ABSTRACT
In the field of uncemented hip arthroplasties, secondary biologic fixation of femoral implants depends directly on the quality of the primary stability. Metaphyseal filling and a good fit between the implant and the proximal femur improve initial stabilization and optimize the transmission of forces to the bone. Precise knowledge of the three-dimensional femoral shape is essential to the design and selection of adapted implants. Three hundred ten femurs in 300 patients suffering from primary hip osteoarthritis were analyzed by computed tomography scanning. After three-dimensional reconstruction, several measurements were extracted, and the parameters essential to the characterization of the diverse femoral morphologies encountered were identified. A new classification of the proximal femur is proposed. The consequences on the design and the preoperative selection of femoral implants are discussed.
Subject(s)
Femur/diagnostic imaging , Image Processing, Computer-Assisted/methods , Tomography Scanners, X-Ray Computed , Adult , Aged , Female , Hip Prosthesis , Humans , Male , Middle Aged , Models, Structural , Osteoarthritis, Hip/diagnostic imaging , Prosthesis Design , Radiographic Image EnhancementSubject(s)
Rotator Cuff Injuries , Rotator Cuff/surgery , Activities of Daily Living , Adult , Aged , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Retrospective Studies , Rupture , Shoulder Joint/physiology , WorkABSTRACT
Rupture of pectoralis major tendon is a rare lesion, often undiagnosed. We present 2 cases of complete rupture and one case of partial rupture. The 2 complete ruptures were treated surgically with, at follow up, a normally strong, painless shoulder and improved esthetics. The partial rupture remained nearly asymptomatic after conservative treatment. We recommend surgical repair of pectoralis major rupture, a lesion that remains symptomatic in the long term. Surgery should be done early, late repairs being technically more difficult and esthetic result less convincing.
Subject(s)
Pectoralis Muscles/injuries , Adult , Athletic Injuries/complications , Athletic Injuries/surgery , Humans , Male , Middle Aged , Pectoralis Muscles/surgery , Rupture , Suture Techniques , Tendon Injuries/etiology , Tendon Injuries/surgeryABSTRACT
Biological fixation of cementless femoral implants requires primary stability by optimal fit in the proximal femur. The anatomy of the bone must then be known precisely. We analysed in vitro the accuracy of bone measurements of 32 femurs and compared the dimensions obtained from radiographs and CT scans with the true anatomical dimensions. Standard radiographs gave only a rough approximation of femoral geometry (mean difference: 2.4 +/- 1.4 mm) insufficiently accurate to allow selection of the best fitting prosthesis from a range of sizes and altogether inadequate to design a custom-made prosthesis. CT scans give greater accuracy (mean difference: 0.8 +/- 0.7 mm) in our experimental conditions, but in clinical practice additional sources of error exist.
Subject(s)
Femur/anatomy & histology , Aged , Aged, 80 and over , Cadaver , Color , Female , Femur/diagnostic imaging , Femur Head/anatomy & histology , Femur Head/diagnostic imaging , Hip Prosthesis , Humans , Male , Reference Values , Tomography, X-Ray ComputedSubject(s)
Athletic Injuries/diagnostic imaging , Shoulder Injuries , Tendon Injuries , Adolescent , Adult , Humans , Male , Radiography , Rupture , Shoulder/diagnostic imaging , Tendons/diagnostic imagingABSTRACT
The cost of hospital treatment of cervical and intertrochanteric fractures of femur is studied in 218 patients aged 70 and over, treated during 1985 in a specialized university department. Real costs show little difference from contractual prices as established by the hospital administration. They depend mainly on the length of hospital stay (a function of the type of treatment) and only indirectly on the type of fracture. The only hope of reducing costs is to shorten the number of days spent by these patients in costly university departments. The physician should therefore try to use methods of treatment that render patients rapidly independent, but the administration should provide enough rehabilitation wards and homes to admit semi-dependent patients rapidly after acute care of the fracture and of any associated pathology.
Subject(s)
Femoral Neck Fractures/therapy , Fracture Fixation/methods , Hip Fractures/therapy , Length of Stay , Aged , Aged, 80 and over , Costs and Cost Analysis , Female , Femoral Neck Fractures/economics , Fracture Fixation/economics , Hip Fractures/economics , Humans , Male , SwitzerlandABSTRACT
40 children and adolescents, recurrence of a spondylolisthesis after posterior or even postero-lateral fusion is a well known fact. Anterior fusion added to the posterior graft is said to prevent such and occurrence. We report a case of a L4/L5 listhesis which followed near complete reduction of a 70% L5/S1 slip fixed by a combined approach. We think this is due to the persisting lumbo-sacral postural abnormalities and that while reducing and fixing the spondylolisthesis one should restore physiological posture to prevent this recurrence at the same level or at a higher one.
