]
13?: ,oot &n>e Int. 2002 Oct3235108:G1H:21.
,unctiona outco"e of patients foo#in! open reduction interna fi<ation for
biatera cacaneus fractures.
N"ur>o $)( 2ar!es 7E.
/a0ne *tate 1niversit0( 7etroit 'eceivin! 9ospita( 7epart"ent of Orthopaedic
*ur!er0( $I( 1*&.
Treat"ent of dispaced intra:articuar cacaneus fractures has historica0
controversia( but recent deveop"ents have ed to resur!ence in open
interna fi<ation 5O'I,8 for dispaced cacaneus fractures. 'ecent functiona
outco"e studies co"parin! operative to nonoperative treat"ent of uniatera
cacaneus fractures has sho#n a trend to#ards i"proved function #ith O'I,. No
studies have investi!ated the functiona outco"e of patients #ho have reCuired
operative treat"ent of biatera dispaced cacaneus fractures. The purpose of
this stud0 #as to revie# our operative e<perience #ith biatera dispaced
intra:articuar cacanea fractures. & retrospective revie# of "edica charts
indicated 13 patients had under!one O'I, for biatera cacaneus fractures.
patients coud be contacted and brou!ht to the cinic for functiona
and radio!raphic .T studies. ,unctiona outco"e #as assessed b0 the
$uscuos>eeta ,unctiona &ssess"ent *core 5$,&8 and the &"erican Orthopaedic
,oot and &n>e 9indfoot *core 5&O,&*8. The avera!e foo#:up #as 5A "onths.
haf of the patients reCuired additiona sur!eries. The avera!e $,& and &O,&*
scores #ere 31.1 and H1.?( respective0. ,unctiona outco"e decreased for
patients #ith "utipe trau"atic fractures and sur!ica procedures of the
cacaneus. Our resuts sho# a di"inished functiona outco"e for patients
sustainin! biatera cacaneus fractures treated #ith O'I, #hen co"pared to
patients "ana!ed sur!ica0 for uniatera cacaneus fractures( but better
functiona outco"es than patients #ho do not under!o O'I, for uniatera
cacaneus fractures. This di"inished function i"its #or> capacit0 and abiit0
to perfor" dai0 activities that reCuire standin!.
D$I7: 123G?1@3 [Dub$ed : inde<ed for $E7%INE]
13G: + Trau"a. 2002 Oct3535@8:A?A:G0.
*>ateboard:associated inIuries: participation:based esti"ates and inIur0
20e *6( Nance $%( 'utherford )/ +r( /inston ,2.
Epide"ioo!0 and 9eath *tatistics( .onsu"er Droduct *afet0 .o""ission(
6ethesda( $ar0and( 1*&.
6&.2)'O1N7: *>ateboardin! is a popuar recreationa activit0 but has attendant
associated ris>s. To pace this ris> in perspective( participation:based rates
of inIur0 #ere deter"ined and co"pared #ith those of other seected sports.
*>ateboard:associated inIuries #ere evauated over ti"e to deter"ine
participation:based trends in inIur0 prevaence. $ET9O7*: 'ates of
s>ateboard:associated inIur0 #ere studied for the 12:0ear period 1G?H to 1GG?
for participants a!ed H 0ears or oder. The Nationa Eectronic InIur0
*urveiance *0ste" provided inIur0 esti"ates for s>ateboardin! and the
additiona sportin! activities. The Nationa *portin! )oods &ssociation annua
surve0 of nationa0 representative househods provided participation
& participation:based rate of inIur0 #as cacuated fro" these data sets for
seected sports for the 0ear 1GG?. 'E*1%T*: The 1GG? rate of e"er!enc0
depart"ent:treated s>ateboard:associated inIuries:?.G inIuries per 1(000
participants 5G54 confidence interva [.I]( A.2( 11.A8:#as t#ice as hi!h as
in:ine s>atin! 53.G [G54 .I( 3.1( @.?]8 and haf as hi!h as bas>etba 521.2
[G54 .I( 1?.3( 2@.1]8. The rate of s>ateboard:associated inIuries decined
1G?H to 1GG3 but is a!ain increasin!: the 1GG? rate #as t#ice that of 1GG3
[G54 .I( 1.A( H.@] and ?.G [G54 .I( A.2( 11.A]( respective08. Increases
occurred pri"ari0 a"on! adoescent and 0oun! adut s>ateboarders. The "ost
freCuent inIuries in 1GG? #ere an>e strainOsprain and #rist fracture: 1.2
.I( 0.?( 1.A8 and 0.A 5G54 .I( 0.@( 0.?8 per 1(000( respective0.
*>ateboard:associated inIuries reCuirin! hospitaiEation occurred in 2.G4 and
#ere 11.@ 5G54 .I( H.5( 1H.58 ti"es "ore i>e0 to have occurred as a resut
a crash #ith a "otor vehice than inIuries in those patients not hospitaiEed.
.ON.%1*ION: This stud0 is the first to reate s>ateboardin! and other sport
inIuries to participation e<posures. /e found that s>ateboardin! is a
co"parative0 safe sport3 ho#ever( increased rates of inIur0 are occurrin! in
adoescent and 0oun! adut s>ateboarders. The "ost co""on inIuries are
"uscuos>eeta3 the "ore serious inIuries resutin! in hospitaiEation
t0pica0 invove a crash #ith a "otor vehice. This ne# "ethodoo!0 that uses
participation:based inIur0 rates "i!ht contribute to "ore effective inIur0
contro initiatives.
D$I7: 123G@?AH [Dub$ed : inde<ed for $E7%INE]
1@0: N N $ed +. 2002 *ep 2H3115511A28:11?@.
The Otta#a an>e rues for the use of dia!nostic =:ra0 in after hours "edica
centres in Ne# Neaand.
/0nn:Tho"as *( %ove T( $c%eod 7( Ferna *( 2Ia>ovic $( 7o#e &( 7urha" +.
7epart"ent of )enera Dractice( /ein!ton *choo of $edicine and 9eath
&I$*: The ai"s of this stud0 #ere to "easure baseine use of Otta#a an>e
5O&'8( vaidate the O&' and( if appropriate( e<pore the i"pact of
the 'ues on =:ra0 rates in a pri"ar0 care( after hours "edica centre
$ET9O7*: )enera practitioners 5)Ds8 #ere surve0ed to find their a#areness of
an>e inIur0 !uideines. 7ata concernin! dia!nosis and =:ra0 utiisation #ere
coected prospective0 for patients presentin! #ith an>e inIuries to t#o
hours "edica centres. The O&' #ere appied retrospective0( and the
and specificit0 of the O&' #ere co"pared #ith )Ds cinica Iud!e"ent in
orderin! =:ra0s. The outco"e "easures #ere =:ra0 utiisation and dia!nosis of
fracture. 'E*1%T*: &#areness of the O&' #as o#. The sensitivit0 of the O&'
dia!nosis of fractures #as 1004 5G54 .I: H5.3 : 1008 and the specificit0 #as
5G54 .I: @0.5 : 5@.58. The sensitivit0 of )Ds cinica Iud!e"ent #as 1004
.I: H5.3 : 1008 and the specificit0 #as 3H4 5G54 .I: 30.2 : @@.28.
the O&' #oud reduce =:ra0 utiisation b0 1A4 5G54 .I: appro< 10.? : 21.38.
.ON.%1*ION*: The O&' are vaid in a Ne# Neaand pri"ar0 care settin!. ,urther
i"pe"entation of the rues #oud resut in so"e reduction of =:ra0s ordered
an>e inIuries( but ess than the reduction found in previous studies.
Dubication T0pes:
Faidation *tudies
D$I7: 123?AAA3 [Dub$ed : inde<ed for $E7%INE]
1@1: Drehosp E"er! .are. 2002 Oct:7ec3A5@8:@0A:10.
.o""ent in:
Drehosp E"er! .are. 2002 Oct:7ec3A5@8:@?A:?.
,e# e"er!enc0 "edica services patients #ith o#er:e<tre"it0 fractures receive
prehospita ana!esia.
$cEachin ..( $c7er"ott +T( *#or '.
7epart"ent of E"er!enc0 $edicine( /iia" 6eau"ont 9ospita('o0a Oa>( $I
1*&. ""
Drevious iterature has identified prehospita pain "ana!e"ent as an i"portant
e"er!enc0 "edica services 5E$*8 function( and fe# patients transported b0 E$*
#ith "uscuos>eeta inIuries receive prehospita ana!esia 5D&8. O6+E.TIFE*:
To describe the freCuenc0 #ith #hich E$* patients #ith o#er:e<tre"it0 and hip
fracture receive prehospita and e"er!enc0 depart"ent 5E78 ana!esia3 28 to
describe E$* and patient factors that "a0 affect ad"inistration of D& to these
patients3 and 38 to describe the ti"e interva bet#een E$* and E7 "edication
ad"inistrations. $ET9O7*: This #as a four:"onth 5&pri to +u0 20008
retrospective stud0 of patients #ith a fina hospita dia!nosis of hip or
o#er:e<tre"it0 fracture #ho #ere transported b0 E$* to a sin!e suburban
co""unit0 hospita. 7ata incudin! patient de"o!raphics( fracture t0pe( E$*
response( and treat"ent characteristics #ere abstracted fro" revie# of E$* and
E7 records. Datients #ho had an>e fractures( had "utipe trau"atic inIuries(
#ere under the a!e of 1? 0ears( or did not have fractures #ere e<cuded.
'E*1%T*: One hundred t#ent0:four patients "et incusion criteria. & basic ife
support 56%*8:on0 response #as provided to 20 51A.048. &nother 3? 53?.@48
received an advanced ife support 5&%*8 response and #ere tria!ed to 6%*
transport. Of a the patients( 22 51?.348 received D&. Datients #ho received
#ere 0oun!er 5A@.0 vs. HH.3 0ears( p J 0.0018 and "ore i>e0 to have a
o#er:e<tre"it0 fracture other than a hip fracture 531.?4 vs. 10.H4( p J
Of a patients( 113 5G1.148 received E7 ana!esia. Datients received
fro" E$* a"ost 2.0 hours sooner that in the E7 5"ean 2?.@ ;O: 3A "in vs. 1@A
;O: H@ "in after E$* scene arriva( p J 0.0018. .ON.%1*ION: & "inorit0 of the
stud0 !roup received D&. Oder patients and patients #ith hip fracture are
i>e0 to receive D&. It is uncear #hether current E$* s0ste" desi!n "a0
adverse0 i"pact ad"inistration of D&. ,urther #or> is needed to carif0
patient need or E$* practice patterns resut in o# rates of D&.
D$I7: 123?5A0H [Dub$ed : inde<ed for $E7%INE]
1@2: *portveretE *portschaden. 2002 *ep31A538:101:H.
[,unctiona resuts of d0na"ic !ait ana0sis after 1 0ear of hobb0:athetes
a sur!ica0 treated an>e fracture]
[&rtice in )er"an]
%osch &( $e0boh" D( *ch"aE T( ,uchs $( Fa"vu>a>is ,( 7resin! 2( 6u"entritt
*tur"er 2$.
1niversitats>ini>u" )ottin!en( &bteiun! fur 1nfachirur!ie( Dastische und
/iderhersteun!schirur!ie( )er"an0.
'etrospective0 20 patients #ith a sur!ica0 treated an>e fracture caused b0
hobb0:accidents #ere e<a"ined cinica0 and radioo!ica0 b0 a score
to Dhiips after 12 "onths postoperative0. ,urther the0 have ta>en part in a
d0na"ica !ait ana0sis at the sa"e ti"e. & !roup of 20 heath0 aduts #as
as a contro !roup co"parabe to a!e( se<( hei!ht and #ei!ht. &thou!h 1G
patients out of 20 have achieved a !ood resut at the score evauation and
of the" #as cinica0 noticed #ith an0 pathoo!ica !ait( !ait ana0sis has
sho#n a si!nificant so#ed !ait speed and a decreased stride en!th. The
reduction of the pantarfe<or "o"ent at the inIured an>e Ioint i""ediate0
foo#in! hee contact #as 0et the "ost re"ar>abe resut of the !ait
The chan!es of !ait pattern are interpreted as an adapted and internaiEed
"otion pattern caused b0 pain and behaviour of rest at an0 ti"e #hie the
"obiisation:phase #as !oin! on. It coud not docu"ent an0 si!nificant
correation bet#een subIective and cinica para"eters and para"eters
b0 !ait ana0sis. 9o#ever( a si!nificant correation of !ait:ana0sed
#as found bet#een the inIured and uninIured side. 60 d0na"ica !ait ana0sis
is possibe to Cuantif0 re"ar>abe !ait chan!es( to obtain obIective data( but
aso to de"onstrate as0""etrica oadin! and "otion that #ere not cinica0
detectabe previous0. It foo#s that it can be reevant to patients #ith
co"paints b0 eadin! the" to specific ph0siotherapeutica treat"ent and !ait
trainin! so that the0 #oud be abe to carr0 on their sports:activities a!ain.
Dubication T0pes:
Evauation *tudies
D$I7: 123?21?2 [Dub$ed : inde<ed for $E7%INE]
1@3: ,oot &n>e .in. 2002 $ar3H518:1G1:20A.
*ava!e after co"pications of tota an>e arthropast0.
$0erson $*( $ier *7.
7epart"ent of Orthopaedic *ur!er0( 1nion $e"oria Orthopaedics( +ohnston
Drofessiona 6uidin!( T@00( 3333 North .avert *treet( 6ati"ore( $7 2121?(
1*&. 0ncKhei<.or!
The probe"s that arise durin! sur!er0 and after faiure of T&& "a0 be
for"idabe to even the "ost e<perienced sur!eon. &s #ith an0 operative
procedure( the consideration of this procedure shoud be te"pered #ith the
difficut0 in sava!e. This artice is an ear0 su""ar0 of so"e of the initia
probe"s #ith the &!iit0 57eDu08 tota Ioint an>e arthropast0.
Dubication T0pes:
'evie# %iterature
D$I7: 123?03?G [Dub$ed : inde<ed for $E7%INE]
1@@: ,oot &n>e .in. 2002 $ar3H518:10H:20.
&rthrodesis as sava!e for cacanea "aunions.
'obinson +,( $urph0 )&.
6rid!er Orthopedic and *ports $edicine( G31 9i!hand 6ouevard( *uite 3210(
6oEe"an( $T 5GH15( 1*&.
Even #ith !reater e"phasis on anato"ic reduction( outco"es after cacanea
fractures continue to be unsatisfactor0 in "an0 patients. %atera #a
i"pin!e"ent( subtaar arthrosis #ith pain and stiffness( nerve co"pression
s0ndro"es( and hindfoot "aai!n"ent a can cause disabin! s0"pto"s. If
conservative treat"ent fais to reieve s0"pto"s( subtaar arthrodesis can
provide a painess( stabe hindfoot in "ost patients. ,or severe defor"it0
anterior an>e i"pin!e"ent and oss of the taar an!e of decination(
distraction bone boc> arthrodesis throu!h a posterior approach is preferred.
Dubication T0pes:
'evie# %iterature
D$I7: 123?03?@ [Dub$ed : inde<ed for $E7%INE]
1@5: &nthropo &nE. 2002 *ep3A0538:30G:1G.
[& severe traffic accident::250 0ears a!o. $edica histor0 presentation]
[&rtice in )er"an]
9err"ann )( 9oc> D( /ihe" 9.
2reis>ran>enhaus )runstadt( .hirur!ische &bteiun!( )runstadtODfaE.
7urin! a scientific e<a"ination in +u0 1GGG both cr0pts beo# the *t.
.hurch in )runstadt( )er"an0( #ere opened and G coffins fro" the count0 fa"i0
of %einin!en e<a"ined. This paper is concentratin! on one of these persons:
)eor! 9er"ann 51AHG:1H518( count of %einin!en:/esterbur!:&teinin!en( #ho
durin! the 1?. centur0 the cit0 its baroc> character. 9e #as aso responsibe
for the rebuidin! of the church. 9is s>eeton reveaed interestin!
chan!es. ,e# 0ears before his death the count had the accident to !et run over
b0 a heav0 #a!on #hich crushed the dista part of his e!s. The fractures
heaed( but !ave hi" an anc0otic and shortened eft e!( #hich "ust have
hi" a ot of sufferin! in his ast 0ears.
Dubication T0pes:
9istorica &rtice
Dersona Na"e as *ubIect:
9er"ann )
D$I7: 123H?HGH [Dub$ed : inde<ed for $E7%INE]
1@A: + 6one +oint *ur! &". 2002 Oct3?@:&5108:1?2G:35.
Intra"uscuar and bood pressures in e!s positioned in the he"iithoto"0
position : carification of ris> factors for #e:e! acute co"part"ent
$e0er '*( /hite 22( *"ith +$( )roppo E'( $ubara> *+( 9ar!ens &'.
7epart"ent of Orthopaedic *ur!er0( 1niversit0 of .aifornia at *an 7ie!o
.enter( *an 7ie!o( .aifornia G2123:@22?( 1*&. rs"
6&.2)'O1N7: &cute co"part"ent s0ndro"e has been #ide0 reported in e!s
positioned in the ithoto"0 position for proon!ed !enera sur!ica( uroo!ic(
and !0necoo!ic procedures. The orthopaedic iterature aso contains reports
this co"pication in e!s positioned on a fracture tabe in the he"iithoto"0
position. The purpose of this stud0 #as to identif0 the ris> factors for
deveop"ent of acute co"part"ent s0ndro"e resutin! fro" this t0pe of e!
positionin!. $ET9O7*: Ei!ht heath0 vounteers #ere positioned on a fracture
tabe. Intra"uscuar pressures #ere continuous0 "easured #ith a sit catheter
in a four co"part"ents of the eft e! #ith the subIect supine( in the
he"iithoto"0 position #ith the caf supported( and in the he"iithoto"0
position #ith the hee supported but the caf free. 6ood pressure #as
inter"ittent0 #ith use of auto"ated pressure cuffs. 'E*1%T*: .han!in! fro"
supine to the caf:supported position si!nificant0 increased the
pressure in the anterior co"part"ent 5fro" 11.A to 1G.@ "" 9!8 and in the
atera co"part"ent 5fro" 13.0 to 25.? "" 9!8. .han!in! fro" the caf:
to the hee:supported position si!nificant0 decreased intra"uscuar pressure
the anterior( atera( and posterior co"part"ents 5to 2.?( 3.@( and 1.G "" 9!(
respective08. The "ean diastoic bood pressure in the an>e avera!ed A3.G ""
9! in the supine position( #hich si!nificant0 decreased to 3@.A "" 9! in the
caf:supported position. .han!in! to the hee:supported position had no
si!nificant effect on the diastoic bood pressure in the an>e 5"ean( 32.? ""
9!8. The "ean difference bet#een intra"uscuar pressure and diastoic bood
pressure in the supine position #as appro<i"ate0 50 "" 9! in each of the four
co"part"ents. This "ean difference si!nificant0 decreased to J20 "" 9! in the
caf:supported position and then( #hen the e! #as "oved into the hee:
position( si!nificant0 increased to appro<i"ate0 30 "" 9! in a
.ON.%1*ION*: The co"bination of increased intra"uscuar pressure due to
co"pression fro" the caf support and decreased perfusion pressure due to the
eevated position causes a si!nificant decrease in the difference bet#een the
diastoic bood pressure and the intra"uscuar pressure #hen the e! is paced
in the he"iithoto"0 position in a #e:e! hoder on a fracture tabe.
#ith a proon!ed sur!ica ti"e( this position "a0 cause an acute co"part"ent
s0ndro"e of the #e e!. %eavin! the caf free( instead of usin! a standard
#e:e! hoder( increases the difference bet#een the diastoic bood pressure
and the intra"uscuar pressure and "a0 decrease the ris> of acute co"part"ent
D$I7: 123HHG15 [Dub$ed : inde<ed for $E7%INE]
1@H: + 6one +oint *ur! &". 2002 Oct3?@:&5108:1HGG:?10.
.on!enita pseudarthrosis of the tibia: resuts of technica variations in the
charne0:#iia"s procedure.
+ohnston .E 2nd.
Te<as *cottish 'ite 9ospita for .hidren( 7aas( Te<as H521G( 1*&.
6&.2)'O1N7: 'esuts of the .harne0:/iia"s "ethod of intra"eduar0 fi<ation
for treat"ent of con!enita pseudarthrosis of the tibia have varied( in part
because of variations in sur!ica techniCue. The outco"es of three variations
this procedure #ere co"pared to deter"ine #hich techniCue #as the "ost i>e0
resut in union. $ET9O7*: The resuts in t#ent0:three consecutive patients
con!enita pseudarthrosis of the tibia #ere revie#ed at four to fourteen 0ears
foo#in! initia sur!ica treat"ent #ith an intra"eduar0 rod. Three t0pes
procedures #ere perfor"ed: t0pe &( #hich consisted of resection of the tibia
pseudarthrosis #ith shortenin!( insertion of an intra"eduar0 rod into the
tibia( and tibia bone:!raftin! co"bined #ith fibuar resection or osteoto"0
insertion of an intra"eduar0 rod into the fibua3 t0pe 6( #hich #as
to t0pe & e<cept that it did not incude fibuar fi<ation3 and t0pe .( #hich
consisted of insertion of a tibia rod and bone:!raftin! but no fibuar
The outco"e #as cassified as !rade 1 #hen there #as uneCuivoca union #ith
#ei!ht:bearin! function and "aintenance of ai!n"ent reCuirin! no additiona
sur!ica treat"ent3 !rade 2 #hen there #as eCuivoca union #ith usefu
#ith the i"b protected b0 a brace( andOor va!us or sa!itta bo#in! for #hich
additiona sur!er0 #as reCuired or anticipated3 and !rade 3 #hen there #as
persistent nonunion or refracture( reCuirin! fu:ti"e e<terna support for
andOor instabiit0. 'E*1%T*: Eeven patients 5@?48 uti"ate0 had a !rade:1
outco"e3 nine( a !rade:2 outco"e3 and three( a !rade:3 outco"e. The fina
outco"e #as not associated #ith either the initia radio!raphic appearance of
the esion or the a!e of the patient at the ti"e of the initia sur!er0. The
resuts foo#in! t0pe:& and 6 operations #ere better than those after t0pe:.
procedures. *ur!er0 on an intact fibua resuted in a o#er prevaence of
!rade:3 outco"es than #as found #hen an intact fibua #as not operated on 5p S
0.058. Transfi<ation of the an>e Ioint b0 the intra"eduar0 rod did not
decrease the prevaence of !rade:3 outco"es. .ON.%1*ION*: There is itte
Iustification for a t0pe:. operation( as it either resuted in a persistent
nonunion or faied to i"prove an eCuivoca outco"e in ever0 case. %eavin! an
intact fibua undisturbed to "aintain stabiit0 or en!th aso #as not
successfu in this series. In addition( the presence of fibuar insufficienc0
5fracture or a pre:pseudarthrotic esion8 #as hi!h0 pro!nostic for subseCuent
va!us defor"it0 5occurrin! in ten of t#eve cases8( #hether or not the fibua
eventua0 heaed.
D$I7: 123HHG11 [Dub$ed : inde<ed for $E7%INE]
1@?: + 6one +oint *ur! &". 2002 Oct3?@:&5108:1H33:@@.
Operative co"pared #ith nonoperative treat"ent of dispaced intra:articuar
cacanea fractures: a prospective( rando"iEed( controed "uticenter tria.
6uc>e0 '( Tou!h *( $c.or"ac> '( Date )( %ei!hton '( Detrie 7( )apin '.
.afar0 )enera 9ospita( .a!ar0( &berta( .anada. buc>cinKuca!
6&.2)'O1N7: Open reduction and interna fi<ation is the treat"ent of choice
dispaced intra:articuar cacanea fractures at "an0 orthopaedic trau"a
centers. The purpose of this stud0 #as to deter"ine #hether open reduction and
interna fi<ation of dispaced intra:articuar cacanea fractures resuts in
better !enera and disease:specific heath outco"es at t#o 0ears after the
inIur0 co"pared #ith those after nonoperative "ana!e"ent. $ET9O7*: Datients at
four trau"a centers #ere rando"iEed to operative or nonoperative care. &
standard protoco( invovin! a atera approach and ri!id interna fi<ation(
used for operative care. Nonoperative treat"ent invoved no atte"pt at cosed
reduction( and the patients #ere treated on0 #ith ice( eevation( and rest.
fractures #ere cassified( and the Cuait0 of the reduction #as "easured.
Faidated outco"e "easures incuded the *hort ,or":3A 5*,:3A( a !enera heath
surve08 and a visua anao! scae 5a disease:specific scae8. 'E*1%T*: 6et#een
&pri 1GG1 and 7ece"ber 1GGH( 512 patients #ith a cacanea fracture #ere
treated. Of those patients( @2@ #ith @H1 dispaced intra:articuar cacanea
fractures #ere enroed in the stud0. Three hundred and nine patients 5H348
foo#ed and assessed for a "ini"u" of t#o 0ears and a "a<i"u" of ei!ht 0ears
foo#:up. The outco"es after nonoperative treat"ent #ere not found to be
different fro" those after operative treat"ent3 the score on the *,:3A #as
and A?.H( respective0 5p S 0.138( and the score on the visua anao! scae
A@.3 and A?.A( respective0 5p S 0.128. 9o#ever( the patients #ho #ere not
receivin! /or>ersB .o"pensation and #ere "ana!ed operative0 had si!nificant0
hi!her satisfaction scores 5p S 0.0018. /o"en #ho #ere "ana!ed operative0
scored si!nificant0 hi!her on the *,:3A than did #o"en #ho #ere "ana!ed
nonoperative0 5p S 0.0158. Datients #ho #ere not receivin! /or>ersB
.o"pensation and #ere 0oun!er 5ess than t#ent0:nine 0ears od8( had a
"oderate0 o#er 6oher an!e 50 de!rees to 1@ de!rees 8( a co""inuted
a i!ht #or>oad( or an anato"ic reduction or a step:off of J or S2 "" after
sur!ica reduction 5p S 0.0@8 scored si!nificant0 hi!her on the scorin!
after sur!er0 co"pared #ith those #ho #ere treated nonoperative0.
/ithout stratification of the !roups( the functiona resuts after
care of dispaced intra:articuar cacanea fractures #ere eCuivaent to those
after operative care. 9o#ever( after un"as>in! the data b0 re"ova of the
patients #ho #ere receivin! /or>ersB .o"pensation( the outco"es #ere
si!nificant0 better in so"e !roups of sur!ica0 treated patients.
Dubication T0pes:
.inica Tria
'ando"iEed .ontroed Tria
D$I7: 123HHG02 [Dub$ed : inde<ed for $E7%INE]
1@G: + Dediatr Orthop 6. 2002 Oct3115@8:2G?:301.
Isoated con!enita pseudoarthrosis of the fibua.
Pan! 2P( %ee E9.
7epart"ent of Orthopaedic *ur!er0( *in!apore )enera 9ospita( *in!apore.
.on!enita pseudarthrosis of the i"b "ost co""on0 invoves the tibia(
various co"binations of bones incudin! fibua( radius( una( cavice and
hu"erus have a been described. Isoated con!enita pseudarthrosis of the
fibua is a ver0 rare entit0 #ith on0 12 cases reported in the En!ish
iterature. /e report three cases of this condition treated in our
The first chid had a varus an>e defor"it0 at the a!e of @ "onths. The other
t#o chidren presented #ith va!us an>e defor"it0 after the0 started to #a>.
T#o patients #ere treated conservative0 #hie the third had a dista
tibio:fibuar fusion in vie# of severe va!us defor"it0. & three patients
sho#ed !ood ear0 resuts after 1 to 2 0ears. /e advocate ear0 dista
tibio:fibuar fusion to prevent va!us defor"it0 in these chidren.
D$I7: 123H05?0 [Dub$ed : inde<ed for $E7%INE]
150: &" + E"er! $ed. 2002 Oct3205A8:502:5.
Dainfu discri"ination: the differentia use of ana!esia in isoated o#er
2oEo#s>i $+( /iater +)( DasCua ')( .o"pton *( *#or '&( +ac>son 'E.
7epart"ent of E"er!enc0 $edicine( /iia" 6eau"ont 9ospita( & /a0ne *tate
1niversit0 &ffiiated Dro!ra"( 'o0a Oa>( $I @?0AH( 1*&.
Our pri"ar0 obIective #as to co"pare use of ana!esia for patients #ith and
#ithout fracture as a resut of isoated o#er e<tre"it0 trau"a( in the
e"er!enc0 depart"ent 5E78. Our secondar0 obIective #as to co"pare the
practices of e"er!enc0 ph0sicians 5EDs8 #ith that of ph0sician assistants
/e perfor"ed a prospective( binded cohort stud0 #ith the presence of fracture
as the ris> factor and provision of an0 pain "edication #hie in the E7 as the
pri"ar0 outco"e. Incuded in the stud0 #ere a patients #ho presented to a
G0(000 visit suburban teachin! hospita #ith an isoated o#er e<tre"it0
#ho received a radio!raph of the foot or an>e over a G:#ee> period. /e
patients #ithout trau"a( #ith "utipe trau"a( ad"itted( or seen b0 one of the
investi!ators. Datients ad"itted and those #ith "utipe trau"a #ere e<cuded
because these patients had contacts #ith "utipe ph0sicians and it is
the0 #oud be abe to differentiate #hich ph0sician prescribed "edication and
the0 #ere e"er!enc0 personne. /e defined ana!esia as an0 pain "edication at
an0 dose. One investi!ator prefor"ed foo#:up intervie#s usin! a standardiEed
Cuestionnaire 3 da0s after the visit. Datients e<pressed their recoection of
their de!ree of pain usin! a verba anao! scae of 1 to 10. /e report crude
adIusted odds ratios 5O'8. Of 51A consecutive patients( 111 "et e<cusion
criteria and 3 had inco"pete data. Of the re"ainin! @05( #e contacted 3?@
in an avera!e of 3 ;O: 1 da0s. Datients #ith and #ithout fractures recaed
their initia de!ree of pain si"iar0( #ith the "ean initia pain scores on
verba anao! scae of A.A ;O: 2.5 versus A.? ;O: 2.1 respective0. Datients
#ith a fracture #ere "ore i>e0 to receive pain "edication #hie in the E7
v 154 D S.0@H( O' 1.H5 5.I G54 1.02( 2.GG8. EDs !ave so"e for" of E7 ana!esia
to 2G4 of patients( as co"pared #ith 104 of patients seen b0 D&s 5O' S 3.5? .I
G54 2.05( A.2@8. EDs provided a prescription to @@4 of patients versus 214 of
patients seen b0 D&s 5O' S 2.G1 .I G54 1.?5( @.5H8. Our esti"ated adIusted O's
for providin! ana!esia in the E7 #ere: fracture S 2.0 5.I G54 1.13( 3.5?83
3.52 5.I G54 1.G?( 2.GG83 and for ever0 additiona point on the verba pain
scae: 1.2? 5.I G54 1.11( 1.@?8. Datients #ith fracture #ere "ore i>e0 to
receive pain( despite reportin! identica de!ree of pain. EDs #ere "ore i>e0
to provide ana!esia than D&s. .op0ri!ht 2002( Esevier *cience 51*&8.
Dubication T0pes:
Evauation *tudies
D$I7: 123AG020 [Dub$ed : inde<ed for $E7%INE]
151: &cta .hir Orthop Trau"ato .ech. 20023AG5@8:2@3:H.
[,racture:disocations of the an>e Ioint in aduts. Dart I: epide"ioo!ic
evauation of patients durin! a 1:0ear period]
[&rtice in .Eech]
+ehic>a 7( 6artonice> +( *vatos ,( 7obias +.
Ortopedic>o:trau"atoo!ic>a >ini>a 3. %, 12 a ,N2F( Draha. Iehic>aKfn>v.cE
D1'DO*E O, T9E *T17P: The ai" of the stud0 is to present a basic statistica
overvie# of fracture:disocations of the an>e in aduts in a one:0ear !roup
patients. $&TE'I&%: The ana0Eed !roup of patients co"prised 232 patients 5121
"en( 111 #o"en8 treated for fracture:disocations of the an>e at the authorsB
depart"ent bet#een 1 +anuar0 and 31 7ece"ber 1GGG. In a patients the ph0ses
#ere cosed. The t0pe of fractures #as cassified after 6. ). /eber. 'E*1%T*:
T0pe & fractures accounted for 234( T0pe 6 fractures for A54 and T0pe .
fractures for 124 of a cases. The avera!e a!e of the inIured #as @G 0ears
5ran!e( 1A:?G8( #ith "en prevaiin! unti 5th decade and #o"en predo"inatin!
fro" Ath decade. In A54 of T0pe & fractures there occurred on0 the fracture
atera "aeous( in 314 the fracture invoved aso "edia "aeous and in
it affected aso the posterior "ar!in of the dista tibia. In @G4 of /eber 6
t0pe of fractures the "edia "aeous #as fractured( in 204 the detoid
i!a"ent #as ruptured and in 314 there occurred no inIur0 on the "edia
&vusion of the posterior "ar!in of the dista tibia occurred in @A4. In H14
T0pe . fractures the fracture #as ocated in the o#er haf of fibua(
$aisonneuve t0pe occurred in 2G4. $edia "aeous #as fractured in 5H4( the
detoid i!a"ent #as ruptured in 3A4( in H4 there #as no "edia inIur0. The
posterior "ar!in of the dista tibia #as avused aso in @A4. ,racture of the
posterior "ar!in of the dista tibia occurred in T0pe & in @4( in T0pe 6 in
and in T0pe . aso in @A4. In T0pes 6 and . the siEe of the avused posterior
part of the dista tibia covered 1O@ of its articuar surface in H54 of cases(
1O3 in 1H4 and 1O2 in ?4 of cases. 7I*.1**ION: /e have found an adeCuate !roup
of patients for co"parison on0 in the %indsIo #or> #ho evauated a !roup of
adut patients treated at his depart"ent bet#een the be!innin! of ,ebruar0
and end of +une 1GH5. Other !roups of patients #hich #e studied and #hich
incuded so"e of the para"eters that #e have e<a"ined are not co"parabe fro"
the vie#point of the basic seection of patients as the seection #as "ade in
different #a0( na"e0 accordin! to the "anner of treat"ent( i.e.
or sur!ica0( or accordin! to the preference of one of the t0pes of the
fractures or the period of foo#:up. &so( the so caed epide"ioo!ica
studies concentrated on0 on one or t#o factors 5"enO#o"en ratio( the cause of
inIur0( the period of the 0ear8. In addition( so"e #or>s aso incude
in !ro#in! individuas. .ON.%1*ION: ,racture:disocations affect eCua0 "en
#o"en. $en prevai unti the a!e of fift0( #o"en after#ards. The avera!e a!e
patients #as @G 0ears. $ost freCuent is /eber 6 T0pe( east freCuent /eber ..
D$I7: 123A2A2H [Dub$ed : inde<ed for $E7%INE]
152: 9osp $ed. 2002 *ep3A35G8:55A:H.
,ractures of the an>e.
.ou '( /iia"s '%.
1.% 9ospitas( %ondon /1N ?&&.
Dubication T0pes:
'evie#( Tutoria
D$I7: 1235H?A1 [Dub$ed : inde<ed for $E7%INE]
153: ,oot &n>e Int. 2002 *ep3235G8:?33:H.
*tress fractures of the an>e and forefoot in patients #ith infa""ator0
$aenpaa 9( %ehto $1( 6et E&.
'heu"atis" ,oundation 9ospita( 9einoa( ,inand. hei>>i."
T#ent0:four stress fractures occurrin! in the "etatarsa bones and an>e
#ere e<a"ined in 1H patients #ith infa""ator0 arthritides. There #ere 1A
"etatarsa( four dista fibuar( t#o dista tibia( and t#o cacaneus
'adio!raphic ana0ses #ere perfor"ed to deter"ine the presence of possibe
predisposin! factors for stress fractures. $etatarsa and an>e re!ion stress
fractures #ere ana0Eed separate0. *tress fractures occurred "ost freCuent0
the second and third "etatarsas. In "etatarsa fractures( there #as a trend
varus ai!n"ent of the an>e to cause fractures of the atera "etatarsa
and va!us ai!n"ent of the "edia "etatarsa bones. Fa!us defor"it0 of the
an>e #as present in patients #ith dista fibuar fractures in the an>e
!roup. .acaneus fractures sho#ed neutra an>e ai!n"ent. $aai!n"ent of the
an>e and hindfoot is often present in dista tibia( fibuar( and "etatarsa
stress fractures. &dditiona0( patients tend to have on! disease histories
#ith diverse "edication( reconstructive sur!er0 and osteoporosis. If such
patients e<perience sudden pain( tenderness( or s#ein! in the an>e re!ion(
stress fractures shoud be suspected and necessar0 e<a"inations perfor"ed.
D$I7: 1235A1?1 [Dub$ed : inde<ed for $E7%INE]
15@: .in Nuc $ed. 2002 Oct32H5108:H0H:10.
& critica appraisa of pinhoe scinti!raph0 of the an>e and foot.
,rater .( E""ett %( van )aa /( *un!aran +( 7eva>u"ar 7( Fan der /a 9.
*choo of .inica *ciences( ,acut0 of 9eath *tudies( .hares *turt
1niversit0( /a!!a /a!!a( &ustraia.
6&.2)'O1N7: *cinti!raph0 is an estabished i"a!in! techniCue for inIuries of
an>e and foot that are not apparent on pain radio!raphs. The scinti!raphic
techniCue has varied( #ith panar and pinhoe i"a!es bein! used. $&TE'I&%* &N7
$ET9O7*: The incre"enta vaue of pinhoe scinti!raph0 over panar i"a!in! #as
studied in 1A patients #ith estabished dia!noses. Inter:reporter
reproducibiit0 #as aso "easured. 'E*1%T*: Dinhoe scinti!raph0 i"proved the
dia!nostic specificit0 in near0 one haf of the patients 5@?48. It did not
contribute substantia infor"ation in @A4 and ed to confusion in the
of one patient. Inter:reporter a!ree"ent #as !ood( #ith a >appa vaue of 0.H?.
7ia!noses varied fro" fractures of the taar do"e to avusion fractures of the
"aeoi and i"pin!e"ent s0ndro"es. .ON.%1*ION*: Dinhoe i"a!es add a
si!nificant incre"enta vaue to panar scinti!raph0 of the foot and an>e.
&thou!h this had been perceived intuitive0 in the past( it has not been
critica0 evauated. The techniCue has !ood inter:reporter a!ree"ent.
Dubication T0pes:
Evauation *tudies
D$I7: 12352112 [Dub$ed : inde<ed for $E7%INE]
155: &" ,a" Dh0sician. 2002 *ep 13AA558:H?5:G@.
.o""ent in:
&" ,a" Dh0sician. 2003 &pr 13AH5H8:1@3?.
&" ,a" Dh0sician. 2003 $ar 153AH5A8:11?H:?.
,oot fractures freCuent0 "isdia!nosed as an>e sprains.
+udd 76( 2i" 79.
Triper &r"0 $edica .enter( 9onouu( 9a#aii GA?5G( 1*&.
$ost an>e inIuries are strai!htfor#ard i!a"entous inIuries. 9o#ever( the
cinica presentation of subte fractures can be si"iar to that of an>e
sprains( and these fractures are freCuent0 "issed on initia e<a"ination.
,ractures of the taar do"e "a0 be "edia or atera( and the0 are usua0 the
resut of inversion inIuries( athou!h "edia inIuries "a0 be atrau"atic.
%atera taar process fractures are characteriEed b0 point tenderness over the
atera process. Dosterior taar process fractures are often associated #ith
tenderness to deep papation anterior to the &chies tendon over the
posteroatera taus( and pantar fe<ion "a0 e<acerbate the pain. These
fractures can often be "ana!ed nonsur!ica0 #ith non#ei!ht:bearin! status and
short e! cast #orn for appro<i"ate0 four #ee>s. 7ea0s in treat"ent can
in on!:ter" disabiit0 and sur!er0. .o"puted to"o!raphic scans or "a!netic
resonance i"a!in! "a0 be reCuired because these fractures are difficut to
detect on pain fi"s.
Dubication T0pes:
'evie#( Tutoria
D$I7: 12322HAG [Dub$ed : inde<ed for $E7%INE]
15A: 1nfachirur!. 2002 &u!31055?8:H@0:3.
['etro!rade tibia intra"eduar0 naiin! #ith the ,e< Nai::treat"ent of
tibia fracture in an unusua case]
[&rtice in )er"an]
/a!ner ,( *chaudi! /( 6auer '.
&bteiun! fur 1nfa: und /iederhersteun!schirur!ie( .hirur!ische 2ini>(
2ini>u" *t. $arien( $ariahifber!#e! H( G222@ &"ber!.
/e report a case b0 a H5 0ear od fe"ae patient sufferin! a third:de!ree open
fracture of the shinbone #ith a severe da"a!e of the soft tissue. Dri"ar0
operation #as a te"porar0 fi<ation #ith a fi<ateur e<terne and a radica
debride"ent of the soft tissue #ith vacuu":seain!. Ten da0s ater #e did the
definitive sur!er0. Osteos0nthesis #as done b0 a retro!rad naiin! #ith the
fe<ibe unrea"ed hu"erus nai 5,e<:Nai8 throu!h the "edia an>e. The
of the soft tissue #as treated b0 a "usce fap and "esh!raft transpantation.
9eain! of the soft tissue and be!innin! consoidation of the fracture co"es
after @ "onths. In our opinion the retro!rad inserted ,e<:Nai is a !ood
for treat"ent of co"pound fractures of the o#er e! in specia cases.
D$I7: 122@301G [Dub$ed : inde<ed for $E7%INE]
15H: &+' &" + 'oent!eno. 2002 Oct31HG5@8:G@G:53.
*ono!raph0 of an>e tendon i"pin!e"ent #ith sur!ica correation.
*hett0 $( ,esse 7D( ,e"ino +E( +acobson +&( %in +( +a"adar 7.
7epart"ent of 'adioo!0( 1niversit0 of $ichi!an $edica .enter( Taub"an .enter
2?0?( 1500 E. $edica .enter 7r.( &nn &rbor( $I @?10G:032A( 1*&.
O6+E.TIFE: This report describes sono!raph0 of an>e tendon i"pin!e"ent due to
osteoph0tes( fracture fra!"ents( and orthopedic hard#are. .ON.%1*ION:
can be hepfu in identif0in! an>e tendon i"pin!e"ent due to osteoph0tes(
fracture fra!"ents( and orthopedic hard#are. In such cases( d0na"ic sono!raph0
can aid assess"ent.
D$I7: 1223G0@3 [Dub$ed : inde<ed for $E7%INE]
15?: .hir NarEado# 'uchu Ortop Do. 20023AH538:2AG:HH.
[E<terna fi<ation of fractures usin! 70snastab:* stabiiEers for "assive
fractures of tibia bone epiph0sea articuations ]
[&rtice in Doish]
7esEcE0ns>i +( *EcEesn0 )( 2arpins>i +( 7esEcE0ns>a 9( Nio>o#s>i $.
2ini>a Ortopedii i 'ehabiitacIi( II /0dEia %e>ars>i( &>ade"ia $ed0cEna #
$assive an>e fractures ead to Ioint stiffness and resutin! decrease in
of "otion. This can be avoided b0 functiona treat"ent. In cases #here severe
soft tissue trau"a coe<ists #ith bone fractures sur!ica treat"ent is i"ited
and e<terna fi<ation is the "ethod of choice. $odern e<terna fi<ation
techniCue ao#s for stabiisation and "aintainin! ran!e of "otion in the
affected Ioint. This paper presents the resuts of appication of the
e<terna fi<ator. The construction of this fi<ator ao#s dorsa and pantar(
reducin! postrau"atic Ioint stiffness. It aso ao#s appropriate insi!ht into
soft tissues and debride"ent of devitaised tissues as #e as their
sur!ica reconstruction. In our "ateria 52H cases8 treated #ith the 70nastab:
fi<ator for an avera!e of 1A #ee>s a satisfactor0 bone heain! process in a
cases #as noted. &ppropriate function of the e<tre"it0 #as "aintained( #ith
co"parabe pantar fe<ion to the contraatera( not affected Ioint. On0 in
case post operative treat"ent #as co"picated b0 a!od0stroph0. Our
sho#ed that i"pe"entation of "odern e<terna stabiisation techniCues eads
appropriate fracture heain! #ith fu function of the inferior e<tre"it0.
D$I7: 1223?3GH [Dub$ed : inde<ed for $E7%INE]
15G: 6one. 2002 *ep331538:@30:3.
Increasin! nu"ber and incidence of o#:trau"a an>e fractures in eder0
,innish statistics durin! 1GH0:2000 and proIections for the future.
2annus D( Davanen $( Nie"i *( Dar>>ari +( +arvinen $.
&ccident and Trau"a 'esearch .enter( Dresident 1rho 2aeva 2e>>onen Institute
for 9eath Dro"otion 'esearch( Ta"pere( ,inand. >pe>
To increase >no#ed!e about recent trends in the nu"ber and incidence of
o#:trau"a inIuries a"on! eder0 peope( #e seected( fro" the Nationa
9ospita 7ischar!e 'e!ister( a patients M or SA0 0ears of a!e #ho #ere
ad"itted to hospitas in ,inand 55 "iion popuation8 for pri"ar0 treat"ent
a first o#:trau"a an>e fracture durin! 1GH0:2000. In each 0ear of the stud0(
the a!e:adIusted and a!e:specific incidence of fracture #as e<pressed as the
nu"ber of patients per 100(000 persons. The predicted nu"bers and incidence
rates of fractures unti the 0ear 2030 #ere cacuated usin! a re!ression
,or the stud0 period( the nu"ber and incidence of o#:trau"a an>e fractures
,innish persons M or SA0 0ears of a!e rose substantia0: the tota nu"ber of
fractures increased fro" 3AG in 1GH0 to 15@5 in 2000( a 31G4 increase( and the
crude incidence increased fro" 5H to 150( a 1A34 increase. The a!e:adIusted
incidence of these fractures aso rose in both #o"en 5fro" AA in 1GH0 to 1H@
2000( a 1A@4 increase8 and "en 5fro" 3? in 1GH0 to 11@ in 2000( a 2004
increase8. The re!ression "ode indicates that( if this trend continues( there
#i be about three ti"es "ore o#:trau"a an>e fractures in ,inand in the
2030 than there #as in 2000. In concusion( the nu"ber of o#:trau"a an>e
fractures in eder0 ,inns is risin! rapid0 at a rate that cannot be
si"p0 b0 de"o!raphic chan!es and( therefore( potentia0 effective preventive
"easures( such as prevention of sippin!s( trippin!s( and fas in eder0
peope( and use of an>e supports( shoud be ur!ent0 studied. .op0ri!ht 2002
Esevier *cience Inc.
D$I7: 12231@1? [Dub$ed : inde<ed for $E7%INE]
1A0: 1nfachirur!. 2002 +u31055H8:A@3:A.
[Ne# concept in therap0 of dista tibia "etaph0sea fractures and pion
fractures #ith "inor disocations and severe soft tissue da"a!e]
[&rtice in )er"an]
)ehr +( ,ried /.
2ini>u" &schaffenbur!( &bteiun! 1nfa: 9and: und
&" 9asen>opf 1( A3H3G &schaffenbur!.
The treat"ent of pion fractures and dista "etaph0sia tibia fractures
ver0 hi!h standards on the osteos0nthesis "ateria re!ardin! the soft tissue
the essentia Ioint reconstruction. The seection of the sur!ica entrance(
particuar0 in case of a critica arteria or venous circuation and the
possibe irritation of the soft tissue caused b0 the osteos0nthesis "ateria
us to search for aternative osteos0nthesis "ethods. &fter the eaboration of
pre:cinica stud0 and !ood first resuts in the treat"ent of patea(
and an>e Ioint fractures b0 "eans of the =*:nai the atter is no# aso
e"po0ed for pion fractures. /ithin a ti"e period of ? "onth 5 fibua
co"in! #ith pion fractures had been treated #ith the =*:nai. This case
#i de"onstrate both the techniCue of treat"ent and the fe<ibiit0 of the
D$I7: 1221GA51 [Dub$ed : inde<ed for $E7%INE]
1A1: 1nfachirur!. 2002 +u31055H8:A12:?.
['etro!rade intra"eduar0 naiin! of >nee para:articuar fractures in
parape!ic patients]
[&rtice in )er"an]
*ch"eiser )( Fast"ans +( Dotus>i $( 9of"ann )O( 6uhren F.
6erufs!enossenschaftiche 1nfa>ini> $urnau( Drof.:2untscher:*tr. ?( ?2@1?
$urnau. !.sch"eiserK!"<.net
INT'O71.TION: Datients #ith spina cord esions suffer inIur0 even b0 "ar!ina
trau"a( especia0 in the area of the >nee Ioint. 6ecause of ost sensitivit0
and proprioception( the treat"ent of the fracture has to be "ini"a0 invasive
but stabe enou!h for ph0siotherap0. $ET9O7*: There #ere 1? patients #ith 20
fractures near the >nee: 15 fractures of the supracond0ar fe"ur #ere treated
#ith a retro!rade intra"eduar0 )*9 nai and 5 fractures of the pro<i"a
#ith a ne# retro!rade naiin! techniCue. 'E*1%T*: &t revie# a patients had a
!ood "otion ran!e of the >nee Ioint 5M 100 de!rees8( and an>e Ioint "otion
free. .ON.%1*ION: /e sa# in this stud0 that the )*9 nai is an e<ceent
for stabiiEin! supracond0ar fractures of the fe"ur in parape!ic patients
because the treat"ent is "ini"a0 invasive and the fracture is stabe enou!h
for ph0siotherap0. The retro!rade naiin! of pro<i"a fractures of the tibia
a !ood aternative "ethod for treat"ent of patients #ith spina cord esions.
D$I7: 1221GA@H [Dub$ed : inde<ed for $E7%INE]
1A2: 1nfachirur!. 2002 +u31055H8:5G5:A01.
[Treat"ent of rare taus disocation fractures. &n ana0sis of 23 inIuries]
[&rtice in )er"an]
6esch %( 7rost +( E!bers 9+.
2ini> fur 1nfachirur!ie( 1niversitats>ini>u" 2ie( &rnod:9eer:*trasse
2@105 2ie.
$ET9O7*: 6et#een 1G?0 and 1GGA #e treated 23 patients for disocated fractures
of the taus. The inIur0 #as caused b0 a car accident in A14 and a hi!h fa
224. ,ive patients had open #ounds 52248( t#o deveoped co"part"ent s0ndro"e
the foot 5G48 at an ear0 sta!e( and 11 patients had "utipe inIuries. /e
the cassifications of 9a#>ins and $artiO/eber. & fractures #ere sur!ica0
treated b0 fi<ation #ith scre# osteos0nthesis( percutaneous #ire
andOor e<terna fi<ation. ,ifteen patients #ith disocated fractures of the
taus under#ent cinica and radioo!ica foo#:up e<a"inations usin! the
score. 'E*1%T*: ,our patients had e<ceent and three !ood resuts. In five
patients #ith "oderate( t#o #ith adeCuate( and one #ith poor resuts( #e found
additiona inIuries to the ipsiatera foot or e! in 504. Of those patients(
H34 deveoped peritaar arthrosis and 3G4 taar necrosis. 7ue to bon0 defects(
anato"ica reconstruction #as unsatisfactor0 in @?4. .ON.%1*ION*: Even
anato"ica reduction and sufficient stabiiEation cannot a#a0s decrease the
rate of taar necrosis and peritaar arthrosis.
D$I7: 1221GA@@ [Dub$ed : inde<ed for $E7%INE]
1A3: InIur0. 2002 Oct3335?8:H2G:3@.
7o t0pe 6 "aeoar fractures need a positionin! scre#L
9ei" 7( *ch"idin F( Nivieo O.
7epart"ent of *ur!er0( 7istrict 9ospita( .9:3H1@( ,ruti!en( *#itEerand.
T0pe 6 "aeoar fractures 5&OO&*I, cassification8 are usua0 stabe an>e
Ioint fractures. Nonetheess( so"e sho# a residua instabiit0 after interna
fi<ation reCuirin! further stabiiEation. 9o# often does such a situation
and can these unstabe fractures be reco!niEed beforehandL,ro" 1GG5 to 1GGH(
"aeoar fractures 5three t0pe &( G0 t0pe 6( 1? t0pe .8 #ere operated on.
*eventeen out of G0 patients 51G48 #ith a t0pe 6 fracture sho#ed residua
instabiit0 after interna fi<ation 5one uniatera( four bi"aeoar and 12
tri"aeoar fractures8. ,ive of these patients sho#ed a disocation in the
sa!itta pane 5anteroposterior8 cinica0 or on the radio!raphs( five a
disocation in the corona pane #ith disocation of the tibia on the "edia
aspect of the an>e Ioint( and four an incon!ruenc0 on the "edia aspect of
Ioint. In three cases( no preoperative abnor"ait0 indicatin! instabiit0 #as
found. The fractures #ere a fi<ed usin! an additiona positionin! scre#.In
patients( the positionin! scre# #as re"oved after ?:12 #ee>s( in si< patients
re"ova #as perfor"ed after 1 0ear aon! #ith re"ova of the pate. & 1H
patients #ere revie#ed 1 0ear after interna fi<ation( 1AO1H sho#ed a !ood or
e<ceent resut #ith identica or on0 "inor i"pair"ent of ran!e of "otion of
the an>e Ioint. .ON.%1*ION: 1nstabe an>e Ioints after interna fi<ation of
t0pe 6 "aeoar fractures e<ist. 'esidua instabiit0 "ost often occurs after
tri"aeoar fractures #ith initia Ioint disocation. Treat"ent #ith an
additiona positionin! scre# !enera0 produced a satisfactor0 resut.
D$I7: 12213@2A [Dub$ed : inde<ed for $E7%INE]
1A@: &rthroscop0. 2002 *ep31?5H8:E35.
6ro>en po0:%:actic acid interference scre# after i!a"ent reconstruction.
*hafer 6%( *i"onian DT.
7epart"ent of Orthopaedics and *ports $edicine( 1niversit0 of /ashin!ton(
*eatte( /ashin!ton G?1G5:A500( 1*&. bshaferKu.#ashin!
The interference scre# is a reiabe "ethod used to secure tendon to bone and
bone to bone in i!a"ent reconstruction. 9istorica0( "eta interference
have been used for this purpose in both anterior cruciate i!a"ent 5&.%8 and
posterior cruciate i!a"ent 5D.%8 reconstruction. 9o#ever( severa probe"s
associated #ith the use of "eta interference scre#s have ed to the
use of bioabsorbabe i"pants. Do0:%:actic acid 5D%%&8 biode!radabe
interference scre#s have been used successfu0 for !raft fi<ation in i!a"ent
reconstruction. &thou!h adverse reactions have been reported #ith the use of
biode!radabe i"pants( ate scre# brea>a!e is rare. To our >no#ed!e no case
e<ists of ate scre# brea>a!e #ith bioabsorbabe interference scre#s used in
i!a"ent reconstruction. /e present one case in the settin! of an &.%
reconstruction and one #ith co"bined D.% and posteroatera corner
D$I7: 1220G@20 [Dub$ed : inde<ed for $E7%INE]
1A5: + 6one +oint *ur! &". 2002 *ep3?@:&5G8:152?:33.
'efractures in patients at east fort0:five 0ears od. a prospective ana0sis
t#ent0:t#o thousand and si<t0 patients.
'obinson .$( 'o0ds $( &braha" &( $c-ueen $$( .ourt:6ro#n .$( .hristie +.
Edinbur!h Orthopaedic Trau"a 1nit( The 'o0a Infir"ar0 of Edinbur!h( *cotand(
1nited 2in!do". c."i>>
6&.2)'O1N7: Individuas #ho sustain a o#:ener!0 fracture are at increased
of sustainin! a subseCuent o#:ener!0 fracture. The incidence of these
refractures "a0 be reduced b0 secondar0 preventative "easures( athou!h
Iustif0in! such interventions and evauatin! their i"pact is difficut #ithout
substantive evidence of the severit0 of the refracture ris>. The ai" of this
stud0 #as to Cuantif0 the ris> of sustainin! another fracture foo#in! a
o#:ener!0 fracture co"pared #ith the ris> in an a!e and se<:"atched reference
popuation. $ET9O7*: 7urin! the t#eve:0ear period bet#een +anuar0 1G?? and
7ece"ber 1GGG( a inpatient and outpatient fracture:treat"ent events #ere
prospective0 audited in a trau"a unit that is the soe source of fracture
treat"ent for a #e:defined oca catch"ent popuation. 7urin! this ti"e(
22(0A0 patients at east fort0:five 0ears of a!e #ho had sustained a tota of
22(@G@ o#:ener!0 fractures of the hip( #rist( pro<i"a part of the hu"erus(
an>e #ere identified. & refracture events #ere in>ed to the inde< fracture
in the database durin! the t#eve:0ear period. The incidence of refracture in
the cohort of patients #ho had sustained a previous fracture #as divided b0
Rbac>!roundR incidence of inde< fractures #ithin the sa"e oca popuation to
obtain the reative ris> of refracture. Derson:0ears at:ris> "ethodoo!0 #as
used to contro for the effect of the e<pected increase in "ortait0 #ith
advancin! a!e. 'E*1%T*: /ithin the cohort( 2G13 patients 513.248 subseCuent0
sustained a tota of 302@ refractures durin! the t#eve:0ear period. Datients
#ith a previous o#:ener!0 fracture had a reative ris> of 3.?G of sustainin!
subseCuent o#:ener!0 fracture. The reative ris> #as si!nificant0 increased
for both se<es( but it #as !reater for "en 5reative ris> S 5.558 than it #as
for #o"en 5reative ris> S 2.G@8. The reative ris> #as 5.23 in the 0oun!est
cohort 5patients bet#een fort0:five and fort0:nine 0ears of a!e8( and it
decreased #ith increasin! a!e to 1.20 in the odest cohort 5patients at east
ei!ht0:five 0ears of a!e8. .ON.%1*ION*: Individuas #ho sustain a o#:ener!0
fracture bet#een the a!es of fort0:five and ei!ht0:four 0ears have an
reative ris> of sustainin! another o#:ener!0 fracture. This increased ris>
!reater #hen the inde< fracture occurred earier in ife3 the ris> decreased
#ith advancin! a!e. *econdar0 preventative "easures desi!ned to reduce the
of refracture foo#in! a o#:ener!0 fracture are i>e0 to have a !reater
i"pact on 0oun!er individuas.
D$I7: 1220?G0? [Dub$ed : inde<ed for $E7%INE]
1AA: ,oot &n>e Int. 2002 &u!3235?8:H@@:?.
'uptured tibio:fibuar s0ndes"osis: co"parison stud0 of "etaic to
bioabsorbabe fi<ation.
*inisaari ID( %uthIe D$( $i>>onen '9.
7epart"ent of Orthopaedic *ur!er0( 2uusan>os>i 7istrict 9ospita(
,inand. i>>a.sinisaariKhesin>
The patients of this stud0 co"e fro" a series of @3 consecutive an>e fracture
patients #ith s0ndes"otic rupture operated on at our depart"ent. Of these
patients( 1? #ere treated #ith bioabsorbabe sef:reinforced po0:%:actide
scre# and 12 treated #ith "etaic scre#. & a!reed to participate in this
stud0. The0 #ere e<a"ined after a "ini"u" foo#:up period of 12 "onths. The
patients #ere e<a"ined for "easure"ents fro" an>e radio!raphic and co"puted
to"o!raph0 fi"s( oaded dorsa ran!e of "ove"ent of the an>e( and duration
sic> eave. *ubIective resuts #ere obtained b0 a constructed Cuestionnaire.
There #ere no si!nificant differences bet#een the patient !roups in an0 of the
para"eters "easured. /e concude that the fi<ation of a s0ndes"otic rupture
be done #ith a bioabsorbabe sef:reinforced po0:%:actide scre#.
D$I7: 121GG3?G [Dub$ed : inde<ed for $E7%INE]
1AH: $ed 6io En! .o"put. 2002 $a03@0538:302:10.
6io"echanica ana0sis of fati!ue:reated foot inIur0 "echanis"s in athetes
recruits durin! intensive "archin!.
)efen &.
7epart"ent of 6io"edica En!ineerin!( ,acut0 of En!ineerin!( Te &viv
1niversit0( Te &viv( Israe. !efenKen!
&n inte!rative ana0sis( co"prisin! radio!raphic i"a!in! of the foot( pantar
pressure "easure"ents( surface eectro"0o!raph0 5E$)8 and finite ee"ent 5,E8
"odein! of the three:di"ensiona 5378 foot structure( #as used to deter"ine
the effects of "uscuar fati!ue induced b0 intensive athetic or "iitar0
"archin! on the structura stabiit0 of the foot and on its interna stress
state durin! the stance phase. The "ediaOatera 5$O%8 tendenc0 to#ards
instabiit0 of the foot structure durin! "archin! in fati!ue conditions #as
e<peri"enta0 characterised b0 "easurin! the $O% deviations of the foot:
centre of pressure 5.OD8 and correatin! these data #ith fati!ue of specific
o#er:i"b "usces( as de"onstrated b0 the E$) spectra. The resuts
acceerated fati!ue of the peroneus on!us "usce in "archin! conditions
5tread"i "arch of 2 >" co"peted b0 four subIects at an appro<i"ate0
veocit0 of ? >" h:18. *evere fati!ue of the peroneus on!us is apparent0 the
do"inant cause of ac> of foot stabiit0( #hich #as "anifested b0 abnor"a
atera deviations of the .OD durin! the stance phase. 1nder these conditions(
an>e sprain inIuries are i>e0 to occur. The E$) ana0sis further reveaed
substantia fati!ue of the pre:tibia and triceps surae "usces durin!
"archin! 5avera!ed decreases of 3A4 and @04 in the "edian freCuenc0 of their
si!na spectra( respective08. Incorporation of this infor"ation into the 37
"ode of the foot resuted in a substantia rise in the eves of cacanea
"etatarsa stress concentrations( b0 504 and 3A4( respective0. This "a0 point
to the "echanis" b0 #hich stress fractures deveop and provide the
toos for future cinica investi!ations.
D$I7: 121G5GHH [Dub$ed : inde<ed for $E7%INE]
1A?: + ,oot &n>e *ur!. 2002 +u:&u!3@15@8:2@3:A.
&cute tarsa tunne s0ndro"e foo#in! partia avusion of the fe<or haucis
on!us "usce: a case report.
$eEro# .2( *an!er +'( $atoub 9*.
7epart"ent of Dastic *ur!er0( $edica .oe!e of /isconsin( $i#au>ee( /I(
&n acute posterior tibia nerve co"pression fro" a partia0 ruptured fe<or
haucis on!us 5,9%8 "usce is reported. This etioo!0 for acute tarsa
s0ndro"e has not been previous0 described. & 1H:0ear:od "ae sustained
"utipe inIuries in a "otor vehice accident( incudin! a tibia shaft
and a posterior "edia ri!ht an>e aceration of the sa"e i"b. The inIured
had no sensation on the pantar aspect of the foot and hee( decreased active
!reat toe fe<ion( and associated e! pain. E<poration of the posterior
nerve for presu"ed aceration reveaed the nerve to be intact( but co"pressed
a tense tarsa tunne fro" a retracted partia0 ruptured fe<or haucis
tendon. 7eco"pression of the tunne and resection of the devascuariEed "usce
resuted in co"pete neuroo!ic recover0.
D$I7: 121G@515 [Dub$ed : inde<ed for $E7%INE]
1AG: + 6one +oint *ur! 6r. 2002 +u3?@558:HH@:53 author rep0 HH5.
.onservative versus operative treat"ent for dispaced an>e fractures in
patients over 55 0ears of a!e.
,araI &&( $on>house '.
Dubication T0pes:
D$I7: 121??503 [Dub$ed : inde<ed for $E7%INE]
1H0: N Orthop Ihre )renE!eb. 2002 +u:&u!31@05@8:@2?:3@.
[Dro!nostic factors for avascuar necrosis foo#in! taar fractures]
[&rtice in )er"an]
*chuEe /( 'ichter +( 'usse O( In!efin!er D( $uhr ).
.hirur!ische 1niversitats>ini> und Doi>ini>( 'uhr:1niversitat 6ochu"(
6erufs!enossenschaftiche 2ini>en 6er!"annshei( 6ochu". *
&I$: /e perfor"ed an investi!ation of factors for avascuar necroses after
fracture and on the reiabiit0 of the 9a#>ins *i!n. $ET9O7: ,ro" 1G?@ unti
1GGH a tota of G? patients #ith GG taus fractures #ere sur!ica0 treated.
these( HG patients #ith ?0 fractures #ere e<a"ined cinica0 and
radioo!ica0. The avera!e postoperative interva #as A 0ears and 2 "onths.
'E*1%T*: /ith respect to the A5 centra fractures( the rate of necrosis
to 1@ 4( that of cou" fractures to 1H 4. Necroses arose soe0 in disocated
centra fractures of the taus( t0pe III and IF accordin! to $artiO/eber
fracture cassification. The rate of necrosis rose #ith the de!ree of
disocation of the fractures. In 2@ patients the 9a#>ins *i!n coud be
retrospective0 investi!ated. It proved to be a reative0 reiabe si!n for
vitait0 since on0 1 out of 12 patients #ith positive or partia positive
9a#>ins *i!n deveoped avascuar necrosis. Neither a short interva bet#een
accident and operation( the a!e at the ti"e of the accident( nor the
fracture of the "edia "aeous sho#ed a necrosis preventive infuence. In 5
out of G taus necroses the patients #ere ver0 or "ost0 satisfied #ith the
resut of their treat"ent. .ON.%1*ION: The 9a#>ins *i!n proved to be a
reative0 reiabe si!n for vitait0 of the taus after fracture. 'is> for
avascuar necrosis increases accordin! to the de!ree of fracture disocation.
D$I7: 121?3HG@ [Dub$ed : inde<ed for $E7%INE]
1H1: Nhon!!uo =iu ,u .hon! +ian /ai 2e Na Nhi. 2002 +u31A5@8:2@5:H.
[,unction of fibua in stabiit0 of an>e Ioint]
[&rtice in .hinese]
7in! P%( *on! P$.
7epart"ent of Orthopedic *ur!er0( /est .hina 9ospita( *ichuan 1niversit0(
.hen!du( *ichuan( D. '. .hina A100@1.
O6+E.TIFE: To su""ariEe the function of fibua in stabiit0 of an>e Ioints.
$ET9O7*: 'ecent ori!ina artices #ere e<tensive0 revie#ed( #hich #ere
to the ph0sioo!ica function and bio"echanica properties of fibua( the
infuence of fibuar fracture on stabiit0 of an>e Ioints and "echanis" of
osteoarthritis of an>e Ioints. 'E*1%T*: The fibua had the function of
#ei!ht:bearin!3 and it #as !enera0 a!reed that discontinued fibua coud
to intra:articuar disorder of an>e Ioint in chidren3 but there #ere various
vie#points re!ardin! the infuence of fibuar fracture on the an>e Ioint in
aduts. .ON.%1*ION: ,ibua "a0 pa0 an i"portant roe in stabiit0 of an>e
Dubication T0pes:
'evie#( Tutoria
D$I7: 121?1H?? [Dub$ed : inde<ed for $E7%INE]
1H2: Io#a Orthop +. 2002322:GG:102.
,ort0:0ear outco"e of an>e RcupR arthropast0 for post:trau"atic arthritis.
$uir 7.( &"endoa &( *atE"an .%.
&n>e arthropast0 for post:trau"atic tibiotaar arthritis re"ains
controversia. The current iterature stron!0 reco""ends arthrodesis(
especia0 in those patients #ho #i overoad the Ioint: the 0oun!( the
and the over#ei!ht patients. The case described here is a @0:0ear foo# up. &
31:0ear od "an under#ent taar do"e resurfacin! #ith a custo" Fitaiu"
for post:trau"atic arthritis in 1GA2. 9e continued to #or> as a heav0 aborer
unti retire"ent in 1G?H and present0 re"ains virtua0 as0"pto"atic #ith
re!ard to his foot and an>e. The on!evit0 of this individua i"pant has
re"ar>abe. The uniCue desi!n( "ini"a resection( sur!ica approach and
re"ar>abe success "erit discussion in the i!ht of pubication of
bea> reports of arthropast0 in this patient popuation.
D$I7: 121?0A22 [Dub$ed : inde<ed for $E7%INE]
1H3: Transpantation. 2002 &u! 153H@538:3A2:A.
'is> factors for fractures in >idne0 transpantation.
OB*hau!hness0 E&( 7ah 7.( *"ith .%( 2asis>e 6%.
7epart"ent of $edicine( 9ennepin .ount0 $edica .enter( $inneapois( $N 55@15.
6&.2)'O1N7: 'is> factors for fracture after >idne0 transpantation need to be
identified to tar!et patients "ost i>e0 to benefit fro" preventive "easures.
$ET9O7*: $edica records #ere revie#ed for 15H2 >idne0 transpants done at a
sin!e center bet#een ,ebruar0( GA3 and $a0( 2000 #ith A.5;O:5.@ 0ears of
foo#:up. 'E*1%T*: One or "ore fractures occurred in 300 51G.148( #ith
fractures in 101 5A.@48. &fter e<cudin! fractures of the foot or an>e 5nS130
transpants( ?.348( avascuar necrosis 5nS?A( 5.548( and vertebra fractures
5nS2?( 1.?48( there #ere one or "ore fractures in 1GA 512.548( #ith a
incidence of 12.04( 1?.54( and 23.04 at 5( 10( and 15 0ears( respective0. In
"utivariate .o< proportiona haEards ana0sis( a!e had no effect on fractures
in "en. .o"pared #ith "en and 0oun!er #o"en( #o"en @A:A0 and MA0 0ears od
respective0( 2.11 5G54 confidence interva 1.@3:3.12( DS0.00028 and 3.@H
52.1A:5.A0( DJ0.00018 ti"es "ore i>e0 to have fractures. 2idne0 faiure fro"
t0pe 1 and 2 diabetes increased the ris> b0 2.0? 51.@H:2.G5( DJ0.00018 and
51.15:3.20( DS0.01318( respective0. & histor0 of fracture pretranspant
increased the ris> b0 2.15 51.@G:3.0G( DJ0.00018. Each 0ear of pretranspant
>idne0 faiure increased the ris> b0 1.0G 51.05:1.1@( DJ0.00018. Obesit0 5bod0
"ass inde< M30 >!O"28 #as associated #ith 554 51H:HA4( DS0.01108 ess ris>.
7ifferent i""unosuppressive "edications( acute reIections( and "utipe other
factors #ere not independent0 associated #ith fractures. .ON.%1*ION*: The
popuation of transpant patients at hi!h ris> for fracture can be identified
usin! a!eO!ender( pretranspant fracture histor0( diabetes( obesit0( and 0ears
of pretranspant >idne0 faiure.
D$I7: 121HHA15 [Dub$ed : inde<ed for $E7%INE]
1H@: + Orthop Trau"a. 2002 &u!31A5H8:525:?.
$aisonneuve fracture associated #ith a bi"aeoar an>e fracture:disocation:
case report.
9ense 2*( 9arpstrite +2.
Triper &r"0 $edica .enter( Orthopaedic *ur!er0 *ervice( 9onouu( 9I GA?5G(
The $aisonneuve fracture consists of a pro<i"a fibuar fracture #ith
s0ndes"otic i!a"ent disruption and inIur0 to the "edia an>e structures. The
accepted "echanis" of inIur0 is an e<terna rotation force appied to the
#ith the foot in either supination or pronation. 6ecause "ost $aisonneuve
fractures invove co"pete s0ndes"otic disruption( operative treat"ent is
usua0 indicated. & case report is presented of an unusua fracture
pattern:i.e.( that of a dista fibuar fracture #ith atera an>e disocation
associated #ith a $aisonneuve fracture. To our >no#ed!e( on0 t#o other
cases are reported in the En!ish iterature.
D$I7: 121H22?A [Dub$ed : inde<ed for $E7%INE]
1H5: + Orthop Trau"a. 2002 &u!31A5H8:@G?:502.
*ur!ica treat"ent of a dispaced atera "aeous fracture: the anti!ide
techniCue versus atera pate fi<ation.
%a"onta!ne +( 6achut D&( 6roe>hu0se 9$( OB6rien D+( $ee> 'N.
%ava 1niversit0( -uebec( $ontrea( .anada( and Fancouver )enera 9ospita(
1niversit0 of 6ritish .ou"bia( Fancouver( 6ritish .ou"bia( .anada.
O6+E.TIFE*: To assess the outco"es of the sur!ica "ana!e"ent of RisoatedR
dispaced atera "aeoar fractures( co"parin! the techniCues of atera
patin! and anti!ide patin! as described previous0. 7E*I)N: This is a
retrospective revie#( bein! ar!e0 a sur!eon:rando"iEed co"parative stud0.
*ETTIN): The stud0 #as carried out at a universit0 teachin! hospita that
as a provincia trau"a referra service and provides oca co""unit0 care. The
senior sur!eons are a orthopaedic trau"a subspeciaists. D&TIENT*: & tota
1G3 patients "eetin! our incusion criteria( #ith isoated atera "aeous
fractures sur!ica0 treated at the Fancouver )enera 9ospita bet#een 1G?H
1GG?( #ere studied. INTE'FENTION: Ei!ht0:five #ere treated #ith anti!ide
patin!( #hereas the re"ainin! 10? patients under#ent traditiona atera
patin!. $&IN O1T.O$E $E&*1'E*: The functiona resuts #ere evauated #ith the
an>e scorin! s0ste" described previous0. /e aso co"pared the co"pication
rates( incudin! faiure of fi<ation( infection( #ound dehiscence( and need
hard#are re"ova. 'E*1%T*: 6oth !roups #ere co"parabe for a!e( se<
distribution( "echanis" of inIur0( and occupation. There #as no difference in
an>e score( function( and infection rate. The incidence of #ound dehiscence
reoperation for hard#are re"ova #as si!ht0 hi!her in the atera pate
but the difference #as not statistica0 si!nificant. .ON.%1*ION*: The outco"e
of the sur!ica "ana!e"ent of a dispaced atera "aeous fracture is
co"parabe #ith both techniCues. &thou!h fe# studies have reported so"e
advanta!es usin! the anti!ide techniCue( our data do not support one
over the other.
D$I7: 121H22?0 [Dub$ed : inde<ed for $E7%INE]
1HA: + Orthop Trau"a. 2002 &u!31A5H8:@H3:?3.
Three:di"ensiona assess"ent of tibia "aunion after intra"eduar0 naiin!:
prei"inar0 stud0.
6oucher $( %eone +( Dierr0no#s>i $( 6handari $.
7epart"ent of Orthopaedic *ur!er0( and the *choo of 'ehabiitation *cience(
$c$aster 1niversit0( 9a"iton( Ontario( .anada.
O6+E.TIFE*: The purpose of this stud0 #as t#ofod: 5a8 to introduce a ne#
three:di"ensiona di!ita assess"ent techniCue for the esti"ation of an!uar
rotationa "aunion and 5b8 to deter"ine if an association e<ists bet#een
"aunion and functiona0 defined post:trau"atic de!eneration at the >nee and
an>e Ioint. 7E*I)N: Nonrando"iEed( cohort stud0( #ith 5.@A 0ears 5ran!e 2 to
0ears8 of foo#:up. *ubIects under#ent a nove three:di"ensiona techniCue to
deter"ine the functiona "echanica a<is of both the >nee and tibiotaar
6oth the affected and unaffected i"bs #ere tested. 7ifferences bet#een both
i"bs provided assess"ent of "aunion in three panes #ith 1.? ;O: 0.1 percent
5"ean ;O: *78 reiabiit0. Datients co"peted the /estern Ontario $c$aster
1niversit0 Osteoarthritis Inde<( the %o#er E<tre"it0 ,unctiona *cae( and the
&ssess"ent *0ste" of %o#er E<tre"it0 ,unction. *tandard postoperative
radio!raphs #ere aso e<a"ined for evidence of "aunion. *ETTIN):
1niversit0:based %eve 1 trau"a center. D&TIENT*: *event0:one subIects #ith an
isoated tibia fracture repaired #ith intra"eduar0 nais #ere identified3
thirteen "et ei!ibiit0 criteria for stud0 incusion. 'E*1%T*: & tota of HH
percent of the patients 5"ean foo#:up 5.5 0ears( ran!e 2 to 10 0ears8 #ere
"aai!ned in one or "ore of the three panes e<a"ined 5"aunion
defined as MorS10 rotation( MorS5 varus:va!us( and MorS10
procurvatu":recurvatu"8. $ean varus:va!us defor"it0 #as 11.? ;O: A.3 de!rees(
"ean procurvatu":recurvatu" defor"it0 #as 3.2 ;O: 2.5 de!rees( and
"edia:atera rotationa defor"it0 #as G.A ;O: @.H de!rees. There #as no
si!nificant correation 5p M 0.058 bet#een the overa ai!n"ent of the
e! 5intertibia difference8 in an0 of the three directiona panes and the
subIectBs response to an0 of the three functiona outco"e scaes used.
Three:di"ensiona ana0sis differed si!nificant0 fro" radio!raphic
interpretation #hen "aunion occurred in the corona pane 5p S 0.00038.
.ON.%1*ION*: This stud0 su!!ests that faiure to "eet conventiona0 accepted
standards for tibia ai!n"ent "i!ht be co""on. ,ortunate0( these vaues #ere
not associated #ith adverse functiona outco"es. & three:di"ensiona s0ste"(
#hich deter"ines the functiona "echanica a<is of the >nee and tibiotaar
Ioints( "a0 be a vauabe and reiabe "ethod b0 #hich to deter"ine "aunion
after fracture fi<ation.
D$I7: 121H22HH [Dub$ed : inde<ed for $E7%INE]
1HH: ,oot &n>e Int. 2002 +u3235H8:A@H:50.
*tress fractures of the "edia "aeous::revie# of the iterature and report
a 15:0ear:od eite !0"nast.
*habat *( *a"pson 26( $ann )( )epstein '( Eia>i" &( *hen>"an N( N0s>a $.
The Orthopaedic *ur!er0 7epart"ent( The *apir $edica .enter( 2far:*aba(
*tress fracture of the "edia "aeous is rare and not reported in chidren.
report a case of a 15:0ear:od eite !0"nast #ith open ph0ses sustainin! a
"edia "aeoar stress fracture. The patient #as treated initia0 b0 rest
!radua0 returned to sport #ith fu recover0. T#o "onths ater she deveoped
co"pete fracture of the "edia "aeous of the sa"e side. This #as treated
sur!ica0 b0 open reduction and interna fi<ation #ith a canceous scre# and
soon after the operation she returned to fu activities. E"phasis is !iven to
the suspected "echanis" #hich ed to this uniCue fracture and to the hor"ona
aspects in the professiona adoescent !0"nast. /e reco""end sur!ica
of stress fracture of the "edia "aeous especia0 for eite athetes(
eadin! to ear0 recover0 and return to sports activities.
Dubication T0pes:
'evie# of 'eported .ases
D$I7: 121@AHHH [Dub$ed : inde<ed for $E7%INE]
1H?: ,oot &n>e Int. 2002 +u3235H8:A25:?.
Darticipation in sports after arthrodesis of the foot or an>e.
Fertuo .+( Nune0 +&.
7ivision of Orthopaedics( 71$1( 7urha"( N. 2HH10( 1*&.
.urrent0 no data or !uideines e<ist for the sur!eon on ho# to advise
about returnin! to sports participation after arthrodesis #ithin the foot or
an>e. *eCueae of inappropriate activit0 after arthrodesis incudes
periarticuar arthrosis( arthrodesis faiure and stress fracture. *o"e
arthrodeses #i precude certain sports because it i"its the patientBs
to perfor" "ove"ent vita to the !a"e( for e<a"pe( an>e arthrodesis
bas>etba pa0ers fro" Iu"pin!. -uestionnaires #ere sent to "e"bers of the
&"erican Orthopaedic ,oot and &n>e *ociet0 5&O,&*8 and to trainers of
professiona bas>etba and &"erican footba tea"s. This paper reports on the
responses of orthopaedic foot and an>e sur!eons about return to sports
participation( after arthrodeses #ithin the foot and an>e( and su!!ests
!uideines for sports participation after an arthrodesis of the o#er
& seective sports participation poic0 is advised. Datients #ith an an>e or
tripe fusion shoud avoid hi!h:i"pact sports( #hie those #ith "ore dista
arthrodeses shoud be "onitored for arthrosis and stress fracture.
D$I7: 121@AHH3 [Dub$ed : inde<ed for $E7%INE]
1HG: &cta Orthop *cand. 2002 +un3H3538:3@@:51.
*ur!ica treat"ent of taus fractures: a retrospective stud0 of ?0 cases
foo#ed for 1:15 0ears.
*chuEe /( 'ichter +( 'usse O( In!efin!er D( $uhr ).
7epart"ent of *ur!er0( 6):2ini>en 6er!"annshei( 'uhr:1niversit0 6ochu"(
/e retrospective0 revie#ed HG patients 5?0 taar fractures8 operated on
1GG@ and 1GGH. The avera!e foo#:up #as A 51:158 0ears. 15 patients had a
$artiO/eber fracture t0pe I( 1@ patients a t0pe II( 32 patients a t0pe III(
1G patients a t0pe IF fracture. @A patients suffered a fracture of the taar
nec>( 9a#>ins t0pe I in 10 patients( t0pe II in 1?( t0pe III in 1H and t0pe IF
in 1 patient. 1?O23 patients direct0 paced in our depart"ent #ere operated
#ithin A hours of ad"ission. Dri"ar0 arthrodesis of both the an>e and
Ioint #as perfor"ed t#ice. *econdar0 arthrodesis of the an>e Ioint #as done
on0 3 patients. .o"bined secondar0 arthrodesis of the an>e and subtaar
#as perfor"ed in 5 and arthrodesis of the taonavicuar Ioint in 1 patient.
&ccordin! to the 9a#>ins score( 35O?0 feet achieved !oodOver0 !ood function
versus @3 #ith the $aEur score. 'adio!raphs sho#ed an>e or subtaar arthrosis
in t#o thirds of the patients. & nor"a ran!e of "otion #as achieved in 1?
and 1G subtaar Ioints. The overa rate of taar necrosis #as GO?0 fractures.
D$I7: 121@3G?5 [Dub$ed : inde<ed for $E7%INE]
1?0: ,oot &n>e .in. 2001 7ec3A5@8:?53:AA( i<.
*oft tissue covera!e options for an>e #ounds.
%evin %*.
7ivision of Dastic( 'econstructive( $a<iofacia and Ora *ur!er0( and
7ivision of Orthopaedic *ur!er0( 7u>e 1niversit0 $edica .enter( 7urha"( N.
2HH10( 1*&. evin001K"c.du>
*oft tissue deficiencies of the an>e are caused b0 severa "echanis"s( such
trau"a( tu"or( and infection. .o"poundin! the reconstructive probe"s is that
soft tissue probe"s often present in patients #ho have under0in! diseases
as periphera vascuar disease( diabetes or both. ,or e<a"pe( a A5:0ear:od
person #ith diabetes #ho s"o>es t#o pac>s of ci!arettes per da0 sustains an
an>e fracture. &fter under!oin! open reduction and interna fi<ation of the
fracture( there is subseCuent #ound behiscence over the patientBs fibuar
The #ound ed!es cannot be reappro<i"ated( and there is oss of soft tissue.
shoud treat"ent be for this soft tissue probe"L &nother e<a"pe is a
@5:0ear:od rheu"atoid patient #ho ta>es 20 "! of steroids a da0 and under!oes
posterior tibia tendon repair after rupture. One "onth after sur!er0( the
sur!ica #ound dehisces( resutin! in e<posure of the tendon repair. /hat is
approach for adeCuate and effective soft tissue treat"entL The purpose of this
artice is to address such co"pe< probe"s and to provide an a!orith" for
tissue reconstruction of the an>e.
Dubication T0pes:
'evie#( Tutoria
D$I7: 1213@5?5 [Dub$ed : inde<ed for $E7%INE]
1?1: + *outh Orthop &ssoc. 2001 ,a310538:12G:3G.
Outco"e of subtaar arthrodesis after cacanea fracture.
2oodEieI D( Nune0 +&.
7ivision of Orthopaedic *ur!er0( 7u>e 1niversit0 $edica .enter( 7urha"( N.
2HH10( 1*&.
6et#een 1G?3 and 1GG5( #e used subtaar arthrodesis to treat 1A consecutive
patients for continued pain after an intra:articuar cacanea fracture.
ti"e to union #as 3 "onths 52 to @ "onths8. .o"pications #ere "inor in @
patients( and "aIor in @ others. %en!th of foo#:up in 1@ patients #as 55
"onths 5ran!e( 12 to 112 "onths8. 9indfoot scores 5cinica ratin! s0ste" of
&"erican Orthopaedic ,oot and &n>e *ociet08 i"proved fro" 3? 5ran!e( 2? to
to AH 5ran!e( 3G to G@8. 'esuts of "edica outco"e surve0s indicate that
patients had o# scores in areas reated to ph0sica conditionin!( ph0sica
functionin!( and bodi0 pain. /e concude that the "aIorit0 of patients can
i"prove"ent #ith sur!ica reconstruction that addresses a specific probe"(
pain reief is usua0 not co"pete.
D$I7: 12132?2@ [Dub$ed : inde<ed for $E7%INE]
1?2: 1nfachirur!. 2002 $a03105558:@H@:H.
[&ntero!rade intra"eduar0 tibio:tao cacaneus arthrodesis 5aI$T.&8 #ith
spon!iosapast0 in pseudarthrosis]
[&rtice in )er"an]
)unter 1( +entsch D( 9eer ).
.aritas:2ini>en Dan>o#( 2ini> fur .hirur!ie( 6erin.
Dseudarthrosis occur in A54 of a an>e Ioint arthrodesis. ,ro" the
therapeutica point of vie# #e "a>e a distinction bet#een vita 5h0pertrophic8
and avita 5h0potrophic8 respective0 stabe and instabe pseudarthrosis. The
h0potrophic for"s de"and an additiona canceous or bone !raftin!. Especia0
instabe pseudarthrosis have to be treated #ith a bioo!ica osteos0nthesis.
the hindfoot the so caed co"pression arthrodesis "ade oneBs #a0. 6ut there
sti a discussion about the best "ethod( intern or e<tern fi<ation. /e report
about a case of h0potrophic pseudarthrosis #ith a "a:position occurrin! after
an an>e Ioint arthrodesis #ith a .harne0:,i<ateur. & fusion of the an>e
coud be carried out #ith a pro<i"a respective0 antero!rade intra"eduar0
nai and ao!ene canceous !raft.
D$I7: 12132210 [Dub$ed : inde<ed for $E7%INE]
1?3: + Trau"a. 2002 +u353518:55:A0.
'esuts of an>e fractures #ith invove"ent of the posterior tibia "ar!in.
%an!enhuiIsen +,( 9eetved $+( 1tee +$( *teer ED( 6utEeaar '$.
7epart"ent of )enera *ur!er0( *t. %ucas &ndreas 9ospita( &"sterda"( The
6&.2)'O1N7: &n>e fractures have a si!nificant0 #orse functiona outco"e #hen
the0 incude a posterior tibia fra!"ent. In 5H tri"aeoar fractures( the
effect of siEe( interna fi<ation( and anato"ic reduction of the posterior
fra!"ent on the pro!nosis #as evauated. $ET9O7*: & "odified /eber protoco
used( providin! a ratin! s0ste" for subIective( obIective( and radio!raphic
resuts. & visua anao!ue scae for subIective actua pain #as aso scored.
'E*1%T*: The invove"ent of the articuar surface ran!ed fro" ?4 to 554. *iEe
fi<ation of the fra!"ent did not infuence pro!nosis. +oint con!ruit0 in
fra!"ents MorS 104 of the articuar surface #as a si!nificant factor
pro!nosis. Overa( the "odified /eber protoco resut #as e<ceent in 104(
!ood in 154( fair in 254( and poor in 504 of patients. 9o#ever( the o#
visua anao!ue scae of 3.0 in the #hoe !roup does not appear representative
of 504 poor resuts( indicatin! that the "odified /eber protoco is fair0
strict and overesti"ates the nu"ber of poor resuts. .ON.%1*ION: +oint
#ith or #ithout fi<ation #as a si!nificant factor infuencin! pro!nosis.
.on!ruit0 shoud be achieved for fra!"ents MorS 104 of the tibia articuar
D$I7: 121313G0 [Dub$ed : inde<ed for $E7%INE]
1?@: 'adio .in North &". 2002 $ar3@0528:2?G:312( vii.
I"a!in! of athetic inIuries to the an>e and foot.
7unfee /'( 7ain>a $2( 2neeand +6.
'adioo!0 &ssociates of Tarrant .ount0( ,ort /orth( T= HA10@( 1*&.
.onventiona radio!raphs in conIunction #ith cinica e<a"ination re"ains the
pri"ar0 "ethod for evauatin! the acute athetic inIur0. In "ost cases(
suspected acute tendon and i!a"ent inIuries are initia0 treated based on
ph0sica e<a"ination. $a!netic resonance 5$'8 i"a!in!( #ith its "utipanar
capabiit0 and superb soft tissue contrast( is Cuic>0 beco"in! the "ethod of
choice for evauatin! chronic foot and an>e pain and further definin! the
e<tent of tendon and i!a"ent inIuries. This artice revie#s the co""on acute
and chronic 5overuse8 foot and an>e athetic inIuries #ith an e"phasis on
i"a!in! characteristics.
Dubication T0pes:
'evie#( Tutoria
D$I7: 1211??2A [Dub$ed : inde<ed for $E7%INE]
1?5: Osteoporos Int. 20023135A8:513:?.
'is> factors for fractures of the #rist( shouder and an>e: the 6ue
E0e *tud0.
Ivers '-( .u""in! ')( $itche D( Deduto &+.
Institute for Internationa 9eath( 1niversit0 of *0dne0( Ne#to#n( N*/(
,e# studies have e<a"ined ris> factors for fractures of the #rist( shouder or
an>e. The 6ue $ountains E0e *tud0 is a popuation:based on!itudina stud0
3A5@ peope a!ed @G 0ears or oder resident in an area #est of *0dne0(
&ustraia. 7etaied e0e e<a"inations and intervie#s #ere carried out at
51GG2:38 and after 5 0ears 51GGH:G8. Infor"ation about fractures sustained
durin! foo#:up #ere coected b0 a co"bination of sef:report and a search
hospita radioo!0 records. &fter @.H 0ears foo#:up subIects had sustained
fractures of the dista forear"( 20 fractures of the pro<i"a hu"erus and 33
an>e fractures. In "utivariate "odes factors independent0 associated #ith
#rist fractures in #o"en #ere no vi!orous e<ercise in the past 2 #ee>s
ris> '' 0.@( G54 .I 0.2:0.G8 and ever use of 9'T 5'' 0.@( G54 .I 0.1:1.08.
,actors independent0 associated #ith an>e fractures #ere "ae se< 5'' 0.3(
.I 0.1:0.?8 and visua fied oss 5'' 2.?( G54 .I 1.2:A.A8. These findin!s are
in >eepin! #ith other studies( and su!!est that different t0pes of
fracture have different( if overappin!( sets of ris> factors.
D$I7: 1210HAAH [Dub$ed : inde<ed for $E7%INE]
1?A: Osteoporos Int. 20023135A8:@50:5.
&n osteoporosis cinica path#a0 for the "edica "ana!e"ent of patients #ith
o#:trau"a fracture.
.hevae0 T( 9off"e0er D( 6onIour +D( 'iEEoi '.
7ivision of 6one 7iseases( /9O .oaboratin! .enter for Osteoporosis and 6one
7iseases( 7epart"ent of Interna $edicine( 1niversit0 9ospitas of )eneva(
*#itEerand. thierr0.chevae0Khcu!
Datients #ith an osteoporotic fracture have at east a 2:fod ris> for
additiona fracture and shoud benefit fro" tar!eted dia!nostic and treat"ent
procedures for osteoporosis. To address this issue( #e set up an osteoporosis
cinica path#a0 5O.D8 for the "edica "ana!e"ent of patients #ith o#:trau"a
fracture. ,oo#in! acute "ana!e"ent of the fracture b0 the orthopedic tea"(
patients are enroed in the path#a0( #hich is based on an interaction bet#een
the O.D "utidiscipinar0 tea"( orthopedic sur!eons andOor pri"ar0 care
ph0sicians. &fter coection of patient data( su!!estions for additiona
dia!nostic e<a"inations #ith their interpretation( and treat"ent proposas are
"ade. Datients and their fa"iies are aso invited to attend a
interactive educationa pro!ra" on ph0sica therap0( ifest0e habits and
nutrition. 7urin! a 3A:"onth period( 3?5 patients 5311 #o"en( H@ "en3 "ean a!e
;O: *7: H3.0 ;O: 13.5 0ears3 hip fracture @54( an>eOtibia 2@4( pro<i"a
?.A4( spine 5.54( pevis 3.G4( dista forear" 3.A4( other sites 1H.@48 #ere
enroed in the O.D. &n osteoporosis a#areness Cuestionnaire ad"inistered
10 da0s of fracture sho#ed that H34 of patients beieved that their fracture
not reated to the disease. 7ua:ener!0 =:ra0 absorptio"etr0( perfor"ed in A34
of patients( sho#ed that ?A4 had o# bone "ass or osteoporosis. *pecific
antiosteoporotic therap0 #as proposed for 334 of patients in addition to
and vita"in 7 suppe"ents( the atter su!!ested for G34. & surve0 perfor"ed in
21A patients A "onths ater( indicated that A34 of the su!!ested treat"ents
been prescribed and that AH4 of this !roup #ere continuin! treat"ent. *uch a
cinica path#a0 for the "edica "ana!e"ent of o#:trau"a fracture can hep to
identif0 patients #ith osteoporosis in a hi!h:ris> popuation( provide support
to the orthopedic sur!eon andOor the pri"ar0 care ph0sician for dia!nostic and
treat"ent procedures( and shoud si!nificant0 contribute to increase
of the disease in patients and their fa"iies.
D$I7: 1210HA5H [Dub$ed : inde<ed for $E7%INE]
1?H: $i $ed. 2002 +un31AH5A8:@5@:?.
The Rfoatin! an>eR: a pattern of vioent inIur0. Treat"ent #ith thin:pin
e<terna fi<ation.
$c9ae 2&( )aIe#s>i 7&.
7epart"ent of Orthopedic *ur!er0 and 'ehabiitation( /ater 'eed &r"0 $edica
.enter( /ashin!ton( 7. 2030H:5001( 1*&.
The Rfoatin! an>eR is an underappreciated pattern of inIur0 that resuts
vioent trau"a andOor bast inIuries in "iitar0 personne. It is
b0 an intact an>e "ortise #ith a dista tibia fracture and an ipsiatera
fracture( creatin! instabiit0 around the an>e. This pattern of inIur0 "a0 be
the resut of the "iitar0 boot( #hich both protects the foot fro" i""ediate
a"putation or further inIur0 and renders the dista tibia susceptibe to
fracture at the boot top. ,our patients #ith open foatin! an>e inIuries #ere
treated #ith thin:pin circuar fi<ation #ith !ood resuts. T#o patients
bone transport for se!"enta oss. & patients are a"buator0 #ithout
assistance or bracin!. Thin:pin e<terna fi<ation is a reasonabe approach to
this co"pe< inIur0 pattern( especia0 in the presence of "ar>ed soft tissue
co"pro"ise #ith or #ithout se!"enta bone oss.
D$I7: 120GG0H? [Dub$ed : inde<ed for $E7%INE]
1??: + %on! Ter" Eff $ed I"pants. 2002312518:35:52.
& on!:ter" cinica stud0 on disocated an>e fractures fi<ed #ith
sef:reinforced po0evoactide 5*':D%%&8 i"pants.
Foutiainen N9( 9ess $/( Toivonen T*( 2ro!erus %&( Dartio E2( Datiaa 9F.
7epart"ent of Orthopaedics and Trau"atoo!0( 9esin>i 1niversit0 .entra
9ospita( Topeiu>sen>atu 5( ,IN:002A0 9esin>i( ,inand.
*i<teen patients #ith disocated an>e fractures fi<ed bet#een 1G?? and 1GG1
#ith sef:reinforced po05%:actide3 *':D%%&8 scre#s andOor rods #ere foo#ed
up after ?.A to 11.H 0ears 5"ean G.A 0ears8 at the 7epart"ent of Orthopaedics
and Trau"atoo!0( 9esin>i 1niversit0 .entra 9ospita. In a patients
reduction of the fractures #as retained and uneventfu bon0 union #as
)ood or e<ceent on!:ter" functiona resuts #ere observed in 15 out of 1A
patients. One patient had post:trau"atic osteoarthritis. In 5 patients( a ate
tissue reaction #as observed over an e<trudin! scre# head #ith "id s0"pto"s(
#hich ed to re"ova of s"a papabe "asses. There #ere t#o superficia
infections( one after a pri"ar0 operation and one caused b0 a ate tissue
reaction after an operation. The correct operative techniCue( #here a
e<trudin! e<traosseous *':D%%& "ateria shoud be re"oved durin! the pri"ar0
operation( shoud be foo#ed.
D$I7: 120GAA@1 [Dub$ed : inde<ed for $E7%INE]
1?G: /iderness Environ $ed. 2002 *u""er313528:153:5.
.inica i"a!es. 7eep acerations to both hands.
'od#a0 ).
D$I7: 120G2GH0 [Dub$ed : inde<ed for $E7%INE]
1G0: Dast 'econstr *ur!. 2002 +u3110518:3A0:2.
9o# reiabe is the dista0 based peroneus brevis "usce fapL
6arr *T( 'o#e0 +$( OBNei D+( 6ario 7+( Dausen *$.
Dubication T0pes:
D$I7: 120?H2GH [Dub$ed : inde<ed for $E7%INE]
1G1: N Orthop Ihre )renE!eb. 2002 $a0:+un31@0538:33@:?.
[,unctiona postoperative treat"ent of interna0 fi<ed an>e fractures #ith a
fe<ibe arthrodesis boot 5Fariostabi8]
[&rtice in )er"an]
6ie#ener &( 'a""et *( Teister ,$( )rass '( N#ipp 9.
2ini> und Doi>ini> fur 1nfa: und /iederhersteun!schirur!ie(
1niversitats>ini>u" )ustav .arusR der T1 7resden( )er"an0.
&I$: Dostoperative treat"ent foo#in! osteos0nthesis of an>e fractures in a
fe<ibe arthrodesis boot 5Fariostabi8 ai"s at fast restoration of the
of the inIured e<tre"it0 #hie ao#in! ear0 fu #ei!ht bearin!. This
treat"ent re!i"en #as vaidated in a cinica and e<peri"enta stud0. $ET9O7*:
518 In the cinica stud0 part( 5A patients #ith interna0 fi<ed an>e
fractures received after treat"ent #ith the arthrodesis boot for A #ee>s. 528
the e<peri"enta stud0 part( the intravascuar pressure #as recorded in a foot
vein of ? heath0 vounteers durin! >nee bends. 'E*1%T*: 518 No i"pant
or secondar0 disocation #as seen due to the after treat"ent. & patients
subIective co"fort and "obiit0 as e<ceent. G0.5 4 had a !ood to e<ceent
functiona resut #ith the Dhiips *core. 528 /earin! the arthrodesis boot
effected si!nificant0 faster venous outfo# 525.? ;O: 15.2 vs. 11.3 ;O: A.0
""9!Osec( p J 0.058 and hi!her pressure a"pitude 553.A ;O: 12.0 vs. 2A.5 ;O:
G.A ""9!8 durin! >nee bends( co"pared to a beo#:the:>nee paster cast.
.ON.%1*ION*: The fe<ibe arthrodesis boot offers safe protection of an>e
fractures co"bined #ith superior functiona perfor"ance 5undisturbed !ait(
trainin! of the an>e Ioint( hi!h patient co"fort and "obiit0( acceerated
venous outfo#8 as co"pared to cast i""obiiEation.
Dubication T0pes:
.inica Tria
D$I7: 120?5301 [Dub$ed : inde<ed for $E7%INE]
1G2: InIur0. 2002 &pr333538:2G2:@.
,racture:disocation of the an>e #ith fi<ed dispace"ent of the fibua behind
the tibia::a rare variant.
/hite *D( Daister I.
7epart"ent of Orthopaedics( $orriston 9ospita( *#ansea( 12.
D$I7: 120?@A5A [Dub$ed : inde<ed for $E7%INE]
1G3: Nhon!!uo =iu ,u .hon! +ian /ai 2e Na Nhi. 1GGG $a0313538:152:@.
[&ppication of repairin! tibia and soft tissue defect #ith free fibua
tissue !raftin!]
[&rtice in .hinese]
Nhen D( %iu =P( /en P$.
.enter of Orthopedic *ur!er0( )enera 9ospita of D%& of %anEhou( %anEhou(
)ansu( D. '. .hina H30050.
O6+E.TIFE: To investi!ate a !ood "ethod for repairin! the on! bone defect of
tibia co"bined #ith soft tissue defect. $ET9O7*: ,ro" 1G??:1GG?( si<teen
patients #ith on! bone defect of tibia #ere ad"itted. There #ere 12 "aes( @
fe"aes and a!ed fro" 1A to @5 0ears. The en!th of tibia defect ran!ed fro" H
c" to 12 c"( the area of soft tissue defect ran!ed fro" 5 c" < 3 c" to 12 c" <
c". ,ree fibua !raftin! #as adopted in repairin!. 7urin! operation( the t#o
ends of fibuar arter0 #ere anasto"osised #ith the anterior tibia arter0 of
recipient( and the co"posited fibuar fap #ere transpanted. 'E*1%T*: &
!rafted fibua unioned and the fap survived co"pete0. ,oo#ed up for A to
111 "onths( 1@ patients acCuired the nor"a function #hie the other 2
received arthrodesis of the tibia:taus Ioint. In a the 1A patients( the
unstabe an>e Ioint coud not be observed. .ON.%1*ION: The "odified "ethod is
characteriEed b0 the cear anato"0( the ess bood oss and the reduced
operation ti"e. $ean#hie( the bood supp0 of the !rafted fibua can be
D$I7: 120?0H?5 [Dub$ed : inde<ed for $E7%INE]
1G@: .an + *ur!. 2002 +un3@5538:1GA:200.
$orbidit0 resutin! fro" the treat"ent of tibia nonunion #ith the IiEarov
*anders 7/( )apin '7( 9osseini $( $ac%eod $7.
7ivision of Orthopedic *ur!er0( 1niversit0 of /estern Ontario( %ondon.
O6+E.TIFE: To deter"ine the sources and "a!nitude of residua "orbidit0 after
successfu treat"ent of tibia nonunion usin! the IiEarov device and
techniCues. 7E*I)N: & retrospective cohort stud0. *ETTIN): & eve 1 trau"a
centre. D&TIENT*: *i<teen patients #ith heaed tibia nonunion. INTE'FENTION:
&ppication of the IiEarov device and techniCues to obtain union of a
ununited tibia fracture. $&IN O1T.O$E $E&*1'E*: Datient satisfaction and
sources of "orbidit0 throu!h cinica revie# and a visua anao!ue scae. T#o
disease:specific outco"e "easure"ent scaes #ere used to assess an>e
d0sfunction. 'adio!raphs #ere e<a"ined to deter"ine the presence of arthrosis.
'E*1%T*: 'esidua pain #as present in over G04 of patients at a "ean foo#:up
of 3G "onths: in ?04 the #orst pain #as in the an>e( ess than 104 fet the
#orst pain in the >nee or at the fracture site. $ean an>e osteoarthritis
#ere 3.@ for pain and @.0 for disabiit0( co"pared #ith 0.HA and 0.G0
respective0 for a!e:"atched contros. $ean an>e:hindfoot scores #ere bet#een
A@ and 100. .ON.%1*ION: &n>e pain #ith disabiit0 is the "aIor source of
residua disabiit0 after successfu use of the IiEarov device for the
treat"ent of tibia nonunion.
D$I7: 120AH1H2 [Dub$ed : inde<ed for $E7%INE]
1G5: Eur + 'adio. 2002 +u3@3518:@5:5A.
Overuse and sports:reated inIuries of the an>e and hind foot: $' i"a!in!
*iIbrandiI E*( van )is &D( de %an!e EE.
7epart"ent of 'adioo!0( 1niversit0 9ospita 1trecht and .entra $iitar0
9ospita( 9eideber!aan 100( 350G && 1trecht( The Netherands.
Drofessiona and recreationa sportin! activities have increased substantia0
in recent 0ears and have ed to a rise in the nu"ber of sports:reated and
overuse inIuries. $a!netic resonance 5$'8 i"a!in! has beco"e an i"portant too
for evauatin! the o#er e! for providin! the necessar0 infor"ation for
"ana!e"ent and rehabiitation foo#in! this inIur0. The purpose of this essa0
is to !ive an overvie# of the $' findin!s of co""on overuse inIuries and
sports:reated inIuries to the bones and soft:tissue structures of the hind
and an>e.
D$I7: 120A5121 [Dub$ed : inde<ed for $E7%INE]
1GA: Instr .ourse %ect. 2002351:15G:AH.
Drincipes of "ana!e"ent of the severe0 trau"atiEed foot and an>e.
6au"hauer +,( $anoi & 2nd.
7ivision of ,oot and &n>e *ur!er0( 7epart"ent of Orthopaedics( 1niversit0 of
'ochester $edica .enter( 'ochester( Ne# Por>( 1*&.
Dubication T0pes:
'evie#( Tutoria
D$I7: 120A@101 [Dub$ed : inde<ed for $E7%INE]
1GH: + 6one +oint *ur! &". 2002 +un3?@:&5A8:GH1:?0.
.o""ent in:
+ 6one +oint *ur! &". 2003 +u3?5:&5H8:13GA3 author rep0 13GA.
+ 6one +oint *ur! &". 2003 $ar3?5:&538:5H13 author rep0 5H1:2.
%on!:ter" outco"e after tibia shaft fracture: is "aunion i"portantL
$iner *&( 7avis T'( $uir 2'( )reen#ood 7.( 7ohert0 $.
7epart"ent of Orthopaedic and &ccident *ur!er0( -ueenBs $edica .enter(
Nottin!ha"( 1nited 2in!do". stephen."
6&.2)'O1N7: ,ractures of the shaft of the tibia often hea #ith so"e
&thou!h there is bio"echanica evidence that such an!uation aters oad
trans"ission throu!h the Ioints of the o#er i"b( it is not cear #hether it
can eventua0 ead to osteoarthritis. $ET9O7*: One hundred and si<t0:four
individuas #ho had sustained a tibia shaft fracture #ere assessed in a
research cinic thirt0 to fort0:three 0ears after the inIur0. The subIects
evauated #ith re!ard to sef:reported o#er i"b Ioint pain( stiffness( and
disabiit0 5assessed #ith the /estern Ontario and $c$aster 1niversities
osteoarthritis Cuestionnaire83 cinica si!ns of osteoarthritis3 and
radio!raphic evidence of osteoph0tes and Ioint:space narro#in! in the >nees(
an>es( and subtaar Ioints. 'E*1%T*: T#ent0:t#o 51548 of the 151 subIects #ho
reported no other >nee inIur0 reported at east "oderate >nee pain( and ei!ht
5A48 of the 1@5 subIects #ho reported no other an>e inIur0 reported at east
"oderate an>e pain. *eventeen 51348 of the 135 subIects #ho reported no other
>nee or an>e inIur0 reported at east "oderate disabiit0. The ipsiatera
de"onstrated a hi!her prevaence than the contraatera side in ter"s of pain
#ith passive an>e "ove"ent 5nineteen versus nine subIects( p S 0.028( pain
passive subtaar "ove"ent 5fifteen versus four subIects( p S 0.018( and
radio!raphic si!ns of an>e Ioint space narro#in! 5t#eve subIects versus one
subIect( p S 0.00558. 2nee osteoarthritis #as freCuent0 biatera. ,ort0:
fractures 52G48 heaed #ith corona an!uation of M or S 5 de!rees. &part fro"
an association bet#een shortenin! of M or S 10 "" and sef:reported >nee pain
S 0.01A8( there #ere no si!nificant univariate associations bet#een these
"aunions and the deveop"ent of osteoarthritis. *eventeen 51548 of 11@
subIects had overa "aai!n"ent of the o#er i"b( defined as a hip:>nee:
an!e outside the nor"a ran!e of A.25 de!rees of varus to @.H5 de!rees of
va!us. This "aai!n"ent #as due to the fracture "aunion in nine subIects
predated the fracture in ei!ht. In i"bs #ith varus or va!us "aai!n"ent(
there #as an e<cess of subtaar stiffness 5p S 0.0@8 and a nonsi!nificant
to#ard "ore freCuent >nee pain. In i"bs #ith varus "aai!n"ent( there #as a
nonsi!nificant trend to#ard "ore freCuent radio!raphic evidence of
osteoarthritis in the "edia co"part"ent of the >nee Ioint. $ost of the
in #ho" osteoarthritis #as observed had nor"a overa ai!n"ent of the o#er
i"b. .ON.%1*ION*: The thirt0:0ear outco"e after a tibia shaft fracture is
usua0 !ood( athou!h "id osteoarthritis is co""on. ,racture "aunion is not
the cause of the hi!her prevaence of s0"pto"atic an>e and subtaar
osteoarthritis on the side of the fracture. &thou!h varus "aai!n"ent of the
o#er i"b occurs occasiona0 and "a0 cause osteoarthritis in the "edia
co"part"ent of the >nee( other factors are "ore i"portant in causin!
osteoarthritis after a tibia shaft fracture.
D$I7: 120A3331 [Dub$ed : inde<ed for $E7%INE]
1G?: &cta Orthop 6e!. 2002 &pr3A?528:1H?:?1.
Denetration inIur0 of the hindfoot foo#in! intra"eduar0 nai fi<ation of a
tibia fracture.
,araI &&( +ohnson F).
Orthopaedic 7epart"ent( 9u 'o0a Infir"ar0( &nab0 'oad( 9u( 1nited
Technica errors durin! intra"eduar0 nai insertion are not unco""on. /e
report a case of tibia !uide #ire penetration into the dista tibia
surface( the taus and the cacaneus durin! insertion of the nai #ith the
dorsife<ed. This has not been reported in the past. .o"puteriEed to"o!ra" #as
usefu too in the dia!nosis. This co"pication #as associated #ith
on!:standin! an>e pain( #hich ho#ever eventua0 setted. /e advise freCuent
use of bipanar .:ar" i"a!e durin! the insertion of the !uide #ire( the rea"er
and tibia nai into the "eduar0 cana of the tibia or other on! bones.
of these instru"ents shoud be forced throu!h. Once the >nobbed !uide #ire is
e<chan!ed to a strai!ht !uide #ire( the #ire shoud not be forced throu!h or
rea"ed over( and the nai shoud be introduced over the !uide #ire #ith
Ear0 intraoperative identification and recordin! of this iatro!enic accident
necessar0 in order to e<pain the situation to the patient and "odif0
D$I7: 1205100H [Dub$ed : inde<ed for $E7%INE]
1GG: 6r + Neurosur!. 2002 &pr31A528:1A5:H.
B%oo> beneath the stoc>in!sB::dea0ed dia!nosis of an>e fractures in patients
#ith thoracic cord co"pression.
'edd0 $$( T0a!i &( To#ns ).
7epart"ent of Neurosur!er0( %eeds )enera Infir"ar0( 12.
T#o patients #ith thoracic cord co"pression and an>e fractures are presented.
The dia!nosis and treat"ent of the an>e fractures #as dea0ed in these
patients. The ac> of pain sensation in the o#er i"bs and the use of TE7
stoc>in!s that covered the area of abnor"ait0 #ere the reasons for the
D$I7: 120@AH3H [Dub$ed : inde<ed for $E7%INE]
200: ,oot &n>e Int. 2002 $a0323558:@0A:10.
Du"onar0 e"bois" foo#in! operative treat"ent of an>e fractures: a report
three cases and revie# of the iterature.
/an! ,( /era )( 2nobich )O( .hou %6.
.orne 1niversit0 $edica .oe!e( Ithaca( NP( 1*&.
The ris>s of thro"boe"bois" foo#in! operative treat"ent of an>e fractures
are deep vein thro"bosis 57FT8 and pu"onar0 e"bois" 5DE8. These are
potentia0 ife:threatenin! co"pications. $an0 orthopedic sur!eons fai to
appreciate the potentia co"pications of thro"boe"boic events because of
rare and dea0ed occurrence in foot and an>e operations. The purpose of this
report is to describe the potentia for 7FT and DE foo#in! an>e operations.
/e present three cases in #hich patients #ho under#ent operative treat"ent of
an>e fractures subseCuent0 deveoped DE. /e aso revie# the iterature on
prevaence of thro"bosis( ris> factors( "ethods of proph0a<is( and use of
proph0a<is in sur!ica procedures of the o#er e<tre"it0.
Dubication T0pes:
'evie#( Tutoria
D$I7: 120@3G?@ [Dub$ed : inde<ed for $E7%INE]