bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep vein thrombosis after total hip replacement. A comparison between spinal and general anaesthesia
Authors: Davis FM , Laurenson VG , Gillespie WJ , Wells JE , Foate J , Newman E
Published: February 2018

The effect of hypobaric spinal anaesthesia or narcotic-halothane-relaxant general anaesthesia on the incidence of postoperative deep vein thrombosis was studied in 140 elective total hip replacements in a prospective randomised manner. Deep vein thrombosis was diagnosed using impedance plethysmography and the 125I fibrinogen uptake test, combined, in selected cases, with ascending contrast venography. The overall incidence of deep vein thrombosis was 20%. Nine patients (13%) developed deep vein thrombosis in the spinal group and nineteen (27%) in the general anaesthetic group (p less than 0.05). The incidences of proximal thrombosis and of bilateral thrombi were also less with spinal anaesthesia than with general anaesthesia. It is concluded that spinal anaesthesia reduces the risks of postoperative thromboembolism in hip replacement surgery. The presence of varicose veins, being a non-smoker and having a low body mass index were associated with an increased incidence of deep vein thrombosis.
Wear characteristics of the canine acetabulum against different femoral prostheses
Authors: Cook SD , Thomas KA , Kester MA
Published: February 2018

We studied cartilage degeneration in 45 canine acetabula after implantation of prostheses with articulating surfaces of low-temperature isotropic (LTI) pyrolytic carbon, cobalt-chromium-molybdenum alloy and titanium alloy for periods ranging from two weeks to 18 months. Gross specimens and histological sections were compared with the nonoperated (control) acetabulum of the same animal. Cartilage articulating with LTI pyrolytic carbon exhibited significantly lower levels of gross wear, fibrillation, eburnation, glycosaminoglycan loss, and subchondral bone change than with metallic surfaces. Survivorship analysis showed a 92% probability of survival for cartilage articulating with LTI pyrolytic carbon at 18 months, as compared to only a 20% probability of survival for cartilage articulating with either of the metallic alloys.
Does myeloma secrete an osteoblast inhibiting factor?
Authors: Evans CE , Galasko CS , Ward C
Published: February 2018

Unlike most other tumours, myeloma causes bone destruction without an osteoblastic reaction; we tried to assess whether myeloma secretes a humoral factor that inhibits osteoblasts. Human bone-derived cells were either co-cultured with myeloma cells, or cultured in medium conditioned by myeloma cells. Bone-derived cell growth was measured by cell counts and by uptake of tritiated thymidine (3H-Tdr); growth was inhibited when cultured in medium conditioned by myeloma cells and some inhibition was seen when the bone-derived cells were co-cultured with myeloma cells. The inhibiting effect was dose-dependent and also dependent upon the density of the myeloma cells conditioning the medium. The results of our study suggest that myeloma secretes an osteoblast inhibiting factor of less than 50,000 Dalton molecular weight.
Maximal isometric patellofemoral contact force in patients with anterior knee pain
Authors: Macdonald DA , Hutton JF , Kelly IG
Published: February 2018

We assessed patellofemoral joint function by combining the measurement of maximal isometric extensor torque at the knee with clinical and radiological measurements in order to calculate the patellofemoral contact force. Eighteen volunteers established the normal ranges of results and the reliability of the system. Of the 39 patients with a variety of knee problems, 29 had anterior knee pain, and all had a subsequent arthroscopy. Patients with anterior knee pain and lesions in the patellar cartilage had significantly reduced isometric contact forces, but those with normal patellofemoral cartilage had normal contact forces. Our method may be useful in providing an objective assessment of anterior knee pain and a quantitative means of monitoring its treatment.
The role of expanding intramedullary rods in osteogenesis imperfecta
Authors: Stockley I , Bell MJ , Sharrard WJ
Published: February 2018

We report the results of using 83 expanding intramedullary rods in 24 children with osteogenesis imperfecta after a mean follow-up of five years three months. In all, 62% of the rods have expanded after one primary operation. Thirty-four additional operations were necessary; 11 for the correction of rotation or angulation deformities and 23 for revision of the rod or T-piece. All these revisions were successful. Complications were more frequent in children who required very small rods. Problems with Bailey-Dubow rods led to the development of the Sheffield rod system; 17 bones treated with these rods are included in the series. Before surgery only eight of the 24 children were able to walk but at review 20 children were walking, 15 without walking aids. Elongating intramedullary rods should be available to all children with osteogenesis imperfecta as they improve walking capability, reduce the number of fractures, prevent deformity and allow integration of the child into society.
The aetiology of multiple loose bodies. Snow storm knee
Authors: Kay PR , Freemont AJ , Davies DR
Published: February 2018

We report four patients who showed hundreds of brilliant white loose bodies at arthroscopy of the knee after a short history of pain and crepitus. Histological, historical and clinical evidence is presented which indicates that the aetiology of this condition is the culture of chondrocytes in synovial fluid. It is suggested that reversal of the usually accepted order of events in synovial osteochondromatosis could provide a better and unified explanation for both that condition and multiple loose bodies. The term 'snow storm knee' is proposed to describe the dramatic picture seen at arthroscopy.
Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Surgical techniques and a review of 70 patients
Authors: Breek JC , Tan AM , van Thiel TP , Daantje CR
Published: February 2018

We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 11 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability. Pinch grip strength was normal in 48. About one-third of the patients had some loss of flexion/extension; this was seldom noticed by the patients and caused no significant disability. Free tendon graft reconstruction is indicated for severe fresh lesions, for old lesions with chronic disability and for lesions which have not responded to conservative management.
Soft tissue recurrence of osteoclastoma
Authors: Exarchou E , Maris J , Assimakopoulos A
Published: February 2018

We report a case of osteoclastoma of the distal radius originally treated by curettage, then by resection and bone replacement. There was a soft tissue recurrence of the tumor 13 years later.
Torsional stability of the femoral component of hip arthroplasty. Response to an anteriorly applied load
Authors: Nunn D , Freeman MA , Tanner KE , Bonfield W
Published: February 2018

Torsional instability of femoral components has not received much attention, and is difficult to detect in conventional radiographs. To test this we designed a system to apply a load in an anteroposterior direction to the head of a femoral component, implanted into a cadaveric femur. Rotation within the bone was measured, using a purpose built transducer, with and without preservation of the neck, with and without cement, and with longitudinal ridges but no cement. The results show that torsional instability may be a problem in uncemented replacement. Preservation of the femoral neck and the use of a ridged prosthesis increases resistance to rotation. Rotational movements occurring in vivo during such activities as climbing stairs and rising from the seated position may contribute to mechanical loosening.
Treatment of displaced subcapital fractures with the Charnley-Hastings hemiarthroplasty
Authors: Rae PJ , Hodgkinson JP , Meadows TH , Davies DR , Hargadon EJ
Published: February 2018

Between December 1982 and June 1986, 98 displaced subcapital femoral neck fractures were treated using the Charnley-Hastings bipolar hemiarthroplasty. Although the patients were elderly, often with associated medical problems, the operation was well tolerated and the mortality at one and six months was 14.4% and 24.5% respectively. Fifty-four hips were reviewed after an average follow-up of 33 months; 64.8% of patients had a good or excellent result. The fair or poor results were seen mainly in patients with poor pre-operative mobility and multiple medical problems. A significant cause of morbidity was dislocation (two interprosthetic) which occurred in six hips. There were two cases of deep sepsis but neither patient was fit for further surgery. There were no cases of acetabular erosion requiring revision surgery.
The effect of immunosuppression on vascularised allografts. A preliminary report
Authors: Doi K , DeSantis G , Singer DI , Hurley JV , O'Brien B , McKay SM , Hickey MJ , Murphy BF
Published: February 2018

Five vascularised allografts of the knee joint were performed in dogs immunosuppressed with cyclosporin A and azathioprine. Three survived with normal function for 3 to 4 months after operation. One of the unsuccessful grafts had a failed vascular anastomosis, the other an inadequate blood level of cyclosporin A. All three successful grafts healed well. In two, bone scans, radiographs and biopsies were indistinguishable from successful autografts; in the third the blood supply to the graft failed despite patent anastomoses but the graft healed well with good function. All three grafts were rejected within 2 to 3 weeks of withdrawal of cyclosporin A and azathioprine. In non-immunosuppressed dogs, allografts of the knee, both vascularised and non-vascularised, were rejected within a few days of operation. In two non-vascularised allografts, administration of cyclosporin and azathioprine had no apparent effect on the rate of rejection of the graft.
The measurement of migration of the acetabular component of hip prostheses
Authors: Nunn D , Freeman MA , Hill PF , Evans SJ
Published: February 2018

Individual components of a total hip replacement are difficult to evaluate and quantify. We have studied the assessment of the acetabular component, and conclude that the measurement of migration allows the comparison of implants, although there is no established link between migration and significant loosening. A method of measurement based on clinical radiographs has been developed, and its limitations estimated. The accuracy of the technique was calculated to be +/- 3 mm.
Scoliosis surgery in the Prader-Willi syndrome
Authors: Rees D , Jones MW , Owen R , Dorgan JC
Published: February 2018

There is a high incidence of spinal deformity in children with the Prader-Willi syndrome. We have encountered major complications following spinal surgery in this condition. We report our experience and conclude that spinal surgery is a formidable undertaking and the risks should be appreciated by the surgeon and the parents.
Congenital dislocation of the hip presenting after the age of three years. A long-term review
Authors: Williamson DM , Glover SD , Benson MK
Published: February 2018

We reviewed the cases of 38 children with 45 congenitally dislocated hips who presented for primary treatment after the age of three years. Of these, 34 hips were managed by the 'direct approach' of Somerville and Scott (1957); 14 of these required secondary operations for subluxation, often with a poor outcome. Eleven hips were treated by combined pelvic and femoral osteotomy which, in general, gave good results. At a mean follow-up of 16.7 years, 80% of the whole series had a good or excellent clinical result and 51% were good or excellent radiologically. Simultaneous correction both above and below the hip is considered to be the best treatment for the older child with congenital hip dislocation.
The skeletal manifestations of congenital syphilis. A review of 197 cases
Authors: Rasool MN , Govender S
Published: February 2018

In a retrospective review of 302 clinically suspected cases of congenital syphilis, bone changes were found in 197. The skeletal manifestations were periostitis (102 cases), osteitis (20), and metaphyseal changes (71). Combinations of more than one lesion were found in 61. Pseudoparalysis was a presenting sign in 34 infants; 12 of these were found to have had pathological fractures and four had dactylitis. Complete radiological healing without residual changes was seen in all 59 cases that were recalled for review. The orthopaedic surgeon should consider the diagnosis of congenital syphilis when destructive lesions of bone are seen in an infant.
Is the KT1000 knee ligament arthrometer reliable?
Authors: Forster IW , Warren-Smith CD , Tew M
Published: February 2018

We set up a trial to test whether the KT1000 arthrometer would give consistent measurements of anteroposterior laxity when used by the same and different examiners on the knees of the same subjects on the same day. The results showed substantial inter- and intra-examiner variation in the measurements both of absolute displacement in single knees and of side-to-side differences between pairs of knees. This casts doubt on the reliability of the instrument when used to compare the results of different techniques for reconstructing injured cruciate ligaments.
Thoracic spine translocation without cord injury
Authors: Simpson AH , Williamson DM , Golding SJ , Houghton GR
Published: February 2018

We report three cases of thoracic spine translocation without neurological deficit. In each case bilateral pedicular fractures, demonstrated by computed tomography, produced 'floating arches' which account for the sparing of the cord. If computed tomography demonstrates adequate canal dimensions, these patients may be treated conservatively, but the treatment of choice at specialist spinal centres is operative stabilisation.
Vertebral hydatidosis and paraplegia
Authors: Karray S , Zlitni M , Fowles JV , Zouari O , Slimane N , Kassab MT , Rosset P
Published: February 2018

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.
Suspected scaphoid fractures. The value of radiographs
Authors: Dias JJ , Thompson J , Barton NJ , Gregg PJ
Published: February 2018

Twenty observers reported independently on the presence or absence of a fracture of the scaphoid on 60 sets of radiographs; these included initial and 2- to 3-week views in patients in whom the outcome was known, normal scaphoids and random copies of these. Analysis of variance of the accuracy of observations revealed that the 2- to 3-week radiographs did not improve diagnostic ability and that this was independent of the experience or seniority of the observer. For normal radiographs, 20% of the observations reported a fracture. Reproducibility of opinion improved with experience but this did not help with accuracy. Radiographs without accurate clinical observation should not determine the management of the suspected scaphoid fracture.
Early open reduction for congenital dislocation of the hip
Authors: Dhar S , Taylor JF , Jones WA , Owen R
Published: February 2018

We have reviewed 82 children with congenital dislocation of the hip, after treatment by anterior open reduction followed by derotation femoral osteotomy. The clinical and radiological results were significantly better in the group that had open reduction before the appearance of the capital femoral epiphysis; this group also had a lower incidence of avascular necrosis. We conclude that, when it is clearly indicated, the earlier an open reduction is carried out the better the results.
Computerised arthrotomography of primary anterior dislocation of the shoulder
Authors: Ribbans WJ , Mitchell R , Taylor GJ
Published: February 2018

Computerised arthrotomography was performed on 33 patients four to six weeks after acute primary anterior dislocation of the shoulder. Seventeen patients were under, and 16 over 50 years of age. Damage to the anterior glenoidal labrum was seen in all the younger patients and in 75% of the older ones. A large redundant capsular pouch, seen in the older patients, was present in 35% of the younger ones, and a posterior humeral head defect was seen in 82% of the younger patients and only 50% of the older. Associated fractures were more common in the older patients, and a tear of the rotator cuff was demonstrated in 63% of the older patients and in none of the younger ones.
Interobserver variability in grading Perthes' disease
Authors: Simmons ED , Graham HK , Szalai JP
Published: February 2018

Fifteen independent observers of three levels of experience (consultant staff, fellows, residents) assessed 40 radiographs of children presenting with Perthes' disease using the Catterall and the Salter-Thompson grading systems. Each observer was supplied with descriptions and illustrations of the classifications and each hip was grouped by both systems by each observer. The results were statistically analysed using 'kappa' statistics. The level of interobserver agreement was higher for the Salter-Thompson system and correlated with the level of experience of the observer. Both systems can give acceptable levels of interobserver agreement, but the Salter-Thompson grouping is simpler and easier to apply in the earlier stages of the disease when treatment must be decided, and has a higher degree of reproducibility amongst more experienced observers.
Cementless total replacement for severely dysplastic or dislocated hips
Authors: Paavilainen T , Hoikka V , Solonen KA
Published: February 2018

We report the short-term results of 100 cementless total hip replacements in 52 severely dysplastic and 48 totally dislocated hips, with some new technical solutions to the problems involved. In cases with a very narrow iliac bone, the acetabular screw ring is seated below the true cotyloid area. In hips with tight flexor and abductor muscles or with deformities of the proximal femur, various osteotomies were performed. Special attention was paid to careful pre-operative planning and precise operative technique. In spite of a high complication rate the results were generally good and even patients who required reoperation were satisfied with the final result.
Prophylactic pinning in slipped upper femoral epiphysis. Prevention of complications
Authors: Emery RJ , Todd RC , Dunn DM
Published: February 2018

We report the complications of prophylactic pinning of slipped upper femoral epiphysis with Crawford Adams pins in 95 cases. Complications of pin placement were seen in 13.7%. Although seven hips had penetration of the joint, there were no cases of chondrolysis or avascular necrosis. Excavation of the lateral femoral cortex was required at pin removal in 12.5% of cases. Analysis of the growth around pins allowed recommendations to be made regarding pin protrusion. The use of improved fixation devices may reduce the need for multiple pins.
Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament
Authors: Staubli HU , Jakob RP
Published: February 2018

We evaluated the accuracy of six clinical tests for posterior instability in 24 knees with acute surgically-proven posterior cruciate ligament injuries and intact anterior cruciate ligaments. We also performed stress radiography under anaesthesia. The gravity sign and the posterior drawer test in near extension and its passive reduction were diagnostic in 20 of the 24 knees, and the active reduction of posterior subluxation was diagnostic in 18. The reversed pivot shift sign helped to diagnose severe posterior and posterolateral subluxations, but the external rotation recurvatum test was negative in all 24 knees. Stress radiography in near extension revealed a highly significant increase in posterior tibial subluxation in the injured knees.
High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up
Authors: Ivarsson I , Myrnerts R , Gillquist J
Published: February 2018

On three occasions we have reviewed a series of knees after high tibial osteotomy for osteoarthritis: 99 were reviewed at one to two years; 81 at a mean of 5.7 years; and 65 at a mean of 11.9 years. At one to two years and at 5.7 years over 50% were good and over 75% acceptable. At 11.9 years, 43% were good and 60% acceptable. We determined the mechanical axis through the knee in maximum varus and maximum valgus; significantly better results were found if a mean angulation of 3 degrees to 7 degrees of valgus had been achieved at operation. We also measured intercondylar distances under varus and valgus stress, and found no significant lateral compartment narrowing. The best results were seen in knees with pre-operative grade I or grade II osteoarthritis and valgus deviation after osteotomy.
Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ
Authors: Seitsalo S , Osterman K , Hyvarinen H , Schlenzka D , Poussa M
Published: February 2018

From 1948 to 1980, 93 children and adolescents had fusion in situ for severe spondylolisthesis with a slip of 50% or more, at a mean age of 14.8 years. Of these, 52 girls and 35 boys were reviewed after a mean follow-up of 13.8 years. The mean pre-operative slip was 76% and pain frequency correlated with the severity of the lumbosacral kyphosis but not with that of the slip. Posterior fusion was used in 54, posterolateral in 30 and anterior fusion in three patients. There were no major complications but 16 had re-operations for non-union or root symptoms. At follow-up there were three non-unions. After operation, 19 patients had 10% or more progression of the slip, but 10 showed correction by more than 10% as a result of remodelling. The lumbosacral kyphosis had increased by more than 10 degrees in 45%. Postoperative progression of the slip and of lumbosacral kyphosis was significantly more if the posterior element had been removed. At follow-up 77 patients were subjectively improved, four were unchanged, and one was worse. These results did not correlate with either the degree of the slip, or the angle of lumbosacral kyphosis. Fusion in situ is safe and gives good long-term clinical results. Secondary changes are associated with increased lumbosacral kyphosis, so reduction of this should be considered in severe cases.
Functional bracing for comminuted extra-articular fractures of the distal third of the humerus
Authors: Sarmiento A , Horowitch A , Aboulafia A , Vangsness CT
Published: February 2018

From 1982 to 1987 we treated 85 extra-articular comminuted distal third humeral fractures in adults with prefabricated plastic braces. Of these, 15% were open fractures and 18% had initial peripheral nerve injury. On average, the sleeve was applied 12 days after injury and used for 10 weeks. There was 96% union, with no infections. All nerve injuries resolved or were improving at the latest examination. At union there was varus deformity averaging 9 degrees in 81% of patients, but loss of range of movement was minimal and functional results were good.
The timing of amputation for lower limb trauma
Authors: Pozo JL , Powell B , Andrews BG , Hutton PA , Clarke J
Published: February 2018

We reviewed 35 patients who had an amputation following the failure of treatment for severe lower limb trauma. Seven of the amputations were for ischaemia, within one month of injury; 13 were between one month and one year for infection complicating loss of wound cover in un-united fractures; and 15 were later than one year after injury, mainly for infected non-union. The latter group of patients had had an average of 12 operations and 50 months of treatment, including eight months in hospital. We used a new limb injury score based on damage to the individual tissue elements; this indicated that, even in the absence of neurovascular injury, the presence of severe damage to skin, bone and muscle, with wound contamination, particularly in the lower tibia, had a poor prognosis. We therefore recommend, to avoid multiple operations, with prolonged hospitalisation and suffering, that these patients should have early independent review by orthopaedic and plastic surgeons with the aim of establishing an accurate prognosis for the salvage of a useful limb.
Effect of postoperative radiation on the incorporation of tibial bone grafts in the rabbit
Authors: De Santis G , Williams JF , Dvir E , O'Brien BM , Hurley JV , Goldberg I
Published: February 2018

A dose of 48 Gy of X-irradiation given over two to five weeks after grafting caused no significant delay in the rate of healing and only a small and statistically non-significant decrease in the torsional strength of the graft-bone junction of either vascularised or non-vascularised bone grafts of the tibiae of rabbits. Healing was faster and the union between the graft and adjacent bone developed torsional strength significantly more rapidly with vascularised than with non-vascularised grafts. These findings suggest that postoperative radiotherapy is unlikely to have a significantly deleterious effect on the healing of bone grafts used to repair defects produced by excision of malignant bone tumours.
A new type of peripheral nerve lesion
Authors: Birch R , St Clair Strange FG
Published: February 2018

We report a hitherto undescribed type of peripheral nerve lesion in which pressure results in mechanical demyelinisation of a length of nerve with interruption of conduction. On release of the pressure, early recovery may follow the return of the myelin insulation.
Rectal indomethacin for postoperative pain in orthopaedic surgery. A double-blind study
Authors: Twiston-Davies CW , Goodwin MI , Baxter PJ
Published: February 2018

We report a double-blind study of the effectiveness of indomethacin suppositories in the relief of postoperative pain and the reduction in demand for opiate analgesia following orthopaedic procedures.
Experimental stress fractures of the tibia. Biological and mechanical aetiology in rabbits
Authors: Burr DB , Milgrom C , Boyd RD , Higgins WL , Robin G , Radin EL
Published: February 2018

We have shown that stress fractures can be induced in the tibial diaphysis of an animal model by the repeated application of non-traumatic impulsive loads. The right hind limbs of 31 rabbits were loaded for three to nine weeks and changes in the bone were monitored by radiography and bone scintigraphy. The presence of stress fractures was confirmed histologically in some cases. Most animals sustained a stress fracture within six weeks and there was a positive correspondence between scintigraphic change and radiological evidence. Microscopic damage was evident at the sites of positive bone scans. The progression, location, and time of onset of stress fractures in this animal model were similar to those in clinical reports, making the model a useful one for the study of the aetiology of stress fractures.
Displaced fractures of the cuboid
Authors: Sangeorzan BJ , Swiontkowski MF
Published: February 2018

We report four cases of fracture of the cuboid treated by open reduction, bone grafting where necessary and internal fixation. We recommend this treatment where there is appreciable displacement of one or more of the articular surfaces. The preliminary results were better than those previously reported for conservative treatment or for later midtarsal fusion.
The role of the tibial nutrient artery. Microsphere estimation of blood flow in the osteotomised canine tibia
Authors: Strachan RK , McCarthy I , Fleming R , Hughes SP
Published: February 2018

There has been a long-standing debate as to whether medullary or periosteal flow is the dominant vascular supply during the healing of diaphyseal fractures. We used radioactive microspheres to quantify blood flow to the canine tibia two weeks after an osteotomy. There was a significant contribution from the periosteum to the blood supply of healing cortical bone after nutrient artery ligation, with a reversal of flow from a centrifugal to a centripetal direction. Our study has confirmed the qualitative observations of Trueta (1974) regarding the significant recruitment of vessels from surrounding soft tissue during fracture healing. We have not studied the later stages of healing.
Knee arthroplasty using a cementless PCA prosthesis with a porous-coated central tibial stem. Clinical and radiographic review at five years
Authors: Kim YH
Published: February 2018

In 44 consecutive patients, 60 porous-coated anatomic total knee (PCA) prostheses with a porous-coated central tibial stem were implanted without using cement. The clinical results and bony remodelling have been assessed after five years' follow-up. The average Hospital for Special Surgery knee score was 33.1 before operation and 95.7 at the latest follow-up, while the average range of movement improved from 63 degrees to 123 degrees. No subsidence or migration of the components was seen. A radiodense line appeared around the components at six months to one year after the operation and became more dense with time. There was no evidence of bone resorption related to stress-shielding in the tibial plateau.
Dislocation of total hip replacements. A comparative study of standard, long posterior wall and augmented acetabular components
Authors: Nicholas RM , Orr JF , Mollan RA , Calderwood JW , Nixon  , Watson P
Published: February 2018

Augmentation of the acetabular component of total hip replacements is a method of increasing stability and preventing recurrent dislocation. We report a series of mechanical experiments designed to evaluate the turning moments and angles required to dislocate standard, long posterior wall and two different augmented prostheses.
Femoral stem fixation in hip replacement. A biomechanical comparison of cementless and cemented prostheses
Authors: Phillips TW , Messieh SS , McDonald PD
Published: February 2018

A leading problem with cementless hip replacement is thigh pain, probably due to some degree of loosening. This is most pronounced during activities such as stair climbing or getting up from a chair. Our study compares the immediate fixation of three stems in widespread clinical use, using a cadaver test simulation in which the femur was horizontal, and cyclic forces acted vertically downward on the prosthetic head with gradual increments of load. We implanted and tested 18 pairs of femurs, making analyses between stem types by right to left comparisons. We found no statistically significant differences in loosening between cementless AML and PCA prostheses, but cemented stems withstood greater loads than uncemented stems by a factor of five or more.
Radiology of low-friction arthroplasty of the hip. A comparison of socket fixation techniques
Authors: Kobayashi S , Terayama K
Published: February 2018

We studied the radiographs of 211 low-friction arthroplasties, followed for five to 15 years after operation. The first 92 simple hemispherical sockets were fixed with an old technique: eburnated bone in the acetabular roof was removed and only a few large anchor holes were bored for cement fixation. With the next 119 sockets, 111 of which were flanged, the eburnated and subchondral bone was preserved and multiple small anchor holes were used. The modified technique and the use of flanged sockets significantly improved the late radiological findings as regards socket demarcation and wear. On the femoral side, the intramedullary canal filling ratio, the distal packing of cement, calcar resorption and atrophy of the femoral cortex were correlated with prosthetic subsidence.
Primary total hip replacement in patients over 80 years of age
Authors: Newington DP , Bannister GC , Fordyce M
Published: February 2018

We have reviewed 107 patients of 80 years or over who underwent primary total hip replacement. They had many more complications than younger patients. Thus, acute dislocation occurred in 15%, and became chronic in 9%; there were femoral shaft fractures in 4.6% and these, with shaft perforation gave universally poor results. Nevertheless, 75% of patients had a satisfactory outcome, with worthwhile relief of pain. It would seem sensible to warn elderly patients and their relatives of the increased risks in this age group.
Treatment of congenital club foot with a modified Denis Browne splint
Authors: Yamamoto H , Furuya K
Published: February 2018

We treated 91 congenital club feet in 59 children using a modified Denis Browne splint, and followed them for an average of 6 years and 3 months. The modified splint has an aluminium crossbar holding a pair of plastic shoe inserts moulded into corrected positions, and its use was started in children whose ages ranged from four weeks to nine months. Operation was later required in only 31 feet in 20 children. We have reviewed the other 60 feet in 39 children treated by splintage alone. All 60 feet had excellent or good function and from radiographic assessment, equinus, adduction, varus and cavus deformities had all been well corrected. Our results show that the modified splint can give good results.
Closed intramedullary tibial nailing. Its use in closed and type I open fractures
Authors: Court-Brown CM , Christie J , McQueen MM
Published: February 2018

We present the results of using the Grosse-Kempf interlocking nail in the management of 125 closed and type I open tibial fractures. The mean time to union was 16.7 weeks and no fracture required bone grafting. Mobilisation of the patient and the range of joint movement were better than with other methods of treating tibial fractures. There was a 1.6% incidence of infection; 40.8% of patients had knee pain and 26.4% needed to have the nail removed. Other complaints were minor. We suggest that closed intramedullary nailing with an interlocking nail system is an excellent method of treating closed and type I open tibial fractures.
Valgus-extension osteotomy for osteoarthritis of the hip. Indications and long-term results
Authors: Maistrelli GL , Gerundini M , Fusco U , Bombelli R , Bombelli M , Avai A
Published: February 2018

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigne scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was radiographic evidence of regression of the arthritic changes in 39% of the hips at final review. Valgus-extension osteotomy is effective for secondary osteoarthritis of the hip in selected younger patients, but not for those with primary hip disease or a poor range of movement.
Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion
Authors: Louw JA
Published: February 2018

Nineteen patients with thoracic or thoracolumbar spinal tuberculosis and neurological deficits were treated by anterior debridement, decompression and vascularised rib grafting, followed, either during the same procedure or 14 days later, by multilevel posterior osteotomies, instrumentation and fusion. Surgery was performed under cover of four-drug antituberculosis chemotherapy, given for 12 months. The average pre-operative kyphotic angulation of 56 degrees was reduced to 27 degrees postoperatively and 30 degrees at the latest follow-up (3 degrees loss of correction). Radiological fusion between the vascularised rib graft and the vertebrae was seen after an average of 3.3 months. Eighteen patients (95%) had normal neurological function at 14 months, and the other could walk with the aid of crutches.
Denatured muscle grafts for nerve repair. An experimental model of nerve damage in leprosy
Authors: Pereira JH , Cowley SA , Gschmeissner SE , Bowden RE , Turk JL
Published: February 2018

About 20% of patients with leprosy develop localised granulomatous lesions in peripheral nerves. We report experiments in guinea-pigs in which freeze-thawed autogenous muscle grafts were used for the treatment of such mycobacterial granulomas. Granulomas were induced in guinea-pig tibial nerves and the animals were left for 7 to 100 days in order to assess maximal damage. The local area of nerve damage was then excised and the gap filled with denatured muscle grafts. Clinical assessment after periods up to 150 days showed good sensory and motor recovery which correlated well with the histological findings. The muscle graft technique may be of value for the treatment of chronic nerve lesions in selected cases of leprosy.
Secondary total hip replacement after fractures of the femoral neck
Authors: Franzen H , Nilsson LT , Stromqvist B , Johnsson R , Herrlin K
Published: February 2018

We studied the rate of revision in 84 consecutive total hip replacements performed for failed osteosynthesis of femoral neck fractures and compared it with that for primary arthroplasty for osteoarthritis. The age and sex adjusted risk of prosthetic failure was 2.5 times higher after failure of fixation, but all the excess risk was in patients over 70 years of age. There were radiographic signs of loosening of the femoral component at five to 12 years after secondary arthroplasty in six of 33 survivors. In general, the results of secondary replacement were no worse than those obtained after primary arthroplasty for femoral neck fracture. We consider that internal fixation should be the primary procedure: total hip replacement is a safe secondary procedure when osteosynthesis fails.
External fixation for type III open tibial fractures
Authors: Court-Brown CM , Wheelwright EF , Christie J , McQueen MM
Published: February 2018

An analysis of 51 type III open tibial fractures treated by external skeletal fixation is presented. The fractures are subdivided according to the classification of Gustilo, Mendoza and Williams (1984) into types IIIa, IIIb and IIIc. The different prognoses of these fracture subtypes is examined. The use of the Hoffmann and Hughes external fixators in the management of type III open tibial fractures is presented and it is suggested that the prognosis is independent of the type of fixator used.
Corticocancellous grafting and an AO/ASIF lag screw for nonunion of the scaphoid. A retrospective analysis
Authors: Sukul DM , Johannes EJ , Marti RK
Published: February 2018

We report our experience in 42 patients, using corticocancellous bone grafts and lag screw fixation for un-united scaphoid fractures. Using a grading system, we analysed the suitability of the method for three types of nonunion. We recommend the operation for the treatment of scaphoid nonunion, except where there is avascular necrosis of the proximal pole.
The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus
Authors: Wong HK , Lee EH , Balasubramaniam P
Published: February 2018

We reviewed 27 patients who had supracondylar closing wedge osteotomy for cubitus varus. There were 10 excellent and 12 good results. However, of these 22 patients, 14 had a significant bony prominence over the lateral condylar region caused by lateral displacement of the elbow when closing the osteotomy. This prominence was less obvious in patients who had their osteotomy at a young age, but worse after operations near or after skeletal maturity. This difference appeared to be due to remodelling.
Transient cyst-like cortical defects following fractures in children. Medullary fat within the subperiosteal haematoma
Authors: Malghem J , Maldague B , Claus D , Clapuyt P
Published: February 2018

Asymptomatic cyst-like cortical defects appearing after fractures in children have been occasionally reported. Typically, these defects appear during fracture consolidation, within the newly formed subperiosteal bone, proximal to the fracture line, do not enlarge, and progressively disappear. We have previously shown a fatty density on CT scan within the early cortical defect. We now present two additional cases in which early CT scans appeared to confirm that these transient cortical defects may consist of fat, and probably result from the inclusion of medullary fat within the subperiosteal haematoma.
A surgical approach to the cervicothoracic spine
Authors: Birch R , Bonney G , Marshall RW
Published: February 2018

We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care.
Is vitamin D necessary for skeletal integrity in the elderly?
Authors: Thompson SP , Wilton TJ , Hosking DJ , White DA , Pawley E
Published: February 2018

Serum 1.25 dihydroxyvitamin D concentrations were reduced in elderly patients with femoral neck fractures, irrespective of the presence of osteomalacia. This reduction was not attributable to a decrease in vitamin D binding protein. The low rate of bone turnover in these elderly patients might reduce the requirement for vitamin D and protect against the development of osteomalacia. Serum vitamin D metabolite concentration cannot be used as a screening test for osteomalacia in these patients.
Osteotomy for osteoarthritis of the hip. A survivorship analysis
Authors: Werners R , Vincent B , Bulstrode C
Published: February 2018

We have reviewed 368 osteotomies carried out for osteoarthritis of the hip at the Nuffield Orthopaedic Centre. Survivorship analysis showed that 10 years after osteotomy 47% had required no further surgery, and even after 20 years 23% had still not had a hip replacement. Hips with moderate arthritic change showed significantly better results than those with more severe degeneration. Osteotomies with varus angulation as well as medial displacement showed longer survival.
Results of a 25-year screening programme for neonatal hip instability
Authors: Macnicol MF
Published: February 2018

From 1962 to 1986, 117,256 neonates were screened for congenital dislocation of the hip (CDH). When the primary physical examination was performed by the junior paediatric staff there was a persistent late diagnosis rate of 0.5 per 1000 live births. When the primary examination was undertaken by experienced orthopaedic personnel (1982 to 1984) the late diagnosis rate fell and fewer infants were splinted.
Intraosseous lipomatosis. A case report
Authors: Szendroi M , Karlinger K , Gonda A
Published: February 2018

We report a case of systemic intraosseous lipomatosis involving the proximal femur, both ends of the tibia, and the tarsal and metatarsal bones. The lesions progressed during a five-year follow-up with a pathological fracture of the tibial plateau. CT scans were characteristic and helpful in diagnosis but MR imaging added little information. Intraosseous lipomatosis is a hamartomatous malformation due to hyperplasia of adipose tissue, and is fundamentally different from solitary benign intraosseous lipoma. Management involves reconstruction of any pathological fracture. Large progressive lesions should be treated by curettage and grafting in an attempt to prevent such fractures.
Dislocation after primary arthroplasty for subcapital fracture of the hip. Wide range of movement is a risk factor
Authors: Gregory RJ , Gibson MJ , Moran CG
Published: February 2018

Dislocation is the most frequent serious complication following total hip replacement for subcapital femoral fracture. We report a prospective study, using matched groups, which compared the range of hip movement following hip replacement for arthritis and for fracture. The range of movement was significantly greater in the fracture group. We suggest that this is a predisposing factor for dislocation.
Transarticular fixation for severely displaced supracondylar fractures in children
Authors: Archibald DA , Roberts JA , Smith MG
Published: February 2018

We have reviewed 34 children who had been treated by open reduction through a medial incision and transarticular pinning for a severely displaced supracondylar fracture of the humerus. Follow-up ranging from nine months to 20 years showed that 27 of 34 elbows (79%) had excellent or good results, with satisfactory resolution of neurovascular problems and no complications due to the method of treatment.
Repair of median and ulnar nerves. Primary suture is best
Authors: Birch R , Raji AR
Published: February 2018

We reviewed, at two to seven years, the results of repair of 108 median and ulnar nerves after clean transection injury between the elbow and wrist in 95 patients ranging in age from 15 to 55 years. Of these, 48 nerves had primary suture, 25 had delayed suture, and 35 were grafted, all repairs being performed by the senior author using standard techniques. Assessment was based on the methods and grading described by Seddon (1975). Thirteen of 60 secondary repairs or grafts failed, but no primary repair failed completely. There were few excellent results; they were found only after primary distal repair in younger patients.
Chondrosarcoma of the soft tissues. Two different sub-groups
Authors: Casadei R , Ricci M , Ruggieri P , Biagini R , Benassi S , Picci P , Campanacci M
Published: February 2018

Chondrosarcomas arising from soft tissues are rare. Two different varieties are described, myxoid and mesenchymal. We have collected nine cases of the tumour, five myxoid and four mesenchymal, from a review of 513 cases of chondrosarcoma seen between 1904 and 1988. We report the principal clinical, radiographical and histological differences between the two varieties and discuss their surgical treatment and prognosis.
Pseudo-abscess of the psoas bursa in failed double-cup arthroplasty of the hip
Authors: Howie DW , Cain CM , Cornish BL
Published: February 2018

Seven psoas bursae filled with purulent fluid and inspissated debris were revealed at revision operations for failed resurfacing hip arthroplasties, an incidence of 5.8% in such revisions. Histological and microbiological investigations demonstrated that the psoas bursa collections resulted from the tissue response to polyethylene wear debris. None was due to infection.