ABSTRACT
Ulnar nerve injury is rarely associated with closed forearm fractures. This report describes a case of ulnar nerve laceration secondary to a closed fracture of the radius and ulna. Although a case report of an ulnar nerve laceration in an open fracture has been described, a review of the literature failed to reveal any cases in closed injuries. The standard surgical approach was modified to allow treatment of the fractures and microscopic repair of the nerve.
Subject(s)
Accidental Falls , Fractures, Closed/complications , Radius Fractures/complications , Ulna Fractures/complications , Ulnar Nerve/injuries , Adolescent , Female , Forearm Injuries/diagnostic imaging , Forearm Injuries/therapy , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , Fracture Healing/physiology , Fractures, Closed/diagnostic imaging , Fractures, Closed/surgery , Humans , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/surgery , Radiography , Radius Fractures/diagnostic imaging , Radius Fractures/surgery , Ulna Fractures/diagnostic imaging , Ulna Fractures/surgery , Ulnar Nerve/surgeryABSTRACT
One hundred consecutive Anatomic Porous Replacement (Intermedics Orthopaedics, Austin, TX) hip replacements were followed for 4 years. Eighty percent of patients had bone ingrowth fixation, 14% stable fibrous, and 6% unstable fibrous (loose) with 4% revised. Only two hips changed fixation grade after 2 years. Bone remodeling showed cancellous hypertrophy of the cortex, usually along the lateral cortex, and 7% had stress shielding (atrophy) of the proximal cortices. Adaptive bone remodeling almost always occurred in type B and C bone. Bone remodeling was statistically related to bone type, prosthetic fill, stem-bone ratio, and collar loading. We concluded that proximal bone ingrowth fixation with proximal load transfer provides good clinical results and excellent bone remodeling. Also, collar loading improves bone response. To expand this fixation in a predictable fashion to all type B and some type C bone requires geometry changes, which have been accomplished in the Anatomic Porous Replacement II.
Subject(s)
Hip Prosthesis/instrumentation , Adult , Aged , Aged, 80 and over , Analysis of Variance , Bone Remodeling , Evaluation Studies as Topic , Female , Femur/anatomy & histology , Follow-Up Studies , Hip Prosthesis/statistics & numerical data , Humans , Male , Middle Aged , Prosthesis DesignABSTRACT
The combined anterior and posterior approach permits access to the front and back of the hip joint for reconstruction and complex arthroplasty, usually without osteotomy of the greater trochanter, with minimal muscle release. There is ease of access to the anterior and posterior capsule, which can be resected under direct vision, thus permitting accurate hemostasis. The entire acetabular rim is exposed for bone grafting as required. The authors review the useful standard approaches and illustrate the combination of the anterior and posterior approaches through a straight lateral incision. Concomitant exploration of the sciatic nerve is demonstrated, as is the osteotomy of the trochanter performed when the ilium superior to the acetabulum must be reconstructed. The utility and limitations of the operation is illustrated by representative cases. This extensive procedure usually can prevent neurologic and vascular compromise and allows excellent observation of the skeletal structures for accurate component alignment.
