ABSTRACT
OBJECTIVE: Aim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder. INDICATIONS: Palsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face. CONTRAINDICATIONS: Not completed rehabilitation after a neurosurgical procedure. Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation. SURGICAL TECHNIQUE: To improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30-60 degrees ). A dynamic compression plate is used for osteosynthesis. POSTOPERATIVE MANAGEMENT: Immobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed. RESULTS: The procedure was performed in 15 cases, followed up on average after 3 years (0.5-8.7 years). In all cases, the shifted arc of rotation (preoperative 37 degrees deficit of external rotation, postoperative 46 degrees increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.
Subject(s)
Humerus/surgery , Osteotomy/methods , Paresis/surgery , Range of Motion, Articular/physiology , Shoulder Joint/physiopathology , Adolescent , Adult , Aged , Bone Plates , Child , Female , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Retrospective Studies , Shoulder Joint/innervationABSTRACT
INTRODUCTION: This prospective study was performed to assess the influence of limited weight-bearing on the outcome of osteochondral drilling in the treatment of an osteochondritis dissecans tali. MATERIALS AND METHODS: Of a total of 85 patients, 68 (80%; 37 male, 31 female, average age 28 years) were followed up after open or arthroscopic drilling between July 1990 and March 2000. The total outcome of 6 weeks limited postoperative weight-bearing (n=26) was compared with the outcome of 12 weeks limited weight-bearing (n=42). The average follow-up time was 4.8 years after surgery. RESULTS: A significant increase (p<0.01) in the HSS and AOFAS scores was found for the entire study group ranging from HSS: 82 points; AOFAS: 68 points before surgery to HSS: 94 points; AOFAS: 90 points at the time of assessment. The duration of limited weight-bearing did not significantly influence the outcome of surgery. Through osteochondral drilling, the average AOFAS score increased 20 points (73/93) and the HSS score 12 points (84/96) in the 6-week group and the AOFAS score 23 points (65/88) and the HSS score 12 points (80/92) in the 12-week group. The total outcome between the two postoperative treatment regimens showed no significant difference. CONCLUSION: Osteochondral drilling is an adequate therapy for osteochondritis dissecans tali. The postoperative duration of limited weight-bearing does not significantly influence the surgical outcome.
Subject(s)
Osteochondritis Dissecans/surgery , Weight-Bearing , Adolescent , Adult , Arthroscopy , Child , Exercise Therapy , Female , Humans , Male , Middle Aged , Osteochondritis Dissecans/rehabilitation , Postoperative Period , Prospective Studies , Time FactorsABSTRACT
BACKGROUND: This study was performed to assess the value of knee arthroscopy in patients with radiological signs of severe osteoarthritis. METHODS: A total of 104 patients (50 men, 54 women, average age 60 years) with radiological knee osteoarthritis grade III/IV were followed up after knee arthroscopy between May 1989 and November 1996. The average follow-up time was 5.4 years after surgery. RESULTS: A significant ( p<0.01) increase in the Lysholm score was found, ranging from 40 points before arthroscopy to 69 points at the assessment. A total of 84 patients (81%) reported an increase in their activities of daily living, 44 patients (43%) were still without any complaints. The total outcome was rated very good or good by 67 patients (65%). Only 21 patients (20%) required further surgery before the assessment. CONCLUSIONS: Knee arthroscopy is a valuable treatment for patients with pain, swelling, and radiological signs of severe osteoarthritis. It improves the patients' activities of daily living and helps to postpone further surgery.
