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Later 40mg inderal, as Associate Professor of Surgery buy 80 mg inderal amex, he was responsi- ble for orthopedic teaching in the University of Manitoba generic 80 mg inderal overnight delivery. His remarkable lectures on applied anatomy made a distinct contribution in bridging the gap between the basic sciences and the clini- cal field. His hospital appointments included: Orthope- dic Surgeon, Winnipeg General Hospital; Direc- tor of the Department of Orthopedic Surgery, Deer Lodge Hospital, Department of Veterans’ Affairs; and Consultant to the Sanatorium Board of Manitoba. During World War I, Gibson was active as a surgeon in the Royal Army Medical Corps in India and Egypt, and World War II found him again in service as orthopedic surgeon in charge of Hermeirs Red Cross Hospital in Scotland. During the war years, from 1942 to 1945, he was Surgeon-in-Chief of the Alfred I. Bruce Gill was always interested in the care of the crippled child; he held state clinics in central Pennsylvania during the whole of his active pro- fessional career. He was Chairman of a Joint Committee on Crippled Children of the American Academy of Orthopedic Surgeons, the American Orthopedic Association, and the American Medi- cal Association from 1942 until 1952. From 1942 to 1950 this committee was called the Com- mittee for the Study of the Public Care of the Arthur Bruce GILL Indigent Orthopedic Cripple and then, from 1951 to 1952, the Committee on the Public Care of 1876–1965 Crippled Children. He was a member of the Advi- sory Committee on Crippled Children to the Arthur Bruce Gill was born of Scotch ancestry on Federal Children’s Bureau for many years. He December 12, 1876, in western Pennsylvania, was at one time Chairman of the Committee on at Greensburg. He received his BA degree in Legislation and Medical Economics of the Amer- 1896 at Muskingum College in Ohio, from which ican Academy of Orthopedic Surgeons and of the college, 42 years later, he received an honorary Committee on the Treatment of Infantile Paraly- Doctor of Science degree. Bruce was always interested in education and He interned at the Presbyterian hospital in research: he was Chairman of the American Philadelphia, with which institution he was asso- Orthopedic Association’s Committee on Under- ciated for 47 years, for many years as Chief of the graduate Education for many years. Ashurst, of the Episcopal Hospital in posium on undergraduate education was held at Philadelphia, first talked to Bruce about going the Joint Meeting of the British, Canadian, and into orthopedics, but it was Dr. Davis as the third Professor of honorary member of the Ambrose Paré Society of Orthopedic Surgery at the University of Pennsyl- France, of the Pennsylvania Orthopedic Society, vania, which position he held until 1942. He was and of the Orange County (Florida) Orthopedic on the staff of the Philadelphia Orthopedic Hos- Society. He was a member of the Philadelphia pital from 1908 until it merged with the Univer- Academy of Surgery, the oldest surgical society sity of Pennsylvania in 1941. In 1911, he became in the United States, the Philadelphia Orthopedic an assistant surgeon at the Widener Memorial Club, of which he was a president, an active Industrial School for Crippled Children in fellow of the College of Physicians of Philadel- Philadelphia, which had been founded by Dr. Sixteen of these publi- 114 Who’s Who in Orthopedics cations are related to congenital dislocation of the spirit of unrest in the specialty and a tendency for hip; six to coxa plana and other conditions of the the rapid adoption of newer methods that prom- hip; six to the hand; four to cerebral palsy; four ised much but had not yet stood the test of time. He results of Stoeffel neurectomies for spastic paral- proposed several significant questions, such as ysis (1918). One of his best publications, “The whether extension of government control would Kenny Concepts and Treatment of Infantile Paral- improve medical services, whether this improve- ysis,” written in 1944, was an answer to many ment could be accomplished by other agencies, of Sister Kenny’s misleading statements and whether it is consistent with our form of govern- unwarranted conclusions on the treatment of ment, and whether this is conducive or detrimen- poliomyelitis. Bruce was always an enthusiastic golfer and Bruce was extremely well known for his work bridge player. He was a charter member and pres- on congenital dislocation of the hip, and was con- ident of the Doctors’ Golf Club of Philadelphia sidered by many to be one of the foremost author- and also a charter member and president of the ities on this subject in the United States. Bruce was one of the believed firmly that every dislocated hip that had organizers of the Golfing Players of the American a shallow acetabulum after reduction should have Orthopedic Association, which for many years a shelf operation—not only to give stability was responsible for the Association’s golf tourna- during the growing period, but also to decrease ments. In addition to golf and bridge, his hobbies the possibility of osteoarthritis in later life. He were swimming, chess, classical music (which he also advocated a shelf procedure for the large often played on the piano), the writing of poetry, femoral head, not well seated in the acetabulum, and in his later years, lawn bowling. For the par- In 1936, Bruce married Mabel Halsey alytic hip dislocation, he frequently advocated Woodrow, a wonderful and talented person, who fusion.

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The third curve on the right is the anterior cruciate deficient knee with complete rupture quality inderal 40 mg. Partial Tears of the ACL Magnetic Resonance Imaging It is difficult to estimate the degree of ACL injury with the MRI cheap 40 mg inderal fast delivery, as the laxity of the ligament cannot be accurately assessed inderal 80mg cheap. Therefore, it is not a useful tool for diagnosing partial tears of the anterior cruciate liga- ment. Arthroscopic Assessment Arthroscopic assessment of the anterior cruciate ligament tear is diffi- cult for two reasons. First, it is hard to see the ligament without remov- ing the synovium and fat pad. Second, it is only an estimate of the degree of tearing of the ligament. A hook probe must be used to examine the ligament proximally to see where the ligament is attached—to the side wall, the roof, or the posterior cruciate ligament. The best position is the side wall at the normal site of the anterior cruciate ligament. The most common situation is to see the ligament attached to the posterior cruciate ligament. This may give a 1+ Lachman test and a negative pivot-shift test, but would not stand up to vigorous pivoting activities. This amount of ligament laxity should allow a return to sports without a reconstruction. Treatment Options Partial Tears The treatment options for a patient with partial ACL tear are to give up or modify his or her sports activities. Partial Tears of the ACL sports activities and avoid pivotal sports will do well with a partial ante- rior cruciate ligament injury. This is the only parameter that the indi- vidual has control over, and that point should be emphasized when counseling athletes. Brace and Arthroscopy The use of a brace combined with modification of activity can be suc- cessful. The best long-term outcome for the young patient is to have a meniscal repair. The results of a meniscal repair are much better when the knee has been reconstructed and is stable. ACL Reconstruction If there is a positive pivot-shift test or a small bundle attached to the femur, and the athlete wants to be active in pivoting sports, anterior cru- ciate ligament reconstruction should be considered. Indications for ACL Reconstruction The patient who is a candidate for reconstruction of the ACL is the com- petitive, pivoting athlete who is involved in sports such as soccer, rugby, and basketball. In addition, the patient should have clinical symptoms of instability, with a history of giving way, a positive Lachman, and pivot- shift test with more than 5mm side-to-side difference on the KT-1000 arthrometer. The treat- ment options for the elite athlete, who needs reconstruction, as well as the inactive patient, who needs no reconstruction, are fairly limited. It is the recreationally active individual whose ACL injury requires counseling for the best treatment plan. There are a number of factors to consider in this decision, including, as Shelbourne has emphasized, age, chronicity, activity level, and associated injury to the meniscus and articular surface. Patient Factors The treatment of the ACL injury should be determined by the follow- ing factors. Age of the Patient The older patient may be more likely to modify his lifestyle and accept a conservative treatment program, while the younger patient, who is involved in competitive sports, wants to return as quickly as possible to high-level sports without the use of a brace. Activity Level and Intensity The competitive football or soccer player will likely require a recon- struction to continue playing at the same level. Noyes has shown that only 10% of nonoperatively treated athletes go back to the same level of sport activities. Treatment Options for ACL Injuries Degree of Instability In the Kaiser study, the outcome was related to degree of instability. If the KT-1000 arthrometer side-to-side difference was greater than 7mm, the chance of a better outcome was with surgical reconstruction.

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Total hip arthroplasty is recommended even for patients with high dislocation of the hip joint and aims at providing patients with a pain-free order 40 mg inderal with amex, stable generic inderal 40mg online, and mobile hip buy inderal 80mg cheap. Back Ground Control Open the Capsule A Resect the Femoral Head Enlarge the Acetabulum Implant the Outer Shell C B Fig. A 61-year-old woman undergoing first stage of operation with spinal cord potential (SCP) monitoring: preoperative (A); after first stage of operation (B); SCP monitor findings in first stage of operation (C) Control 55mm A Pull Down Implant Prosthesis Reduction C B Fig. In such patients, implantation of the component at the level of the original ace- tabulum is recommended, while equalizing leg length through the improvement of static body balance. For patients with an extremely narrow acetabulum and slender femur, a technique for enlarging the hypoplastic structure with subsequent use of normal-sized components is advantageous. The method mentioned in this chapter is not suitable for all patients with a high dislocation of the hip joint, but it is indicated when preoperative CT scanning indi- cates the need for enlargement of the acetabulum and of the medullary canal. Selective enlargement of only the acetabulum or femoral side can be performed in selected instances. Sofue M, Dohmae Y, Endo N, et al (1989) Total hip arthroplasty for secondary osteo- arthritis due to congenital dislocation of the hip (in Japanese). Crowe JF, Mani J, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. Eftekhar NS (1993) Congenital dysplasia and dislocation in total hip arthroplasty. Azuma T (1985) Preparation of the acetabulum to correct severe acetabular deficiency for total hip replacement—with special reference to stress distribution of periacetabu- lar region after operation (in Japanese). Yamamuro T (1982) Total hip arthroplasty for high dislocation of the hip (in Japanese). Harris WH, Crothers O, Indong AO, et al (1977) Total hip replacement and femoral- head bone-grafting for severe acetabular deficiency in adults. Nagai J, Ito T, Tanaka S, et al (1975) Combined acetabuloplasty for the socket stability by the total hip replacement in dislocated hip arthrosis (in Japanese). Buchholz HW, Baars G, Dahmen G (1985) Frueherfahrungen mit der Mini- Hueftgelenkstotalendoprothese (Modell “St Georg-Mini”) bei Dysplasie-Coxarthrose. Matsuno T (1989) Long-term follow-up study of total hip replacement with bone graft. Paavilainen T, Hoikka V, Solonen KA (1990) Cementless replacement for severely dysplastic or dislocated hip. Charnley J, Feagin JA (1973) Low-friction arthroplasty in congenital subluxation of hip. Kinoshita I, Hirano N (1985) Some problems about indication of total arthroplasty for secondary coxarthrosis (in Japanese). Kuroki Y (1986) Total hip arthroplasty for high dislocation of the hip joint (in Japanese). Kerboull M, Hamadouche M, Kerboull L (2001) Total hip arthroplasty for Crowe type IV developmental hip dysplasia. Inoue S (1983) Total hip arthroplasty for painful high dislocation of the hip in the adult (in Japanese). Kanehara, Tokyo, pp 257–266 A Biomechanical and Clinical Review: The Dall–Miles Cable System Desmond M. The Dall–Miles Cable System (Stryker Orthopaedics, Mahwah, NJ, USA) has been in clinical use since 1983. It was initially developed for reattachment of the greater trochanter in low-friction arthroplasty of the hip. It is now used largely as a cerclage system, par- ticularly in revision total hip arthroplasty (THA).

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A An iliac bone block of about 45 × 25 × 15mm is harvested from the iliac crest cheap 40mg inderal fast delivery, preserving a vascular bundle containing the deep circumflex iliac artery and vein with the sur- rounding iliac muscle cheap inderal 40 mg otc. The muscular branches of the deep circumflex iliac artery and vein must be ligated and severed order inderal 80mg with visa. The affected hip joint is exposed using an anterior approach after the Smith-Petersen technique. The tendon of the rectus femoris muscle is detached from the infe- rior anterior iliac spine and is reflected caudally. B The harvested iliac bone is passed beneath the iliopsoas muscle to bring it anteriorly to the hip joint. C A bony window of about 20 × 15 × 30mm is made on the anterior aspect of the femoral neck using a drill point and a chisel. Percentages of femoral head collapse, osteoarthritic changes (OA), and need for second operation at each stage at initial diagnosis were 76. Joints with further collapse at initial diagnosis showed more pro- gression of collapse, osteoarthritic changes, and need for second operation. When joints had collapse of more than 3mm at initial diagnosis, more than 80% showed progression of collapse and osteoarthritic changes and more than half (55. The radiologic endpoint was set at the time when femoral collapse occurred or advanced after VIBG. We analyzed the effects of age, gender, body mass index (BMI), side of ION, side of VIBG, method of bone graft, and preoperative collapse of the femoral head on JOA scores and sur- vival rates. A Mann–Whitney U test and a Kaplan–Meier analysis were used for sta- tistical analyses using Stat View version 5. Results Radiologic Changes After VIBG Radiologic changes and rate of second operation are shown in Fig. Percentages of femoral head collapse progression and osteoarthritic changes were 56. Average time period until col- lapse occurred or advanced was 13 ± 11 months. Time period until additional surgical treatment such as total hip arthroplasty, hemiarthroplasty, or arthrodesis was required was 117. Clinical Effects of VIBG on ION Average total points of pre- and postoperative JOA scores were 70 and 73. There was no significant difference between pre- and postoperative JOA scores (Fig. Factors Affecting the JOA Score To identify factors affecting the JOA score and survival rate after VIBG, we analyzed operative age, sex, body mass index (BMI), side of ION, side of VIBG, method of bone 100 80 60 40 73. The JOA score of the total pain category in joints with preoperative collapse was significantly lower than that in joints without preop- erative collapse (Fig. The old method of bone graft, in which the osteonecrotic lesion was com- pletely curetted and the vascularized iliac bone was grafted using iliac bone chips, also negatively affected the JOA score of ROM (Fig. The score of walking activity was lower in joints that underwent bilateral VIBG than that in joints which underwent unilateral VIBG (Fig. Sex (A), side of affected hip joints (B), side of VIBG (C), and inducer of ION (D) did not affect survival (Surv. In addition, sex, side of ION, and side of VIBG never affected survival rate after VIBG when the endpoint was set as collapse of the femoral head (Fig. However, for operative age over 30 years, the old bone graft method and preoperative collapse of the femoral head reduced survival rate when the endpoint was set at collapse (Fig. Discussion The concepts of VIBG are based on two goals: (1) to revascularize the necrotic lesion by using vascularized iliac bone, and (2) to prevent femoral head collapse by the iliac strut.

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