Treatment of ipsilateral femoral neck and shaft fractures with the Russell-Taylor reconstructive nail.

Twenty-seven ipsilateral femoral neck and shaft fractures were treated with the Russell-Taylor reconstructive nail. Follow-up ranged from 6-48 months (average: 23.6 months). Femoral neck fractures healed within an average of 3.7 months and femoral shaft fractures healed within an average of 4.8 months. Complications included one case of avascular necrosis of the femoral head, a varus healing of one femoral neck fracture, and a rotational malalignment of the femoral shaft in another case. There were no cases of hardware failure. The Russell-Taylor reconstructive nail allows concomitant hip and shaft fractures to be fixed with a single implant.

The treatment of anterior recurrent dislocation of the shoulder: the Bankart-Delitala procedure.

The authors report the results of 110 shoulder capsulorrhaphies performed according to the Bankart-Delitala technique. After a mean period of 104 months +/- 63 the clinical results, evaluated on the basis of the Rowe method were excellent-good in 94.6% of cases, and fair-poor in 5.4%. In 83.6% of cases there was no deficit in motility of the shoulder submitted to surgery, in 16.4%, the shoulder presented deficit in extrarotation (exceeding 15 degrees in only 1 case, equal to 0.9%).

Preventive cobalt therapy in heterotopic ossification consequent to prosthetic hip reimplantation.

Prosthetic hip reimplantation is considered to be a procedure at risk for the development of periprosthetic heterotopic ossification, which may be responsible for functional limitations of the hip operated on. Preventive treatment may be carried out with radiation or drug therapy. The authors report the results of 54 cases submitted to prosthetic reimplantation and treated by cobalt therapy, as compared to the results of 76 reimplantations (control group) that did not undergo any kind of treatment: the occurrence of high grade ossification (exceeding Brooker grade III) was 2% in cases treated, as compared to 9% in those not treated. Males were more at risk for the development of ossification.

Antibiotic and antithromboembolic prophylaxis in hip arthroplasty (a review of 700 primary implants).

The authors report the results obtained with antibiotic and antithromboembolic prophylaxis used in 700 consecutive primary total hip arthroplasties. As for antibiotic prophylaxis (5 cases of infection: 0.7%) the various types of antibiotic used always kept the infection rate under 1%, confirming the effectiveness of the preventive use of antibioticotherapy. The incidence of deep venous thrombosis and pulmonary embolia were 3.7% and 0.7%, respectively (26 cases of DVT and 5 of PET). The incidence of DVT rose to 34.4% in a selected group of cases in which phlebography had been carried out even in the absence of symptoms of DVT. This confirms that the routine use of this method would without a doubt be useful in preventing complications with a high risk for the life of the patient (pulmonary embolia). As for pharmacological prophylaxis, indobufene and calcium heparin were the drugs used most: their effectiveness was nearly similar, despite the fact that the use of calcium heparin in patients considered to be at a higher risk for thromboembolic complications should be made clear.

The use of cobalt therapy to prevent heterotopic ossification after total hip arthroplasty.

The occurrence of heterotopic ossification after total hip arthroplasty may be prevented by radiation or medical therapy. The authors report the results obtained in 96 cases treated by cobalt therapy: the occurrence of high grade ossification (Brooker III and IV) is equal to 1% in cases treated, as compared to 9% in cases not treated. Male patients of advanced age and who are characterized by primary arthrosis are more at risk for ossification.

A comparison of time to exhaustion at VO2 max in élite cyclists, kayak paddlers, swimmers and runners.

A recent study has shown the reproducibility of time to exhaustion (time limit: tlim) at the lowest velocity that elicits the maximal oxygen consumption (vVO2 max). The same study found an inverse relationship between this time to exhaustion at vVO2 max and vVO2 max among 38 élite long-distance runners (Billat et al. 1994b). The purpose of the present study was to compare the time to exhaustion at the power output (or velocity) at VO2 max for different values of VO2 max, depending on the type of exercise and not only on the aerobic capacity. The time of exhaustion at vVO2 max (tlim) has been measured among 41 élite (national level) sportsmen: 9 cyclists, 9 kayak paddlers, 9 swimmers and 14 runners using specific ergometers. Velocity or power at VO2 max (vVO2 max) was determined by continuous incremental testing. This protocol had steps of 2 min and increments of 50 W, 30 W, 0.05 m s-1 and 2 km-1 for cyclists, kayak paddlers, swimmers and runners, respectively. One week later, tlim was determined under the same conditions. After a warm-up of 10 min at 60% of their vVO2 max, subjects were concluded (in less than 45 s) to their vVO2 max and then had to sustain it as long as possible until exhaustion. Mean values of vVO2 max and tlim were respectively equal to 419 +/- 49 W (tlim = 222 +/- 91 s), 239 +/- 56 W (tlim = 376 +/- 134 s), 1.46 +/- 0.09 m s-1 (tlim = 287 +/- 160 s) and 22.4 +/- 0.8 km h-1 (tlim = 321 +/- 84 s), for cyclists, kayak paddlers, swimmers and runners. Time to exhaustion at vVO2 max was only significantly different between cycling and kayaking (ANOVA test, p < 0.05). Otherwise, VO2 max (expressed in ml min-1 kg-1) was significantly different between all sports except between cycling and running (p < 0.05). In this study, time to exhaustion at vVO2 max was also inversely related to VO2 max for the entire group of élite sportsmen (r = -0.320, p < 0.05, n = 41). The inverse relationship between VO2 max and tlim at vVO2 max has to be explained, it seems that tlim depends on VO2 max regardless of the type of exercise undertaken.

Arthroplasty in the ankylotic hip.

A total of 30 cases submitted to arthroplasty for the treatment of ankylotic hip are reported. The clinical results show that movement improved in 63% of the cases, with recovery of normal joint excursion in 37%. Severe limping consequent to hypotrophy of the gluteal musculature persisted in 62% of the cases, requiring the use of two canes in 17% of the patients. There was pain < or = 3 based on the Merle D'Aubigné and Postel evaluation scale in 13% of the patients, while 87% remained totally asymptomatic. Radiographic results were favorable: the incidence of aseptic loosening 86 months after surgery in 25 cemented prostheses was 20% for the acetabulum and 12% for the stem, while the 5 cementless prostheses were stable an average of 27 months after surgery. The incidence of aseptic loosening was greater in patients < or = 45 years of age (30% vs 10%). Early complications included dislocation (6.6%), caused by hypotrophy of the gluteal musculature secondary to the ankylosis. Leg length discrepancy, which was present preoperatively in 10 cases with an interval ranging from -5 to 6 cm (mean 3 cm), was corrected in 6 cases and reduced by half in the remaining 4 patients.

A computerized morphometric evaluation of x-ray films for preoperative planning of hip arthroplasty.

Methods for measuring metric size on radiograms constitute an instrument of proven utility. For example, when preoperatively evaluating hip arthroplasty the diameter of the medullary canal and the cervicodiaphyseal angle, must be measured in order to determine the center of rotation of the femoral head, and to establish the flare index of the diaphyseal canal. These results may be obtained by using a computer-controlled graphic table to place the coordinates for the areas of greater anatomical and physiological importance on the radiologic image. Thus, a calculation of distances, anatomical axes and angles is obtained immediately, accurately defining the morphometry of the joint. In this study, the anteroposterior preoperative radiographic views of 87 femurs in 84 patients were evaluated by this method. The values provided by the morphometric analysis were then related to sex, age and weight. The diaphyseal canal was classified by typology for the preoperative planning of hip arthroplasty.

Force and power of preferred and non-preferred leg in young soccer players.

The purpose of this study was to assess the effects of soccer training on strength and power of leg extensor muscles in preadolescent boys and their possible influence in developing a muscular lateral dominance. Twenty male children (mean age 9.6 yr), ten soccer players and ten untrained subjects, participated in this study. Force and power were measured at five constant cranking velocities on an isokinetic bicycle dinamometer. Each isokinetic load was given after each trial. Force and power outputs were calculated for each limb. Soccer players always showed higher and statistically significant differences (p < 0.05) for force and power values for all considered pedal frequencies. No significant differences were observed for force and power values between preferred and non preferred limb. The results demonstrate the effect of soccer training on the increase of force and power of both legs regardless of lateral dominance.