ABSTRACT
Several theories and anatomical variations have been described to explain pes planus. Inherent within these has been the notion that the condition is bilateral. In this paper some causes for an acquired unilateral flatfoot in the adult are discussed and illustrative cases are presented.
Subject(s)
Flatfoot/etiology , Adult , Aged , Arthritis/complications , Exostoses/complications , Female , Foot Diseases/complications , Foot Injuries , Fractures, Bone/complications , Humans , Male , Middle Aged , Rupture , Tendon Injuries/complicationsABSTRACT
Fractures of the neck of the femur require prompt treatment and an anatomic or translated reduction on the fracture table with traction applied parallel with the body. Valgus position is not satisfactory. The plate and minimum of nine pins, by hammer impaction at surgery, coapts the irregular surfaces. Strain-gauge studies showed that only 25% of the stress on the fracture site is borne by a "tell-tale" nail. Seventy-five percent of the stress is dissipated by the surrounding bone. It is essential to immediately secure the 75% support of the surrounding bone by impaction at surgery and by recording the degree of impaction on the chart. To accept shortening or collapse over the first six to eight weeks means six to eight weeks of secondary healing going through a cartilage phase instead of healing per primam. Avascular necrosis, if it occurs, will not manifest itself until six months later. In this period the fracture site is vulnerable to nonunion. One must promote primary endosteal bone healing with no cartilage and no motion at fracture site. Resilient fixation dissipates the forces tending to displace the fracture, yet holds it with sufficient rigidity to promote early prompt union, typically within nine weeks. Secure plate-stabilized properly applied fixation allows full weight-bearing on the third to fourth postoperative day.
Subject(s)
Bone Nails , Hip Fractures/surgery , Biomechanical Phenomena , Cartilage, Articular , Femur Head Necrosis/etiology , Femur Neck/surgery , Hip Fractures/physiopathology , Hip Joint/blood supply , Humans , Motion , Postoperative Complications , Pressure , Time Factors , Wound HealingSubject(s)
Methylmethacrylates/adverse effects , Prostheses and Implants/adverse effects , Surgery, Plastic , Blood Pressure/drug effects , Bone Cements/adverse effects , Bone Plates , Craniosynostoses/surgery , Heart Arrest/chemically induced , Hot Temperature/adverse effects , Humans , Osteonecrosis/etiology , Skull/surgery , Surgical Wound Infection/etiologySubject(s)
Early Ambulation , Femoral Fractures/therapy , Tibial Fractures/therapy , Braces , Casts, Surgical , Exercise Therapy , Humans , Nursing CareABSTRACT
The use of full-thickness iliac bone grafts shaped into cigar and cigarette forms in the treatment of nonunion of the femoral neck and idiopathic avascular necrosis of the femoral head was studied. Results of 36 operations (18 hips in each category) were classified according to pain, range of motion, function, and roentgenographic appearance. Follow-up with a two-year minimum revealed that bone grafting contributed to a successful result in the nonunion group with 17 hips uniting. Thirteen hips with avascular necrosis, however, showed progression of disease and were classified as failures. In light of these results, bone grafting in the treatment of idiopathic avascular necrosis must be questioned.
Subject(s)
Bone Transplantation , Femoral Neck Fractures/surgery , Femur Head Necrosis/surgery , Femur Neck/surgery , Fractures, Ununited/surgery , Osteonecrosis/surgery , Adult , Aged , Female , Humans , Ilium/transplantation , Male , Middle Aged , Osteonecrosis/diagnostic imaging , Radiography , Transplantation, AutologousABSTRACT
A retired teamster with abdominal pain and anemia was found to have lead intoxication presumably due to and old bullet in his ankle. Most lead particles within the body need not be removed. Lead solubility characteristics exemplified by this case cuase us to recommend that bullets and lead particles facing synovial spaces should be removed.
