bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous screw fixation for fractures of the scaphoid
Authors: Wozasek GE , Moser KD
Published: February 2018

We describe a percutaneous technique for screw fixation of all types of fractures of the scaphoid. During a 15-year period ending in 1984, 280 cases were treated by this method; 198 of them returned for evaluation in 1986 and comprise the material for this report. After a mean postoperative time of 82 months, 89% of the recent fractures had united as well as 81.8% of those with delayed or nonunion and 42.8% of those with sclerotic nonunion.
Bone lesions secondary to benign phaeochromocytoma. Four cases in childhood
Authors: Hoeffel JC , Diard F , Loirat C , Worms AM , Schmitt M
Published: February 2018

Metaphyseal sclerotic bone changes associated with benign phaeochromocytoma are very rare in childhood. We report four cases, in each of which the radiographic changes returned to normal after removal of the tumour.
Fatigue failure of noncemented porous-coated implants. A retrieval study
Authors: Cook SD , Thomas KA
Published: February 2018

The causes of mechanical failure of five noncemented porous-coated components were studied. There were two cobalt-chromium alloy and three titanium alloy implants which fractured after 12 to 48 months. The implants included one acetabular component, and one femoral condylar, one patellar and two tibial components. Examination of the fractured surfaces revealed fatigue to be the mechanism of failure in all cases. The porous coating and the processes required for its fabrication had resulted in weakening and reduction of substrate thickness. Additional factors were stress concentration due to limited, localised bone ingrowth, and some features of the design of the implants.
The effect of continuous passive motion on knee ligament reconstruction with carbon fibre. An experimental investigation
Authors: Zarnett R , Velazquez R , Salter RB
Published: February 2018

Our purpose was to determine whether continuous passive motion enhanced the quality of knee ligament reconstruction using carbon fibre. In 46 rabbits the medial collateral ligaments were excised and replaced with carbon fibre prostheses. The animals were treated postoperatively by either continuous passive motion, cast immobilisation or cage activity, termed intermittent active motion. At six weeks, the ligaments were compared histologically and biomechanically with normal (control) medial collateral ligaments and with sham-operated controls. The ligaments treated with continuous passive motion were superior to those in the other two treatment groups. There were no ligament failures in any of the groups. This study suggests that continuous passive motion, initiated immediately postoperatively, enhances the biomechanical properties of carbon fibre ligament replacement of the medial collateral ligament while preventing the harmful effects of joint immobilisation.
Heterotopic bone formation after hip replacement. The influence of the type of osteoarthritis
Authors: Goel A , Sharp DJ
Published: February 2018

The relationship between heterotopic bone formation and the morphological type of osteoarthritis was examined after 43 hip replacements. Of the 43 hips studied, nine were atrophic, 19 were normotrophic, and 15 were hypertrophic. The incidence of heterotopic bone formation in the atrophic type was 11%, in the normotrophic type 32%, and in the hypertrophic type 87%. The difference between each type was statistically significant (p less than 0.001).
Flexion osteotomy of the femur for genu recurvatum after poliomyelitis
Authors: Mehta SN , Mukherjee AK
Published: February 2018

We report the results of 21 femoral osteotomies performed in 18 patients for genu recurvatum and flattening of the femoral condyles after poliomyelitis. Before operation the average angle of recurvatum was 31 degrees and all the limbs required bracing. After a mean follow-up of four years there has been partial recurrence in only one case. Nine patients (10 limbs) needed no orthosis and the others had less discomfort and an improved gait. Complete remodelling of the femoral and tibial epiphyses was noted in two of the younger patients.
Primary total knee arthroplasty in patients with psoriasis
Authors: Beyer CA , Hanssen AD , Lewallen DG , Pittelkow MR
Published: February 2018

Between 1976 and 1988, 50 primary total knee arthroplasties were performed on 34 patients with psoriasis vulgaris. The skin lesions were graded for severity in all patients and the extent of affected body surface was mapped. All patients received peri-operative antibiotics. Only one deep infection, with Staphylococcus aureus, occurred 25 months after operation. The average length of follow-up was nearly four and a half years, being to a minimum of two years or until failure of the arthroplasty. There appears to be no increased risk of deep infection in patient with psoriasis vulgaris undergoing primary total knee arthroplasty.
Compound tibial fractures with bone loss treated by the Ilizarov technique
Authors: Dagher F , Roukoz S
Published: February 2018

We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound tibial fractures. The mean defect in bone was 6.3 cm, and four cases were infected. All nine patients had satisfactory union and function without the use of bone grafts or antibiotics. The Ilizarov technique was very satisfactory; there were no major complications.
Reconstruction of the anterior cruciate ligament with an intra-articular patellar tendon graft and an extra-articular tenodesis. Results after six years
Authors: Rackemann S , Robinson A , Dandy DJ
Published: February 2018

We describe 74 patients with disabling instability of the knee due to isolated anterior cruciate deficiency. None responded to conservative measures or correction of internal derangements. All patients were treated by replacement of the anterior cruciate ligament with the medial third of the patellar tendon as a free graft, supplemented by an extra-articular MacIntosh lateral reconstruction. A satisfactory outcome was found in 93% of knees after an average of 70 months follow-up. Cast immobilisation after operation, the interval between injury and reconstruction, the age of the patient and the severity of symptoms before reconstruction had no significant effect on the final outcome.
The anatomy of the cauda equina on CT scans and MRI
Authors: Cohen MS , Wall EJ , Kerber CW , Abitbol JJ , Garfin
Published: February 2018

The nerve roots of the cauda equina may be visualised by contrast-enhanced CT scans and by surface-coil MRI. We have identified the pattern of anatomy from L2-L3 to L5-S1 in 10 human cadaver specimens and correlated this with anatomical dissections. Individual roots are slightly more distinct on contrast-enhanced CT than on surface-coil MRI. There is a crescentic oblique pattern of nerve roots at the lower lumbar levels which is still apparent in the more crowded proximal sections. In all cases, the axial images correlated precisely with the dissections. Current imaging modalities can help the clinical understanding and management of abnormalities in this region of the spine.
The effect of arm position and capsular release on rotator cuff repair. A biomechanical study
Authors: Zuckerman JD , Leblanc JM , Choueka J , Kummer F
Published: February 2018

A cadaver study was performed to determine the effect of arm position and capsular release on rotator cuff repair. Artificial defects were made in the rotator cuff to include only the supraspinatus (small) or both supraspinatus and infraspinatus (large). The defects were repaired in a standard manner with the shoulder abducted 30 degrees at the glenohumeral joint. Strain gauges were placed on the lateral cortex of the greater tuberosity and measurements were recorded in 36 different combinations of abduction, flexion/extension, and medial/lateral rotation. Readings were obtained before and after capsular release. With small tears, tension in the repair increased significantly with movement from 30 degrees to 15 degrees of abduction (p < 0.01) but was minimally affected by changes in flexion or rotation. Capsular release significantly reduced the force (p < 0.01) at 0 degree and 15 degrees abduction. For large tears, abduction of 30 degrees or more with lateral rotation and extension consistently produced the lowest values. Capsular release resulted in 30% less force at 0 degree abduction (p < 0.05).
Forearm realignment with elbow reconstruction using the Ilizarov fixator. A case report
Authors: Lammens J , Mukherjee A , Van Eygen P , Fabry G
Published: February 2018

A case of osteogenesis imperfecta, presenting with bowed deformity of both forearm bones and dislocation of the radial head was treated by separate elongation of both bones using Ilizarov's external fixator.
The acetabular rim syndrome. A clinical presentation of dysplasia of the hip
Authors: Klaue K , Durnin CW , Ganz R
Published: February 2018

The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. The symptoms are pain and impaired function. All our cases were treated by operation which consisted in most instances of re-orientation of the acetabulum by peri-acetabular osteotomy and arthrotomy of the hip. In all cases, the limbus was found to be detached from the bony rim of the acetabulum. In several instances there was a separated bone fragment, or 'os acetabuli' as well. In acetabular dysplasia, the acetabular rim is subject to abnormal stress which may cause the limbus to rupture, and a fragment of bone to separate from the adjacent bone margin. Dysplastic acetabuli may be classified into two radiological types. In type I there is an incongruent shallow acetabulum. In type II the acetabulum is congruent but the coverage of the femoral head is deficient.
Leg lengthening by distraction through the callus of an arthrodesis
Authors: De Pablos J , Barrios C , Canadell J
Published: February 2018

Limb lengthening by means of distraction through the callus of a knee arthrodesis was performed in a 14-year-old boy with congenital hypoplasia of one lower limb. Knee arthrodesis was indicated because of destruction of the distal femoral epiphysis caused by a previous bone lengthening procedure.
Anterior tarsal tunnel syndrome
Authors: Liu Z , Zhou J , Zhao L
Published: February 2018

We have reviewed 10 patients treated for anterior tarsal tunnel syndrome produced by compression of the deep peroneal nerve or its branches, and we have studied the anatomy of the tunnel in 25 adult feet. The causes of onset of the syndrome included contusion of the dorsum of the foot, tight shoe laces, talonavicular osteophytosis, ganglion, and pes cavus. The clinical signs were often diagnostic but electromyography was helpful. Operative decompression in nine feet of eight patients gave successful results at 1.5 to 4 years follow-up.
Chymopapain versus conventional surgery for lumbar disc herniation. 10-year results of treatment
Authors: Tregonning GD , Transfeldt EE , McCulloch JA , Macnab I , Nachemson A
Published: February 2018

We reviewed two comparable groups of patients who had been treated for lumbar disc herniation by chymopapain chemonucleolysis (145) or conventional surgical discectomy (91). They were reviewed 10 years after treatment by questionnaire, followed by a personal interview by an independent observer. The results of the surgically treated groups were slightly better than those treated with chymopapain. In particular, there was significantly better early relief of leg and low back pain, and fewer patients needed a second procedure. Complications were few in both groups.
Changes in bone after high-dose irradiation. Biomechanics and histomorphology
Authors: Sugimoto M , Takahashi S , Toguchida J , Kotoura Y , Shibamoto Y , Yamamuro T
Published: February 2018

We studied the effects of high-dose irradiation on the mechanical properties and morphology of cortical bone in rabbits for 52 weeks after a single dose of 50 Gy of electron-beam to the tibia. After four weeks, the bending strength of the irradiated bone was unchanged, but at 12 weeks, the strength had decreased significantly. At 24 weeks after irradiation mean strength was less than half of controls but by 52 weeks there was a tendency toward recovery. Similar, synchronous changes of damage and recovery were seen in cortical porosity, haematopoietic cells in the bone marrow and endosteal new bone formation.
Neovascularisation of the meniscus with angiogenin. An experimental study in rabbits
Authors: King TV , Vallee BL
Published: February 2018

Angiogenin, a potent blood vessel inducing protein, was implanted into experimentally injured menisci of 75 New Zealand white rabbits. Localised neovascularisation occurred in 52% of the angiogenin-treated animals, and in 9% of the controls. Neovascularisation induced by angiogenin may enhance healing of injuries within the poorly vascularised meniscal fibrocartilage, and improve the results of meniscal repair.
Fractures of the carpal scaphoid. A critical study of the standard splint
Authors: Yanni D , Lieppins P , Laurence M
Published: February 2018

The effect of the position of splintage on displacement of fractures of the waist of the scaphoid was studied during operations and in cadavers. We found that these fractures were best splinted in neutral or slight palmar flexion with no ulnar deviation. Providing the wrist was not ulnar deviated, the position of the thumb had no effect on displacement.
Axial movement and tibial fractures. A controlled randomised trial of treatment
Authors: Kenwright J , Richardson JB , Cunningham JL , White SH , Goodship AE , Adams MA , Magnussen PA , Newman JH
Published: February 2018

Diaphyseal fractures of the tibia in 80 patients were treated by external skeletal fixation using a unilateral frame, either in a fixed mode or in a mode which allowed the application of a small amount of predominantly axial micromovement. Patients were allocated to each regime by random selection. Fracture healing was assessed clinically, radiologically and by measurement of the mechanical stiffness of the fracture. Both clinical and mechanical healing were enhanced in the group subjected to micromovement, compared to those treated with frames in a fixed mode possessing an overall stiffness similar to that of others in common clinical use. The differences in healing time were statistically significant and independently related to the treatment method. There was no difference in complication rates between treatment groups.
Measurement of lower limb alignment using long radiographs
Authors: Wright JG , Treble N , Feinstein AR
Published: February 2018

Long radiographs are used to measure lower limb axial alignment, to assess the progression of deformity, and to plan corrective surgery. The purpose of this study was to test the belief that jigs are necessary in order to control limb position for radiography. Above-knee amputated limbs were fixed in different positions of rotation and of knee flexion and radiographed to study the effect on the apparent alignment of the limb. If the limb was rotated no more than 10 degrees from the neutral the effect on apparent axial alignment was minimal and radiographic measurement was reliable. This suggests that standardised positioning jigs are not needed in routine clinical practice.
Total arthroplasty of the hip after childhood sepsis
Authors: Kim YH
Published: February 2018

Total hip arthroplasty was performed in 45 hips of 44 patients who had pyogenic arthritis of the hip during childhood. The average age of the patients was 36.4 years (range 19 to 50). The interval between active infection and arthroplasty ranged from 11 to 40 years, and average follow-up was 65.4 months (range 58 to 80). Specimens of tissue taken before and during operation gave negative cultures in all hips, and no patient had reactivation of infection. The mean functional rating of the hips was 58 points before operation and 90 at the final review. Complications were seen in 11 cases (24%), loosening of components occurred in six (13%) and one hip had to be revised for acetabular component migration. Acetabular allografts were required in 27 hips (60%). All allografts united but there was partial resorption of the graft in the non-weight-bearing area in all.
A new approach to the hip for revision surgery
Authors: McMinn DJ , Roberts P , Forward GR
Published: February 2018

A new approach to the hip is described that allows better exposure for difficult revision surgery without the need for trochanteric osteotomy. A V-shaped myofascial flap consisting of the proximal part of vastus lateralis and its fascia with gluteus medius and minimus, is reflected off the greater trochanter and proximal femur giving access to the entire capsule of the hip. If the leg has been significantly lengthened by the revision procedure, abductor tension can be adjusted at closure by altering the reattachment of the flap, analogous to a V-Y-plasty.
The response of osteocytes to a lipid clearing agent in steroid-treated rabbits
Authors: Maruno H , Shimizu T , Kawai K , Hirohata K
Published: February 2018

We studied the effect of a lipid clearing agent (clinofibrate) on the osteocytes of rabbits treated with corticosteroids. Thirty-one rabbits were divided into four groups: (A) steroid-treated with a normal diet, (B) steroid-treated and one a diet with added clinofibrate, (C) non-steroid-treated, on a diet with clinofibrate; and (D) non-steroid-treated on a normal diet. All the steroid-treated animals demonstrated hyperlipidaemia and fatty degeneration of the liver. Lipid-containing osteocytes were seen in the femoral heads of these animals. However, those which received clinofibrate (group B) had less severe lipidaemia, and less severe degeneration of the liver. In them, only the osteocytes around the haversian canals exhibited lipid inclusions. Clinofibrate appears to modify lipid metabolism, diminishing the steroid induced accumulation of lipids within osteocytes. This effect may protect against steroid-mediated osteonecrosis.
Congenital discoid lateral meniscus in children. A follow-up study and evolution of management
Authors: Aichroth PM , Patel DV , Marx CL
Published: February 2018

Fifty-two children with 62 discoid lateral menisci were reviewed at an average follow-up of 5.5 years. Their average age at operation was 10.5 years and the mean delay in diagnosis was 24 months. Most of the children had vague and intermittent symptoms and the classical clunk was demonstrable in only 39% of the knees. An associated osteochondritis dissecans of the lateral femoral condyle was seen in seven knees. Forty-eight knees with symptomatic torn discoid menisci underwent open total lateral meniscectomy, six had arthroscopic partial meniscectomy and eight knees with intact discoid menisci, were left alone. Based on Ikeuchi's grading (Ikeuchi 1982), 37% of the knees had an excellent result, 47% had a good result and 16% had a fair result: none was poor. Arthroscopic partial meniscectomy is recommended only when the posterior attachment of the discoid meniscus is stable. A total meniscectomy is indicated for the Wrisberg-ligament type of discoid meniscus with posterior instability.
Sickle cell disease and silent avascular necrosis of the hip
Authors: Ware HE , Brooks AP , Toye R , Berney SI
Published: February 2018

We reviewed the prevalence of avascular necrosis (AVN) in a series of patients with sickle cell disease, using radiography and magnetic resonance imaging. We found AVN of at least one hip in 11 of 27 patients (41%). This is a significantly greater prevalence than reported. MRI was not as helpful in patients with sickle cell disease as it is in patients with AVN from other causes; it detected no more cases than radiography.
Luque rod instrumentation in the treatment of adolescent idiopathic scoliosis. A comparative study with Harrington instrumentation
Authors: McMaster MJ
Published: February 2018

Adolescent idiopathic scoliosis in 152 patients was treated by Luque L-rod instrumentation and early mobilisation without external support. This series was compared with a matched group of 156 patients treated by Harrington instrumentation and immobilised in an underarm jacket for nine months. All the operations in both groups were performed by one surgeon and the patients were followed prospectively for more than two years. Correction of the scoliosis in the frontal plane was similar in both groups. However, the normal sagittal contour was better maintained with Luque rods, especially in the thoracolumbar and lumbar regions, and provided less loss of correction than with Harrington rods. Neither method significantly derotated the scoliosis. All the patients with Luque instrumentation developed a solid fusion despite breakage of the sublaminar wires at one or two levels in 4.9%. There were no major neurological complications with either type of instrumentation.
Pelvic underpinning: eight years' experience
Authors: Butler-Manuel PA , James SE , Shepperd JA
Published: February 2018

A new method to reconstruct major acetabular floor defects is described. It relies on the placement of special nails into each of the three bones of the hemipelvis. Curved lugs attached to the nails are coalesced using bone cement forming a platform onto which a standard acetabular prosthesis is located. Forty-seven cases are reported with a mean follow-up of 4.4 years (1 to 8). No loosening of an acetabular cup or migration of the device has occurred.
One-stage reimplantation for infected total knee arthroplasty
Authors: Goksan SB , Freeman MA
Published: February 2018

One-stage reimplantation for the salvage of infected total knee arthroplasty in 18 patients was reviewed at an average follow-up of five years. There had been one recurrence and one new infection, both in rheumatoid patients with another focus of infection. In four other patients the clinical result was impaired by pain after walking (2) and limited flexion (2). Our results suggest that one-stage reimplantation is a reasonably reliable procedure for the management of a loose infected prosthesis.
Results of the Harris-Galante cementless hip prosthesis
Authors: Kim YH , Kim VE
Published: February 2018

We reviewed 82 primary arthroplasties (in 71 patients) in which cementless porous-coated hip prostheses were used. The mean age of the patients at operation was 52 years (24 to 86); they were followed up for an average of 62.1 months (60 to 66). The diagnosis was avascular necrosis of the femoral head in 35%, fracture of the femoral neck in 24%, primary osteoarthritis in 16% and miscellaneous in 25%. The average preoperative Harris hip score was 56.7 points and the average postoperative score was 83.3 points. Eight hips (10%) had component loosening; four had been revised and four were awaiting revision. In 27 hips (33%) there was a radiolucent line wider than 2 mm in zones 1 and 7. In 55 hips (67%) there was calcar resorption of more than 10 mm. Twenty patients (28%) complained of thigh pain although they had no radiographic evidence of loosening of a component. Factors that may have contributed to the poor clinical and radiographic results were: 1) inadequate surface area for bone ingrowth, particularly on the lateral aspect of the upper part of the prosthesis, 2) poor initial fit of the stem in the metaphysis, which resulted in cantilever motion of the proximal part of the stem about the well-fixed distal stem, and 3) the collar of the prosthesis, which prevented it from subsiding to a naturally stable position and caused damage to the calcar.
Compartment pressures after closed tibial shaft fracture. Their relation to functional outcome
Authors: Triffitt PD , Konig D , Harper WM , Barnes MR , Allen MJ , Gregg PJ
Published: February 2018

We measured pressures in the anterior and deep posterior compartments continuously for up to 72 hours in 20 patients with closed fractures of the tibial shaft treated primarily in plaster casts. All were examined independently after periods of three to 14 months. Pressures above 40 mmHg occurred in seven (35%) and above 30 mmHg in 14 (70%). No patient had the symptoms of compartment syndrome during monitoring. Abnormalities at review did not correlate with the maximum consecutive time periods during which the compartment pressures were raised. Thus, in the absence of symptoms the monitored pressures did not relate to outcome. Routine monitoring in this type of patient is therefore of doubtful benefit.
Reduced risk of hip fracture in the mothers of patients with osteoarthritis of the hip
Authors: Astrom J , Beertema J
Published: February 2018

In a population-based study we identified a cohort of 282 women, whose children had been treated for osteoarthritis of the hip. The incidence of hip fracture in these mothers was 0.54 (95% CI 0.35 to 0.83) of that in the whole population of their age and sex. This finding could be explained by a genetic factor for increased rigidity of subchondral bone, making osteoarthritis more likely and osteoporosis less likely.
The blood supply of the greater trochanter
Authors: Churchill MA , Brookes M , Spencer JD
Published: February 2018

We perfused 16 human femora with a 50% barium sulphate suspension and studied the intra-osseous vessels by microfocal radiography and histology. There were few anastomoses between the vessels of the greater trochanter and those of the adjacent cancellous bone of the shaft. Ischaemia of the trochanter may contribute to nonunion after trochanteric osteotomy.
Ossification of the ligamentum flavum induced by bone morphogenetic protein. An experimental study in mice
Authors: Miyamoto S , Takaoka K , Yonenobu K , Ono K
Published: February 2018

Ossification of the ligamentum flavum and secondary spinal-cord compression were produced experimentally in mice by implanting bone morphogenetic protein (BMP) in the lumbar extradural space. The ligamentum flavum became hypertrophied and ossified, and protruded into the spinal canal. The thickness of the ossified ligament increased gradually with time, leading to compression and deformation of the spinal cord which showed various degrees of degeneration. Demyelination occurred in the posterior and lateral white columns and neuronal loss or chromatolysis in the grey matter. The pathological findings in the experimental animals closely resemble those found in the human disease and suggest that BMP may be a causative factor of ossification of the ligamentum flavum in man. This experimental model may be useful for the study of myelopathy caused by gradual spinal-cord compression.
Overuse injuries of the olecranon in young gymnasts
Authors: Maffulli N , Chan D , Aldridge MJ
Published: February 2018

We report overuse injuries in 14 elbows of ten elite young gymnasts. In 12 elbows of eight patients aged 11 to 15 years there was a spectrum of radiological abnormalities including widening of the olecranon physis and fragmentation of the epiphysis. The radiographs were compared with those of normal elbows matched for age and sex. The radiograph appearances were very similar to those of the Osgood-Schlatter lesion of the tibial tuberosity. Two older boys, aged 18 and 19, had stress fractures through the olecranon growth plate. Conservative management was successful in all except one case of stress fracture which required internal fixation.
Leg oedema due to a rheumatoid cyst in the pelvis
Authors: Chalmers J , Chalmers N
Published: February 2018

We describe a case in which chronic oedema of a leg was due to pressure on the external iliac vein from an intrapelvic rheumatoid cyst. Ultrasound and CT scanning gave the clues to diagnosis.
Bilateral femoral shortening for unaccepted tallness
Authors: Nordsletten L , Holm I , Steen H , Folleras G , Bjerkreim I
Published: February 2018

We performed bilateral femoral shortening operations on 15 skeletally mature patients (11 women and four men). Their mean height pre-operatively was 193.5 cm and they were shortened by 5 to 9 cm. We used a subtrochanteric Z-osteotomy with an AO condylar plate in 11 patients, and mid-diaphyseal osteotomy with an intramedullary locking nail in four. After an average follow-up of 8.1 years, isokinetic muscle testing showed that muscle strength was reduced bilaterally in five patients. The strength ratio between hamstrings and quadriceps muscles was normal in all those treated by subtrochanteric shortening; in those shortened at the mid-shaft the quadriceps was relatively weaker. The result was rated as excellent by 11 patients, very good by three, and good by one.
Selection bias in treatment of soft-tissue sarcoma
Authors: Gustafson P , Rydholm A
Published: February 2018

We analysed 256 patients with primary soft-tissue sarcoma of the extremities diagnosed between 1970 and 1990 to see if tumour-related and host-related prognostic factors influenced both the selection of operation and the margin of clearance obtained at surgery. Amputation was more often performed in young patients, in those with distal tumours, and in those with deep-seated tumours. Inadequate surgical margins (those with a high risk of local recurrence) were more common in patients with deep-seated and large tumours than in patients with superficial and small tumours. These features of the tumour and the host, which have been shown to be prognostic for survival, also influenced the choice and performance of surgical procedures.
Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis
Authors: Labelle H , Guibert R , Joncas J , Newman N , Fallaha M , Rivard CH
Published: February 2018

We have reviewed 185 articles published since 1966 to assess the scientific evidence for methods of treatment for lateral epicondylitis of the elbow. Of the 185 articles, 78 discussed treatment, but since the natural history of the syndrome is uncertain we considered only those series with concurrent control groups. Only 18 of these were randomised and controlled studies. We then graded these papers for scientific validity, using the methods of Chalmers et al (1981). The mean score of the 18 articles was only 33%, with a range from 6% to 73%. A minimum of 70% is required for a valid clinical trial, and we therefore concluded that there was insufficient scientific evidence to support any of the current methods of treatment. There were too many methodological differences to allow a quantitative meta-analysis, but our qualitative review established the importance of the natural evolution of the syndrome and of the placebo effect of all treatments. Properly designed, controlled trials are needed.
Articular cartilage fibrillation and permeability to Light Green SF dye. A method for the detection of pre-microscopic disease?
Authors: McArthur SD , Gardner DL
Published: February 2018

We describe a method which may be useful for the selection of samples for the study of early fibrillation in human articular cartilage. Blocks of cartilage and bone were cut post-mortem from the medial tibial condyles of 29 male and 31 female subjects and the grade of fibrillation was assessed from sections. Contiguous, unfixed blocks of cartilage from the same surface were immersed in a solution of the dye Light Green SF. Sections of these blocks were cut and the rate of penetration of the dye measured at 30 equidistant points across the condylar surface. The relationship between the grade of fibrillation and the rate of dye diffusion was then determined. We demonstrated a significant correlation between the two variables. This technique may make it possible to detect a pre-fibrillary state in apparently normal specimens.
Rotational osteotomy for non-traumatic avascular necrosis of the femoral head
Authors: Sugano N , Takaoka K , Ohzono K , Matsui M , Saito M , Saito S
Published: February 2018

We reviewed 41 hips in 40 patients at three to 11 years (average 6.3 years) after Sugioka transtrochanteric rotational osteotomy for non-traumatic avascular necrosis of the femoral head. The clinical results were excellent or good in 23 hips (56%) and the radiological success rate was 56%. Failure was due to fracture of the femoral neck, nonunion of the osteotomy, secondary collapse, or osteoarthritis. Nonunion and femoral neck fracture were more common after the use of the large screws described by Sugioka than with AO blade plates. Secondary collapse was significantly more common when less than one-third of the posterior articular surface was intact (p = 0.002). Postoperative degenerative changes were seen in cases with stage III avascular necrosis. We conclude that success depends to a large extent on the amount and stage of necrosis of the femoral head, but that careful technique and the use of AO hip plates may increase the likelihood of a satisfactory result.
Infection after intramedullary nailing of the tibia. Incidence and protocol for management
Authors: Court-Brown CM , Keating JF , McQueen MM
Published: February 2018

There is concern about the incidence and serious nature of infection after intramedullary nailing of the tibia, especially for open injuries. We have reviewed 459 patients with tibial fractures treated by primary reamed nailing. The incidence of infection was 1.8% in closed and Gustilo type I open fractures, 3.8% in type II, and 9.5% in type III fractures (5.5% in type IIIa, 12.5% in type IIIb). These incidences appear to be acceptable in comparison with other published results. We describe the different modes of presentation of infection in these cases, and suggest a protocol for its management, which has been generally successful in our series.
Repair of cervical nerve roots proximal to the root ganglia. An experimental study in sheep
Authors: Hems TE , Glasby MA
Published: February 2018

An experimental model was established to investigate the possibility of repairing cervical nerve roots damaged above the dorsal root ganglion, as occurs in traction injuries of the brachial plexus. In four sheep the C6 root was divided and repaired within the dura using freeze-thawed muscle grafts. Recovery was assessed after eight months by electrophysiology and histology. Action potentials were recorded distal to the grafts in all four sheep, indicating regeneration of motor fibres. Histological examination showed regenerated fibres in the ventral roots below the grafts in all cases. These fibres could be traced distally to the brachial plexus. There was no evidence of recovery of dorsal roots.
A technique for removing an intrapelvic acetabular cup
Authors: Grigoris P , Roberts P , McMinn DJ , Villar RN
Published: February 2018

We describe a simple, retroperitoneal approach for the removal of acetabular components that have migrated into the pelvis. The dense fibrous tissue layer which surrounds the implant protects the iliac vessels during removal of the cup by this method.
Timing of antibiotic administration in knee replacement under tourniquet
Authors: Richardson JB , Roberts A , Robertson JF , John PJ , Sweeney G
Published: February 2018

Cephamandole levels in serum and drain fluid were measured in 32 knee replacement operations to determine the benefit of an intravenous dose of antibiotic at the time of tourniquet deflation. Concentrations of cephamandole in drain fluid were directly proportional to the serum concentration at the time of tourniquet release. A 'tourniquet-release' dose of antibiotic increased drain fluid concentration threefold.
Laboratory comparison of the cannulated Herbert bone screw with ASIF cancellous lag screws
Authors: Marshall PD , Evans PD , Richards J
Published: February 2018

The compression produced by and the resistance to pullout of the 6.5 mm cannulated Herbert screw were compared with those of ASIF headed screws. The latter were tested with and without washers and in the following sizes: 4.5 mm cortical, 6.5 mm cancellous with a 16 mm threaded segment, and 6.5 mm cancellous with a 32 mm threaded segment. Polyurethane foam was used as a substitute for cancellous bone and ASIF artificial bone for corticocancellous bone. The compression produced by a cancellous lag screw with a washer was significantly greater than that produced by a Herbert screw of equivalent size (p < 0.05). When the screws were tested using the corticocancellous composite the ASIF cancellous screw without a washer produced significantly greater compression (p < 0.05); when used with a washer the difference was highly significant (p < 0.001). The dual pitch Herbert screw is not appropriate for the management of fractures in which compression is of greater importance than the need to avoid prominence of the screw head.
Plasma bone-specific alkaline phosphatase as an indicator of osteoblastic activity
Authors: Leung KS , Fung KP , Sher AH , Li CK , Lee KM
Published: February 2018

The total plasma alkaline phosphatase level has long been recognised as an indicator of osteoblastic activity, but lack of specificity makes it an insensitive index of the progress of disease and the response to treatment. Selective precipitation by wheatgerm lectin allows measurement of the plasma bone-specific alkaline phosphatase. We measured the plasma levels of this isoenzyme in 170 normal Chinese adolescents and adults, in 49 adults with fractures of a long bone, in 15 patients with osteosarcoma and in 38 patients with osteolytic metastases. The enzyme activity was also determined in 39 patients with liver disease. Of the patients with fractures, 94% had increased plasma activity during the healing process. The level was also increased in those with osteosarcoma but not in those with osteolytic bone metastases. There was no significant increase in activity in the patients with liver disease. We conclude that the plasma bone-specific alkaline phosphatase activity is a sensitive and reliable measure of osteoblastic activity.
Redisplacement after manipulation of distal radial fractures in children
Authors: Proctor MT , Moore DJ , Paterson JM
Published: February 2018

We reviewed 68 fractures of the distal radius in children, all treated by primary manipulation and plaster immobilisation. Complete displacement of the fracture and failure to achieve a perfect reduction were both associated with a significant increase in the chance of redisplacement. We recommend the use of percutaneous Kirschner wires to maintain a satisfactory position in all cases in which a perfect reduction cannot be achieved.
Evaluation of painful hip arthroplasties. Are technetium bone scans necessary?
Authors: Lieberman  , Huo MH , Schneider R , Salvati EA , Rodi S
Published: February 2018

We reviewed the plain radiographs, bone scans and hip aspiration results of 54 patients with painful hip arthroplasties which had been explored surgically, to compare the results of the investigations with the operative findings. For acetabular loosening, the sensitivity and specificity of bone scanning were 87% and 95%, with an accuracy of 90%: for serial plain radiography sensitivity was 95%, specificity 100% and accuracy 97%. For femoral component loosening, bone scan sensitivity was 85%, specificity 100% and accuracy 89%: the sensitivity of plain radiography was 100%, with specificity 92% and accuracy 98%. Technetium bone scanning did not provide additional information with regard to loosening and is not necessary in the routine investigation of a painful hip arthroplasty. Serial pain radiography is the most effective method of detecting loosening, and bone scanning is useful only when radiography is inconclusive with regard to loosening or infection.
Os acromiale: anatomy and surgical implications
Authors: Edelson JG , Zuckerman J , Hershkovitz I
Published: February 2018

We examined 270 scapular bones and found an incidence of os acromiale of 8.2%. In most cases, the free fragment was approximately one-third of the overall length of the acromion, and included the acromioclavicular facet and the principal areas of attachment of the coracoacromial ligament. Two-thirds of the specimens showed a distinctive pattern of osteophytic lipping. Based on this study, we devised operative procedures for symptomatic patients, and operated upon seven, with good results in six.
Chronic multifocal osteomyelitis
Authors: Carr AJ , Cole WG , Roberton DM , Chow CW
Published: February 2018

We describe 22 patients who presented between the ages of 4 and 14 years with gradual onset of malaise and pain at the sites of multiple bone lesions. The symptoms from the bone lesions were sometimes sequential in onset and often relapsing. The radiological findings were typical of osteomyelitis. Radioisotope bone scans identified some clinically silent lesions. Bone biopsies were performed in 20 patients and the changes of osteomyelitis were seen in 17; microbiological culture was positive in only one. Seven patients had polyarthritis, two had palmoplantar pustulosis and one had psoriasis. Some symptomatic relief was obtained with anti-inflammatory agents and, to a less extent, with antibiotics. No patient had primary immunodeficiency. The mean duration of symptoms from the bone lesions was two years (1 to 4). When arthritis was present the joint symptoms lasted considerably longer (mean 7 years; range 4 to 10). The long-term prognosis was generally good. There was no evidence of altered bone growth or abnormal joint development. One patient developed a progressive kyphosis requiring fusion, but no other surgical intervention was necessary.
Tibial high-density polyethylene wear in conforming tibiofemoral prostheses
Authors: Plante-Bordeneuve P , Freeman MA
Published: February 2018

We have studied 27 tibial prostheses retrieved from knee replacements after 1 to 9 years. In 22 the femoral components were of cobalt-chrome, in five polyacetal. The design of the components gave a nominal contact area of 320 mm2 on each condyle. The tibial component was of high-density polyethylene (HDP) at least 6 mm thick, and not heat-treated. In the metal/HDP prostheses the average wear rate was 0.025 mm/year. The relative wear on the medial and lateral sides was related to the leg axis. None of the retrieved prostheses showed any severe disruption of their surface. The polyacetal/HDP prostheses showed similar wear with a statistically insignificant trend towards slower penetration. We conclude that the rate of wear of HDP in a conforming tibiofemoral bearing with a fixed tibial component at least 6 mm thick and not heat-treated is slow enough to be safe in clinical practice.
Osteomyelitis of the pelvis
Authors: Rand N , Mosheiff R , Matan Y , Porat S , Shapiro M , Liebergall M
Published: February 2018

Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise. Extensive surgical drainage and antibiotic treatment led to recovery in all cases.
Extra-articular augmentation for residual hip dysplasia. Radiological assessment after Chiari osteotomies and shelf procedures
Authors: Klaue K , Sherman M , Perren SM , Wallin A , Looser C , Ganz R
Published: February 2018

The Chiari osteotomy and various shelf procedures are used to augment the weight-bearing area in dysplastic acetabula. The new articular surface derives by metaplasia from the acetabular rim and joint capsule, and is therefore of poorer quality than congruous hyaline cartilage. We reviewed 32 patients after augmentation procedures, using conventional radiographs and three-dimensional reconstruction from CT scans. We showed that Chiari osteotomy and shelf procedures generally achieve less than complete cover, especially over the posterolateral quadrant of the femoral head. Our results suggest that alternative methods which reorientate the whole of the acetabulum are the treatment of choice. Augmentation procedures remain as a salvage option when reorientation is inappropriate or the original hyaline cartilage surface is absent, as in subluxed joints with a secondary acetabulum. Computerised assessment is recommended before operation to assess existing cover and the possible extent of provision of new cover.
Evoked spinal cord potentials for diagnosis during brachial plexus surgery
Authors: Murase T , Kawai H , Masatomi T , Kawabata H , Ono K
Published: February 2018

We used evoked spinal cord potentials (ESCP) for intraoperative diagnosis in 17 cases of traumatic brachial plexus palsy. Forty spinal nerves were directly stimulated during exploration of the brachial plexus and ESCP recorded from the cervical epidural space were compared with simultaneously observed somatosensory evoked potentials (SEP) and myelographic findings. Both SEP and ESCP could be evoked in 21 spinal nerves but ESCP were always more distinct and five to ten times greater in amplitude than SEP. In four nerves, ESCP but no SEP were produced, suggesting that there was continuity from the nerves to the spinal cord. ESCP were obtained from two spinal nerves which appeared to be abnormal on the myelogram. The results show that intraoperative electrodiagnosis by epidural ESCP recordings can provide useful information on the lesions of traumatic brachial plexus palsy.
Shoulder instability. An analysis of family history
Authors: Dowdy PA , O'Driscoll SW
Published: February 2018

A family history of shoulder instability in first-degree relatives was found in 24 of 100 patients who had been operated on for recurrent anterior shoulder instability. The patients with and without a family history were similar in respect of sex ratio, age at first dislocation and age at operation. The initial dislocation was non-traumatic in 22% of the patients with and in 13% of those without a positive family history (p = 0.3). Postoperative recurrence of instability was experienced by 34% of patients with and 33% of those without a family history (p = 0.9). In those with a family history, 13% of the recurrences were dislocations and 87% were subluxations. In patients without a family history 52% of the recurrences were dislocations and 48% were subluxations (p < 0.05). The contralateral shoulder was unstable in 50% of the patients with a family history and in 26% of those without (p = 0.03).
Migration of hydroxyapatite coated femoral prostheses. A Roentgen Stereophotogrammetric study
Authors: Soballe K , Toksvig-Larsen S , Gelineck J , Fruensgaard S , Hansen ES , Ryd L , Lucht U , Bunger C
Published: February 2018

We allocated randomly 27 patients undergoing 28 primary uncemented total hip replacements (THR) to receive prosthetic components of similar design with either plasma-sprayed titanium alloy (Ti) coating (n = 13) or hydroxyapatite (HA) coating (n = 15). After some exclusions, 15 of the patients (15 THR; 7 with HA- and 8 with Ti-coating) were followed by roentgen stereophotogrammetric analysis at 3, 6 and 12 months to measure migration of the femoral component. Twenty-six of the patients (26 THR) were followed clinically and by conventional radiography. All the femoral components had migrated at 3 months. From 3 to 12 months, the migration of Ti-coated components continued whereas the HA-coated components had stabilised. At 12 months there was significantly less migration of the HA-coated components (p < 0.05). The maximum subsidence was 0.2 mm in both groups. The Harris hip score was equal in the two groups preoperatively but at follow-up it was better in the HA-coated group (p < 0.05) and visual analogue scale scores showed that they had less pain (p < 0.05).