Laura A. Timmerman

Primary repair of patellar tendon rupture without augmentation

Repair of patellar tendon ruptures has often relied on cerclage augmentation and prolonged immobilization in extension. We are reporting our experience with avulsion injuries as well as midsubstance ruptures, both treated with primary repair without augmentation, allowing early mobilization in the athlete less than 40 years of age. Repairs were performed to allow knee flexion to more than 60°. Rehabilitation was performed with heel slides, allowing flexion to 45° for the first 3 weeks, increasing to 90° at 3 to 6 weeks, and thereafter without restriction. An accelerated weightbearing and muscle strengthening program was adopted. At a mean follow-up of 2.6 years (range, 20 to 61 months), 12 patients had returned to their previous levels of activity. No loss of extension or extensor lag was noted; mean flexion loss was 5°. Patellofemoral symptoms and signs were present in five patients, but activity was limited in only two. Mean peak torque at 60 deg/sec was 92% (range, 73% to 105%). Mean Lysholm score was 94 2.5 points. Primary repair with immediate, protected range of motion resulted in uniformly excellent results and obviated the need for manipulation or subsequent hardware removal.

A Quantitative Assessment of the Effect of Metatarsal Pads on Plantar Pressures

The treatment of metatarsalgia secondary to the plantar prominence of the metatarsal heads has lead to the development of numerous orthotic devices designed to decrease pressures in these areas. In spite of the considerable cost of some of these devices, there has yet to be much objective evidence of their efficacy. This study assessed the effect of a simple metatarsal pad on pressures transmitted to the metatarsal heads. Quantitative measurements of dynamic peak pressures for 10 asymptomatic subjects with and without metatarsal pads were made using the pedobarograph. Female volunteers had a reduction in peak metatarsal pressures from 12% to 60% when a small metatarsal pad was appropriately applied to the foot. In two of five males there was a decrease in metatarsal pressure of 14% to 44%. One male had no change in pressure, while two others had an increase in pressure from 8% to 28%. When properly positioned and appropriately monitored, metatarsal pads can be an inexpensive and effective means of reducing metatarsal pressures.

Intramedullary nailing of femoral shaft fractures in adolescents

Summary: Twenty-two femoral shaft fractures in 20 patients aged 10-14 years with open physes treated with closed reamed intramedullary nailing were studied retrospectively. Follow-up averaged 26.7 months in 18 of 20 patients. Eleven additional patients with 11 femoral shaft fractures treated with casting and traction were included for comparison of hospitalization time, cost, and time to mobilization. All of the fractures treated with an intramedullary nail healed without malunion or leg length inequality, and there was no evidence of growth plate arrest. The patients treated with an intramedullary nail had statistically significant shorter hospitalizations and shorter times to mobilization, and treatment had an estimated cost of less than half of traction treatment. Results of this study suggest that closed intramedullary nailing of femur fractures in adolescents is an effective treatment option.

The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison.

The displaced femoral neck fracture poses difficult decision-making issues for the orthopedic surgeon. Young patients frequently require a rapid open reduction and rigid internal fixation in the face of multiple associated injuries. Elderly patients present the typical decision dilemma of internal fixation versus arthroplasty. Consecutive, randomized, prospective series of cases for evaluation of alternatives in the treatment of this difficult fracture are lacking. Between 1982 and 1984, 34 elderly patients with displaced femoral neck fractures were randomized to open reduction or hemiarthroplasty study groups. Although the surgical risks are relatively high, two-year observations showed better functional results in the cemented hemiarthroplasty group.

Practical Considerations for the Use of the Pedobarograph

The pedobarograph functions as a device for the dynamic, quantitative measurement of pedal pressures. To date, little attention has been paid to various practical questions concerning its operation. For example, the number and timing of trials sufficient to provide meaningful information upon which to reliably base investigational or management decisions has yet to be addressed. Twenty volunteers were used for the measurement of pedal pressures for 15 trials during three separate sessions. Statistical analysis for the determination of MIVQUE(0) estimates and maximum likelihood estimates were used to determine the individual variability, the variability of the specific area of the foot, the daily variability, and the trial-to-trial variability. This analysis indicated that for the assessment of pedal pressures in a clinical setting, the variance factors were sufficiently minimized by obtaining multiple measurements. The improvement in the estimate of error by obtaining trials on different days was overshadowed by the potential benefit of doing extra trials on a single day. Three trials on 1 day should sufficiently reduce estimates of error for both clinical and investigational purposes.

Fracture of the trochlea.

Isolated fracture of the humeral trochlea is rare. Recent fracture classification schemes do not specifically address this injury in regards to treatment. This case report describes an isolated fracture of the humeral trochlea treated with open reduction internal fixation. Radiographic union was present at 13 weeks, and at 20 weeks post-op, the patient had regained full elbow range of motion minus 5 degrees of terminal flexion. Open reduction and internal fixation can be performed with success if the trochlear fragment is large enough.

Open surgical procedures for injuriesto the elbow in throwers

Abstract Elite throwers subject the elbow to extremely high forces that, over long periods of time, may cause significant injury.Surgical techniques developed to treat these injuries have allowed many athletes to resume careers that might have otherwise ended. In this article, open surgical techniques and the indications for surgery to the elbow are presented in detail. Included in the discussion is a detailed description of ulnar collateral ligament reconstruction.

Arthroscopically assisted posterior cruciate ligament reconstruction using autologous patellar tendon graft

Although the surgical reconstruction of the posterior cruciate ligament (PCL) at times can be controversial, there is a certain population of patients in which this is indicated. In previously described techniques, an open procedure is required. This procedure has the associated drawbacks of longer rehabilitation and increased surgical morbidity because of the arthrotomy incision. With the further refinement of arthroscopic techniques, the arthroscopically assisted PCL reconstruction using autologous patellar tendon graft has been refined to offer improved results compared with those of an open procedure. The indications for the surgery and the techniques of the surgical procedure of arthroscopic PCL reconstruction will be described.

Clinical anatomy, histology, & pathomechanics of the elbow in sports

Abstract The elbow is an integral link in the athletes upper extremity function transferring force, position, and load-bearingcapability to the hand. This paper focuses upon the salient clinical anatomy and biomechanics of the elbow relative to specific athletic skills. First, the pertintent anatomy of the elbow will be discussed emphasizing those aspects that are clinically relevant. In the second section, the pathomechanics of the elbow will be reviewed using the throwing motion as the representative athletic skill. An understanding of the functional anatomy and pathomechanics of the elbow will aid in developing a rational approach to the evaluation, treatment, and rehabilitation of sports-related injuries.

Clinical Anatomy and Pathomechanics of the Elbow in Sports

This review focuses on the relevant clinical anatomy and pathomechanics of the elbow as they directly relate to specific athletic activities and injury patterns. An appreciation of the anatomy and mechanics of the elbow will facilitate health care professionals in the care of sports-related injuries.