bluuebunny/crossref_metadata_2025 huggingface dataset:
Stable intertrochanteric femoral fractures. A misnomer?
Authors: MacEachern AG , Heyse-Moore GH
Published: February 2018

Intertrochanteric fractures of the femur are usually classified into stable and unstable groups, partly to predict the likelihood of displacement with early weight-bearing after internal fixation. Of 82 internally fixed intertrochanteric fractures which would normally be classified as stable, 25 subsequently underwent impaction along the axis of the nail or screw; varus displacement occurred in another six. Of these 31 fractures, 10 were two-part fractures which had been anatomically reduced, and 12 were originally undisplaced. It did not seem possible to predict the subsequent instability from the pre-operative radiographs. Of the 82 fractures, 47 had been treated with a Jewett nail-plate and 35 by a Richards compression screw-plate. Two groups of stable fractures were recognised: Group 1 was undisplaced and Group 2 displaced. Axial impaction occurred in a quarter of all Group 1 fractures however treated. In Group 2 fractures it occurred in a quarter of those treated with a nail-plate, and in over a third of those treated with a sliding screw-plate. The six fractures that underwent varus displacement had all been treated with Jewett nail-plates. Penetration into the joint occurred in 10 patients, all of them in the group treated with Jewett nail-plates; four required re-operation.
Comparison of the structure of neotendons induced by implantation of carbon or polyester fibres
Authors: Amis AA , Campbell  , Kempson SA , Miller JH
Published: February 2018

Carbon-fibre and polyester-fibre implants of comparable dimensions were used to replace the calcaneal tendon in 30 sheep. The neotendon produced in proximity to the polyester fibres was denser, more collagenous and more closely adherent than that in the carbon-based neotendon. Fragmentation of the carbon caused continuing cellular reaction which was associated with a poor collagen response.
Pre-operative and postoperative scintimetry after femoral neck fracture
Authors: Stromqvist B , Hansson LI , Ljung P , Ohlin P , Roos H
Published: February 2018

In 22 patients with femoral neck fractures 99mTc-MDP scintimetry was performed before operation and again shortly after operation; in 17 of these patients the investigation was repeated after four months. Six patients with increased uptake in the femoral head before operation and eight with decreased uptake had similar results at the first postoperative investigation. Of eight patients with an intermediate uptake before operation, two showed increased and six decreased femoral head uptake after operation. It is concluded that for the patients in the group with intermediate femoral head uptake before operation, the operative procedure probably influenced the postoperative blood supply of the femoral head.
Malignant fibrous histiocytoma of bone at the site of a total hip arthroplasty. A case report
Authors: Bago-Granell J , Aguirre-Canyadell M , Nardi J , Tallada N
Published: February 2018

A patient who presented with a malignant fibrous histiocytoma in the proximal femur after a total hip replacement is reported. The arthroplasty was of the Charnley-Muller type with detachment of the greater trochanter; polymethylmethacrylate cement was used. The possible tumour-forming effect of implant materials is discussed and the literature reviewed.
Osteoid osteoma and benign osteoblastoma of the spine. Clinical presentation and treatment
Authors: Kirwan EO , Hutton PA , Pozo JL , Ransford AO
Published: February 2018

The clinical presentation and treatment of 18 cases of osteoid osteoma or osteoblastoma of the spine are described, with an average follow-up of 4.2 years (range three months to 11.5 years). The average delay between the onset of symptoms and definitive diagnosis was 19 months. All patients presented with marked spinal stiffness and a painful scoliosis. The lesion was situated in the pedicle in the 15 patients with involvement of the thoracolumbar spine. A surgical approach allowing direct access to the pedicle without entering the spinal canal or jeopardising spinal stability is described. Surgical treatment afforded immediate relief of pain and an early return of full spinal mobility.
Fracture of the neck of the femur associated with posterior dislocation of the hip
Authors: Klasen HJ , Binnendijk B
Published: February 2018

Two patients are described, each with a fracture-dislocation of the hip combined with a fracture of the neck of the same femur. Open reduction combined with internal fixation was performed in both cases. Eight years later one patient had developed avascular necrosis of the femoral head; no signs of avascular necrosis or associated arthritis have appeared in the other patient after four years. A plea is made for considering this more conservative type of operation for these serious injuries before resorting to total hip replacement.
The long-term results of Stanmore total knee replacements
Authors: Grimer RJ , Karpinski MR , Edwards AN
Published: February 2018

One hundred and three sequential Stanmore knee replacements were reviewed retrospectively on two occasions with a maximal follow-up period of nine years three months. This knee prosthesis, which is hinged, was successful in alleviating pain, stabilising an unstable knee and modestly increasing the arc of flexion. Walking capacity was increased and flexion contractures were reduced. There were seven cases of infection and four of fracture around the prosthesis. All these proved difficult to treat and two knees with both fracture and infection needed amputation. Eight knees were revised for aseptic loosening and a further 14 were found to have radiological signs of loosening. The results have been analysed by the methods advocated by Tew and Waugh and give a cumulative success rate of 80 per cent at seven years, provided success is judged solely by whether the prosthesis is still in situ. The role of the Stanmore knee as a primary arthroplasty is discussed.
Radical excision of the nailfold for ingrowing toenail
Authors: Antrum RM
Published: February 2018

A simple method of treatment for ingrowing toenail by radical excision of the affected nailfold is described. The results in a prospective series of 50 patients are presented. This procedure, first described in 1872, does not destroy the nail, which heals to give an excellent cosmetic result. The recurrence rate after 18 months was 20 per cent, which compares favourably with procedures in which the nailbed is ablated. This method is proposed as an alternative to more complex procedures, especially when a cosmetic result is desired.
Lambrinudi triple arthrodesis for correction of severe rigid drop-foot
Authors: Tang SC , Leong JC , Hsu LC
Published: February 2018

The results of 10 patients with severe rigid drop-foot corrected by the Lambrinudi triple arthrodesis were studied. The average amount of correction was 47 degrees, as evaluated from standing radiographs taken before and after operation. Radiological features of osteoarthritis and of flattening of the talus were common, but the feet were painless when reviewed at an average of 70 months later. A satisfactory range of movement was obtained at the ankle joint.
Flexible carbon fibre in late ligamentous reconstruction for instability of the knee
Authors: Leyshon RL , Channon GM , Jenkins DH , Ralis ZA
Published: February 2018

Sixty-three knees with chronic ligamentous instability treated with flexible carbon fibre are reviewed. Assessment was by pre-operative and postoperative grading of function in work and sport, together with a subjective evaluation of the result based on stability. Fifteen knees had collateral repairs, seven had cruciate repairs and 41 had combined collateral and cruciate repairs. Overall, 71% of knees showed improvement in function and 67% had good or excellent results subjectively. Clinical examination did not correlate well with the patient's evaluation of the result. Nineteen unselected cases with intra-articular (cruciate) carbon fibre had arthroscopies. Infiltration of collagen tissues into the cruciate replacement was a slower process than at the extra-articular (collateral) site. There was no clinical or macroscopic evidence of synovitis but microscopically there was evidence of synovial irritation.
Telescoping osteotomy for pressure metatarsalgia
Authors: Helal B , Greiss M
Published: February 2018

A review is presented of 508 feet in 310 patients after telescoping osteotomy of the lesser metatarsals for metatarsalgia. The patients were predominantly female (80%), with a mean age of 55 years; the range of follow-up was 1 to 12 years. In 22% of the patients the metatarsalgia was associated with rheumatoid arthritis. Improvements in assessment and modifications in technique are reported and the management of complications is discussed. The results show that telescoping osteotomy for established cases of pressure metatarsalgia is a simple and reliable operation. Permanent relief of symptoms can be expected in over 80% of patients.
Surgical treatment of the symptomatic accessory navicular
Authors: Macnicol MF , Voutsinas S
Published: February 2018

The accessory navicular is occasionally the source of pain and local tenderness over the instep. If conservative measures fail, surgical treatment may be required and the results of 62 operations to one or both feet in 47 patients are reported. Twenty-six patients were treated by the Kidner operation, in which the main insertion of the tibialis posterior is re-routed; in the remaining 21 the ossicle was merely excised. Excision was as effective as the Kidner technique, provided that the medial surface of the main navicular bone was contoured to prevent any residual prominence. Both procedures were successful in relieving symptoms in the majority of cases and failures resulted from errors in the selection of patients or in the surgical technique. Correction of any associated flat foot was secondary to growth and maturation of the foot rather than to the operation; hence the Kidner procedure does not confer any particular advantages over simple excision.
Basilar impression in osteogenesis imperfecta. A report of three cases in one family
Authors: Pozo JL , Crockard HA , Ransford AO
Published: February 2018

Basilar impression is a well-recognised though rare complication of osteogenesis imperfecta. Three patients, all members of the same family, with advanced basilar impression complicating osteogenesis imperfecta tarda, are described. The clinical features in these cases illustrate the natural history of this condition: from asymptomatic ventricular dilatation, through the foramen magnum compression syndrome, to death from brain-stem compression. The radiological criteria on which the diagnosis is based, are defined. Review of the literature reveals only seven previously documented cases, all in patients with mild forms of osteogenesis imperfecta. The unusually low incidence of basilar impression in osteogenesis imperfecta and its apparent restriction to patients with mild forms of the disease is discussed. The examination of close relatives of patients with basilar impression and osteogenesis imperfecta is emphasised in order to anticipate the onset of severe neurological complications.
The development of an unconstrained elbow arthroplasty. A clinical review
Authors: Lowe LW , Miller AJ , Allum RL , Higginson DW
Published: February 2018

This paper describes the development, operative technique and results of an unconstrained total elbow arthroplasty. Forty-seven elbow replacements were carried out in 44 patients between 1974 and 1982. There was a high rate of loosening in the early condylar replacements. The results in patients with post-traumatic arthritis were poor. The later design employs an ulnar stem, with a humeral stem if the distal humeral bone stock is poor. When used in carefully selected patients with rheumatoid arthritis, pain is reduced significantly, stability and movement are preserved and function is improved.
The effects of chemonucleolysis as demonstrated by computerised tomography
Authors: Konings JG , Williams FJ , Deutman R
Published: February 2018

Computerised tomography (CT) was performed in 30 patients with herniated lumbar discs; this was done both before chemonucleolysis and three months after. In 20 of the 28 patients who were CT positive, the compression produced by the herniated disc was eliminated or reduced. Twenty-three of the 28 patients developed diffuse bulging of the annulus. There was good correlation between the clinical results at three months and the alteration in compression as shown by the CT scan. No evidence of alteration in the bony relationship was seen in the scan and none of the patients developed epidural fibrosis. Chemonucleolysis has thus been shown to be an effective treatment of herniated lumbar discs, but it is definitely not indicated in cases where compression of the nerve root or dural sac is due to a bulging annulus.
Parosteal osteosarcoma
Authors: Campanacci M , Picci P , Gherlinzoni F , Guerra A , Bertoni F , Neff
Published: February 2018

Forty-one cases of parosteal osteosarcoma were reviewed clinically, radiologically and pathologically. The fibrous and cartilaginous elements of each tumour were graded from I to IV for malignancy. Primary intramedullary involvement was found in one third of Grade I lesions, two-thirds of Grade II and nearly 90% of Grade III lesions. Thirty-five patients with adequate follow-up were also studied and evaluated as to the adequacy of surgical management in relation to the later development of local recurrence or metastasis or both. No metastases were seen from Grade I tumours despite a number of local recurrences. One third of patients with Grade II and half of those with Grade III tumours developed pulmonary metastases and died, all with involvement of the medullary cavity before distant spread. No patients with adequate surgical management developed local recurrence; in those with inadequate treatment there was an 88% local recurrence rate.
The long-term results of conservative management of severely displaced fractures of the calcaneus
Authors: Pozo JL , Kirwan EO , Jackson AM
Published: February 2018

A subjective, objective and radiographic study of 21 patients with comminuted calcaneal fractures showing severe involvement of the subtalar joint is reported. The average follow-up was 14.6 years (range 8 to 29 years). Only patients with unilateral closed fractures and no associated injuries to either lower limb were admitted to the study. All were treated by early active mobilisation of the ankle, and the subtalar and the midtarsal joints. Seventy-six per cent of the patients achieved a good result with minor symptoms which did not interfere with their occupation or leisure requirements. Although two-thirds of the patients reached a point of maximal recovery at two to three years, 24% continued to improve for six years. None of the patients experienced any deterioration after this time. Neither the degree of clinical stiffness nor the degeneration of the subtalar joint, assessed radiographically, correlated with the severity of symptoms or functional disability. The role of the soft tissues in the aetiology of residual symptoms is discussed.
A new operation for atlanto-axial arthrodesis
Authors: Mitsui H
Published: February 2018

Thirty patients with atlanto-axial subluxation were operated on using the Mitsui Memorial Hospital System. The follow-up averaged one and a half years, and the results were satisfactory in comparison with other operative methods, all patients regaining almost normal function. Stability and safety are the main advantages of this procedure, with almost complete correction of subluxation in most patients.
Metabolic effects of tourniquet ischaemia studied by nuclear magnetic resonance spectroscopy
Authors: Newman RJ
Published: February 2018

A model of tourniquet ischaemia was developed in the hind limb of the rat, and the metabolic changes that occurred in the calf muscles were monitored by the non-invasive technique of phosphorus-31 nuclear magnetic resonance spectroscopy. During ischaemia the intramyocellular pH became acidic as the level of phosphocreatine declined and that of inorganic phosphate rose. Phosphocreatine was no longer detectable after approximately 2 hours and ATP was depleted after approximately 3.5 hours. Metabolic recovery was rapid (1 hour) if ATP was present when the tourniquet was released but was prolonged (3 or more hours) if ATP was depleted. Hourly release of the tourniquet for 10 minutes ensured the maintenance of ATP and rapid metabolic recovery. Release for intervals of only 5 minutes did not have the same protective effect and in fact worsened tissue pH during the period of tourniquet ischaemia. Heparin and corticosteroids were without effect during and after periods of tourniquet ischaemia.
Injuries of the cervical spine in schoolboy rugby football
Authors: McCoy GF , Piggot J , Macafee AL , Adair IV
Published: February 2018

Serious neck injury in rugby football is becoming more common, especially in schoolboys. We report five who presented with spinal cord damage between 1977 and 1983, two in the 1982-83 season. The mechanisms of injury, the treatment, and the outcome are discussed. We suggest measures to reduce the incidence of this most serious injury and draw attention to the appropriate management in the critical phase directly after injury.
Experimental epiphysial distraction producing and correcting angular deformities
Authors: Peltonen JI , Karaharju EO , Alitalo I
Published: February 2018

Angular deformities of the distal radius of 15 sheep were induced by asymmetrical epiphysial distraction. Eleven sheep were between 10 and 20 weeks old; four were older than 24 weeks. Gradual distraction on the medial side of the limb caused partial separation of the epiphysis from the metaphysis, resulting in a valgus deformity. The distraction device was removed three to six weeks after insertion. Spontaneous correction of angulation with growth occurred in the younger sheep; but when the induced valgus angle exceeded 20 degrees correction was poor. In two sheep further distraction was applied on the lateral side and this produced complete correction. Premature closure of epiphyses did not occur after distraction and longitudinal growth of the bone remained normal. In the older sheep asymmetrical distraction succeeded in inducing angulation in only one case, and correction was poor.
Closed intramedullary rodding for osteogenesis imperfecta
Authors: Middleton RW
Published: February 2018

Three cases of severe osteogenesis imperfecta are reported. Each was treated by closed intramedullary rodding, combined with osteoclasis to correct deformity. Operation was performed within a few months of birth. Both tibiae and both femora were stabilised in one operation, using x-ray image intensification to monitor placement of the rods. The technique used to insert the rods is described. The procedure appeared to be entirely satisfactory in reducing the incidence of fractures and it allowed the affected infants to be handled much more easily.
Walking ability after transplantation of the iliopsoas. A long-term follow-up
Authors: Stillwell A , Menelaus MB
Published: February 2018

Of 47 patients with spina bifida who had had transplantation of the iliopsoas more than 10 years previously, 32 (68%) were community walkers, 3 were household walkers and 12 were non-walkers. Comparison with other published reports showed that, at the very least, the patients reviewed had not had their walking ability jeopardized by the inevitable loss of hip flexor power. Furthermore, all but three of the community walkers were able to climb and descend stairs. There was a high proportion of non-walkers in those patients whose operation had been performed in the first year of life and such early surgery is no longer recommended. We also found that the pre-operative assessment of muscle power had, in some patients, been inaccurate. Finally, we found that, at review, the power of the transferred muscles was poor, suggesting that transplantation is beneficial because it achieves permanent and major reduction in hip flexor power; this usually prevents recurrent hip flexion deformity and dislocation.
Talectomy for club foot in arthrogryposis
Authors: Hsu LC , Jaffray D , Leong JC
Published: February 2018

Talectomy was performed on 10 patients (15 feet) for club foot deformity in arthrogryposis multiplex congenita. These were reviewed after an average follow-up of eight years. At follow-up nine feet were plantigrade, and six had less than 15 degrees residual equinus at the ankle. All the feet were asymptomatic but had mild residual adduction of the forefoot and marked stiffness of the hindfoot. Seven feet developed spontaneous bony ankylosis in the tibiotarsal joint. The common technical errors were incomplete removal of the talus and incorrect positioning of the calcaneus in the ankle mortise.
Acquired spondylolysis after spinal fusion
Authors: Brunet JA , Wiley JJ
Published: February 2018

Spondylolysis occurring after a spinal fusion is considered to result from operative damage to the pars interarticularis on both sides. Fourteen cases are reported, and compared with the 23 cases which have previously been published. The defects are usually recognised within five years of fusion, and usually occur immediately above the fusion mass. Other contributory causes may be: fatigue fracture from concentration of stress; damage and altered function of the posterior ligament complex; and degenerative disc disease immediately above or below the fusion. Fusion technique is critical, since virtually all cases occurred after posterior interlaminar fusions. This complication is easily overlooked in patients with recurrent back pain after an originally successful posterior spinal fusion.
The operative treatment of scapular fractures
Authors: Hardegger FH , Simpson LA , Weber BG
Published: February 2018

Fractures of the scapula occur mainly from direct trauma involving considerable violence and associated injuries of the shoulder and thorax are common. In most cases early functional treatment gives good or excellent results. Operative treatment may, however, be indicated, especially with displaced intra-articular fractures, fractures of the glenoid rim associated with humeral head subluxation, or unstable fractures of the scapular neck. Between 1967 and 1981, we treated 37 such fractures by open reduction and stable osteosynthesis. We were able to follow up 33 cases (89%), of which 21 (64%) had complete functional recovery. The other 12 had varying degrees of pain, loss of mobility, and weakness. Overall, however, 79% of the patients had good to excellent results.
Late surgical decompression for compartment syndrome of the forearm
Authors: Geary N
Published: February 2018

Two cases are reported of the late diagnosis of compartment syndrome secondary to alcohol and drug overdose. Surgical decompression at two and a half days and at six days, respectively, produced worthwhile recovery. Other reports are reviewed and a case is made for the value of decompression even when performed late, and for delayed and minimal excision of apparently necrotic muscle.
Late degenerative changes after meniscectomy. Factors affecting the knee after operation
Authors: Allen PR , Denham RA , Swan AV
Published: February 2018

Late degenerative changes are known to follow meniscectomy, but there is little agreement on their incidence or on which patients are most at risk. A total of 210 patients have been reviewed 10 to 22 years after meniscectomy, and long leg radiographs taken of both knees. Radiological degeneration was seen in 18%, while 7% had significant symptoms and signs. Statistical analysis showed increased changes in older patients, in those with abnormal leg alignment, and in those who had undergone lateral as against medial meniscectomy. Our findings emphasise the important mechanical function of the meniscus and support the current cautious approach to meniscectomy, especially for patients in high risk groups. They also indicate the value of early high tibial osteotomy for symptomatic varus deformity after medial meniscectomy.
Meniscal repair. An arthroscopic technique
Authors: Barber FA , Stone RG
Published: February 2018

Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. In previous reports an arthrotomy was used to accomplish this repair; in this paper an arthroscopic technique is presented. The potential risks are significant and include damage to the peroneal nerve and popliteal vascular structures, failure of meniscal healing and the usual complications of arthroscopy. The procedure is recommended only for the advanced arthroscopist who is advised first to establish clearly by cadaver dissections the anatomical relationships.
The management of primary acetabular dysplasia. Its association with habitual side-lying
Authors: Heikkila E , Ryoppy S , Louhimo I
Published: February 2018

Fifty-one infants with limited abduction of the hip and acetabular dysplasia were, between 1969 and 1975, treated with abduction-adduction exercises, administered by the parents; no abduction devices were used. In 1983 a follow-up examination was carried out on 41 of these patients. Although at birth these children had characteristics similar to patients with congenital dislocation of the hip, none of their hips dislocated. At birth acetabular measurements showed that half the children had severe dysplasia and the other half slight dysplasia; the difference between the affected and the healthy hips was significant. At follow-up the gait was normal in all the patients. Movements at the hips were symmetrical and within normal limits in all but one patient. The acetabular angle, the centre-edge angle, the shaft-neck angle, the hip ratio, and the size of the femoral head were the same on the previously affected side as on the normal side. Nineteen of the children followed up had preferred lying on one side and dysplasia of the upper hip had developed. The significance of the sleeping position on the development of acetabular dysplasia is discussed.
The natural history of anterior knee pain in adolescents
Authors: Sandow MJ , Goodfellow JW
Published: February 2018

Anterior knee pain in adolescents is generally recognised as a common but benign self-limiting condition. Although many operative procedures for its treatment have been proposed, there is little statistical evidence that they are more effective than expectant management. A group of 54 adolescent girls has been followed for two to eight years from presentation with anterior knee pain. Although some pain persisted in the majority, in many the symptoms declined in severity. This study provides a baseline for comparison with the results of operative intervention; it is suggested that surgical treatment is unproven and unnecessary.
Entrapment neuropathy of the superficial peroneal nerve. A bilateral case
Authors: McAuliffe TB , Fiddian NJ , Browett JP
Published: February 2018

A 21-year-old female athlete presented with bilateral lumps in her calves which became painful on exercise. Exploration revealed entrapment of the superficial peroneal nerves. Her symptoms were relieved by fasciectomy.
Free vascularised fibular graft in the treatment of congenital pseudarthrosis of the tibia
Authors: Pho RW , Levack B , Satku K , Patradul A
Published: February 2018

Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.
Injection-induced contractures of the quadriceps in childhood. A comparison of proximal release and distal quadricepsplasty
Authors: Jackson AM , Hutton PA
Published: February 2018

Thirty-two contractures of the quadriceps induced by injection in 17 children have been reviewed. The average age at presentation was 3 years 4 months. All the children had suffered a severe illness within the first few weeks of life and all had received intramuscular injections into the thigh. Three methods of treatment were used: conservative, distal quadricepsplasty, and proximal release. At follow-up none of the patients treated by proximal release had an extension lag, which was present in 70% of those treated by distal quadricepsplasty. Apart from one case with slight improvement in the range of knee flexion, conservative treatment, at best, could only prevent further loss. The clinical presentation and management is described, and the advantages of proximal release are discussed.
Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren
Authors: Daruwalla JS , Balasubramaniam P , Chay SO , Rajan U , Lee HP
Published: February 2018

Routine examination for spinal deformity as part of a school health screening programme was introduced in Singapore in 1981. The three different ethnic groups included in the study provided figures for the prevalence of idiopathic scoliosis in an Asian population. A three-tier system of examination was used and a total of 110744 children in three age groups were studied. In those aged 6 to 7 years the prevalence was 0.12%. The prevalence in those aged 11 to 12 years was 1.7% for girls and 0.4% for boys, a ratio of 3.2 to 1. In girls aged 16 to 17 years the prevalence was 3.1%. In the latter two age groups there was a significantly higher prevalence in Chinese girls as compared with Malay and Indian girls. The optimal age for school screening seemed to be 11 to 12 years, but repeated examinations may be worthwhile.
Moire topography in scoliosis. Its accuracy in detecting the site and size of the curve
Authors: Daruwalla JS , Balasubramaniam P
Published: February 2018

Moire topography was added to school scoliosis screening in Singapore in 1982. The results from 1342 topographs, assessed in isolation, were used to study the accuracy of the method in predicting the radiographic location and magnitude of scoliotic curves. Accuracy in identifying the site of the curve was 68% in the thoracic spine, 54% in the thoracolumbar spine, and 15% in the lumbar region. There were 12.7% false-positive results and 4.3% false negatives. Of patients with a deviation of one moire fringe, 76.5% had a curve of 15 degrees or less; of those with a deviation of four moire fringes, 69% had a curve greater than 26 degrees. The prediction of the Cobb angle was less accurate when there was a deviation of two or three fringes. It is suggested that moire topography as a screening device should be reserved for use in the second tier of screening, since the forward-bending test is an effective and cheap method for the first tier of a mass school-screening programme.
Primary total hip replacement for displaced subcapital fractures of the femur
Authors: Taine WH , Armour PC
Published: February 2018

The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.
Osteolytic changes in the upper femoral shaft following porous-coated hip replacement
Authors: Brown IW , Ring PA
Published: February 2018

Ten uncemented total hip replacements were performed in 1975 using an implant in which the cobalt-chrome femoral stem was coated to give a porous surface. In all but one case a high-density polyethylene head was used. The radiological changes in the upper femoral shafts were assessed between three and nine years later. Seven showed extensive stress-relieving changes, loss of calcar, stress fractures at the root of the lesser trochanter with subsequent detachment, and osteoporosis followed by avulsion of the greater trochanter. In these seven patients the lower part of the stem appeared to be soundly embedded, although in only one was there evidence of bony incorporation. It is suggested that if the fixation of a fully coated implant of this sort remains sound, gross atrophy of the upper femoral shaft develops after five years. This atrophy, associated with an implant which can be removed only at the expense of further bone destruction, presents substantial problems if revision is needed.
Acetabular cup failure after total hip replacement
Authors: Harley JM , Boston DA
Published: February 2018

Fracture of the polyethylene acetabular cup is a rare late complication of total hip replacement. Five cases are reported. In each one this followed a fall, and involved a Muller arthroplasty which had previously been symptomless. It is postulated that ridges or other irregularities of bone, produced by keying holes, could lead to areas of thin cement and potential weakness of support for the cup.
Infection in experimental hip arthroplasties
Authors: Southwood RT , Rice JL , McDonald PJ , Hakendorf PH , Rozenbilds MA
Published: February 2018

The relationship between the route of inoculation, the dose of inoculum and the development of infection after prosthetic replacement has been determined in an animal model. The rabbit hip served as the model and a Staphylococcus aureus isolated from an infected human hip arthroplasty was introduced using different protocols. The 50% infective dose (ID50) was determined for comparative purposes. Contamination of the wound site with only a few bacteria was likely to result in infection. It was considerably more difficult to induce infection when the operation was performed without inserting the prosthesis, which suggests that the implant inhibits the body's mechanism for dealing with the insult. It was difficult to produce infection by inoculating the organisms into the bloodstream: if this inoculation was delayed till three weeks after operation the animals were often grossly septicaemic by the time the arthroplasty was infected. The results emphasise the importance of minimising intra-operative contamination and the efficacy of antibiotic cover.
Stemmed revision arthroplasty for aseptic loosening of total knee replacement
Authors: Bertin KC , Freeman MA , Samuelson KM , Ratcliffe SS , Todd RC
Published: February 2018

Fifty-three failed knee replacements were revised using minimally constrained implants with smooth uncemented intramedullary stems and metal-backed tibial components. Polymethylmethacrylate was used only to replace lost bone near the surface of the implant. Excluding four knees which had serious postoperative complications, 91% had successful relief of pain, 84% had over 90 degrees of movement and 80% could walk for more than 30 minutes. Review of the radiographs showed that there were no progressive lucencies at the interface between bone and cement, and no subsidence of components or changes in alignment. At the uncemented stem-to-bone interface, thin white lines developed near the metal, and their significance is discussed. This revision technique is an effective treatment for aseptic failure of primary total knee arthroplasty.
Fragmentation of the proximal pole of the patella. Another manifestation of juvenile traction osteochondritis?
Authors: Batten J , Menelaus MB
Published: February 2018

Six boys with fragmentation of the proximal pole of the patella are reported; the condition was bilateral in one. Four of the six presented with symptoms of Osgood-Schlatter's disease or Larsen-Johansson disease of the same or of the contralateral knee, but they had no symptoms or signs relating to the proximal pole of the patella; one also had features suggesting minimal chondromalacia patellae. Two boys had no objective abnormality in either knee. It is suggested that the fragmentation may be a further form of traction osteochondritis of the attachments of the quadriceps mechanism. Attention is drawn to its characteristic radiographic appearance, its association with other forms of juvenile traction osteochondritis (which are commonly symptomatic), and to its occurrence in boys aged 10 or 11 years.
Avulsion of the distal pole of the patella in cerebral palsy. A cause of deteriorating gait
Authors: Lloyd-Roberts GC , Jackson AM , Albert JS
Published: February 2018

Avulsion of the distal pole of the patella in spastic children with a flexed knee gait may upset the equilibrium of the knee and cause deterioration in walking. We emphasise the clinical features, discuss the mechanism and outline the principles of treatment.
Electrically powered prostheses for the adult with an upper limb amputation
Authors: Heger H , Millstein S , Hunter GA
Published: February 2018

The value of fitting adult upper limb amputees with electrically powered prostheses is assessed. In a series of 164 amputees, complete or useful acceptance of an electrically powered prosthesis was recorded in 80% of below-elbow amputees, 69% of above-elbow amputees and 72% of high level amputees. Patients expressed satisfaction with the combination of comfort, cosmesis and function. Results indicate that, accepting the high cost, an electrically powered prosthesis can provide important function to the upper limb amputee.
Spontaneous healing of aneurysmal bone cysts. A report of two cases
Authors: McQueen MM , Chalmers J , Smith GD
Published: February 2018

Two cases of aneurysmal bone cyst in the pelvis which healed spontaneously are described. Spontaneous regression of aneurysmal bone cysts has not previously been well documented. Our experience with these two cases suggests that radical intervention is not always necessary.
The effect of induced electric currents on bone after experimental osteotomy in sheep
Authors: Law HT , Annan I , McCarthy ID , Hughes SP , Stead AC , Camburn MA , Montgomery H
Published: February 2018

We have investigated the effect of currents induced by electromagnetic fields on the healing of the tibia of sheep after osteotomy, using objective and quantifiable criteria wherever possible. A battery-powered, induction apparatus was developed and was enclosed within the cast applied to the limb, so that the treated fractures received pulsed magnetic fields for 24 hours a day while the animals were freely mobile. In all, 13 sheep were treated and 13 were used as controls. The response was assessed by radiography of the limb and of the excised bone, by histology, including measurement of the areas of callus, fibrocallus and cortical bone, and by measurement of the uptake and extraction of bone-seeking mineral. All the bones healed and no statistically significant differences between the treated animals and the controls were discovered except (at only P less than 0.05) in the uptake of bone-seeking mineral; this increased more rapidly in treated animals over the two to three weeks after osteotomy, although at six weeks the uptake in both groups was the same.
Brachial artery damage accompanying closed posterior dislocation of the elbow
Authors: Grimer RJ , Brooks S
Published: February 2018

Four cases of arterial damage resulting from closed posterior dislocation of the elbow are described. Two of these have been successfully treated by conservative methods and two by vein graft to the damaged artery. Sixteen previous cases are detailed and the management of this uncommon complication of dislocated elbow is discussed.
Treatment of unstable fractures of the distal radius by external fixation
Authors: Vaughan PA , Lui SM , Harrington IJ , Maistrelli GL
Published: February 2018

The Roger Anderson external fixator was used in the treatment of unstable fractures of the distal radius in 52 patients, and the results evaluated after a follow-up averaging 58 months. The indications for its use were failure to maintain adequate closed reduction using plaster, and instability of the fracture as determined by the initial radiographs. Our radiological criteria for instability included dorsal angulation of more than 20 degrees, fractures involving the joint, radial shortening of more than 10 mm, and severe dorsal comminution. Using the Lucas modification of the Sarmiento demerit point-rating system, we found that 46 patients (89%) had good or excellent results and six (11%) were classified as fair. There were no poor results. Seven patients (14%) developed complications. None of these affected the long-term results except in one elderly woman where the pins loosened and had to be removed.
Resection of a peri-acetabular chondrosarcoma and reconstruction of the pelvis. A case report
Authors: Nielsen HK , Veth RP , Oldhoff J , Koops HS , Scales JT
Published: February 2018

We report a patient with a peri-acetabular chondrosarcoma which was treated by resection of part of the pelvis and the femoral head. This was followed by replacement with a custom-made titanium alloy pelvic portion and a conventional total hip prosthesis. The operation was carried out in two stages, and yielded a good functional and cosmetic result.
Talus partitus. A case report
Authors: Schreiber A , Differding P , Zollinger H
Published: February 2018

A 15-year-old girl presented with a four-year history of pain in the left ankle. There was no known trauma, only a postnatal soft tissue infection which had healed with no sequelae. Radiographs showed that the talus consisted of two large fragments and one small one.
Focal lacunar resorption in the articular cartilage of femoral heads
Authors: Lothe K , Spycher MA , Ruttner
Published: February 2018

Human articular cartilage taken from 92 femoral heads at autopsy was examined macroscopically and microscopically. Fifty-two showed no changes except for occasional slight degeneration in the non-pressure areas; these changes were visible only microscopically. In the remaining 40 heads, different degrees of osteoarthrosis were seen; half the heads also showed focal lacunar resorptive lesions in the cartilage. The origin of this focal cartilage resorption is discussed and its possible association with necrosis, pannus formation and enzymatic synovial activities. We conclude that there is no evidence of a direct relationship between focal cartilage resorption and osteoarthrosis.
Long-term results of Geomedic total knee replacement
Authors: Riley D , Woodyard JE
Published: February 2018

Seventy-one Geomedic total knee replacements were reviewed retrospectively at a maximum of eight and a half years. The prosthesis was found to be successful in its primary aim of relieving pain. However, there was an overall failure rate of 18.3%. Analysis of the results by an actuarial method allowed comparison with other prostheses. The factors involved in failure are discussed.
Torsion of localised pigmented villonodular synovitis of the knee
Authors: Howie CR , Smith GD , Christie J , Gregg PJ
Published: February 2018

Torsion and subsequent ischaemia is a well-recognised cause of symptoms and morbidity in general surgery. We present three cases of solitary pigmented villonodular tumours of the knee which were found to have undergone torsion. We believe these to be the first intra-articular tumours in which torsion has been reported.
The treatment of 143 tibial shaft fractures by Ender's nailing and early weight-bearing
Authors: Merianos P , Cambouridis P , Smyrnis P
Published: February 2018

A prospective study of 141 patients with 143 tibial shaft fractures has been carried out; 102 fractures were closed and 41 open. All the patients were treated by Ender's nailing and early weight-bearing. The average healing time was 15.2 weeks. There were no cases of bone infection and complications were minimal, the commonest being slight malalignment. Using this method, rapid restoration of bone continuity was achieved, combined with almost normal limb function during treatment.
Pectoralis major transfer for paralysis of elbow flexion in children
Authors: Atkins RM , Bell MJ , Sharrard WJ
Published: February 2018

Seven pectoralis major transfers in children suffering from bilateral paralysis of elbow flexion due to arthrogryposis or to trauma are reported. A technique is described in which the muscle is mobilised from the clavicle to allow the tendon of insertion to be attached to the biceps tendon at the elbow. The biceps tendon was found to be present and could be mobilised forwards in all the arthrogrypotic elbows. Subjectively, the results were considered by patients or parents to be very good in six cases and fair in one. Elbow flexion power against gravity and against some resistance was achieved in all patients except one. The overall function was very good in one elbow, good in two, fair in three and poor in only one. The merits of the various procedures described for the restoration of elbow flexion in arthrogryposis are discussed. It is concluded that total pectoralis major transfer by the method described here has given the best results.
Collagen and fibronectin in a healing skeletal muscle injury. An immunohistological study of the effects of physical activity on the repair of injured gastrocnemius muscle in the rat
Authors: Lehto M , Duance VC , Restall D
Published: February 2018

The presence of the connective tissue components fibronectin and the different types of collagen was demonstrated by histological and immunohistological methods in the granulation and scar tissue of a healing injury in rat muscle. The effects of physical activity on granulation tissue production, scar formation and muscle regeneration at various stages of healing were studied. It was shown that immobilisation after injury accelerates granulation tissue production, but if continued too long, leads to contraction of the scar and to poor structural organisation of the components of regenerating muscle and scar tissue. However, a certain period of immobilisation, about five days for rat muscle, is required to allow newly-formed granulation tissue to cover the injured area and to have sufficient tensile strength to withstand subsequent mobilisation. This mobilisation, at the correct interval, seems essential for the quicker resorption of scar tissue and the better structural organisation of the muscle.
Delayed union of humeral shaft fractures treated by closed flexible intramedullary nailing
Authors: Pritchett JW
Published: February 2018

Ten patients with humeral shaft fractures and no clinical or radiographic signs of healing after at least six weeks' immobilisation were treated by flexible intramedullary nailing using a closed retrograde technique. Bone grafting was not performed, and active movement was encouraged after operation. Nine fractures healed; the mean time to union was 10.5 weeks (range 6 to 22 weeks). One patient needed compression plating and bone grafting at 22 weeks, and another required re-operation for distal migration of the rods. There were no infections, nerve palsies or other complications. Stiffness of the shoulder which had developed during early treatment improved after operation.