Dynamic assessment of shoulder and patellofemoral pathology using limited-volume gas arthroscopy.

Subtle instability problems of the glenohumeral joint and patellofemoral joint are difficult to assess and accurately diagnose with current methods of preoperative imaging and physical examination. A simple technique is described that provides objective information for diagnosing dynamic problems of the shoulder and patellofemoral joint. Limited-volume gas arthroscopy avoids many of the potential risks and complications of pressure-based gas arthroscopy. In addition to assessing joint dynamics, it allows for initial arthroscopic inspection of joints during open surgical cases, eliminating the additional morbidity and expense of fluid arthroscopy. Objective intraoperative assessments of completed reconstructions can also be made to insure that stabilizing procedures are adequate but not overzealous. The technique requires no special equipment, adds little time to an arthroscopic procedure, and requires only basic arthroscopic skills.

Cemented internal fixation for supracondylar femur fractures in osteoporotic patients.

Seventeen, supracondylar femur fractures in 15 severely osteoporotic patients (average age, 81.9 years) were treated with a 95 degree supracondylar plate and dynamic compression screw supplemented with intramedullary methyl methacrylate and massive cancellous bone graft harvested from the distal femoral metaphysis. Interfragmentary compression and rigid fracture fixation was obtained in all cases with the use of the A-O compression device. Patients were allowed early protected weight bearing without external immobilization. At follow-up observation (average, 2.1 years), bony union was noted in all cases, and knee flexion averaged 100.4 degrees. There were no malunions or cases of implant failure. Complications included two early postoperative deaths and three femur fractures above the plate. This technique was effective in rapidly restoring patient mobility while avoiding the complications of implant failure.

Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure.

Revision of an infected uncemented hip arthroplasty can be significantly complicated by the presence of extensive bony ingrowth. Although removal of the prosthesis is desirable, technical difficulties in extracting a well anchored prosthesis can be extreme. Femoral windowing or splitting may be necessary. In these cases, treatment alternatives that avoid destruction of the femoral cortex are desirable. A 47-year-old man presented with a deep infection of a virtually fully coated porous implant two years postoperatively. Radiographs revealed extensive bony ingrowth and an arthrogram revealed no dye tracking down the femoral canal. The infecting organism was Staphylococcus epidermis. In order to avoid the possible complications of extraction of this fully coated stem, treatment was carried out initially with removal of the bipolar head, joint debridement, and placement of antibiotic impregnated beads. After seven weeks of intravenous antibiotic therapy with the patient in tibial pin traction, a revision was undertaken and the acetabulum was revised with a threaded uncemented acetabular component. The patient recovered and at 18 month follow-up is without evidence of infection and back to full function. Revision with a two-stage femoral stem preserving procedure is presented as an alternative in the management of infected uncemented hip arthroplasty.

Solitary (unicameral) bone cyst. The fallen fragment sign revisited.

The fallen fragment sign is a prominent radiologic feature in a minority of cases of unicameral bone cyst (20% in this series). This sign is always associated with pathologic fracture. Intramedullary fracture fragments may be single or multiple and may or may not be entirely dislodged from overlying periosteum. The finding appears limited to unicameral bone cysts in patients with open physes. When present, the fallen fragment is a pathognomonic finding as it defines the interior of the cyst as nonsolid. This is particularly helpful in cases where absence of the cyst wall secondary to fracture can simulate an intramedullary malignancy with cortical erosion.

Replantation of an autoclaved autogenous segment of bone for treatment of chondrosarcoma. Long-term follow up.

Seven patients who had a low-grade chondrosarcoma of the proximal part of the humerus or femur were treated by resection, autoclaving of the excised segment, and reinsertion of that segment with supplementary fresh autogenous grafts. The length of follow-up ranged from fourteen to twenty-four years, and sequential roentgenograms were made during the follow-up period. A biopsy of the autoclaved segments was done in one patient eleven years after the operation, and examination of the specimen showed predominantly live bone; there were very few spicules of dead bone. Although the principal roentgenographic changes were demonstrated by the end of the first year, serial roentgenograms showed a continuing process of remodeling for two decades. No secondary procedures were required for treatment of fracture, resorption, infection, or loss of function.