Avraham Ganel

The Total Condylar Knee Prosthesis: A Review of 71 Operations*

SummarySeventy-one operations are reviewed, in which knees were replaced with the total condylar prosthesis. The follow-up period ranged between 1 and 7 years, with an average of 3.25 years. Osteoarthritis was diagnosed preoperatively in 53 knees and rheumatoid arthritis in 18. The results obtained in cases of osteoarthritis were better than those in cases of rheumatoid arthritis. The prognosis was adversely affected by obesity, preoperative flexion contracture of 30° or more, wound-healing problems, wound infection, and postoperative manipulation under general anesthesia. The overall results were excellent in 48% of cases (34 knees), good in 28% (20 knees), fair in 11.3% (eight knees), and poor in 4.3% (three knees). Failure was experienced in 8.4% of cases (six knees).ZusammenfassungDie Resultate von 71 Kniearthroplastiken mit der Totalcondylären Endoprothese wurden überprüft. Der postoperative Zeitabschnitt lag zwischen 1 und 7 Jahren, Durchschnitt 3,25 Jahre. In 53 Kniegelenken war die präoperative Diagnose Osteoarthritis, in 18 rheumatoide Arthritis. Die Resultate in den Osteoarthritis-Fällen waren wesentlich besser als in den rheumatoiden Fällen. Die Prognose wurde negativ beeinflußt durch Übergewicht, eine Flexions Kontraktur von 30° oder mehr, Wundheilprobleme, Wundsepsis und postoperative Manipulation unter Allgemein-Narkose. Die Gesamtresultate waren wie folgt: ausgezeichnet 48% (34 Kniee), gut 28% (20 Kniee), zufriedenstellend 11,3% (8 Kniee), schlecht 4,3% (3 Kniee), Mißerfölg (Entfernung der Endoprothese) 8,4% (6 Kniee).

Ultrasonography: an imaging modality enabling the diagnosis of bipartite patella.

Ultrasound was used to diagnose bipartite patella in seven adolescents with anterior knee pain, and the findings were compared to those from plain radiography and to those of a group of asymptomatic subjects. In all affected individuals the quadriceps and patellar tendons appeared normal on ultrasound. Sonographic examination of the patella demonstrated an irregularity of the bony contour with occurrence of a cleft between the main part of the patellar body and the large superolateral accessory ossicle. The signal detected in the interface between bones was less echogenic than bone reflecting its fibrocartilaginous nature. The correlation with conventional radiography was absolute, as was the inter- and intraobserver reliability. Ultrasound is thus proposed as a simple and reliable imaging modality in bipartite patella. We do not believe that it should replace the initial radiographic, but it can be used to evaluate the contralateral knee for bilaterality and as an adjunct to therapeutic procedures such as local injections to increase the accuracy of treatment.

ULTRASONOGRAPHIC DIAGNOSIS IN THE EVALUATION OF SHOULDER PAIN

The benefit of adding sonography to the examination of patients suffering from shoulder pain, was examined in this retrospective evaluation. A patient suffering from shoulder pain consults generally his family physician, who sends his patient first to a radiography and not to sonography. In 75% of the patients examined by sonography, shoulder lesions were diagnosed, demonstrated in only 33% of radiographs. Most patients had more than one lesion: 38% had partial or full-thickness tears of the supraspinatus tendon, about one third bicipital tendonitis, 18% irregularities of the humeral greater tuberosity, 10% subdeltoid bursitis and about 10% calcified tendonitis. In about a quarter of the patients, no pathology was found. Many patients had more than one lesion. In conclusion, clinicians encountering shoulder pain should not be content with conventional radiography and are encouraged to make sonographic examinations part of the early diagnostic protocol.

CHARACTERISTICS OF SOFT TISSUE MASS IN THE HAND BY ULTRASONOGRAPHIC EXAMINATION

Soft tissue masses are amongst the commonest complaints encountered in orthopedic practice. Of these, masses found in the hand and the wrist are presented at higher frequency. They are often painful and may cause limitation of movement. This work describes the prevalence and the nature of soft tissue masses in the hand and wrist encountered in routine practice. This work was performed to assess the characteristics of soft tissue mass in the hand and the effectiveness of ultrasonography in the diagnosis of soft tissue masses and their differentiation from other lesions in the hand and wrist. Orthopedic surgical conditions that involve soft tissue in the hand and wrist may remain a diagnostic challenge when clinical diagnosis is uncertain and standard X-rays are non-diagnostic. High resolution ultrasound is widely available, non-invasive, without damage of radiation, imaging modality that can help the diagnosis. We reviewed retrospectively 25 patients with soft tissue masses. We compared the ultrasound findings with the histological findings in seven operated patients. A substantial majority of these lesions occurred in the right hand: 79% of the lesions were in the dorsal aspect of the hand, of which 37% were distal to the wrist joint, among them 42% at wrist either radial or ulnar; and 21% of the lesions were found in the volar aspect, among them 17% at wrist aspect, either radial or ulnar side. No predisposing factors could be found. The findings of this study reaffirm the utility of ultrasonography as primary diagnostic tool in routine orthopedic practice.

DETECTION OF GREATER TUBEROSITY FRACTURES BY SONOGRAPHY

Objective: To describe the prevalence and sonographic appearance of greater tuberosity fractures in patients undertaking shoulder sonography in an outpatient clinic. Methods: We retrospectively reviewed the reports of 854 sonographic shoulder examination and detected 42 patients (26 men, 14 women aged 35–60) with greater tuberosity fractures. Clinical data, sonographic results and plain radiographs correlation were evaluated. Results: 28/42 patients showed discontinuity of the humeral head. 10/42 patients showed gap greater than 2 mm. 4/42 patients showed double line configuration. In 14/2 patients, the fracture was not seen even retrospectively. Conclusions: Greater tuberosity fractures are characterized by sonography as cortical discontinuity, which may appear as a cortical gap or step-off (double line). They can be seen in shoulder sonography examination and should be looked for in every shoulder sonography examination even without clear history of trauma.

Recurrent volar carpal perilunate subluxation

SummaryRecurrent volar carpal perilunate subluxation (RVCPS) is a rare injury (Linschied 1972). Reviewing the literature we found only 5 reported cases of this condition. Four of them were due to congenital ligamentous laxity, two described by Suturo (1946), and the rest by Linschied and Dobyns (1972). Stark reported on a post traumatic case (Stark 1970). The purpose of this paper is to present an additional case of post traumatic RVCPS.ZusammenfassungDie rezidivierende volare perilunäre Subluxation ist eine seltene Verletzung (Linschied 1972). Bei Durchsicht der Literatur fanden wir nur 5 derartige Fälle beschrieben. Vier waren die Folge einer congenitalen Bandlaxheit, 2 von ehnen wurden von Suturo 1946, die anderen von Linschied u. Mitarb. (1972) beschrieben. Stark berichtete 1970 über einen posttraumatischen Fall.Im vorliegenden Fallbericht wird ein weiterer posttraumatischer Fall von volarer perilunärer Subluxation vorgestellt.