bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical release of the 'snapping iliopsoas tendon'
Authors: Taylor GR , Clarke NM
Published: February 2018

We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed, abducted and externally rotated position and most were tender in the adductor triangle. Plain radiographs and an arthrogram were normal. A clinical diagnosis of subluxation of the iliopsoas tendon was made. Conservative management failed in 14 patients, two of whom had bilateral pain. All 14 had surgical release of the iliopsoas tendon through a medial approach. At follow-up (mean 17 months) the click had resolved in ten hips, was occasional but painless in five and unchanged in one. The syndrome of a painful 'snapping' psoas may result in disproportionately disabling symptoms. It may be diagnosed on clinical grounds and effectively treated, when severe, by release of the iliopsoas tendon.
The repair of a ruptured deltoid ligament is not necessary in ankle fractures
Authors: Stromsoe K , Hoqevold HE , Skjeldal S , Alho A
Published: February 2018

We randomised 50 patients with ankle fractures of Weber types B and C and a ruptured deltoid ligament treated by open reduction and internal fixation to two treatment groups to examine the influence of the repair of a ruptured deltoid ligament. No differences were found except for a longer duration of surgery in the repair group. Our findings suggest that a ruptured deltoid ligament can be left unexplored without any effect either on early mobilisation or on the long-term result.
Rotation osteotomy of the proximal humerus to stabilise the shoulder. Five years' experience
Authors: Kronberg M , Brostrom LA
Published: February 2018

A reduced retroversion angle of the humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft-tissue repair. We performed rotational osteotomy of the proximal humerus in 20 patients with recurrent anterior shoulder dislocations (10 traumatic, 10 non-traumatic) and a decreased retroversion angle of the humeral head. The mean preoperative retroversion angle was 12 degrees, which was increased after surgery to a mean value of 32 degrees. All patients regained a normal range of shoulder motion and normal function within three months after surgery. At the five-year review all shoulders were stable, pain-free and had no radiological signs of osteoarthritis.
Scheuermann's kyphosis. The Portuguese technique of surgical treatment
Authors: Ferreira-Alves A , Resina J , Palma-Rodrigues R
Published: February 2018

Between 1969 and 1989, we performed posterior segmental instrumentation on 38 patients with thoracic Scheuermann's kyphosis. We used a dynamic system without sublaminar fixation, and a kyphosis of 50 degrees was the main indication for surgery. The mean initial angle was 68 degrees (50 to 100) and the mean final kyphosis was 43 degrees at five-year follow-up, with a mean final loss after surgery of 3.7 degrees. Reconstruction of the vertebral bodies, vertebral wedging and the anterior-body height ratio were observed even in skeletally mature patients. There were no medical complications. There were three cases of loss of correction by more than 10 degrees and one of rod fracture with pseudarthrosis. The role of non-operative treatment is evaluated and early surgical treatment is advocated.
Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty
Authors: Kimura I , Shingu H , Nasu Y
Published: February 2018

We have studied 29 patients for at least five years after canal-expansive laminoplasty for cervical spondylotic myelopathy. The short- and long-term clinical results were compared, and successive radiographs assessed. The long-term clinical outcome was excellent in five patients, good in 12, fair in 11 and poor in one. The mean short- and long-term improvements were 54.4% and 48.5% but patients with focal kyphotic, kyphotic and S-shaped cervical spines did less well, as did those who had a decrease in the index of curvature of the cervical spine of more than 10 at follow-up. Canal-expansive laminoplasty with reconstitution of the posterior soft tissues may help to prevent postoperative malalignment and late neurological deterioration.
THE EFFECT OF METHOTREXATE-LOADED BONE CEMENT ON LOCAL DESTRUCTION BY THE VX2 TUMOUR
Authors: Wang H. M. , Crank S. , Oliver G. , Galasko C. S. B.
Published: February 2018

Previous studies have shown that the activity of the cytostatic drug methotrexate (MTX) embedded in acrylic cement is not affected by thermal changes in the cement. MTX is slowly released from the cement for several months and remains biologically active throughout this period. Our aim was to determine whether MTX embedded in cement would control the local growth of a tumour.

In 15 rabbits we injected 0.1 ml of VX2 tumour suspension into the proximal tibia. At 3, 5, 7, 10 and 14 days three animals were killed and the tibiae removed and examined histologically. With increasing growth of the VX2 carcinoma there was increased bone destruction and a rise in the numbers of osteoclasts, but after 14 days the numbers of osteoclasts had decreased.

We then injected VX2 into the tibiae of another 45 rabbits. After 5 days most of the tumour was curetted out and the defect filled with cement containing either 0 g, 0.1 g, 0.5 g, 1.0 g or 2.0 g MTX/40 g cement. The rabbits were divided into three groups and killed at 3, 7 or 10 days after implantation of cement. The number of osteoclasts and the amount of bone destruction were measured in each tibia. In all three groups bone destruction and osteoclast proliferation were markedly decreased with higher doses of MTX, but bone destruction was not eliminated.

Our findings show that in the higher doses used, which were not toxic to the animal, MTX-embedded cement may be of value in minimising the amount of tumour-induced osteolysis and may be a useful adjunct in the surgical management of pathological fractures.
HIV INFECTION OF HUMAN CARTILAGE
Authors: Campbell D. G. , Li P. , Oakeshott R. D.
Published: February 2018

Infection of human cartilage with HIV in vivo has not previously been reported. Specimens of articular cartilage taken at postmortem from ten patients who were HIV-positive were examined. Two had AIDS and eight were believed to have stage-2 disease.

The standard polymerase chain reaction (PCR) protocol was modified to allow semiquantitative analysis of the samples. Oligonucleotide primers labelled with 32P gamma-ATP were used to detect a segment of HIV DNA and a control DNA gene segment (HLA genome) to estimate the ratio of infected cells. The 32P-labelled PCR products were separated on acrylamide gels and visualised directly by autoradiography and computer densitometry.

Infection of human cartilage in vivo was demonstrated in nine of the ten samples in which the PCR analysis was positive. The other did not react sufficiently to produce detectable radiolabelled PCR product despite repeated DNA digestion and extraction. Cartilage infected with HIV could be a potential source of HIV when used in operations.
TIBIALIS POSTERIOR TRANSFER FOR THE CORRECTION OF FOOT DROP IN LEPROSY
Authors: Soares D.
Published: February 2018

A comparison was made of the results produced by the circumtibial and interosseous routes of transfer of tibialis posterior for the correction of foot drop due to leprosy neuritis. The findings in 69 feet, of which 63 also had elongation of tendo Achillis, showed that the interosseous route gave a much lower incidence of recurrent inversion deformity of the foot. The results, in terms of improvement in gait and prevention of trophic changes, were satisfactory.
QUALITY-OF-LIFE IMPROVEMENT COMPARED AFTER HIP AND KNEE REPLACEMENT
Authors: Norman-Taylor F. H. , Palmer C. R. , Villar R. N.
Published: February 2018

Total hip and total knee arthroplasty both provide a considerable improvement in quality of life, but there is no evidence to suggest that one is more successful than the other. We studied 72 patients in a prospective trial before and after total hip or total knee replacement. We recorded scores for disability and distress derived from the Harris hip score and the British Orthopaedic Association knee assessment score, and used them to generate quality of life (QoL) scores using the Rosser Index Matrix immediately before and at one year after surgery.

The patients awaiting knee replacement had significantly lower QoL scores than those awaiting hip replacement (p = 0.011). The QoL scores at one year were high and almost identical for both groups (p = 0.46). Further analysis showed that gender and weight were not significant predictors of improvement of QoL scores, but age (p = 0.03) and whether the hip or knee was replaced (p = 0.006) were significant factors.
PREDICTION OF THE OUTCOME AFTER HIP FRACTURE IN ELDERLY PATIENTS
Authors: Svensson O. , Strömberg L. , Öhlén G. , Lindgren U.
Published: February 2018

We report a prospective study of 232 consecutive patients with hip fractures. All were over 64 years of age and living independently before admission to a geriatric orthopaedic ward. We assessed the value, at admission, of predicting factors for independent living at one year after injury.

The most important factors were: (1) preinjury function in activities of daily living (grade A or B on the Katz et al (1963) scale); (2) absence of other medical conditions which would impair rehabilitation; and (3) cognitive function better than 7 on the Pfeiffer (1975) mental questionnaire. The odds ratios (95% CI) for these three predictors were 3.5 (1.3 to 9.1), 2.9 (1.3 to 6.1) and 2.4 (1.9 to 4.9), respectively. When all predictors were positive at admission, 92% were living independently at one year; with one, two or three negative predictors, the percentages living independently were 76, 61 and 27, respectively.

The median values of the total number of days in hospital, irrespective of diagnosis, during the first year were 12, 24, 29 and 149 days for the four groups. The mortality at one year was predictable on admission only by the number of medical conditions: with no other diagnosis than the fracture the mortality was 0%; with one or two additional conditions the mortality was 14%; and with three or more additional diagnoses it was 24%.

These simple and robust predictors can be used to optimise resources for rehabilitation.
BIPOLAR SALVAGE SHOULDER ARTHROPLASTY
Authors: Watson M.
Published: February 2018

A bipolar spacer was inserted for severe arthritic destruction of the shoulder in 14 patients, and followed up for a mean of 5.9 years. In one patient the operation failed because of infection. Two others required revision for loss of low-friction properties which caused loosening of the humeral component.

At the end of the follow-up all the patients showed improvement. The Hospital for Special Surgery pain score had increased from 5.3 to 18.9 and the movement score from 7.5 to 20.1.
METACARPAL LENGTHENING AFTER TRAUMATIC AMPUTATION OF THE THUMB
Authors: Finsen V. , Russwurm H.
Published: February 2018

In nine patients of median age 34 years who had sustained an amputation of the thumb at a median 24 (5 to 131) months previously, we lengthened the first metacarpal by 30 (17 to 36) mm. Seven amputations had been through the proximal phalanx and two through the metacarpal.

The first two patients had autogenous grafting at a second stage, but the other seven had callotasis alone. In these patients the external fixators were removed at a median 189 (115 to 271) days after osteotomy. In six cases the adductor pollicis tendon was transferred proximally and the first web deepened. There was late fracture or palmar flexion of the callus in five patients, but this required further surgery in only one. Treatment was complete at 326 (140 to 489) days after osteotomy. The extended thumb retained its sensitivity; both grasp and key-pinch strength were satisfactory and only one patient felt that the result did not warrant the long course of treatment.

Metacarpal lengthening by this method is a prolonged procedure, but provides a valuable alternative to more complex reconstructions.
TREATMENT OF SEVERE FLEXION DEFORMITY OF THE KNEE IN CHILDREN AND ADOLESCENTS USING THE ILIZAROV TECHNIQUE
Authors: Damsin J.-P. , Ghanem I.
Published: February 2018

We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years.

The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20°. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients.

At the last review all patients were able to walk on their operated leg with or without an orthosis.

We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.
STRUCTURAL ALLOGRAFT IN TWO-STAGE REVISIONS FOR FAILED SEPTIC HIP ARTHROPLASTY
Authors: Alexeeff M. , Mahomed N. , Morsi E. , Garbuz D. , Gross A. , Latner A. J.
Published: February 2018

We report 11 patients having revision of total hip arthroplasty using massive structural allografts for failure due to sepsis and associated bone loss. All patients had a two-stage reconstruction and the mean follow-up was 47.8 months (24 to 72). Positive cultures were obtained at the first stage in nine of the 11 patients, with Staphylococcus epidermidis being the most common organism. The other two patients had draining sinuses with negative cultures.

There was no recurrence of infection in any patient. The mean increase in the modified Harris hip score was 45 and all the grafts appeared to have united to host bone. Two patients required additional procedures, but only one was related to the allograft. Complications included an incomplete sciatic nerve palsy and one case of graft resorption. Our results support the use of massive allografts in failed septic hip arthroplasty in which there is associated bone loss.
AN EVALUATION OF THE CONSTANT-MURLEY SHOULDER ASSESSMENT
Authors: Conboy V. B. , Morris R. W. , Kiss J. , Carr A. J.
Published: February 2018

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients.

We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.
ANTERIOR INTEROSSEOUS NERVE LESIONS
Authors: Seror P.
Published: February 2018

Lesions of the anterior interosseous nerve in the forearm are rare and often misdiagnosed as tendon injuries. A consecutive series of 13 patients with this condition referred for electrodiagnosis is reviewed. Only three had originally a correct clinical diagnosis and three were initially considered to have tendon ruptures.

Five cases were of mechanical origin and seven due to ‘neuritis’. All showed electrophysiological abnormalities, most commonly involving the pronator quadratus. Late spontaneous recovery was common, and only one case had surgical exploration.
OCCIPITO-ATLANTO-AXIAL FUSION IN MORQUIO-BRAILSFORD SYNDROME
Authors: Ransford A. O. , Crockard H. A. , Stevens J. M. , Modaghegh S.
Published: February 2018

In 17 patients (eleven males, six females) with Morquio-Brailsford syndrome (mucopolysaccharidosis IV) we have used onlay femoral and tibial autografts placed posteriorly and secured to the laminae of C1 and C2 to obtain satisfactory occipito-C1/C2 posterior fusion. They were immobilised postoperatively in a halo-plaster body jacket for four months. The age at operation varied between three and 28 years. Those with myelopathic symptoms of recent onset made some recovery, but severely myelopathic patients showed little or no recovery.

We advise prophylactic occipitocervical fusion in these patients since the cartilaginous dens is not strong enough to ensure atlanto-axial mechanical stability.
TRANSFORMING GROWTH FACTOR-β1 STIMULATES BONE ONGROWTH TO WEIGHT-LOADED TRICALCIUM PHOSPHATE COATED IMPLANTS
Authors: Lind M. , Overgaard S. , Ongpipattanakul B. , Nguyen T. , Bünger C. , Søballe K.
Published: February 2018

Bone growth into cementless prosthetic components is compromised by osteoporosis, by any gap between the implant and the bone, by micromotion, and after the revision of failed prostheses. Recombinant human transforming growth factor-β1 (rhTGF-β1) has recently been shown to be a potent stimulator of bone healing and bone formation in various models in vivo.

We have investigated the potential of rhTGF-β1, adsorbed on to weight-loaded tricalcium phosphate (TCP) coated implants, to enhance bone ongrowth and mechanical fixation. We inserted cylindrical grit-blasted titanium alloy implants bilaterally into the weight-bearing part of the medial femoral condyles of ten skeletally mature dogs. The implants were mounted on special devices which ensured stable weight-loading during each gait cycle. All implants were initially surrounded by a 0.75 mm gap and were coated with TCP ceramic.

Each animal received two implants, one with 0.3 μg rhTGF-β1 adsorbed on the ceramic surface and the other without growth factor. Histological analysis showed that bone ongrowth was significantly increased from 22 ± 5.6% bone-implant contact in the control group to 36 ± 2.9% in the rhTGF-β stimulated group, an increase of 59%. The volume of bone in the gap was increased by 16% in rhTGF-β1-stimulated TCP-coated implants, but this difference was not significant. Mechanical push-out tests showed no difference in fixation of the implant between the two groups. Our study suggests that rhTGF-β1 adsorbed on TCP-ceramic-coated implants can enhance bone ongrowth.
UNIPOLAR OR BIPOLAR PROSTHESIS FOR DISPLACED INTRACAPSULAR HIP FRACTURE IN OCTOGENARIANS
Authors: Calder S. J. , Anderson G. H. , Jagger C. , Harper W. M. , Gregg P. J.
Published: February 2018

We performed a randomised prospective trial to compare a cemented unipolar prosthesis (Thompson) with a cemented bipolar prosthesis (Monk) in the treatment of displaced intracapsular fractures of the hip in patients over 80 years of age. Patients with a mental test score of less than 5/13 were excluded but the mortality was still about 30% at one year in both groups. We therefore feel that subjective criteria such as the level of pain and the return to the preinjury state are of paramount importance.

Two years after operation there was no statistical difference between the rate of complications in the two groups. After adjusting for confounding factors such as differences in the level of function before injury between the groups, the degree of return to the preinjury state was significantly greater (p = 0.04) when using the unipolar prosthesis, which is one-quarter of the price of the bipolar.

We cannot therefore justify the use of an expensive bipolar prosthesis in patients over 80 years of age.
LATE MANAGEMENT OF POST-TRAUMATIC PALMAR CARPAL SUBLUXATION
Authors: Apergis E. , Dimitrakopoulos K. , Chorianopoulos K. , Theodoratos G.
Published: February 2018

Only a few cases of palmar carpal subluxation associated with an ulnovolar fragment from the distal radius have been reported previously. We report a case which was treated operatively six months after the injury.
SURVIVORSHIP ANALYSIS OF THE KINEMATIC STABILIZER TOTAL KNEE REPLACEMENT
Authors: Emmerson K. R. , Moran C. G. , Pinder I. M.
Published: February 2018

The Kinematic Stabilizer is a posterior-cruciate-substituting design of total knee replacement. We have reviewed 109 primary total knee replacements in 95 patients at a mean follow-up time of 12.7 years (10 to 14). We used survival analysis with failure defined as revision of the implant. This gave a cumulative survival rate of 95% (95% CI± 5%) at ten years and 87% (± 10%) at 13 years.

These results from an independent centre confirm the value of an established design of cemented total knee replacement and question the wisdom of the introduction of modifications and new designs without properly controlled trials.
SIMULTANEOUS OPEN REDUCTION AND SALTER INNOMINATE OSTEOTOMY FOR DEVELOPMENTAL DYSPLASIA OF THE HIP
Authors: Haidar R. K. , Jones R. S. , Vergroesen D. A. , Evans G. A.
Published: February 2018

We have studied retrospectively 37 hips in 36 children at an average of 91 months after simultaneous open reduction and Salter innominate osteotomy for developmental hip dysplasia. At the latest review 97.3% were clinically and 83.8% radiologically good or excellent. In three hips (8%) there were signs of avascular necrosis, but only one had been symptomatic. There were no cases of recurrent posterior displacement.
CARPAL BOX RADIOGRAPHY IN SUSPECTED SCAPHOID FRACTURE
Authors: Roolker W. , Tiel-van Buul M. M. C. , Bossuyt P. M. M. , Bakker A. J. , Bos K. E. , Marti R. K. , Broekhuizen A. H.
Published: February 2018

We have assessed the value of using a simple apparatus, the Carpal Box, in patients with suspected scaphoid fracture, to produce elongated and magnified radiographs of the carpus. The interobserver agreement between 60 observers of standard scaphoid radiographs and longitudinal and transverse Carpal Box radiographs (X-CB) was compared in 11 patients. Three-phase bone scanning was used as a comparative standard. If at least 75% of the observers agreed and the result was confirmed by three-phase bone scanning, the outcome was termed reliable.

Scaphoid radiographs and the longitudinal X-CB films were reliable in four patients and the transverse X-CB films in six patients. The bone scan suggested a scaphoid fracture in five of the 11 patients.

Agreement in the interpretation of the standard scaphoid radiographs was acceptable in only 36% of patients: in interpretation of transverse Carpal Box radiographs this figure increased to 55%.
FRACTURES OF THE DISTAL END OF THE RADIUS TREATED BY INTERNAL FIXATION AND EARLY FUNCTION
Authors: Rikli D. A. , Regazzoni P.
Published: February 2018

Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency.

Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the ‘lateral’ and the ‘intermediate’ columns of the wrist at an angle of 50° to 70°. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all.
TREATMENT OF HIGH-ENERGY TIBIAL PLATEAU FRACTURES BY THE ILIZAROV CIRCULAR FIXATOR
Authors: Dendrinos G. K. , Kontos S. , Katsenis D. , Dalas A.
Published: February 2018

We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months.

All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110° of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis.

Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution.
LONG-TERM RESULTS AFTER REALIGNMENT OPERATIONS FOR SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Jerre R. , Hansson G. , Wallin J. , Karlsson J.
Published: February 2018

We reviewed the long-term results of the treatment of slipped upper femoral epiphysis (SUFE) using realignment procedures in 36 patients (37 hips) at an average follow-up of 33.8 years (26 to 42). There were serious short-term complications in seven of the 22 hips treated by subcapital osteotomy, three of the 11 hips treated by intertrochanteric osteotomy and three of the four hips treated by manipulative reduction.

At re-examination, the clinical and radiological results were excellent or good in 41% of the hips treated by subcapital osteotomy, in 36% treated by intertrochanteric osteotomy and in none treated by manipulative reduction. In all, seven hips (19%) had had arthrodesis or total hip replacement.

The natural history of SUFE was probably not improved by any of the treatments used in our study. We therefore discourage the use of subcapital and intertrochanteric osteotomy as well as manipulative reduction in the primary treatment of chronic SUFE.
CONGENITAL DISLOCATION OF THE HIP IN EXTRAUTERINE PREGNANCY
Authors: Uglow M. G. , Clarke N. M. P.
Published: February 2018

Only two cases have been reported of congenital dislocation of the hip in infants born after extrauterine pregnancies. We report a further two and discuss the management and the variable outcome. These cases seem to confirm that congenital dislocation of the hip is associated with moulding forces rather than being a teratological abnormality.
NON-CEMENTED REPLACEMENT OF THE TRAPEZIOMETACARPAL JOINT
Authors: Wachtl S. W. , Sennwald G. R.
Published: February 2018

We treated 43 patients (38 women and 5 men) with osteoarthritis of the basal joint of the thumb by non-cemented arthroplasty of the first carpometacarpal joint as described by Ledoux. The probability of a patient avoiding revision for 12 months was 62% and for 16 months 59%. The indications for revision were aseptic loosening in 83% and luxation in 17%.

The surviving prostheses were reviewed clinically and radiologically at a mean follow-up of 25.3 months. Pain on loading, movement or at rest was seen in 75% of the patients. There was significant reduction in the range of movement of the trapeziometacarpal joint and of wrist strength. Radiological assessment showed significant subsidence of the stem in the first metacarpal and migration of the cup, with the stem loose in 15% and the cup in 46%.

We no longer recommend this method of joint replacement.
ACUTE CALCIFIC TENDINITIS OF THE RECTUS FEMORIS
Authors: Sarkar J. S. , Haddad F. S. , Crean S. V. , Brooks P.
Published: February 2018

We report six caucasian patients who had acute pain in the hip and marked limitation of all movements of the joint. Plain radiographs and CT of the pelvis showed calcification within the reflected head of rectus femoris. All six responded to accurate CT-controlled injections of corticosteroid and local anaesthetic with dramatic and prolonged pain relief, although one required a second injection for recurrence of symptoms after two months.
SURGICAL RELEASE OF KNEE FLEXION CONTRACTURES IN MYELOMENINGOCELE
Authors: Marshall P. D. , Broughton N. S. , Menelaus M. B. , Graham H. K.
Published: February 2018

We report the results of a prospective study of the surgical release of 45 knee flexion contractures in 28 patients with myelomeningocele. The neurosegmental level was thoracic in ten patients, L1/2 in one, L3/4 in 11, and L5/S1 in six. In walkers the indication for surgery was a fixed flexion contracture impeding walking, and in non-walking patients it was a flexion contracture impeding transfers or sitting balance, or likely to do so with increasing deformity.

The mean age at surgery was 6.4 years (3 to 21) and the mean period of follow-up 13 years (4 to 20). The mean knee flexion contracture before surgery was 39° (25 to 70) which improved to 5° at maximum correction and to 13° at latest follow-up.

We conclude that surgical release of knee flexion contractures in myelomeningocele improves gait in all children who walk, particularly those with low lumbar lesions. Recurrence of knee flexion contractures after surgical release is most common in those with thoracic lesions who do not achieve independent walking.
DEVELOPMENT OF PATHOLOGICAL LUMBAR KYPHOSIS IN MYELOMENINGOCELE
Authors: Carstens C. , Koch H. , Brocai D. R. C. , Niethard F. U.
Published: February 2018

We analysed the cases of lumbar kyphosis in 151 (21%) of a series of 719 patients with myelomeningocele. Three different types were distinguished: paralytic, sharp-angled and congenital. In a cross-sectional and partly longitudinal study the size and magnitude of the kyphosis, the apex of the curve and the level of paralysis of each group were recorded and statistically analysed.

Paralytic kyphosis (less than 90° at birth) occurred in 44.4% and increased linearly during further development. Sharp-angled kyphosis (90° or more at birth) was present in 38.4% and also showed a linear progression. In both types, progression seemed to depend also on the level of paralysis. Congenital kyphosis occurred in 13.9% and we could find no significant factor which correlated with progression.
FEMORAL COMPONENT REVISION USING IMPACTED MORSELLISED CANCELLOUS GRAFT
Authors: Malkani A. L. , Voor M. J. , Fee K. A. , Bates C. S.
Published: February 2018

We have tested the axial and torsional stability of femoral components after revision arthroplasty in a cadaver model, using impacted morsellised cancellous graft and cement. Each one of six matched pairs of fresh frozen human femora had either a primary or a revision prosthesis cemented in place. For the ‘revision’ experiments, all cancellous bone was removed from the proximal femur which was then over-reamed to create a smooth-walled cortical shell. An MTS servohydraulic test frame was used to apply axial and torsional loads to each specimen through the prosthetic femoral heads with the femur submerged in isotonic saline solution at 37°C.

The mean subsidence was 0.27 ± 0.17 mm for the primary and 0.52 ± 0.30 mm for the revision groups. The difference was statistically significant (p < 0.025), but the mean subsidence was < 1 mm in both groups. The mean maximum torque before failure was 42.9 ± 26.9 N-m for the primary and 34.8± 20.7 N-m for the revision groups. This difference was not statistically significant (p > 0.015).

Based on our results we suggest that revision of the femoral component using morsellised cancellous graft followed by cementing with a collarless prosthesis with a polished tapered stem restores the integrity of the proximal femur and provides immediate stability of the implant.
THE FORCES WHICH DEVELOP IN THE TISSUES DURING LEG LENGTHENING
Authors: Simpson A. H. R. W. , Cunningham J. L. , Kenwright J.
Published: February 2018

Axial forces were measured during limb lengthening in a series of ten patients with varying pathologies in order to assess the mechanical characteristics of the distracted tissues and the levels of axial force to which soft tissues are subjected during leg lengthening.

The pattern of force was found to vary according to the underlying pathology. For post-traumatic shortening in adults both the peak and the resting forces rose steadily during lengthening reaching maximum forces of the order of 300 N. Patients with congenitally short limbs developed very high peak forces (in some cases over 1000 N) and also showed large amounts of force relaxation (typically 400 to 500 N).

When very high levels of force were recorded, there was a higher complication rate. In particular, there was a high instance of angular deformity. This occurred because the loads encountered resulted in failure of some of the external fixation frames.
ANEURYSMAL BONE CYSTS TREATED BY CURETTAGE, CRYOTHERAPY AND BONE GRAFTING
Authors: Schreuder H. W. B. , Veth R. P. H , Pruszczynski M. , Lemmens J. A. M. , Koops H. Schraffordt , Molenaar W. M.
Published: February 2018

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture.

We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required.

We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.
EXTRADIGITAL GLOMUS TUMOUR CAUSING THIGH PAIN
Authors: Amillo S. , Arriola F. J. , Muñoz G.
Published: February 2018

Glomus tumours are rare and benign, arising from a neuromyoarterial glomus body, most commonly in the hand. We report a patient with such a tumour in an atypical site, the right vastus lateralis. Pain was aggravated by muscle contraction, and ultrasonography and MRI were required to locate the lesion accurately. Surgical excision gave immediate pain relief.
UPTAKE OF 99mTC-MDP AFTER UNCEMENTED HIP ARTHROPLASTY
Authors: Maniar R. N. , Todd R. C. , Robinson S. , Critchley M.
Published: February 2018

We studied the pattern of 99mTc-methylene diphosphonate uptake around uncemented femoral components in 44 asymptomatic hip arthroplasties, performing isotope scans at intervals from 4 to 48 months after operation. We used phase-III images obtained with a high-resolution gamma camera and measured the activity in various zones using a specially designed computer program. The components studied at 4, 6, 9 and 12 months were coated with hydroxyapatite (HA) and those studied at 18, 24, 36 and 48 months were not coated.

We found a statistically significant fall in activity between four and six months around HA-coated prostheses in all five femoral periprosthetic zones. After six months activity was relatively uniform, but remained higher than that in normal femoral bone at 48 months in non-coated prostheses. We discuss the application of these patterns in the evaluation of painful cementless hip arthroplasties.
FIXED PELVIC OBLIQUITY AFTER POLIOMYELITIS
Authors: Lee D. Y. , Choi I. H. , Chung C. Y. , Cho T.-J. , Lee J. C.
Published: February 2018

We classified fixed pelvic obliquity in patients after poliomyelitis into two major types according to the level of the pelvis relative to the short leg. Each type was then divided into four subtypes according to the direction and severity of the scoliosis.

In 46 patients with type-I deformity the pelvis was lower and in nine with type II it was higher on the short-leg side. Subtype-A deformity was a straight spine with a compensatory angulation at the lower lumbar level, mainly at L4-L5, subtype B was a mild scoliosis with the convexity to the short-leg side, subtype C was a mild scoliosis with the convexity opposite the short-leg side, and subtype D was a moderate to severe paralytic scoliosis with the convexity to the short-leg side in type I and to the opposite side in type II.

A combination of surgical procedures improved the obliquity in most patients. These included lumbodorsal fasciotomy, abductor fasciotomy and stabilisation of the hip by triple innominate osteotomy with or without transiliac lengthening. In patients with type ID or type IID appropriate spinal fusion was usually necessary.
ARTICULAR PENETRATION IS MORE LIKELY IN GARDEN-I FRACTURES OF THE HIP
Authors: Hernigou P. , Besnard P.
Published: February 2018

Plain radiographs show only two dimensions of a three-dimensional object. On anteroposterior and lateral radiographs an implant may appear to be safely within the head of the femur although surface penetration has occurred.

We have attempted to identify this complication in the treatment of fractures of the femoral neck and have analysed the position of a screw or pin in the femoral head and neck on the basis of orthogonal frontal and lateral radiographs. A retrospective analysis of 60 cases of osteosynthesis of fractures of the femoral neck confirmed the risk of non-recognition of articular penetration or breaking of the cortex of the neck during surgery.

Unrecognised screw penetration of the hip was observed in 8% and of the posterior part of the neck in 10%. The risk differs according to the type of fracture: it is greater in the coxa valga produced by Garden-I fractures of the femoral neck.
BILATERAL DISLOCATION OF THE HIP DURING CONVULSIONS
Authors: Rath E. , Levy O. , Liberman N. , Atar D.
Published: February 2018

Simultaneous bilateral posterior dislocation of the hip is very uncommon and most cases are caused by road accidents. Simultaneous bilateral posterior dislocation of the hip due to convulsions is extremely rare.

We report the case of a man who was diagnosed late and operated on 15 weeks after the injury. We discuss the treatment of chronic dislocation of the hip and review the literature.
IN VITRO HUMAN MONOCYTE RESPONSE TO WEAR PARTICLES OF TITANIUM ALLOY CONTAINING VANADIUM OR NIOBIUM
Authors: Rogers S. D. , Howie D. W. , Graves S. E. , Pearcy M. J. , Haynes D. R.
Published: February 2018

Our aim was to determine whether in vitro studies would detect differences in the cellular response to wear particles of two titanium alloys commonly used in the manufacture of joint replacement prostheses. Particles were of the order of 1 μm in diameter representative of those found adjacent to failed prostheses.

Exposure of human monocytes to titanium 6-aluminium 4- vanadium (TiAlV) at concentrations of 4 x 107 particles/ml produced a mean prostaglandin E2 release of 2627.6 pM; this was significantly higher than the 317.4 pM induced by titanium 6-aluminium 7-niobium alloy (TiAlNb) particles (p = 0.006). Commercially-pure titanium particles induced a release of 347.8 pM. In addition, TiAlV stimulated significantly more release of the other cell mediators, interleukin-1, tumour necrosis factor and interleukin-6. At lower concentrations of particles there was less mediator release and less obvious differences between materials. None of the materials caused significant toxicity.

The levels of inflammatory mediators released by phagocytic cells in response to wear particles may influence the amount of periprosthetic bone loss. Our findings have shown that in vitro studies can detect differences in cellular response induced by particles of similar titanium alloys in common clinical use, although in vivo studies have shown little difference. While in vitro studies should not be used as the only form of assessment, they must be considered when assessing the relative biocompatibility of different implant materials.
MEASUREMENT OF POLYETHYLENE WEAR IN CEMENTLESS TOTAL HIP ARTHROPLASTY
Authors: Shih C.-H. , Lee P.-C. , Chen J.-H. , Tai C.-L. , Chen L.-F. , Wu J. S.-S. , Chang W. H.
Published: February 2018

We made a clinical study of polyethylene wear in 240 hips of 187 patients having primary total hip arthroplasties from 1989 to 1990, using uncemented Osteonics components, with a head size of 26 mm. We excluded cups with anteversion of over 20° and measured linear wear by a new method using a digitiser and special software of our design. Follow-up was from two to five years (mean 4.3).

The mean age at operation was 50.3 years, with more men than women (1.4:1). The mean linear wear per year was 0.15 mm; this did not increase with the longevity of the prosthesis (p = 0.54). In 59 hips showing evidence of osteolysis, the mean linear wear rate was significantly higher at 0.23 mm/year (p < 0.001). The mean linear wear rate also correlated significantly with age at the time of operation (p = 0.008), but we found no significant correlations with body-weight, gender, aetiology of the disease, thickness of polyethylene, or cup position.

Our new method of measurement is time-saving and reproducible. The results confirm the greater rate of linear wear of polyethylene in patients showing osteolysis and in those who are younger.
MIDDLE-TERM RESULTS OF THREADED ACETABULAR CUPS
Authors: Simank H.-G. , Brocai D. R. C. , Reiser D. , Thomsen M. , Sabo D. , Lukoschek M.
Published: February 2018

We report our results using three different threaded acetabular components (Mecring A, Mecring B and Weill) in 715 hips with a follow-up of between one and ten years (median: 99.1, 56.5, 38.3 months, respectively). All cups were implanted with one type of cementless stem.

The clinical results were good or acceptable in about 70% of the hips, but signs of loosening with radiolucency and/or migration were found in 10.1%. Radiological evidence of loosening did not correlate significantly with the clinical outcome. Pain was not a reliable indicator of loosening and its absence sometimes allowed severe osteolysis to develop. Twenty-five hips were revised (3.5%) for aseptic loosening of the acetabular component. Kaplan-Meier estimates of the cumulative rate of failure showed a rapid increase five years after the initial operation, but no significant correlation with gender, age or weight.

The high rate of failure indicates that further use of these acetabular components cannot be recommended. Annual radiographs are required to assess osteolysis even if the patients are free from pain.
TREATMENT OF DISPLACED PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS
Authors: Zyto K. , Ahrengart L. , Sperber A. , Törnkvist H.
Published: February 2018

We randomised 40 elderly patients of mean age 74 years with displaced three- or four-part fractures of the humerus to either conservative treatment or tension-band osteosynthesis.

At one year and after three to five years, clinical follow-up showed no functional differences between the two groups of patients, with optimal function achieved within one year. There were major complications only in the surgically-treated group. Radiological review showed that surgery had improved the position of the fractured humeral head, but this was not reflected in improved function.

Semi-rigid fixation with tension-band wiring of displaced multifragment fractures of the proximal humerus in the elderly did not improve the functional outcome when compared with conservative treatment.
OSTEOSYNTHESIS WITHOUT INSTRUMENTATION FOR VERTEBRAL PSEUDARTHROSIS IN THE OSTEOPOROTIC SPINE
Authors: Hasegawa K. , Homma T. , Uchiyama S. , Takahashi H. E.
Published: February 2018

We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture.

At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients.
A BIOMECHANICAL EVALUATION OF SUTURE ANCHORS IN REPAIR OF THE ROTATOR CUFF
Authors: Rossouw D. J. , McElroy B. J. , Amis A. A. , Emery R. J. H.
Published: February 2018

Repair of the rotator cuff requires secure reattachment, but large chronic defects cause osteoporosis of the greater tuberosity which may then have insufficient strength to allow proper fixation of the tendon. Recently, suture anchors have been introduced, but have not been fully evaluated.

We have investigated the strength of suture-to-anchor attachment, and the use of suture anchors in repairs of the rotator cuff either to the greater tuberosity or the lateral cortex of the humerus. The second method gave a significant increase in the strength of the repair (p = 0.014).

The repairs were loaded cyclically and failed at low loads by cutting into bone and tendon, casting doubt on the integrity of the repair in early mobilisation after surgery. Repairs with suture anchors did not perform better than those with conventional transosseous attachment.
MECHANORECEPTORS IN THE PALMAR WRIST LIGAMENTS
Authors: Petrie S. , Collins J. , Solomonow M. , Wink C. , Chuinard R.
Published: February 2018

Three palmar wrist ligaments from fresh human cadavers were dissected from the proximal to the distal insertions and stained to identify the mechanoreceptors. Golgi organs, Pacinian corpuscles, Ruffini endings and free nerve endings were present in all three ligaments. In the radial collateral and radiolunate ligaments they were found in increased density towards the proximal and distal insertions. A more uniform distribution was found in the radioscaphocapitate ligament which has attachments to three bones.

The palmar wrist ligaments may have a significant sensory role in maintaining the stability of the wrist and in controlling its movement. Although technically difficult, the surgical repair of traumatic wrist defects should attempt to preserve the innervation of the ligaments, shown to be mainly near bony attachments. This may allow improvement in postoperative outcomes by preserving some proprioception. In some painful post-traumatic or degenerative conditions, however, denervation may be advantageous.
ISOLATED BILATERAL RECURRENT DISLOCATION OF THE CALCANEOCUBOID JOINT
Authors: Mcharo C. N. , Ochsner P. E.
Published: February 2018

An 18-year-old girl with moderate joint laxity presented with recurrent dislocation of the calcaneocuboid joint in both feet. We achieved successful stabilisation on both sides by reconstruction of the ligaments and capsule using the plantaris tendons.
MONITORING THE TREATMENT OF DEVELOPMENTAL DYSPLASIA OF THE HIP WITH THE PAVLIK HARNESS
Authors: Taylor G. R. , Clarke N. M. P.
Published: February 2018

We report the six-year results of a prospective, controlled demographic trial of developmental dysplasia of the hip (DDH) treated in the Pavlik harness using ultrasound supervision. Our aim was to assess the value of ultrasound and its role in monitoring reduction in the harness, in terms of progression or failure of reduction at an early state.

From 1988 to 1994, a total of 221 patients with 370 ultrasonographically abnormal hips was treated in the Pavlik harness. This represents a treatment rate for the Southampton district of 5.1 per 1000 live births. Sixteen hips in 12 patients were not reduced in the harness and required surgical treatment; 95.7% were successfully reduced. One case of mild avascular necrosis (0.3%) was identified in those treated by harness alone. Of the 221 patients 87.8% remain under radiological review, with 3.2% of affected hips showing continued, mild acetabular dysplasia.

We conclude that ultrasound monitoring has led to an acceptably low level of intervention, a high reduction rate and minimal iatrogenic complications. The trial is continuing.