bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases
Authors: Raaymakers EL , Marti RK
Published: February 2018

In a prospective study, 170 impacted femoral neck fractures were treated by early mobilisation and weight-bearing. The overall mortality at one year was 16%. In the 167 patients who were followed up until fracture healing or secondary instability, 143 fractures (86%) united. Instability occurred only in patients over 70 years of age, and in younger patients with a short life expectancy. Stepwise logistic regression analysis indicated that poor general health and old age (over 70 years) were risk factors. None of the other variables, such as the Garden index, Pauwels' type, and time to full weight-bearing had any influence on the development of secondary instability. Delayed operation after secondary instability caused no increase in mortality, nonunion or avascular necrosis. Functional treatment of all patients with impacted femoral neck fractures seems therefore to be justified.
External fixation of intertrochanteric fractures of the femur
Authors: Dhal A , Varghese M , Bhasin VB
Published: February 2018

External fixation was used in the treatment of 154 intertrochanteric fractures of the femur over a period of eight years. Good fixation and early ambulation was achieved in all cases. Blood loss was slight. There were 12 deaths due to medical causes unrelated to the surgical procedure. Deep pin-track infection occurred in six cases and late displacement of the fracture fragments in nine. The average time for union was 16 weeks. The technique is simple, quick and inexpensive, and causes minimal surgical trauma. All these features are particularly relevant where resources are limited.
Unilateral facet dislocations and fracture-dislocations of the cervical spine
Authors: Beyer CA , Cabanela ME , Berquist TH
Published: February 2018

We treated 36 patients with unilateral facet dislocations or fracture-dislocations of the cervical spine at the Mayo Clinic between 1975 and 1986. Adequate records were available for 34: ten patients were treated by open reduction and posterior fusion, and 24 by nonoperative management. Of these, 19 had halo traction followed by halo-thoracic immobilisation, four had a simple cervicothoracic orthosis, and one received no active treatment. Anatomical reduction was achieved more frequently in the operative group (60% compared with 25%). Nonoperative treatment was more likely to result in cervical translation on flexion/extension lateral radiographs, and in significant symptoms. Only 36% of the patients treated by halo traction achieved anatomical alignment; in 25% halo traction failed to achieve or maintain any degree of reduction. During halo-thoracic immobilisation, half of the patients lost some degree of reduction and patient satisfaction with the appliance was low. Open reduction and internal fixation of unilateral facet injuries gave better results. 6
Fractures of the distal femur treated with the AO dynamic condylar screw
Authors: Shewring DJ , Meggitt BF
Published: February 2018

We report the results of treatment with the dynamic condylar screw of 21 cases of supracondylar and intercondylar fractures of the femur in patients aged 22 to 91 years. There were two nonunions and no deaths. We found the device easy to use and the good fixation allowed early patient mobilisation.
Experimental stretch neuropathy. Changes in nerve conduction under tension
Authors: Wall EJ , Massie JB , Kwan MK , Rydevik BL , Myers RR , Garfin
Published: February 2018

We developed an animal model of stretch injury to nerve in order to study in vivo conduction changes as a function of nerve strain. In 24 rabbits, the tibial nerve was exposed and stretched by 0%, 6% or 12% of its length. The strain was maintained for one hour. Nerve conduction was monitored during the period of stretch and for a one-hour recovery period. At 6% strain, the amplitude of the action potential had decreased by 70% at one hour and returned to normal during the recovery period. At 12% strain, conduction was completely blocked by one hour, and showed minimal recovery. These findings have clinical implications in nerve repair, limb trauma, and limb lengthening.
Can burst fractures be predicted from plain radiographs?
Authors: Ballock RT , Mackersie R , Abitbol JJ , Cervilla V , Resnick D , Garfin
Published: February 2018

Plain radiographs of 67 acute spinal compression fractures in 49 patients were analysed by subjective and objective criteria, using CT scans as the diagnostic standard for the diagnosis of burst fracture. Discriminant analysis correctly predicted the type of fracture in 88% of cases. Burst fractures, however, were almost as frequently misdiagnosed as being wedge compression fractures using this technique, compared with the reading of 25 films from patients without previous information. A quarter of the injuries would have been misdiagnosed had reliance been placed solely on the plain radiographs. CT scans of all patients with acute spinal compression fractures should be considered to decrease this potentially serious diagnostic error.
Resorption of bone by inflammatory cells derived from the joint capsule of hip arthroplasties
Authors: Athanasou NA , Quinn J , Bulstrode CJ
Published: February 2018

The role of inflammatory cells in aseptic loosening and failure of cemented joint replacements is unclear. Inflammatory cells from the revision joint capsule of four failed hip arthroplasties were examined to determine their nature and resorptive capacity. The capsules contained numerous macrophages and abundant foreign-body macrophage polykaryons, distinguished from osteoclasts by their antigenic phenotype and lack of response to calcitonin. When cultured on cortical bone slices in vitro, both macrophages and macrophage polykaryons produced small resorption pits and were associated with areas of superficial resorption of the bone surface. These results indicate that foreign-body induced macrophages and macrophage polykaryons are capable of a type of low-grade bone resorption which may be of pathogenic significance in the loosening of cemented joint prosthetic components.
The floating hip. Ipsilateral pelvic and femoral fractures
Authors: Liebergall M , Lowe J , Whitelaw GP , Wetzler MJ , Segal D
Published: February 2018

A consecutive series is reported of 17 patients who underwent early surgical treatment for acetabular or unstable pelvic fractures associated with ipsilateral fractures of the femur. Treatment included external and internal fixation, and required careful consideration of the surgical approach and the positioning of the patient. The multiple injuries sustained by these patients required simultaneous procedures by several surgical teams. All the femoral fractures were internally fixed at the initial operation and eight patients had primary definitive treatment of all their other fractures as well. In nine patients the definitive treatment of their other fractures was delayed for an average of 11 days. There were no deaths, and no serious infections. The long-term morbidity resulted from the associated injuries and not from the pelvic or femoral fractures.
The Sheffield splint for controlled early mobilisation after rupture of the calcaneal tendon. A prospective, randomised comparison with plaster treatment
Authors: Saleh M , Marshall PD , Senior R , MacFarlane A
Published: February 2018

Forty patients with acute complete rupture of the calcaneal tendon were managed conservatively and randomly allocated to treatment groups using either cast immobilisation for eight weeks, or cast immobilisation for three weeks, followed by controlled early mobilisation in a Sheffield splint. The splint is an ankle-foot orthosis which holds the ankle in 15 degrees of plantar flexion, but allows some movement at the metatarsophalangeal joints. It is removed to allow controlled movement during physiotherapy. Patients treated with the splint regained mobility significantly more quickly (p less than 0.001) and preferred the splint to the plaster cast. The range of dorsiflexion at the ankle improved more rapidly after treatment in the splint (p less than 0.001), and patients were able to return to normal activities sooner. Recovery of the power of plantar flexion was similar in the two treatment groups, and no patient had excessive lengthening of the tendon. One re-rupture occurred in each group.
Fixation of osteochondral fractures in rabbit knees. A comparison of Kirschner wires, fibrin sealant, and polydioxanone pins
Authors: Plaga BR , Royster RM , Donigian AM , Wright GB , Caskey PM
Published: February 2018

We compared fibrin sealant, polydioxanone (PDS) pins and Kirschner wires in the fixation of osteochondral fractures in rabbit knees. Standardised osteochondral fractures of the right medial femoral condyle were made in 56 adult New Zealand white rabbits. There were equal groups of control knees, and those which had Kirschner-wire, fibrin-sealant or PDS-pin fixation. No external immobilisation was used. One animal from each group was killed at two, three and four weeks. The remaining rabbits were killed at six weeks. A fracture which healed with less than 1 mm of displacement was considered a success. There was successful healing in 29% of the control group, in all of the Kirschner-wire group, in 50% of the fibrin-sealant group, and in 86% of the PDS-pin group. The use of PDS pins appears to be a reliable alternative to the use of metal in the fixation of osteochondral fractures in rabbits.
De la Caffiniere arthroplasty for basal thumb joint osteoarthritis
Authors: Nicholas RM , Calderwood JW
Published: February 2018

We performed 20 de la Caffiniere trapeziometacarpal arthroplasties for osteoarthritis occurring only at this joint and reviewed all patients after periods of up to ten years. Eighteen arthroplasties were satisfactory postoperatively, although all 20 patients had a satisfactory range of motion and only one experienced pain after surgery such that it impeded normal function. Failure occurred in two patients and was due to overreaming of the trapezium during surgery and a traumatic dislocation. A radiolucency between the prosthesis and bone was observed in one arthroplasty, although this patient was asymptomatic. We recommend arthroplasty using the de la Caffiniere prosthesis as a satisfactory method of treatment for the osteoarthritic trapeziometacarpal joint.
Locked nailing for nonunion of the tibia
Authors: Rosson JW , Simonis RB
Published: February 2018

We treated 24 patients with nonunion of tibial shaft fractures by locked intramedullary nailing, 18 by open and six by closed techniques. Union was achieved in 22 patients, failing only in two patients with active infection. Locked nailing prevented recurrence of deformity and allowed the patients to mobilise without external support. Supplementary bone grafting was essential only for major defects.
The initial stability of uncemented acetabular components
Authors: Curtis MJ , Jinnah RH , Wilson VD , Hungerford DS
Published: February 2018

The osseo-integration of an uncemented acetabular component depends on its initial stability. This is usually provided by under-reaming of the acetabulum. We have assessed the fixation of 52 mm porous-coated hemispherical prostheses inserted into cadaveric acetabula under-reamed by 1, 2, 3 and 4 mm. We tested the torsional stability of fixation, after preloading with 686 N in compression, by measuring the torque required to produce 1 degree and 2 degrees of rotation. Under-reaming by 2 mm and 3 mm gave significantly better fixation than 1 mm (p less than 0.01, p less than 0.02). Insertion after under-reaming of 4 mm caused some fractures. To obtain maximum interference fit and optimal implant stability, we recommend the use of an implant 2 mm or 3 mm larger than the last reamer.
Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review
Authors: Barrack RL , Mulroy RD , Harris WH
Published: February 2018

To assess the effect of improved methods of femoral cementing on the loosening rates in young patients, we reviewed 50 'second-generation' cemented hip arthroplasties in 44 patients aged 50 years or less. The femoral stems were all collared and rectangular in cross-section with rounded corners. The cement was delivered by a gun into a medullary canal occluded distally with a cement plug. A clinical and radiographic review was undertaken at an average of 12 years (10 to 14.8) and no patient was lost to follow-up. No femoral component was revised for aseptic loosening, and only one stem was definitely loose by radiographic criteria. By contrast, 11 patients had undergone revision for symptomatic aseptic loosening of the acetabular component and 11 more had radiographic signs of acetabular loosening.
Primary degenerative arthritis of the elbow. Treatment by ulnohumeral arthroplasty
Authors: Morrey BF
Published: February 2018

Degenerative arthritis of the elbow is a poorly recognised condition, usually seen in a middle-aged man with an occupation or activity which involves the repetitive use of his dominant arm. Flexion contracture and pain at terminal extension are common presenting features. Fifteen patients were reviewed at a mean of 33 months after debridement by ulnohumeral arthroplasty. Fourteen had good relief of pain, elbow extension had improved by an average of 11 degrees and elbow flexion by 10 degrees. On an objective scale 12 of the 15 patients had good or excellent results and 13 (87%) felt that they were improved by the operation.
Clinical diagnosis of tears of the rotator cuff
Authors: Lyons AR , Tomlinson JE
Published: February 2018

We have studied the reported clinical assessment of the presence and extent of a rotator cuff tear in 42 patients presenting to a special shoulder clinic. This pre-operative diagnosis was compared with the findings at operation. The clinical tests had a sensitivity of 91% and a specificity of 75%. It is important to exploit clinical examination before resorting to costly and sometimes harmful special investigations.
Closed division of the flexor tendon sheath for trigger finger
Authors: Lyu
Published: February 2018

Closed tenotomy was used to treat triggering of the fingers and thumb in 54 patients. In 56 digits the method was successful; in seven it was a simple matter to proceed to open tenotomy. With experience, the closed procedure can be completed within minutes without risk of damaging the digital nerves.
Treatment of the missed Monteggia fracture in the child
Authors: Stoll TM , Willis RB , Paterson DC
Published: February 2018

Eight children with missed Monteggia fracture-dislocations are described. Seven had reconstructive surgery which included resection of scar tissue from the radiohumeral joint, proximal ulnar osteotomy, reduction of the radial head and reconstruction of the annular ligament. One had excision of the radial head. Excellent results were obtained in patients under ten years of age, up to four years after the initial injury.
Corrosion between the components of modular femoral hip prostheses
Authors: Collier JP , Surprenant VA , Jensen RE , Mayor MB , Surprenant HP
Published: February 2018

We studied the tapered interface between the head and the neck of 139 modular femoral components of hip prostheses which had been removed for a variety of reasons. In 91 the same alloy had been used for the head and the stem; none of them showed evidence of corrosion. In contrast, there was definite corrosion in 25 of the 48 prostheses in which the stem was of titanium alloy and the head of cobalt-chrome. This corrosion was time-dependent: no specimens were corroded after less than nine months in the body, but all which had been in place for more than 40 months were damaged. We discuss the factors which may influence the rate of these changes and present evidence that they were due to galvanically-accelerated crevice corrosion, which was undetected in previous laboratory testing of this type of prosthesis.
Plasma viscosity and C-reactive protein after total hip and knee arthroplasty
Authors: Choudhry RR , Rice RP , Triffitt PD , Harper WM , Gregg PJ
Published: February 2018

We studied the changes in plasma viscosity and C-reactive protein to establish normal values after total hip or knee arthroplasty. Viscosity decreased from 1.68 (+/- 0.017) to 1.57 (+/- 0.014) on the first postoperative day and thereafter rose to 1.60 (+/- 0.019), 1.75 (+/- 0.015), and 1.74 (+/- 0.011) on the third, seventh and fourteenth days respectively. Six to eight weeks after operation it had returned to pre-operative levels. A viscosity above the upper limit of the laboratory range, obtained more than two months after operation, may be considered as abnormal. The C-reactive protein level increased significantly on the first postoperative day and then decreased from a peak on the second day, attaining nearly normal levels at six to eight weeks after operation. It may be a more sensitive indicator of deep postoperative infection than plasma viscosity.
Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period
Authors: Robinson CM , Bell KM , Court-Brown CM , McQueen MM
Published: February 2018

We report the results of locked Seidel nailing for 30 fractures of the humerus. There were frequent technical difficulties at operation especially with the locking mechanisms. Protrusion of the nail above the greater tuberosity occurred in 12 cases, usually due to inadequate locking, and resulted in shoulder pain and poor function. Poor shoulder function was also seen in five patients with no nail protrusion, presumably because of local rotator cuff damage during insertion. Our results suggest that considerable modifications are required to the nail, and possibly to its site of insertion, before its use can be advocated.
Seat-belt injuries of the spine in young children
Authors: Rumball K , Jarvis J
Published: February 2018

Seat-belt fractures of the lumbar spine in adolescents and adults are well recognised but there are few reports of these injuries in young children. We reviewed all seat-belt injuries in skeletally immature patients (Risser 0), seen at a tertiary referral centre between 1974 and 1991. There were ten cases, eight girls and two boys, with an average age of 7.5 years (3 to 13). Four distinct patterns of injury were observed, most commonly at the L2 to L4 level. Paraplegia, which is thought to be uncommon, occurred in three of our ten cases. Four children had intra-abdominal injuries requiring laparotomy. There was a delay in diagnosis either of the spinal or of the intra-abdominal injury in five cases, although all had contusion of the abdominal wall, the 'seat-belt sign'. Treatment of the fractures was conservative, by bed rest and then hyperextension casts. The incidence of this potentially devastating injury can be reduced by the optimal use of restraints, but there is often a delay in diagnosis. Our classification system may aid in the early detection and evaluation of this injury.
Biological resurfacing of full-thickness defects in patellar articular cartilage of the rabbit. Investigation of autogenous periosteal grafts subjected to continuous passive motion
Authors: Moran ME , Kim HK , Salter RB
Published: February 2018

We compared the effects of continuous passive motion with those of intermittent active motion on the results of the resurfacing with autogenous periosteal grafts of full-thickness defects on the articular surface of rabbit patellae. Of 45 rabbits with defects, 30 received grafts. Fifteen of these had continuous passive motion for two weeks and intermittent active motion for four weeks; the other 15 had intermittent active motion for six weeks. In 15 the defects were not grafted (control group) and they had intermittent active motion for six weeks. Ten more rabbits had a sham operation. Six weeks after surgery, the results were assessed by the gross appearance, histology, histochemistry, immunohistochemistry and electron microscopy. By all assessments the quality of neochondrogenesis produced by periosteal grafts was superior to that in ungrafted defects (p less than 0.05) and the results in continuous passive motion treated animals were superior to those in intermittent active motion treated animals (p less than 0.05). The periosteal grafts produced hyaline cartilage containing type II collagen but the organisation of its fibres was irregular.
Measurement of blood flow in tibial fracture patients using positron emission tomography
Authors: Ashcroft GP , Evans NT , Roeda D , Dodd M , Mallard  , Porter RW , Smith FW
Published: February 2018

The quantification of local bone blood flow in man has not previously been possible, despite its importance in the study of normal and pathological bone. We report the use of positron emission tomography, using 15O-labelled water, to measure bone blood flow in patients with closed unilateral fractures of the tibia. We compared fractured and unfractured limbs; alterations in blood flow paralleled those found in animal models. There was increased tibial blood flow at the fracture site as early as 24 hours after fracture, reaching up to 14 times that in the normal limb at two weeks. Blood flow increase was less in displaced than in undisplaced fractures. The muscle to bone ratios of blood flow were similar to those in previous animal work using other techniques. Positron emission tomography will allow study of human bone blood flow in vivo in a wide variety of pathological conditions.
CT scan prediction of neurological deficit in thoracolumbar burst fractures
Authors: Fontijne WP , de Klerk LW , Braakman R , Stijnen T , Tanghe HL , Steenbeek R , van Linge B
Published: February 2018

In 139 patients with burst fractures of the thoracic, thoracolumbar or lumbar spine, the least sagittal diameter of the spinal canal at the level of injury was measured by computerised tomography. By multiple logistic regression we investigated the joint correlation of the level of the burst fracture and the percentage of spinal canal stenosis with the probability of an associated neurological deficit. There was a very significant correlation between neurological deficit and the percentage of spinal canal stenosis; the higher the level of injury the greater was the probability. The severity of neurological deficit could not be predicted.
Destructive spondylo-arthropathy during long-term haemodialysis
Authors: Naito M , Ogata K , Nakamoto M , Goya T , Sugioka Y
Published: February 2018

We reviewed 29 patients who had developed destructive arthropathy of the spine during long-term haemodialysis. Their mean age when haemodialysis began was 43.8 years; at diagnosis they had been dialysed for an average of 8.6 years. In 26 patients, the lesions were between C4 and C7; in six they were between L4 and S1, three having lesions in both regions. Sixteen patients had had previous surgery for carpal tunnel syndrome. Spinal surgery was performed in nine patients with satisfactory results in only five. We demonstrated beta-2 microglobulin amyloid deposits in the discs and surrounding ligaments in all biopsied cases. The natural history and management of this condition are not yet clear.
The use of reinforcement rings to reconstruct deficient acetabula
Authors: Rosson J , Schatzker J
Published: February 2018

We reviewed 64 patients in whom 66 acetabula had been reconstructed with either the Muller ring (46) or the Burch-Schneider anti-protrusio cage (20) at a mean follow-up of five years. Five hips had been revised a second time for loosening, all after a Muller ring had been used for a medial segmental defect (2), ungrafted cavitary defects (2) or after resorption of a block graft (1). The use of bone grafts with the implants reduced the incidence of failure from 13% to 6% and of circumferential radiolucent lines at the bone-implant interface from 39% to 2%. The Muller ring is indicated for acetabula with isolated peripheral segmental defects or cavitary defects confined to one or two sectors. The Burch-Schneider cage should be used for medial segmental defects, extensive cavitary defects and combined deficiencies. Defects should be reconstituted with bone graft rather than cement.
Compression of the sciatic nerve by methylmethacrylate cement after total hip replacement
Authors: Oleksak M , Edge AJ
Published: February 2018

Severe leg pain in a patient after total hip replacement was found to be caused by compression of the sciatic nerve by methylmethacrylate cement which had leaked from the acetabulum during fixation of the acetabular cup. The pain persisted for six years but was immediately relieved by removal of the cement mass.
Cement burn of the sciatic nerve
Authors: Birch R , Wilkinson MC , Vijayan KP , Gschmeissner S
Published: February 2018

We present the case of a 63-year-old woman who sustained an acrylic cement burn of the sciatic nerve at hip replacement. She was treated by resection of the damaged segment and grafting. Electron microscopy showed that the nerve was nearly normal 1 cm from the cement margin indicating that this is a safe level for resection.
Intra-articular morphine for pain relief after knee arthroscopy
Authors: Joshi GP , McCarroll SM , Cooney CM , Blunnie WP , O'Brien TM , Lawrence AJ
Published: February 2018

We performed a randomised double-blind controlled study in patients undergoing elective knee arthroscopy to assess the effect of intra-articular morphine on postoperative pain relief. Patients in the study group (n = 10) received 5 mg of morphine in a 25 ml dilution intra-articularly while those in the control group (n = 10) received 25 ml of saline. Postoperative pain was assessed at intervals by a visual analogue scale and the requirement for supplementary analgesia was recorded. Those in the study group had significantly lower pain scores and required less systemic analgesics than those in the control group. Plasma profiles for morphine and its metabolites were assayed and showed that they were too low to produce effective analgesia. Evidence suggests that analgesia was mediated by local action within the joint.
The A-V Impulse System reduces deep-vein thrombosis and swelling after hemiarthroplasty for hip fracture
Authors: Stranks GJ , MacKenzie NA , Grover ML , Fail T
Published: February 2018

We performed a prospective randomised controlled trial of the A-V Impulse System in 82 patients treated by hemiarthroplasty for subcapital fracture of the femoral neck. The incidence of proximal deep-vein thrombosis as assessed by Doppler ultrasonography was 23% in the control group and 0% in those using the device (p less than 0.01). Calf and thigh circumferences were measured in both groups at seven to ten days after operation. In the treatment group there was a mean relative reduction of postoperative swelling of the thigh by 3.27 cm (p less than 0.001) and of the calf by 1.55 cm (p less than 0.001). The A-V Impulse System appears to be a safe and effective method of reducing the incidence of proximal deep-vein thrombosis, and of postoperative swelling.
Management and outcome in tibial dysplasia
Authors: Pattinson RC , Fixsen JA
Published: February 2018

Tibial dysplasia is a rare congenital deformity which must be distinguished from the more common fibular dysplasia. We have reviewed 24 patients with 35 affected legs. The classification system of Kalamchi and Dawe (1985) was found to be preferable to that of Jones, Barnes and Lloyd-Roberts (1978) as a guide to prognosis and management. We discuss the outcome of surgical treatment, recommending selective amputation for most cases.
Osteomyelitis of the calcaneum
Authors: Wang EH , Simpson S , Bennet GC
Published: February 2018

We reviewed 52 cases of osteomyelitis of the calcaneum. The clinical symptoms and signs were well defined, but different and less dramatic than those of long-bone osteomyelitis. Blood cultures were positive in 41% of cases and tissue cultures in 91%. Routine haematological tests were of little value, and radiological changes were often delayed, and were absent in 12%. With early diagnosis, treatment with antibiotics alone was usually effective, but complications and chronic disease were more likely if there was delay. Early diagnosis is the key to successful treatment. We describe a new physical sign and consider that diagnosis is almost always possible by clinical methods.
Medial meniscus replacement by a tendon autograft. Experiments in sheep
Authors: Kohn D , Wirth CJ , Reiss G , Plitz W , Maschek H , Erhardt W , Wulker N
Published: February 2018

In 20 skeletally mature female merino sheep, divided into four groups, we performed total medial meniscectomy, removal of the middle third of the patellar tendon, and tenotomy of the calcaneal tendon of the right hind leg. Group I (control) had no additional procedures. In the other three groups the medial meniscus was replaced by the middle third of the patellar tendon from the ipsilateral knee. The animals were killed at three (group II), six (group III), or 12 months (group IV) and the tendon-meniscus examined macroscopically, by light and scanning electron microscopy, and biomechanically. Remodelling of the tissue had taken place by 12 months but the failure stress and tensile modulus for the tendon-meniscus were lower than for the normal meniscus. Our evidence suggests that, in sheep, replacement of a meniscus by a tendon autograft may decrease the severity of the degenerative changes that occur after meniscectomy.
Lipids and Dupuytren's disease
Authors: Sanderson PL , Morris MA , Stanley JK , Fahmy NR
Published: February 2018

We studied prospectively the relationship between serum lipids and Dupuytren's disease of the hand in 85 patients, 65 men and 20 women. The Dupuytren patients had significantly higher fasting serum cholesterol and triglyceride levels than did the controls (p < 0.001). The raised levels of serum lipids appeared to be associated with the pathogenesis of Dupuytren's disease, and this may help to explain the high incidence of Dupuytren's disease in alcoholic, diabetic and epileptic patients, since these conditions are also associated with raised serum lipid levels.
Vascularised fibular grafts for reconstruction of the femur
Authors: Yajima H , Tamai S , Mizumoto S , Ono H
Published: February 2018

From 1979 to 1990 we treated 20 patients with large bone defects or established nonunion of the femur by vascularised fibular grafts. There were 18 men and two women with an average age at operation of 36.6 years (16 to 69). Ten patients had infected nonunion, three had post-traumatic nonunion or a bone defect without infection, four had a defect after tumour resection, and three had other lesions. The mean length of the fibular grafts was 18.1 cm. Postoperative circulatory disturbances needed revision surgery in five patients, including three with circulatory problems in the monitoring flap, but not at their anastomoses. The outcome was successful in 19 of the 20 patients with bone union at means of 6.1 months at the proximal site and 6.6 months at the distal site. Three patients had fractures of the fibular grafts but all these united in two to three months after cast immobilisation.
Avoiding nerve damage during elbow arthroscopy
Authors: Marshall PD , Fairclough JA , Johnson  , Evans EJ
Published: February 2018

To define the anatomical relationships of the nerves to the common arthroscopy portals at the elbow an arthroscope was introduced into 20 cadaver elbows and the positions of the nerves were then determined by dissection. In all cases the posterior interosseous nerve lay close to the radiohumeral joint and to the anterolateral portal. Pronation of the forearm displaced the nerve away from the arthroscope. The median nerve passed consistently within 14 mm of the arthroscope when it was introduced through the anteromedial portal. The branches supplying the superficial forearm flexor muscles were at risk.
The relative strengths of the rotator cuff muscles. A cadaver study
Authors: Keating JF , Waterworth P , Shaw-Dunn J , Crossan J
Published: February 2018

We studied five cadaver shoulders to determine the strength relationship of the four rotator cuff muscles. The mean fibre length and volume of each muscle were measured, from which the physiological cross-sectional area was calculated. This value was used to estimate the force which each muscle was capable of generating. The lever arm of each muscle about the humeral head was then measured and the moment exerted was calculated. The strength ratios between the muscles were more or less constant in the five specimens. Subscapularis was the most powerful muscle and contributed 53% of the cuff moment; supraspinatus contributed 14%, infraspinatus 22% and teres minor 10%. The force-generating capacity of the subscapularis was equal to that of the other three muscles combined.
Exchange arthroplasty for infected knee replacements. A new two-stage method
Authors: Scott IR , Stockley I , Getty CJ
Published: February 2018

We report a series of 17 exchange arthroplasties for infected knee prostheses, ten one-stage and seven two-stage procedures. The method proved successful in controlling infection and restoring function. In two-stage exchanges the interval between the stages was managed by using a prosthesis as a spacer, and acrylic cement beads containing the appropriate antibiotic to provide high local concentrations. Three one-stage procedures had recurrence of infection, but were successfully treated by further exchange operations. All patients had satisfactory function and there have been no serious complications. We recommend this modified two-stage technique for the management of infected knee arthroplasties.
Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years
Authors: Neyret P , Donell ST , Dejour H
Published: February 2018

We reviewed 195 knees in 167 patients at least 20 years after a rim-preserving meniscectomy. They were considered in two groups: 102 knees had had an intact anterior cruciate ligament (ACL), and 93 had had an unrepaired rupture. More patients with a ruptured ACL had downgraded their sport activity by five years after meniscectomy. The incidence of radiographic osteoarthritis was about 65% at 27 years in patients with a ruptured ligament, and 86% in those followed up for over 30 years. In the ligament-deficient group 10% had had operations for osteoarthritis, and another 28% had had other operations, mainly further meniscectomies. Only 6% of those with an intact ligament had needed a second operation after meniscectomy and at long-term follow-up 92% of them were satisfied or very satisfied. Only 74% of the ligament-deficient patients were satisfied with their result. The long-term outcome after rim-preserving meniscectomy depends mainly upon the state of the anterior cruciate ligament.
Can muscle co-contraction protect knee ligaments after injury or repair?
Authors: O'Connor JJ
Published: February 2018

A computer-based model of the knee was used to study forces in the cruciate ligaments induced by co-contraction of the extensor and flexor muscles, in the absence of external loads. Ligament forces are required whenever the components of the muscle forces parallel to the tibial plateau do not balance. When the extending effect of quadriceps exactly balances the flexing effect of hamstrings, the horizontal components of the two muscle forces also balance only at the critical flexion angle of 22 degrees. The calculations show that co-contraction of the quadriceps and hamstring muscles loads the anterior cruciate ligament from full extension to 22 degrees of flexion and loads the posterior cruciate at higher flexion angles. In these two regions of flexion, the forward pull of the patellar tendon on the tibia is, respectively, greater than or less than the backward pull of hamstrings. Simultaneous quadriceps and gastrocnemius contraction loads the anterior cruciate over the entire flexion range. Simultaneous contraction of all three muscle groups can unload the cruciate ligaments entirely at flexion angles above 22 degrees. These results may help the design of rational regimes of rehabilitation after ligament injury or repair.
The distal radio-ulnar joint in Colles' fractures
Authors: Roysam GS
Published: February 2018

The effect of involvement of the distal radio-ulnar joint on subsequent function was studied in 170 patients with Colles' fractures, reviewed for one year after cast removal. Patients with involvement of this joint had significantly weaker grips and a significantly greater incidence of pain and tenderness over the joint at all stages of follow-up. They also had a poorer range of supination at six months and at one year. The presence or absence of an ulnar styloid fracture was not related to the functional results.
Ultrasound or image intensifier for closed femoral nailing
Authors: Mahaisavariya B , Laupattarakasem W
Published: February 2018

We describe a method of closed, unlocked nailing for femoral fractures using ultrasound instead of an image intensifier. Radiography was used only to confirm that the guide wire had been passed into the intramedullary canal of both fragments. The method succeeded in 26 of 30 cases. The failures all occurred in fractures which could not be reduced within 20 minutes. The operating time in those nailed successfully with ultrasound control was not different from the time for 30 control cases using conventional methods with an image intensifier.
Meniscal injury associated with femoral shaft fractures. An arthroscopic evaluation of incidence
Authors: Vangsness CT , DeCampos J , Merritt PO , Wiss DA
Published: February 2018

We studied 47 patients with closed, displaced, diaphyseal fractures of the femur caused by blunt trauma, to determine the incidence of associated knee injuries, particularly of the meniscus. After femoral nailing, all patients had an examination under anaesthesia and an arthroscopy. There were 12 medial meniscal injuries (5 tears) and 13 injuries of the lateral meniscus (8 tears). Ten of the 13 tears were in the posterior third of the meniscus, and two patients had tears of both menisci. Synovitis was common at the meniscal attachments. Complex and radial tears were more common than peripheral or bucket-handle tears. Examination under anaesthesia revealed ligamentous laxity in 23 patients (49%), but meniscal injuries had a similar incidence in knees with and without ligament injury. Femoral shaft fractures are often associated with injuries to the ipsilateral knee, and a high index of suspicion is necessary to identify these lesions.
Dome osteotomy of the pelvis for osteoarthritis secondary to hip dysplasia. An over five-year follow-up study
Authors: Anwar MM , Sugano N , Matsui M , Takaoka K , Ono K
Published: February 2018

We performed Kawamura's dome osteotomy of the pelvis, with simultaneous distal transfer of the greater trochanter on 101 hips in 91 patients with osteoarthritis secondary to hip dysplasia. The mean age at operation was 30 years (15 to 55), and follow-up was for a mean of 8.3 years (5 to 14). Clinical evaluation using the Merle d'Aubigne score showed 92% excellent or good results. Radiologically, 91 hips had good acetabular remodelling and showed no signs of progression of osteoarthritis. In ten hips the osteoarthritic process progressed despite the osteotomy and six of these eventually underwent total hip replacement. Factors which were significantly associated with a poor outcome included an advanced stage of osteoarthritis, valgus deformity of the proximal femur, old age at the time of operation and postoperative persistence of abductor insufficiency.
Inguinal lymphadenopathy due to metal release from a prosthesis. A case report
Authors: Shinto Y , Uchida A , Yoshikawa H , Araki N , Kato T , Ono K
Published: February 2018

We report the case of a 19-year-old man with inguinal lymphadenopathy caused by metallic debris from the loosening of a prosthesis inserted after tumour resection. Large amounts of wear debris may be released from such massive replacements, and surgeons should be aware of the range of possible adverse effects.
Cysts of the medial meniscus. Arthroscopic diagnosis and management
Authors: Mills CA , Henderson IJ
Published: February 2018

We report the clinical and arthroscopic findings in 20 cases of medial meniscal cyst with a mean follow-up of 20 months. These were studied prospectively from a series of 7435 knee arthroscopies in which there were 1246 stable non-arthritic knees with medial meniscal tears. The diagnosis on referral was incorrect in seven, and incomplete in seven. There was coexistent meniscal injury in 17 (85%), but in the other three no tear was visible at arthroscopy. Ten knees had additional intra-articular abnormalities. Treatment of the cyst was by open resection in 12 and arthroscopic evaluation at meniscectomy in seven. In one case the cyst resolved after arthroscopic partial meniscectomy alone. Meniscal tears were treated by arthroscopic partial medial meniscectomy. Medial meniscal cysts are an important but under-diagnosed cause of knee pain and are frequently related to arthroscopically diagnosable and treatable meniscal pathology. Treatment should be directed towards both the meniscus and the cyst, which may require open surgery.
Audit of a bone bank
Authors: Ivory JP , Thomas IH
Published: February 2018

The results are reported of an audit of allografts collected in the first 18 months of the Leicester Bone Bank. We retrieved 161 femoral heads at primary arthroplasty of which 103 were implanted into 59 patients. There were deep infections in two recipients and wound infections in five. In two of these cases, culture of the femoral head at implantation was positive but the organisms grown were not those which caused the clinical infection. We retrieved 22 large allografts from six cadavers. Four of these were contaminated at retrieval and required irradiation for sterilisation. There has been one clinical infection in the nine large allografts implanted so far. We recommend that all bone banks undertake prospective audit to ensure that high standards are maintained and wastage minimised.
Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients
Authors: Smith MD , Emery SE , Dudley A , Murray KJ , Leventhal M
Published: February 2018

Ten patients who suffered iatrogenic injury to a vertebral artery during anterior cervical decompression were reviewed to assess the mechanisms of injury, their operative management, and the subsequent outcome. All had been undergoing a partial vertebral body resection for spondylitic radiculopathy or myelopathy (4), tumour (2), ossification of the posterior longitudinal ligament (1), nonunion of a fracture (2), or osteomyelitis (1). The use of an air drill had been responsible for most injuries. The final control of haemorrhage had been by tamponade (3), direct exposure and electrocoagulation (1), transosseous suture (2), open suture (1), or open placement of a haemostatic clip (3). Five patients had postoperative neurological deficits, but most of them resolved. We found direct arterial exposure and control to be safe, quick and reliable. Careful use of the air drill, particularly in pathologically weakened bone, as in infection or tumour, is essential. Arterial injury is best avoided by a thorough knowledge of the anatomical relationships of the artery, the spinal canal, and the vertebral body.
Arthroscopic debridement versus open repair for rotator cuff tears. A prospective cohort study
Authors: Ogilvie-Harris DJ , Demaziere A
Published: February 2018

We compared two treatments for tears of the rotator cuff of 1 to 4 cm in size. One group of 22 patients had an arthroscopic subacromial decompression and rotator-cuff debridement; the other comparable group of 23 patients had open repair and acromioplasty. Review was at 2 to 5 years postoperatively. Both groups had similar pain relief and range of active forward flexion, with significant improvement from the preoperative condition. The open repair group scored better for function, strength and overall score, but patient satisfaction was similar in the two groups. We recommend the use of arthroscopic subacromial decompression and debridement for low-demand patients who require mainly pain relief and range of movement. Open repair is necessary if strength and functional recovery are the prime objectives.
Non-extensile surgical approaches for two-column acetabular fractures
Authors: Schmidt CC , Gruen GS
Published: February 2018

We reviewed the outcome, at a mean follow-up of 14 months, of 21 two-column fractures of the acetabulum treated by operation through one or two non-extensile approaches. Eighteen procedures resulted in reduction of the articular surfaces to within 3 mm. The blood loss and operating time when two combined non-extensile approaches were used were similar to those reported for extended acetabular approaches. The incidence of heterotopic ossification which limited joint motion was low, and the average Harris hip score was 81 points. The use of non-extensile approaches for acetabular fractures in which both columns are involved avoids iatrogenic injury to the abductors, and reduces the incidence of complications.
Treatment of adolescent tibia vara by asymmetrical physeal distraction
Authors: de Pablos J , Franzreb M
Published: February 2018

We have treated 12 adolescent patients with idiopathic tibia vara by asymmetrical physeal distraction using a modified Wagner external fixator. There were no major complications and a mean correction of 13 degrees was achieved. The main advantages of the technique are that no osteotomy, internal fixation or bone graft is needed, and that the operation can be performed on both tibiae simultaneously. No shortening is produced and lengthening can be added to angular correction if required.
Silicone granulomatous reactions after first metatarsophalangeal hemiarthroplasty
Authors: Rahman H , Fagg PS
Published: February 2018

We reviewed 55 patients (78 feet) who had undergone silicone hemiarthroplasty of the first metatarsophalangeal joint for hallux valgus (40) or hallux rigidus (38). At a mean period of 4.5 years (1 to 11), 56 feet had radiological evidence suggestive of silicone granulomatous disease. The frequency and severity of the changes increased with time from the operation. Histological material from three revisions confirmed the presence of silicone granulomata. We recommend that the operation of silicone hemiarthroplasty for hallux valgus and hallux rigidus be abandoned.
Serum ionised calcium and its relationship to parathyroid hormone after tibial fracture
Authors: Hardy  , Conlan D , Hay S , Gregg PJ
Published: February 2018

The changes in serum adjusted ionised calcium and parathyroid hormone (PTH) were prospectively studied in 32 patients with isolated tibial fractures, treated conservatively. We measured serum albumin, adjusted total calcium, phosphate, pH, adjusted ionised calcium and PTH at intervals until the fractures had healed. The mean ionised calcium adjusted for pH fell within 24 hours of injury, and then rose to a peak at between four and six weeks. These changes cannot be explained by changes in serum pH or PTH. The restoration of normal ionised calcium levels after fracture coincided with the period when the callus was being calcified. Analysis of the changes in ionised calcium, phosphate and PTH suggests that PTH levels alter in response to changes in ionised calcium levels. PTH is highest immediately after fracture and lowest, often not recordable, at six weeks. The cause of the changes in the ionised calcium level has yet to be elucidated.
Leukergy--a new diagnostic test for bone infection
Authors: Otremski I , Newman RJ , Kahn PJ , Stadler J , Kariv N , Skornik Y , Goldman G
Published: February 2018

This new blood test for infection is based on the phenomenon of leukergy in which white cells agglomerate in the peripheral blood of patients with inflammatory diseases. It was used in 26 patients with proven bone or joint infection and was positive in 25. The leukergy test was more accurate than the ESR, white cell count or blood culture. The percentage of cells agglomerated correlated with the clinical severity of the infection and the test detected reactivation of the septic process better than the other haematological tests. It is a rapid and inexpensive method which is useful in the diagnosis and management of bone and joint infections.