The purpose of this study was to review our intermediate-term experience with posterior fracture-dislocations of the hip. We evaluated the accuracy of the Pipkin and Brumback classification schemes as predictors of outcome, assessed the importance of certain treatment variables, and determined the complication rates of this injury in a group of 33 patients followed for an average of 49 months. The overall results were 67% good, 18% fair, and 15% poor, with no excellent results. The Pipkin classification scheme was a useful predictor of outcome because patients with less severe Pipkin 1 or 2 injuries had statistically significant better outcomes than did those who sustained Pipkin 3 or 4 injuries (p < 0.02). Due to a large number of subgroups, we could not demonstrate the usefulness of the Brumback classification system as a predictor of outcome. There were no statistically significant differences in outcome or complication rates when comparing time with hip reduction, definitive operative intervention, or anatomic operative approach to injury. Our study represents the second largest report on posterior dislocation of the hip associated with femoral head fracture. Although outcome of the patients in our series is not outstanding, the 67% good results represent a significant improvement over all previous reports with large numbers of patients. We demonstrate significant improvement in prognosis when treatment goals for these injuries include anatomic reduction, restoration of hip joint stability, and removal of all interposed bone fragments.
We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoulder on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examination was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic examination; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No anterior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients underwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury performance levels; however, one pitcher is no longer playing competitive baseball. The Bennett lesion is an extraarticular posterior ossification associated with posterior labral injury and posterior undersurface rotator cuff damage. It is not, however, a result of traction stresses in the region of the triceps insertion. Recognition is important for identification and treatment of the lesion and associated pathologic damage.
This study evaluates the role of magnetic resonance imaging in assessing the factors affecting the rate and healing time in scaphoid nonunions after surgery. Nineteen patients were assessed before surgery by radiographs, tomography, and magnetic resonance imaging. Fifteen bad viable bone marrow and 4 patients had nonviable bone marrow on magnetic resonance imaging. All patients with normal preoperative magnetic resonance imaging healed in an average time of 4.7 months. Of the 4 patients with abnormal magnetic resonance imaging, but normal plain radiographs, 2 went on to heal in 10.5 months. The remaining 2 patients with abnormal magnetic resonance imaging and abnormal plain radiographs did not heal by 24 months. This study suggests 3 groups of scaphoid nonunions. Group 1 has normal trabecular bone radiographically and
Posterolateral instability of the knee is difficult to diagnose and treat. It has been attributed to failure of ligament reconstruction and has been the cause of numerous knee operations. We present a small group of patients who complained of giving way of the knee and who had an increased range of external rotation of the tibia at 90 degrees knee flexion. The patients all had similar symptoms. We describe the standing apprehension test, which was positive in every case. Anterior subluxation of the lateral femoral condyle was detected manually in four patients and confirmed by radiography and MRI in one. The medial knee pain which is often associated with episodes of instability is probably due to stretching of the posteromedial soft tissues and perhaps the saphenous nerve.
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