ABSTRACT
In impaction grafting of contained bone defects after revision joint arthroplasty the graft behaves as a friable aggregate and its resistance to complex forces depends on grading, normal load and compaction. Bone mills in current use produce a distribution of particle sizes more uniform than is desirable for maximising resistance to shear stresses. We have performed experiments in vitro using morsellised allograft bone from the femoral head which have shown that its mechanical properties improve with increasing normal load and with increasing shear strains (strain hardening). The mechanical strength also increases with increasing compaction energy, and with the addition of bioglass particles to make good the deficiency in small and very small fragments. Donor femoral heads may be milled while frozen without affecting the profile of the particle size. Osteoporotic femoral heads provide a similar grading of sizes, although fewer particles are obtained from each specimen. Our findings have implications for current practice and for the future development of materials and techniques.
Subject(s)
Bone Transplantation , Joint Prosthesis , Bone Density , Bone Transplantation/physiology , Femur Head/transplantation , Humans , Particle Size , Stress, Mechanical , Transplantation, HomologousABSTRACT
Bone loss following total knee arthroplasty (TKA) may be focal or diffuse. It may be caused mechanically, either by unloading of the bone leading to disuse osteoporosis, or by overloading of the bone leading to trabecular fractures and bone destruction. Osteolysis, instigated by an inflammatory reaction to particulate wear debris, is an important and common cause of bone loss after TKA. Less common, though sometimes dramatic, causes of bone loss are infection and osteonecrosis.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Bone Resorption/etiology , Biocompatible Materials/adverse effects , Biocompatible Materials/chemistry , Fractures, Bone/etiology , Humans , Knee Prosthesis/adverse effects , Osteolysis/etiology , Osteolysis/prevention & control , Osteonecrosis/complications , Osteoporosis/etiology , Prosthesis-Related Infections/complications , Stress, Mechanical , Surface PropertiesABSTRACT
A 43-year-old female fell backward outside her home while carrying a watering can. She sustained an ipsilateral fracture of the proximal ulna and distal radius (Colles fracture). The ulnar fracture was plated, and the Colles fracture was managed by closed reduction and percutaneous Kirschner wiring. The patient recovered without incident. This association of forearm fractures is unusual. Both fractures can be caused by a fall on the hand with the wrist in mid-extension and the elbow flexed, and they probably occurred in quick succession.
Subject(s)
Colles' Fracture/therapy , Fracture Fixation, Internal/methods , Multiple Trauma/therapy , Ulna Fractures/therapy , Accidental Falls , Adult , Colles' Fracture/diagnosis , Colles' Fracture/diagnostic imaging , Elbow Joint/diagnostic imaging , Female , Fracture Fixation, Internal/instrumentation , Fracture Healing , Humans , Multiple Trauma/diagnosis , Multiple Trauma/diagnostic imaging , Radiography , Range of Motion, Articular , Ulna Fractures/diagnosis , Ulna Fractures/diagnostic imaging , Wrist Injuries/diagnosis , Wrist Injuries/diagnostic imaging , Wrist Injuries/therapy , Elbow InjuriesABSTRACT
We present two cases of traumatic total extrusion of the talus, leaving no soft-tissue attachment. The management of this rare injury is controversial. These cases were managed by reimplantation of the tali. The tali revascularised and survived without collapse. One patient developed posttraumatic osteoarthritis of the ankle.
Subject(s)
Accidental Falls , Ankle Injuries/pathology , Ankle Injuries/surgery , Postoperative Complications/physiopathology , Talus/injuries , Adult , Ankle Injuries/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Postoperative Complications/rehabilitation , RadiographyABSTRACT
Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.
Subject(s)
Barium Sulfate , Colonic Diseases/diagnosis , Sigmoidoscopy , Colonic Diseases/diagnostic imaging , Colonic Polyps/diagnosis , Diverticulum, Colon/diagnosis , Enema , Humans , Inflammatory Bowel Diseases/diagnosis , Radiography , Sensitivity and SpecificityABSTRACT
Daily ultrasonography of the gallbladder bed was performed in patients with suction or passive tube drains after elective cholecystectomy. A total of 19 patients was randomized to suction drainage and 17 to passive tube drainage. A policy of early drain removal was followed. No significant difference was found between the volume drained and the size of collection detected in either group. Significant bile leaks were detected and were adequately drained by suction and passive tube drains. There were no complications from drains. In view of these findings, we advocate short-term drainage of the gallbladder bed after both open and laparoscopic cholecystectomy using the drain of the surgeon's choice.
