ABSTRACT
The clinical features of a superior dislocation of the glenohumeral joint are described. Reposition, even under general anaesthesia, cannot be achieved. Associated supraspinatus tear, acromioclavicular separation and the dislocated position of the humeral head can be clearly visualized.
Subject(s)
Manipulation, Orthopedic , Shoulder Dislocation/therapy , Aged , Aged, 80 and over , Chronic Disease , Female , Humans , Radiography , Range of Motion, Articular , Shoulder Dislocation/diagnostic imaging , Shoulder Dislocation/physiopathologyABSTRACT
The incidence of nerve injuries in primary shoulder dislocation and humeral neck fracture is uncertain. We made a prospective study of 101 patients, using clinical examination and extensive electrophysiological assessment when there was suspicion of nerve damage. We found electrophysiological evidence of nerve injury in 45%, most involving the axillary, suprascapular, radial and musculocutaneous nerves. There were significantly more nerve injuries in older patients and those with a haematoma. Most patients recovered partially or completely in less than four months, and only eight had persistent motor loss. Early diagnosis and physiotherapy are recommended.
Subject(s)
Peripheral Nerve Injuries , Shoulder Dislocation/complications , Shoulder Fractures/complications , Shoulder/innervation , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Electromyography , Female , Humans , Male , Middle Aged , Prospective Studies , Radial Nerve/injuriesABSTRACT
In case of irreversible failed total hip replacement, a Girdlestone operation is sometimes the obvious solution: excision of cement and prosthesis without attempting a new hip replacement. Reasons for not implanting a new prosthesis are severe loss of bone stock, the risk of recurrent infection, or poor general condition. A clinical follow-up study was performed on 40 patients who underwent a Girdlestone hip procedure using the following criteria: pain, walking distance and the use of a walking support. The mean follow-up was 4.9 years. Postoperatively 33 of 40 patients had less pain compared with the situation before the operation. Sixteen patients walked more than 500 m, 13 patients walked 200-500 m and 11 patients walked less than 200 m, of whom 4 were wheelchair bound. The objective result was good in 40% of the patients, moderate in 42.5%, and bad in 17.5%. Subjectively 62.5% were satisfied. A Girdlestone arthroplasty after loosening of the hip prosthesis was a satisfying solution in most cases.
Subject(s)
Arthroplasty/methods , Hip Prosthesis , Adult , Aged , Aged, 80 and over , Female , Gait , Hip Joint/diagnostic imaging , Hip Joint/physiology , Humans , Male , Middle Aged , Prosthesis Failure , Radiography , ReoperationABSTRACT
We studied two groups of 6 adult female African pygmy goats, which received cemented or uncemented femoral endoprostheses in their right hip. One additional goat was used for in vivo angiography preoperatively and postoperatively. The blood supply to the proximal femur at a macroscopic level was not severed by the operation. Until the 6th postoperative week, the animals were killed at weekly intervals. Microangiography and fluorescence microscopy revealed that rapid revascularization of the metaphyseal trabecular bone in the vicinity of the implants occurred as early as the first postoperative week in both groups. However, in general, the revascularization of the bone around the uncemented prostheses occurred more rapidly, resulting in earlier bone remodeling when compared with the cemented group. Surprisingly, the apposition of periosteal bone was longer lasting and more intensive in the uncemented group, particularly at the metaphyseal level. We suggest that this phenomenon may be enhanced by mechanical stimuli; the restoration of function was delayed in the noncemented goats.