1/19. A novel surgical procedure for osteonecrosis of the humeral head: reposition of the joint surface and bone engraftment.A novel surgical procedure was performed on a 33-year-old woman with idiopathic osteonecrosis of the head of the left humerus. The operation involved repositioning of the joint cartilage and bone engraftment through her humeral head from under the greater tuberosity with shoulder arthroscopy. The patient wore an abduction brace for 8 weeks after the operation to hold the joint surface in its new position. This surgical procedure resulted in considerable improvement of the functional status of the shoulder by relieving pain and increasing range-of-motion. A preoperative radiograph showed stage IV osteonecrosis of the humeral head. However, at follow-up, repositioning of the joint surface and improvement of the necrotic bone were observed by radiography and magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/19. Preiser's disease: arthroscopic treatment of avascular necrosis of the scaphoid.We report the case of a 50-year-old female patient with Preiser's disease (avascular necrosis of the scaphoid) who, after a 2-year history of wrist pain, underwent arthroscopic debridement of the necrotic scaphoid using a standard technique. Osteoarthritic changes of the articular cartilage, partial rupture of the scapholunate ligament, local synovitis, and loose fragments were documented. The patient reported significant improvement in pain relief and complete relief of mechanical symptoms at 31-month follow-up examination. Radiographs demonstrated no progression of collapse of the scaphoid or acceleration of degenerative changes in the wrist. arthroscopy in Preiser's disease allows direct visualization and assessment of the exact pathology of the radiocarpal and midcarpal joint and the scaphoid cartilage. Arthroscopic debridement of the necrotic scaphoid increased wrist functional range of motion, provided excellent pain relief, and improved health-related quality of life.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/19. Avascular necrosis. A case history and literature review.We describe a patient with avascular necrosis in both shoulders. Confirmatory testing in making the diagnosis included plain radiography, bone scan, and magnetic resonance imaging. The pathogenesis and staging of the disease by radiography are presented in the article. Treatment options include a conservative regimen of shoulder range of motion exercises and nonsteroidal anti-inflammatory agents or surgery (arthroplasty or core decompression). The patient's risk factors include long-term corticosteroid use, smoking, and alcohol consumption. Other known risk factors include sickle cell disease, gaucher disease, chemotherapy, lymphoma, dysbaric conditions, and trauma. This literature search shows that prevention and early diagnosis lend the best outcomes for the diagnosis of avascular necrosis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/19. Arthroscopic treatment of bilateral humeral head osteonecrosis.A 37-year-old woman with a renal transplant was treated by arthroscopic debridement for bilateral steroid-induced humeral head osteonecrosis. Radiologically, the right shoulder had been categorized as stage III and the left as stage IV according to Arlet and Ficat. Relief of pain and improved range of motion were obtained especially on the right shoulder. arthroscopy is an efficient procedure for treatment of humeral head osteonecrosis in the renal transplant recipient including radiological stages III with episodes of locking.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/19. Fishtail deformity following fracture of the distal humerus in children: historical review, case presentations, discussion of etiology, and thoughts on treatment.Fishtail deformity is an uncommon complication of distal humeral fractures in children. This article reports four cases accompanied by premature closure of a portion of the distal humeral physis with resultant deformity, length retardation, decreased elbow motion, and functional impairment. The ages of the patients at time of injury ranged from 4 years 2 months to 6 years 1 month (average 5 years 4 months). The average length of follow-up was 9 years 9 months (range, 3 years 5 months to 18 years 10 months). The cause of the arrest is multifactorial and may be due to a gap in reduction of an intracondylar fracture, avascular necrosis of the epiphysis, or central premature physeal arrest (bar formation) without a fracture gap or avascular necrosis. If identified in a young child, surgical closure of the medial and lateral portion of the physis may prevent the deformity from progressing and would not cause significant additional humeral length discrepancy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/19. Avascular necrosis of the talus in children with haemophilia.patients who have haemophilia often present with joint problems. Haemarthrosis can occur spontaneously or after minor trauma. Later, degenerative changes can cause pain and loss of motion. Avascular necrosis of the talus has a high incidence after serious trauma. Furthermore, avascular necrosis of the talus has been associated with multiple systemic conditions. The association of haemophilia and avascular necrosis of the femoral head has been described. This study reports three cases (four ankles) where we suspect an avascular necrosis of the talus in children with haemophilia. To the authors' knowledge, the possible association of haemophilia and avascular necrosis of the talus has not yet been described in children.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/19. Avascular necrosis of the hamate: a case report with reference to the hamate blood supply.Avascular necrosis of the hamate bone has not previously been reported. In this case the proximal fragment of the fractured hamate underwent avascular necrosis and prolonged healing. In an attempt to explain this sequela, angiography of the cadaver carpus followed by dissection of intact wrists and a study of enzyme-cleaned hamates showed that their wedge-shaped proximal segments were mostly enveloped by a distal extension of the midcarpal joint cavity and thus totally dependent on intraosseous nutrition. Consequently, the segment is at risk when a fracture line transects the body proximal to the base of the wedge. Clinically, this condition resulted in persistent discomfort and limitations of motion. A postinjury bone scan of the wrist indicated avascular changes in the proximal third of the hamate, and a delayed union was followed by later revascularization and a more normal scan image.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/19. Postsurgical rehabilitative management of avascular necrosis in the capitate.OBJECTIVE: To discuss a case of avascular necrosis of the capitate and the follow-up postsurgical rehabilitation. CLINICAL FEATURES: A 41-year-old woman had severe left wrist pain. A short course of passive therapy was administered with no significant change. She was referred for additional diagnostic testing, including magnetic resonance imaging, which assisted in diagnosing the patient with avascular necrosis of the capitate. After undergoing surgical intervention, she was cleared to start an active rehabilitation program. She had significant loss of muscle strength and muscle atrophy and diminished active range of motion in the wrist and forearm. INTERACTION AND OUTCOME: The patient underwent surgical intervention consisting of an arthroplasty to the capitate. The follow-up rehabilitation techniques included the use of active and passive stretching, therapeutic putty, and light dumbbells. The patient was seen a total of 21 times during a 9-week time period. Outcome assessments were given intermittently during care to monitor progress. At the end of the program, she reported full function of the wrist with minimal to no pain. A 6-month follow-up showed improvements that were maintained with little pain. CONCLUSION: Avascular necrosis of the capitate is relatively rare. Advanced imaging should be used for diagnostic purposes. Surgical intervention may be warranted; however, it is recommended a postsurgical rehabilitative procedure be implemented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/19. Arthroscopic treatment of steroid-induced osteonecrosis of the humeral head.shoulder arthroscopy was performed on a 52-year-old man for the treatment of steroid-induced osteonecrosis of the humeral head. The removal of loose bodies and joint debridement has successfully improved the patient's functional status through relief of pain, improved range of motion, and elimination of locking. This case suggests another use of arthroscopy in the treatment of shoulder pathology.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/19. Avascular necrosis of the carpal lunate: a case report.A case is presented of avascular necrosis of the carpal lunate (Kienbock's disease). Orthopedic findings included marked decrease in ranges of motion in all directions and marked decrease in grip strength. Radiographic findings revealed increased density of the lunate, along with evidence of rotation. Conservative therapy of immobilization, ultrasonic and galvanic currents was later followed by orthopedic surgery. This case clearly demonstrates the importance of a team approach to the management of a problem of this sort and the importance of proper and timely diagnosis and treatment in order to prevent chronic disability of the wrist. Initial management of this case consisted of conservative treatment to alleviate pain and swelling. Surgery further alleviated pain and provided increased ranges of motion of flexion, extension and ulnar deviation and grip strength. movement of radial deviation did not improve at this time. The goal of postsurgical conservative (rehabilitative) therapy, designed to provide satisfactory ranges of movement in all directions and grip strength, was expected to be reached.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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