No abstract

The high probability of SCT among those admitted to an emergency department within six hours from the onset of the symptoms justifies immediate surgical exploration.

Forty-four rabbits were operated on when five weeks old; in one group a 2 mm drill-hole was made in the intercondylar portion of the right femur across the central portion of the growth plate up to the diaphysis, while in the other group a similar drill-hole of 3.2 mm was made. At 3, 6, 12 and 24 weeks after operation, specimens from the growth plates of both femora were analysed using radiographic, microradiographic, histological and histomorphometric techniques. It was found that destruction of 7% of the cross-sectional area of the growth plate caused permanent growth disturbance and shortening of the femur.

Background:The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.Purpose:To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.Results:Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.Conclusion:Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

Totally absorbable internal fracture fixation devices were introduced clinically in the treatment of fractures and osteotomies of the extremities at our department in 1984. A total of 2,500 patients were managed using bone or ligament fixation devices made of self-reinforced (matrix and fibers of same polymer) absorbable alpha-hydroxy polyesters between November 5, 1984, and January 12, 1994. The devices used included cylindrical rods or pins, screws, tacks, plugs, and wires. The most common indication for the use of absorbable implants was displaced malleolar fracture of the ankle. Transphyseal fixation with small-diameter polyglycolide pins was used in children. The postoperative clinical course was uneventful in over 90% of the patients. The complications included bacterial wound infection in 3.6% and failure of fixation in 3.7%. In one-fifth of these cases, however, reoperation was not necessary. The occurrence of noninfectious foreign-body reactions 2 to 3 months postoperatively has been observed in 2.3% of the patients operated in the last years with polyglcolide implants but in none of the patients with polylactide implants. This inflammatory tissue response often required aspiration with a needle or small incision but did not influence the ultimate functional or radiologic result of treatment. Owing to the biodegradability of these internal fixation devices, over 1,000 implant removal procedures were avoided during the 9-year period under review, allowing medical personnel at these facilities to focus on other procedures. Avoidance of removal procedures results in financial benefits and psychological advantages. The benefits of absorbable implants for war surgery are the same as for civilian life. Absorbable implants can also be used in open fractures and infection operations.