תוצאת חיפוש

Importance of Internal Fixation for Talar Neck Fractures

Daniel Levin, Chaim Zinman

Orthopedic Dept. B, Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

Fracture of the talus, which articulates with 4 other bones in the ankle and foot, must be properly diagnosed, classified and treated to avoid the common complications of post-traumatic osteoarthritis and avascular necrosis. Knowledge of blood supply and anatomy is imperative, since the surgical approach must not damage the few vascular structures that remain intact after the trauma. We present 5 cases of fractures at the neck of the talus. All underwent internal fixation, 1 after closed reduction and 4 after open reduction. In all the results were satisfactory, although 1 patient developed avascular necrosis of the talar body.

Aseptic Loosening of Joint Implants

Dror Fuchs, Chaim Zinman, Dina Lewinson

Orthopedic and Traumatology Dept. B, Rambam Medical Center; and Div. of Morphology Sciences, Bruce Rappaport Faculty of Medicine, The Technion, Haifa

The purpose of orthopedic joint implants is to improve joint movement. Within the past 30 years, biomechanical improvements affecting the life-span of the implants has brought a new type of problem: the biological response to debris from the implant material contributes greatly to aseptic loosening of the prosthesis. The process is mediated by osteotropic factors, cytokines released from mononuclear cells, and osteoblasts and osteoclasts in the bone-cement interface or bone-implant interface.

Postoperative Ulnar Nerve Palsy of the Elbow

Shalom Stahl, Doron Norman, Chaim Zinman

Hand Surgery Unit and Dept. of Orthopedic Surgery B, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

Ulnar nerve neuropathy of the elbow is a recognized complication of surgery involving general anesthesia. In 13 patients, aged 21-76 years, ulnar nerve palsy developed at various times and of varying degrees of severity during the postoperative period. Diagnosis was based on clinical and electrophysiological findings. 3 patients had subclinical entrapment of the ulnar nerve. All were treated conservatively by rest, splinting and physical therapy: 10 improved slowly with time and 3 were operated on, but only 1 recovered fully. Preventive measures, such as proper positioning on the operative table, use of elbow pads, avoiding adduction of the arm, pronation of the forearm and prolonged elbow flexion, may reduce the incidence of ulnar nerve palsy. Unfortunately, treatment of established lesions has yielded mixed results.