1/16. osteochondritis dissecans of the distal radioulnar joint.To our knowledge there has been no report of osteochondritis dissecans of the distal radioulnar joint. This patient was seen with episodes of painful motion in the left wrist. At operation two free bodies were removed from the distal radioulnar joint. From the clinical, radiographic, operative, and histologic findings, the diagnosis was osteochondritis dissecans of the distal radioulnar joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/16. Lunate osteomyelitis in a patient with bilateral Kienbock's disease.Kienbock's disease, which is osteonecrosis of the carpal lunate bone, was described by Peste in 1843 and by Kienbock in 1910. Histologic studies of affected lunate bones have revealed avascularity, osseous necrosis, fragmentation, and fibrous proliferation. The disease most often occurs between the ages of 20 to 40 years, and the onset is usually insidious. There may be a history of a single episode or repetitive trauma, although this is not the rule. The patient usually will present with pain and decreased motion of the wrist. X-ray will reveal sclerosis of the lunate of varying degrees. There are many theories of how the inciting event of avascular necrosis takes place. There are several reports in the American literature of unilateral disease complicated by osteomyelitis, but to our knowledge there are no reports of bilateral Kienbock's with one side complicated by osteomyelitis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/16. Compressive fixation of osteochondritis dissecans fragments with Herbert screws.Current methods of fixation of femoral osteochondritic fragments do not provide rigid enough stabilization to allow early postoperative motion. We describe a technique using Herbert screws in a patient to secure a large unstable medial condylar fragment. A second procedure for removal of the screws was not required, and the patient had an excellent clinical result. The Herbert differential pitch bone screw is able to provide compressive fixation, allow early motion, and minimize the potential for complications.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
4/16. osteochondrosis of the temporomandibular joint presenting as an apparent parotid mass.A mass in the preauricular area usually indicates the presence of a neoplastic or inflammatory process within the parotid gland. osteochondrosis is an unusual disease process affecting large joints, particularly the knee. Rarely, the temporomandibular joint (TMJ) may be affected. The disease process involves the synovial lining of the TMJ and is commonly ascribed to a benign neoplastic process or metaplasia, although trauma and inflammation have also been implicated. This process can result in single or multiple loose cartilage bodies (joint mice) within the joint cavity. Symptoms are usually those of a mass in the preauricular area, or those of TMJ dysfunction (pain, dislocation, click, decreased range of motion). Physical findings are limited to presence of a mass in the pre-auricular parotid area with a paucity of other parotid findings. Treatment involves removal of the loose cartilage bodies from the TMJ and possibly the synovial lining, if it appears to be severely damaged.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/16. The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee.osteochondritis dissecans in two adults with a large osteochondral defect on the weight-bearing surface was treated by transplantation of an autogeneic osteochondral fragment. The graft was transplanted from the normal portion of the medial femoral condyle, which in extension was in contact with neither patella nor meniscus. The donor site was repaired with an iliac bone fragment. After curettage of the crater, the osteochondral fragment was transfixed with AO mini-cancellous screw(s). Six months after the operation, the grafted cartilage of one patient looked the same as normal cartilage when macroscopically observed and showed no sign of histologic degeneration. At the follow-up examination, the patients were asymptomatic. One patient had a full range of motion two years and three months later; the other three years later. Roentgenographic examinations revealed slight irregularities at the grafted site. There was no significant change in the patellofemoral joint except the concavity of the donor site.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/16. The surgical treatment of osteochondritis of the capitellum.This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
7/16. Surgical treatment of Freiberg's infraction with the use of total joint replacement arthroplasty.Freiberg's infraction is an osteochondrosis of the second metatarsal head, although it may be seen less often in the other metatarsals. It usually occurs in the second decade of life and is more commonly seen in females. The etiology is generally of a traumatic nature and symptoms include painful, limited range of motion of the joint. If untreated, destructive joint changes may lead to a painful degenerative arthritis requiring surgical intervention. The authors discuss joint replacement with a Swanson Silastic flexible hinged toe implant.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/16. Primary articular osteochondroses.Primary articular osteochondroses involve the primary articular and growth cartilage and the subjacent endochondral ossification, with resulting incongruity of the joint surface and potential degenerative osteoarthritis. weight-bearing areas, such as the metatarsal head, are at greater risk than nonweight-bearing parts in the upper extremity, such as the capitellum of the humerus. Treatment has two phases: protected mobilization, followed by graduated functional activity; later, surgery may be required to correct the resultant degenerative osteoarthritis. The accepted period for protected mobilization of the symptomatic patient is two to three years in the upper extremity, but three years or even longer in the weight-bearing lower extremity. The longer the period of painful motion, the longer the period of indicated protected mobilization. The prognosis concerning degenerative osteoarthritis should not be estimated by the extent of acute articular involvement on roentgenograms, but rather by the duration of symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/16. Use of a hand-carved silicone-rubber spacer for advanced Kienbock's disease.We found that the use of a hand-carved silicone-rubber (Silastic) spacer was reasonably effective in relieving symptoms in thirty-six patients with advanced Kienbock's disease, even though there was still some residual postoperative loss of wrist motion and grip strength. Preoperatively all patients had pain and limited motion of the wrist as well as weakness of grip. Roentgenographically all had fragmentation and collapse of the lunate, and 92 per cent had measurable carpal collapse. Most had had symptoms for longer than one year. After removal of the deformed lunate through a dorsal incision, a silicone-rubber spacer was shaped to fit the defect. patients were followed for an average of fifty-four months. Thirty-two patients were followed for at least two years; all but three were improved. This procedure is not recommended when the shape of the lunate is normal or not significantly altered, or when the lunate has not collapsed as measured by precise determinants.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/16. adult idiopathic chondrolysis of the hip--report of two cases.Idiopathic chondrolysis of the hip is characterized by pain, limping and a progressive restriction in the range of motion of the hip. The paper describes the case of two female patients, age 28 and 37, who were referred to our hospital in October 1985 and May 1991 for pain and limitation of movement in the right hip. Neither patient had a previous history of systemic illness or trauma or medication such as steroids. On admission they underwent clinical and X-ray examinations. Both required an open biopsy to confirm the diagnosis. They have been followed for 4 years and 8 years, respectively.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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