bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerised tomography after posterior dislocation of the hip
Authors: Hougaard K , Lindequist S , Nielsen LB
Published: February 2018

We have reviewed 19 consecutive patients admitted to the Odense University Hospital after traumatic dislocation of the hip. We aimed to perform computerised tomography as soon as possible after closed reduction; this was accomplished in 15 patients. The CT scans revealed intra-articular fragments of bone in five hips, and fractures of the femoral head or acetabulum in six. In two cases the CT scans excluded fractures or intra-articular fragments which had been suspected on conventional radiography. CT scanning is a useful diagnostic tool in traumatic dislocation of the hip; we consider that it makes an important contribution to management.
The mechanical properties of cement and loosening of the femoral component of hip replacements
Authors: Weightman B , Freeman MA , Revell PA , Braden M , Albrektsson BE , Carlson LV
Published: February 2018

Mechanical and biomechanical testing of a new bone cement suggests that improved load transfer to the proximal femur could be achieved with the combination of a cement having a lower modulus, a greater ductility and a lower creep resistance than polymethylmethacrylate and a suitably shaped femoral component.
Biodegradable internal fixation for malleolar fractures. A prospective randomised trial
Authors: Bostman O , Vainionpaa S , Hirvensalo E , Makela A , Vihtonen K , Tormala P , Rokkanen P
Published: February 2018

Fifty-six patients with displaced malleolar fractures had open reduction and fixation of the fracture fragments using, by random selection, either biodegradable implants or metal AO plates and screws. The cylindrical biodegradable implants were made of polylactide-glycolide copolymer (polyglactin 910). The complications, radiographic results and functional recovery were studied prospectively. After follow-up of at least one year, no significant differences emerged in the complication rate or in the results of treatment between the two methods of fixation. Because of the advantage of avoiding the need to remove metal fixation after union, we now use biodegradable internal fixation routinely to treat displaced malleolar fractures.
Cementing technique and the effects of bleeding
Authors: Benjamin JB , Gie GA , Lee AJ , Ling RS , Volz RG
Published: February 2018

We report the results of simple laboratory experiments which showed that bleeding pressures known to occur at the bone surface during total hip arthroplasty may compromise the integrity of the bone-cement interface and the cement itself. Such undesirable effects can be prevented by maintaining adequate pressure on the cement until its increased viscosity can resist displacement caused by the bleeding pressure.
Hepatitis B antigen in joint irrigation fluid. A hazard for hospital personnel
Authors: Koornneef M , van Houte DP , Olsthoorn PG , Fidler MW
Published: February 2018

We report the case of a carrier of the hepatitis B virus who required arthroscopy of the knee. The irrigation fluid was shown to contain the virus. In view of the highly infective nature of this virus, appropriate precautions are necessary when carrying out arthroscopy in such patients.
Early mobilisation of Colles' fractures. A prospective trial
Authors: McAuliffe TB , Hilliar KM , Coates CJ , Grange WJ
Published: February 2018

The results of a prospective controlled trial of early mobilisation of Colles' fractures in the elderly are presented. Early mobilisation produced less pain and a stronger grip. It did not lead to any greater loss of reduction of the fracture. However, there was no significant improvement in the final range of movement of the wrist. Immobilisation of the wrist for six weeks in plaster is extremely inconvenient for the elderly living alone and the patients greatly appreciated the reduction of this period of time to a minimum.
The microsurgical treatment of lumbar disc protrusion. Follow-up of 60 cases
Authors: Thomas AM , Afshar F
Published: February 2018

The technique and results of microsurgical techniques for lumbar disc protrusions in 60 patients are presented. All patients were followed up for a minimum of 2.5 years, and 91% had good or excellent results. The only patient with a recurrent disc sequestration had a good result after a second operation.
The postphlebitic syndrome following shaft fractures of the leg. A significant late complication
Authors: Aitken RJ , Mills C , Immelman EJ
Published: February 2018

Sixty patients each of whom had a fracture of the lower limb a minimum of five years (median 11 years) previously were studied by photoplethysmography, foot volumetry, popliteal venous reflux and arterial Doppler measurements. The non-fractured limb was used as a control. Postphlebitic symptoms were present in 51% and signs in 49% of fractured limbs compared with 4% and 24% respectively in the control limbs. The incidence was greater in patients who had fractured 15 years or more previously than in those who had fractured 5 to 15 years previously. Eleven limbs had clinically disabling postphlebitic symptoms including venous ulceration. The postphlebitic syndrome following lower limb fractures in young patients is more common than generally appreciated and develops after a prolonged latent interval. A prospective randomised study using prophylactic anticoagulation for lower limb shaft fractures may be justified.
Periosteal division and longitudinal growth in the tibia of the rat
Authors: Lynch MC , Taylor JF
Published: February 2018

Growth at the proximal tibial epiphyseal plate of the rat has been measured following three different growth-stimulating procedures. These were proximal periosteal release, distal periosteal release and full periosteal stripping of the diaphysis. A new radiographic method using a photographic technique has made it possible to take accurate measurements of the rate of long-bone growth in small experimental animals. From the results of this animal series we conclude that proximal tibial periosteal division is likely to be the most effective of the three procedures when used to correct leg-length discrepancy in the growing child.
Circumferential periosteal release in the treatment of children with leg-length inequality
Authors: Wilde GP , Baker GC
Published: February 2018

We present the results of 38 children with leg inequality treated by circumferential periosteal release. Leg-length discrepancy was expressed as a percentage of the longer limb. All patients showed a decrease in percentage difference at one year after operation, the mean difference dropping from 7.24% to 5.45%. The size of the response was directly related to the age of the patient at operation, being more pronounced in the younger patients. The response was not related to sex, diagnosis, or rate of growth of the patient immediately preceding operation.
Congenital talipes equinovarus: II. A staged method of surgical management
Authors: Porter RW
Published: February 2018

A staged method of surgical management for congenital talipes equinovarus is described. The hindfoot was corrected and rebalanced early in 125 feet, and in 66 feet a second-stage medial forefoot correction was performed in the second, third or fourth year. The hindfoot relapsed in 19% and the forefoot in 9%; these feet were treated by further soft-tissue surgery. No bony operation was necessary. Assessment before and after operation allows comparison with other series.
Bonding of bone to apatite-coated implants
Authors: Geesink RG , de Groot K , Klein CP
Published: February 2018

Implants of solid sintered hydroxyapatite form very tight bonds with living bone, but are susceptible to fatigue failure. This problem can be overcome by using plasma-sprayed apatite coatings on titanium implants. A very strong bond is formed between bone and this composite material; this was studied in canine bone with plug implants, avoiding any mechanical retention. Mechanical testing showed an interface shear strength at six weeks of 49 MPa with a maximum of 64 MPa after six months. There was histological evidence of direct bonding between the apatite coating and living bone while uncoated control plugs were easily extracted. The results indicate that apatite-coated implants can form a chemical fixation with a strength comparable to that of cortical bone itself. This fixation is far stronger than that provided by current cemented or uncemented fixation techniques.
Transcutaneous electrical nerve stimulation after major amputation
Authors: Finsen V , Persen L , Lovlien M , Veslegaard EK , Simensen M , Gasvann AK , Benum P
Published: February 2018

We studied the effect of transcutaneous electrical nerve stimulation (TENS) on stump healing and postoperative and late phantom pain after major amputations of the lower limb. A total of 51 patients were randomised to one of three postoperative treatment regimens: sham TENS and chlorpromazine medication, sham TENS only, and active low frequency TENS. There were fewer re-amputations and more rapid stump healing among below-knee amputees who had received active TENS. Sham TENS had a considerable placebo effect on pain. There were, however, no significant differences in the analgesic requirements or reported prevalence of phantom pain between the groups during the first four weeks. The prevalence of phantom pain after active TENS was significantly lower after four months but not after more than one year.
The shelf operation in the management of late presentation of congenital hip dysplasia
Authors: Summers BN , Turner A , Wynn-Jones CH
Published: February 2018

Shelf operations performed on 24 patients (27 hips) for late presentation of congenital hip dysplasia were evaluated. The mean age at operation was 14 years 9 months and the mean follow-up 16 years 8 months. Two-thirds of the hips had good clinical results at follow-up. Patients operated on under the age of 20 years and with little or no radiological evidence of degenerative joint changes had the highest likelihood of success. The shelf operation was found to provide good cover of the femoral head and, should failure occur, also provides adequate superior support for the seating of an acetabular prosthesis.
Tibia vara due to focal fibrocartilaginous dysplasia. The natural history
Authors: Bradish CF , Davies SJ , Malone M
Published: February 2018

We report five patients with tibia vara due to focal fibrocartilaginous dysplasia of the medial aspect of the proximal tibia. In three patients spontaneous correction occurred, while in one of the remaining two treated by operation, a valgus deformity and neurological complications resulted. Conservative management is therefore recommended.
Injuries of the acetabular triradiate cartilage and sacroiliac joint
Authors: Heeg M , Visser JD , Oostvogel HJ
Published: February 2018

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury of the triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically for at least one year.
Acrodysostosis and protrusio acetabuli. An association
Authors: Macnicol MF , Makris D
Published: February 2018

Progressive protrusio acetabuli in a patient with acrodysostosis (peripheral dysostosis Type 12) has not, as far as we know, been reported previously. It is recognised that epiphyseal dysplasias may lead to disturbances of acetabular growth, but generally this results in a shallow socket with associated changes in the proximal femoral epiphysis.
Stanmore total hip replacement. A nine- to ten-year follow-up
Authors: van der Schaaf DB , Deutman R , Mulder TJ
Published: February 2018

Between February 1975 and August 1976, 195 total hip replacements using Stanmore components were performed; of these, 146 were in 135 patients who had not had previous hip surgery. At review 52 had died, but none of the others was lost to follow-up. Of the 52, two had had a second operation, one for infection and one for recurrent dislocation. In the remaining 83 patients (92 hips) five revisions were necessary: four for aseptic loosening, and one for stem fracture. The remaining 78 patients had little or no pain and little restriction of activity. After a follow-up period of at least nine years, the survival rate of the prosthesis was 95%. There had been migration of the femoral component in five cases and migration of the acetabular cup in one case, but no wear of the acetabular component could be demonstrated.
Long-term results of hip arthroplasty for failure of previous surgery
Authors: Echeverri A , Shelley P , Wroblewski BM
Published: February 2018

We report a retrospective review of 127 low friction arthroplasties carried out for the failure of a previous hip operation. After an average follow-up of 10.4 years, 20% of cases required further revision, over half of them for deep infection. We estimated from the radiographic appearances that eventual failure by loosening was probable in 58% on the femoral side and 56% on the acetabular side of the arthroplasties.
Orientation of the cruciate ligament in the sagittal plane. A method of predicting its length-change with flexion
Authors: Bradley J , FitzPatrick D , Daniel D , Shercliff T , O'Connor J
Published: February 2018

We have studied the kinematics of the knee in the sagittal plane, using a four-bar linkage as model, and assuming that a "neutral fibre" in each ligament remains isometric throughout flexion. We devised a computer program to calculate the distance separating any pair of points, one on each bone, for various cruciate attachments at various angles of flexion. The parameters for the linkage in four cadaveric knees were obtained by marking the centre of attachment of the cruciate ligaments with tacks and taking lateral radiographs. The movements of the bones were then calculated, in the computer model, for various attachments of "replacement" ligament fibres, the distance between the attachment sites being plotted against the angle of flexion. It was then possible to define zones around the isometric attachment points within which changes in length would be predictable. Our results show that the position of the femoral sites of attachment of both anterior and posterior cruciate replacement was more critical than that of the tibial attachments.
A statistical study of papers in the Journal of Bone and Joint Surgery [BR] 1984
Authors: Morris RW
Published: February 2018

The statistical quality of 103 original articles published in The Journal of Bone and Joint Surgery (British Volume) in 1984 was assessed. Some papers were found to be deficient: thus, it was not always clear how series were selected and sometimes neither the data nor the results were clearly presented. Sample sizes were frequently inadequate for the conclusions reached and statistical techniques should have been used more frequently. A majority of papers were descriptions of case series for which no comparative data were made available. It is suggested that collaborative research would best advance knowledge about the relative benefits of various managements, and that statistical advice could make a substantial contribution.
Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation
Authors: Bach BR , Warren RF , Fronek J
Published: February 2018

Experimental work has shown that dislocation of the shoulder may involve disruption of the capsule from its lateral humeral attachment. We report two patients with recurrent dislocation due to this injury. Lateral repair gave good results. It is suggested that this injury be considered and looked for when glenoid labral injury is minimal or absent.
A biomechanical analysis of halo fixation in children
Authors: Letts M , Kaylor D , Gouw G
Published: February 2018

The use of prolonged halo stabilisation in a child is increasingly indicated for trauma and congenital instability of the cervical spine, but complications of pin fixation in this age group are frequent. We have analysed four aspects of the mechanics of the halo pin: the forces applied by each of six surgeons was shown to vary widely, penetration of the inner table occurred relatively easily, friction at the pin-halo interface influenced forces, and the skull thickness measured by CT scan varied from 1.1 mm to 4.3 mm in children under six years of age. We recommend CT scanning of the skull before elective halo application in young children to ascertain the safest pin sites.
The blood supply of the osteocutaneous free fibular graft
Authors: Carr AJ , Macdonald DA , Waterhouse N
Published: February 2018

The use of an osteocutaneous free fibular graft as a single-stage reconstructive procedure for composite tissue loss is increasingly common. Detailed anatomical study in cadavers of the blood supply to the graft demonstrates cutaneous arteries arising from the peroneal artery and then passing along the posterior surface of the lateral intermuscular septum. These vessels pierce the crural fascia and then ramify to supply the skin. Knowledge of the vascular anatomy of the skin overlying the fibula is essential to the success of the graft.
Surgery for malignant extradural tumours of the spine
Authors: Turner PL , Prince HG , Webb JK , Sokal MP
Published: February 2018

We have reviewed 41 patients with malignant extradural tumours of the spine treated by anterior decompression for cord compression, or uncontrolled back pain or both. An anterior operation alone was performed in 37 cases, four had combined or staged anterior and posterior decompression. An anterior operation on its own achieved major neurological recovery in 18 of the 33 cases with neurological loss (56%); only four remained unchanged. Eleven had minor improvement but not enough to allow them to walk or to regain bladder function. No patient with complete paraplegia gained a useful neurological recovery. Back pain was improved in 30 of the 41 patients (73%), sound internal fixation being important in this respect. There were four early deaths and another 23 died from disseminated disease after a mean survival of 4.1 months. Fourteen patients are still alive with a mean survival of 14 months.
Plaster support after Wilson's osteotomy for hallux valgus
Authors: Ramanathan EB , Heywood-Waddington MB
Published: February 2018

In a five-year period, 153 feet in 101 patients were treated by a Wilson's osteotomy of the first metatarsal for hallux valgus. Postoperative support was provided by either a below-knee or a forefoot plaster, and was continued for either three weeks or six weeks. The results showed overall success in 91% with no significant difference between the four groups. We suggest that a forefoot plaster for three weeks is adequate support after a Wilson's osteotomy.
Open reduction of the severely slipped upper femoral epiphysis
Authors: Broughton NS , Todd RC , Dunn DM , Angel JC
Published: February 2018

The results of open reduction of the severely slipped upper femoral epiphysis are reported for 115 hips with an average follow-up of 12 years 11 months (range 2 to 33 years). In 70 hips with a chronic slip and an open growth plate the incidence of complications was low: two developed avascular necrosis, five chondrolysis, and one had both. There were more complications in the 38 hips with an acute-on-chronic slip: six developed avascular necrosis, one chondrolysis, and three had both. Of the seven hips operated upon with a partially fused plate, only one did well. All these complications were obvious within the first year but there were also three hips in the series in which osteoarthritis developed between 10 and 20 years after operation.
Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion
Authors: Fang D , Leong JC , Ho EK , Chan FL , Chow SP
Published: February 2018

We reviewed 40 extensive destructive vertebral lesions in 35 patients with established ankylosing spondylitis. Of these, 31 had presented with localised pain while three had a neurological deficit. The radiographs suggested ununited fractures through either ankylosed discs (37) or vertebral bodies (3). Corresponding fractures were seen in the posterior column in 34 cases. Sixteen patients with 18 lesions underwent anterior spinal fusion, and pseudarthrosis was consistently proven by histopathology. Two pseudarthroses healed in conservatively treated patients. Thirteen of the operated patients were followed for an average of 7 years 7 months. There were two cases of non-union and one required an additional posterior fusion; in the remainder fusion was sound.
Peripheral nerve repair in humans using muscle autografts. A new technique
Authors: Norris RW , Glasby MA , Gattuso JM , Bowden RE
Published: February 2018

Coaxial autografts of skeletal muscle which had been frozen then thawed were used to repair injured digital nerves in eight patients. Assessment from three to 11 months after operation showed recovery to MRC sensory category S3+ in all but one patient, an excellent level of recovery. We conclude that bespoke muscle grafts treated and used in this way may offer significant advantages over conventional nerve grafts or cable grafts especially where large peripheral nerves are involved.
Cementless total replacement for old tuberculosis of the hip
Authors: Eskola A , Santavirta S , Konttinen YT , Tallroth K , Hoikka V , Lindholm ST
Published: February 2018

We report the results of cementless total joint replacement in 18 patients with old tuberculosis of the hip, performed, on average, 34 years after the onset of infection. Mean follow-up was 3.5 years. Only seven of the patients had antituberculous drugs during or after the operation. Using the Mayo hip score, 15 patients had excellent or good results and two had a fair rating. One patient had the prosthesis removed more than one year postoperatively for late haematogenous staphylococcal infection and had a poor rating. All the patients had relief of hip-related pain. Despite the absence of any reactivation of tuberculosis in our series, we recommend the use of specific prophylaxis.
Plate fixation of open fractures of the tibia
Authors: Clifford RP , Beauchamp CG , Kellam JF , Webb JK , Tile M
Published: February 2018

The results of immediate plate fixation of 97 open fractures of the tibial shaft in 95 patients are reported. Significant joint stiffness occurred in 11.4% and angular malunion of greater than 5 degrees in any plane was seen in 3.1%. The infection rate was 10.3%. However, even in those cases which develop delayed union or other complications, plate fixation of open fractures can produce excellent recovery of limb function.
Retained surgical swab debris in post-laminectomy arachnoiditis and peridural fibrosis
Authors: Hoyland JA , Freemont AJ , Denton J , Thomas AM , McMillan JJ , Jayson MI
Published: February 2018

We examined soft tissue biopsies from 26 patients with symptomatic nerve root fibrosis and arachnoiditis after a previous laminectomy. Dense fibrous connective tissue was found about the nerve roots and in 14 cases (55%) fibrillar foreign material was seen within it. This material had the histochemical characteristics of cotton fibres from swabs and neurosurgical patties. In two other cases nerve root fibrosis was associated with residual radiopaque lipid thought to derive from earlier myelography. Our findings suggest that risks may be associated with the introduction of foreign material into the vertebral canal, and that microscopic fragments of surgical swabs and patties may have a role in the pathogenesis of postoperative periradicular fibrosis.
Skeletal infection by group B beta-haemolytic streptococci in neonates. A case report and review of the literature
Authors: Baxter MP , Finnegan MA
Published: February 2018

In the neonate, Group B beta-haemolytic streptococcal osteomyelitis presents with few inflammatory signs, a mild clinical course, extensive bony destruction, and usually single bone involvement. Onset is late (10 to 60 days after birth) and obstetric trauma appears to predispose to infection. Serotype studies suggest transmission from mother to child at the time of delivery.
Long-term follow-up of fused and unfused idiopathic scoliosis
Authors: Edgar MA , Mehta MH
Published: February 2018

We reviewed 77 unfused and 91 fused patients with idiopathic scoliosis who first attended between 1949 and 1965. Both groups were re-examined at least 10 years after reaching skeletal maturity, with attention to progression of the Cobb angle, increased in vertebral rotation, back pain and psychosocial problems. We found that spinal fusion protects the scoliotic spine from further deterioration during adult life except for those with severe curves and marked rotation. Fusion also significantly reduced the incidence of severe pain and allowed patients to carry out heavy physical work, but did not confer complete immunity from backache. Surgery improved the appearance, but patients were not always completely satisfied with the cosmetic result.
The predictability of acetabular development after closed reduction for congenital dislocation of the hip
Authors: Brougham DI , Broughton NS , Cole WG , Menelaus MB
Published: February 2018

We have reviewed the serial radiographs of 63 hips in 53 children treated by closed reduction for congenital dislocation with a view to finding a radiological measurement which can predict subsequent acetabular development. All had been followed for more than seven years, and at latest review, 34 hips were dysplastic. Failure to obtain concentric reduction or its loss by migration of the femoral head within one year of reduction were the best predictors of persisting acetabular dysplasia and were best quantitated by the h/b ratio (Smith et al. 1968). The acetabular index at reduction or its decrease in the first year were not reliable predictors. Late treatment was less likely to lead to normal acetabular development, but avascular necrosis did not appear to have a significant influence. The average age at which the acetabulum stopped developing was five years, but ranged from 17 months to eight years. The failure of a dysplastic acetabulum to improve in each annual radiograph after closed reduction should lead to consideration of operation on the acetabulum.
Long posterior flap versus equal sagittal flaps in below-knee amputation for ischaemia
Authors: Falstie-Jensen N , Christensen KS , Brochner-Mortensen J
Published: February 2018

We analysed the complication rate in 140 below-knee amputations in relation to surgical technique and the presence of diabetes. In all cases, the skin perfusion pressure was measured below the knee before operation to provide an objective evaluation of the microcirculation. In diabetic patients we found a significantly higher complication rate after using a long posterior flap than after equal sagittal flaps. No such difference could be demonstrated in non-diabetic patients. We suggest that the higher incidence of atherosclerotic lesions in the three major arteries below the knee in diabetic patients may account for the difference. We recommend the use of the sagittal technique for below-knee amputation in diabetic patients.
Meniscal lesions and chronic anterior cruciate ligament deficiency. Meniscal tears occurring before and after reconstruction
Authors: Bray RC , Dandy DJ
Published: February 2018

We examined the menisci in 47 patients at the time of anterior cruciate ligament reconstruction. Twenty-one patients had abnormal menisci at a mean of 34 months after injury, but there was no difference between the Lysholm scores of patients with intact or damaged menisci. Eleven patients had a new meniscal injury between reconstruction and review at a mean of six years later; only 15 patients had both menisci intact nine years after injury. If pivot shift had been cured, the incidence of meniscal injury was reduced, but remained higher than normal. If pivot shift returned after reconstruction there was a significantly higher incidence of meniscal injury. Meniscal lesions appear to be the result of instability and not the cause.
Freezing of orthopaedic specimens before mechanical testing
Authors: Ralis ZA
Published: February 2018

The effect of storage at sub-zero temperatures and subsequent thawing was investigated in dissected muscles, tendons, limbs and spines. Freezing caused a noticeable shortening of muscles which when thawed could easily be elongated; the same effects, though less pronounced, were observed with tendons. During freezing, myotomy or tenotomy led to the development of a striking deformity owing to unopposed shortening of the opposing muscles. After thawing, all frozen specimens containing muscles and joints showed an increased range of passive movements, easily demonstrable by mild tensile forces.
Measurement of anteversion of the femoral neck. Ultrasound and computerised tomography compared
Authors: Lausten GS , Jorgensen F , Boesen J
Published: February 2018

Anteversion of the femoral neck of 30 unpaired dry bones was measured directly, by ultrasound, and by computerised tomography. The angles measured directly corresponded well with the angles found by CT scan, but there was poor correlation between these and the angles measured by ultrasound. At present ultrasound seems to be unsuitable for the measurement of anteversion of the femoral neck.
Ultrasound measurement of vertebral rotation in idiopathic scoliosis
Authors: Suzuki S , Yamamuro T , Shikata J , Shimizu K , Iida H
Published: February 2018

Ultrasound can be used to outline the spinous processes and the laminae, and thus to measure axial rotation. Using our own technique, we measured vertebral rotation in 47 patients with idiopathic scoliosis. There was a strong linear relationship between the Cobb angle and the rotation of the apical vertebra in untreated patients, but this relationship was lost in patients who had had brace treatment. Vertebral rotation can easily be measured by ultrasound. This is a harmless and fairly rapid investigation which can be used at routine follow-up examination of patients with idiopathic scoliosis.
Triceps to biceps transfer for established brachial plexus palsy
Authors: Hoang PH , Mills C , Burke FD
Published: February 2018

We have reviewed seven patients who had triceps transfer after an old brachial plexus injury. All patients had a useful functional improvement with a good range of powerful elbow flexion; five patients could manage to bring their hand to their mouth. The basis of patient selection and the relative advantages of triceps transfer are discussed.
Subchondral screw fixation for femoral neck fractures
Authors: Rehnberg L , Olerud C
Published: February 2018

We describe a method of internal fixation for femoral neck fractures which has been newly developed to reduce the frequency of early complications. Two cannulated screws are inserted in the axis of the femoral neck to reach into the subchondral bone of the femoral head. The screws are inserted over guide pins and the tip of the screw is self-tapping and designed to provide good anchorage in the femoral head. We used this method in 44 consecutive patients in a prospective study with no exclusions, followed for a minimum of 24 months. All fractures healed within 12 months, and there were no cases of early loosening or nonunion. In four cases, late segmental collapse had developed during the mean follow-up period of 30 months.
The movements of the components of the Hastings bipolar prosthesis. A radiographic study in 65 patients
Authors: Chen SC , Badrinath K , Pell LH , Mitchell K
Published: February 2018

We aimed to find out whether the Hastings bipolar prosthesis moved in a bipolar fashion after its use for displaced fractures of the femoral neck. In 65 patients non-weight-bearing movement was assessed radiographically and compared with an earlier study of the Monk prosthesis. In 70% of patients, the only movement was between the acetabulum and the prosthetic shell, the prosthesis behaving as if it were unipolar. This did not change with time, but there was a slight improvement in the range of movement, particularly in flexion. The absence of movement between the outer shell and the metal head is most probably due to the design of the prosthesis and makes this prosthesis unsuitable for use in osteoarthritic hips.
The effect of hydroxyapatite coating on bone growth into porous titanium alloy implants
Authors: Oonishi H , Yamamoto M , Ishimaru H , Tsuji E , Kushitani S , Aono M , Ukon Y
Published: February 2018

In rabbits and goats, test implants with a porous surface of two layers of Tl-6A;-4V beads were examined at intervals for bond strength with bone. Half of the implants were coated with hydroxyapatite by plasma spray. The bonding strength with bone in the coated specimens was about four times greater than that of the uncoated specimens at two weeks, and twice as strong at six weeks. Twelve weeks after implantation, the strengths were similar. The hydroxyapatite coating of the beads provided earlier and stronger fixation.
Anterior spinal fusion for spondylolysis and isthmic spondylolisthesis. Long term results in adults
Authors: Cheng CL , Fang D , Lee PC , Leong JC
Published: February 2018

We reviewed 20 adult patients with spondylolysis and isthmic spondylolisthesis an average of 10.5 years after treatment by anterior spinal fusion. Nineteen patients had excellent or satisfactory results. Ten of the patients were symptom-free at one year, and 15 were asymptomatic at final follow-up. Anterior spinal fusion can produce results comparable to those of posterior fusion with or without decompression. The results tend to improve with time in contrast to the known worsening of late results after posterior decompression without fusion.
Cerclage for torsional fractures of the tibia
Authors: Habernek H , Walch G , Dengg C
Published: February 2018

We report the technique and results of percutaneous cerclage used in treating 186 torsional fractures of the tibia, most of which were due to skiing accidents in young patients. It is recommended only for this type of fracture and has the advantages of simplicity, a low rate of complications and a relatively brief period in hospital.
Shortwave ultraviolet radiation in operating rooms
Authors: Berg M , Bergman BR , Hoborn J
Published: February 2018

We have evaluated the effect of shortwave ultraviolet radiation on bacterial levels in an operating theatre, both in experimental conditions and during 20 hip operations. When compared with the use of sham blue light, there was a significant reduction in the number of bacteria. The reduced level was comparable with that suggested for ultraclean air ventilation systems.
The three-dimensional anatomy of the proximal femur in Perthes' disease
Authors: Howell FR , Newman RJ , Wang HL , Nevelos AB , Dickson RA
Published: February 2018

A new method of recording the three-dimensional anatomy of the proximal femur from a single anteroposterior radiograph is described. This technique shows that in Perthes' disease the femoral head and neck are in significant anteversion and true varus. This anatomical configuration may be important in the pathogenesis and treatment of this disorder.
Acetabular fractures in children and adolescents
Authors: Heeg M , Klasen HJ , Visser JD
Published: February 2018

A retrospective study of 23 acetabular fractures in patients up to 17 years of age is presented, with an average follow-up of eight years. Good or excellent functional results were achieved in 21 patients; radiographic results were good or excellent in 16. Conservative treatment gave consistently good results in fractures with minimal initial displacement, stable posterior fracture-dislocations and Salter-Harris type 1 and 2 triradiate cartilage fractures. Less favourable results were seen in type 5 triradiate cartilage fractures and in comminuted fractures, but operation was no better. Unstable posterior fracture-dislocations and irreducible central fracture-dislocations need operative treatment but the results may still be unsatisfactory.
Morphology of the femur in proximal femoral fractures
Authors: Ferris BD , Kennedy C , Bhamra M , Muirhead-Allwood W
Published: February 2018

We studied the morphology of the contralateral femur in 10 patients with subcapital fractures, 10 with trochanteric fractures and 10 with unilateral osteoarthritis. We found that the patients with trochanteric fractures had a significantly shorter femoral neck (4.5 +/- 0.5 cm) than patients with subcapital fractures or osteoarthritis (5.4 +/- 0.4 cm). It may be that this difference in femoral neck length is related to the site at which a proximal femoral fracture occurs.
Arthroscopic management of synovial chondromatosis of the knee. Findings and results in 18 cases
Authors: Coolican MR , Dandy DJ
Published: February 2018

We report the results of arthroscopic removal of loose bodies and abnormal synovium from 18 knees with primary synovial chondromatosis. After a mean of three years, six months (range one to 10 years), 14 knees were either symptom-free or had only minor symptoms. Three of these had required two arthroscopic operations. Three patients were improved but not cured and there was one failure. The results were better than the published results of open operation for this condition. Three patterns of macroscopic appearances were noted: four knees had large lesions covered by normal synovium, 10 had small fragments of cartilage lying in or on the synovium and four had only free fragments of cartilage in the joint cavity but none in, on, or under, the synovium. These three appearances may represent three different disease processes.
Incomplete ruptures of the anterior cruciate ligament
Authors: Fruensgaard S , Johannsen HV
Published: February 2018

In a prospective study, 41 consecutive patients with a partial tear of the anterior cruciate ligament, diagnosed by arthroscopy, were reviewed after an average of 17 months, having been in plaster for six weeks after injury. Their average age was 29 years and review included clinical examination, measurement of anterior and posterior laxity with the Stryker knee laxity tester as well as evaluation of knee function and activity level. Twenty-one patients had unstable knees at follow-up; the mean total anteroposterior laxity for these patients was 12.6 +/- 3.9 mm compared with 7.1 +/- 4.3 mm for the normal knee. Most patients had few symptoms, but there was a significant reduction in the mean level of activity in the unstable group.
Lumbar facet joint syndrome. A randomised clinical trial
Authors: Lilius G , Laasonen EM , Myllynen P , Harilainen A , Gronlund G
Published: February 2018

A group of 109 patients with unilateral low back pain for over three months were randomised to receive one of three types of injection treatment: cortisone and local anaesthetic injected into two facet joints (28), the same mixture around two facet joints (39), or physiological saline into two facet joints (42). The effect of the treatment was evaluated in relation to work attendance, pain, disability and movements of the lumbar spine. Patients were examined one hour and two and six weeks after treatment and also completed a questionnaire after three months. A significant improvement was observed in work attendance, pain and disability scores, but this was independent of the treatment given and movements of the lumbar spine were not improved. Of the 70 patients with initial pain relief after injection, 36% reported persisting benefit at the three month follow-up, independent of the mode of treatment given. We conclude that facet joint injection is a non-specific method of treatment and the good results depend on a tendency to spontaneous regression and to the psychosocial aspects of back pain.
Operative or conservative treatment for trochanteric fractures of the femur. A randomised epidemiological trial in elderly patients
Authors: Hornby R , Evans JG , Vardon V
Published: February 2018

All elderly patients with extracapsular hip fractures seen in hospitals in Newcastle upon Tyne over a 12-month period were studied and followed up for six months. At one of the hospitals, patients were randomised to treatment by AO dynamic hip-screw or by traction. Complications specific to the two treatments were low, and general complications, six-month mortality and prevalence of pain, leg swelling and unhealed sores, showed no difference between the two modes of treatment. Operative treatment gave better anatomical results and a shorter hospital stay, but significantly more of the patients treated by traction showed loss of independence six months after injury.
Curved Kuntscher nail arthrodesis after failure of knee replacement
Authors: Fern ED , Stewart HD , Newton G
Published: February 2018

We report the use of long curved Kuntscher nails to maintain stability during arthrodesis of nine infected and five uninfected failures of total knee replacement. The curvature of the nail helps positioning and avoids the need for cortical perforation. A single-stage operation was possible in most cases. Union rates are comparable with those of other series and even patients with delayed union have satisfactory function.
Abnormalities of proximal femoral growth after severe Perthes' disease
Authors: Sponseller PD , Desai SS , Millis MB
Published: February 2018

We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.
Leg length discrepancy after femoral shaft fractures in children. Review after skeletal maturity
Authors: Stephens MM , Hsu LC , Leong JC
Published: February 2018

We reviewed and radiographed 30 skeletally-mature patients after isolated closed femoral shaft fractures in childhood which had been treated conservatively. When the fracture had occurred between the ages of 7 and 13 years, the limb overgrew about 1 cm regardless of sex, upper limb dominance, age, fracture site or configuration. Excessive fracture overlap at the time of injury, but not at union, increased limb overgrowth. Angulation of the fracture remodelled in children injured under 10 years of age, but in older patients this sometimes added to limb shortening. Rotational deformities were minor and gave no symptoms. Treatment of the 7- to 13-year-old patient should aim at 1 cm overlap at union, with correction of angular deformity being more important in children over 10 years of age. This management of fractures will give a maximum leg length discrepancy of 1 cm at skeletal maturity.
The diagnostic value of C-reactive protein in infected total hip arthroplasties
Authors: Sanzen L , Carlsson AS
Published: February 2018

In 50 patients with non-infected total hip arthroplasties (THA), 233 C-reactive protein (CRP) values were obtained over a three-year period. Six of these 50 patients occasionally had CRP values of over 20 mg/l. The erythrocyte sedimentation rate (ESR) and CRP concentration were measured in 23 patients with deep infections of THA before revision. In 11 patients the infections were caused by coagulase-negative staphylococci. CRP exceeded 20 mg/l in 18 patients and the ESR was more than 30 mm/hr in 14. In only one infected patient were both CRP and ESR below these levels. All of 33 patients with non-septic loosening had CRP less than 20 mg/l and ESR less than 30 mm/hr before revision. C-reactive protein seems to be a valuable supplement to the ESR in the monitoring of infection after THA.
Results of drilling osteochondritis dissecans before skeletal maturity
Authors: Bradley J , Dandy DJ
Published: February 2018

We report the arthroscopic drilling of classical lesions of osteochondritis dissecans in 11 knees in 10 children with at least six months history and no sign of clinical or radiological improvement. There were eight boys and two girls and the average age at operation was 12 years 11 months. Relief of pain was noticed within days of operation; radiological healing occurred within 12 months in nine of the 11 knees.
Dwyer-Hartshill transpedicular fixation for spinal fusion
Authors: Mehdian H , Jaffray D , Eisenstein SM
Published: February 2018

We report the technique and early results of the Dwyer-Hartshill method for segmental fixation of the spine. This uses pedicular screws wired to a rectangular frame and is indicated after laminectomy.
Interosseous transfer of tibialis posterior for common peroneal nerve palsy
Authors: Richard BM
Published: February 2018

The interosseous route remains popular for tibialis posterior tendon transfer for drop-foot. It leaves a smaller range of movement than the circumtibial route, but lengthening the calcaneal tendon may improve this. The results of this present series indicate that, in order to predict a good functional result, the ankle must be held in at least 20 degrees of dorsiflexion at the time of tendon transfer.
Acetabular fractures in older patients
Authors: Spencer RF
Published: February 2018

Retrospective review of 25 patients over 65 years of age with unilateral acetabular fractures managed conservatively showed that seven of the 23 survivors (30%) had an unacceptable functional result. Poor results were associated with: displaced posterior column fractures, osteoporosis, femoral head fracture, delayed diagnosis, inadequate radiographs, inappropriate or too brief traction, and early weight-bearing. In this age group acetabular fractures tend to be low-velocity injuries of osteoporotic bone and are not comparable with those in younger patients.
Tendinitis of the pectoralis major insertion with humeral lesions. A report of two cases
Authors: Chadwick CJ
Published: February 2018

Two patients presented with pain in the arm and a radiographic lesion of the upper humerus which warranted surgical exploration and excision biopsy. In both cases the pathology was inflammatory and involved the insertion of pectoralis major. Tendinitis of the pectoralis major with an associated lesion of the humerus has not previously been described.
Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci
Authors: Hope PG , Kristinsson KG , Norman P , Elson RA
Published: February 2018

We reviewed a series of 91 patients with deep infection of a cemented total hip arthroplasty caused by coagulase-negative staphylococci (C-NS). Of these, 72 were treated by one-stage exchange arthroplasty with a failure rate of 13% due to recurrence of infection. The other 19 patients have started or completed treatment by a two-stage exchange without failure to date. In 27 of the 91 patients multiple strains of C-NS were discovered, many being resistant to previously used antibiotics. The use of gentamicin-containing cement in the primary arthroplasty was significantly associated with the emergence of gentamicin-resistant C-NS in subsequent deep infection. Bacteriological diagnosis of such infections must take into consideration the possibility that multiple strains of the organism are involved.