bluuebunny/crossref_metadata_2025 huggingface dataset:
Monteggia injuries in children
Authors: Wiley JJ , Galey JP
Published: February 2018

Forty-six children with Monteggia fracture-dislocations have been studied. The circumstances of the accident could rarely be recalled so that the mechanism of injury remains unclear. The study did, however, confirm the importance of conservative management of the injury in children; unlike the adult variety, this gave very satisfactory results. Our review also supports the classification into three basic types of Monteggia lesion according to the direction of displacement of the dislocated radial head. For simplicity, all other types, variations or equivalents can be regarded as belonging to these basic patterns; in particular we include those controversial cases in which the radiohumeral dislocation is combined with a fractured olecranon.
Bony ankylosis of the elbow after burns
Authors: Seth MK , Khurana JK
Published: February 2018

Ten patients with 13 ankylosed elbows after burns are described. Six elbows, fixed in nearly full extension, had almost total functional disability; the other seven had varying amounts of deformity. In five of the 13 elbows there was a continuous bony mass with loss of the joint space; these were treated by a modified excision arthroplasty which restored good movement and useful function, though there was some lateral laxity. Six elbows had a posterior bony block; this was excised, which restored a useful arc of movement. The literature on bony ankylosis after burns is reviewed and the management of these cases in a developing country is described.
Tibia vara caused by focal fibrocartilaginous dysplasia. Three case reports
Authors: Bell SN , Campbell PE , Cole WG , Menelaus MB
Published: February 2018

We present three cases of a previously undescribed condition characterised by unilateral tibia vara associated with an area of focal fibrocartilaginous dysplasia in the medial aspect of the proximal tibia. The three children affected were aged 9, 15 and 27 months respectively. Two required tibial osteotomy, but in one the deformity resolved without treatment. The pathogenesis of the focal lesion remains conjectural; the most likely explanation is that the mesenchymal anlage of the tibial metaphysis has, for unknown reasons, developed abnormally at the insertion of the pes anserinus.
Total ankle arthroplasty. A long-term review of the London Hospital experience
Authors: Bolton-Maggs BG , Sudlow RA , Freeman MA
Published: February 2018

We report a retrospective study of 62 total ankle arthroplasties performed between 1972 and 1981. Forty-one of these have been reviewed clinically after an average follow-up of five and a half years; only 13 can be described as satisfactory. The complications encountered in all 62 arthroplasties are detailed, the most significant being superficial wound healing problems, talar collapse, and loosening of the components; 13 prosthetic joints have already been removed and arthrodesis attempted. The management of the complications is discussed. In view of the high complication rate and the generally poor long-term clinical results, we recommend arthrodesis as the treatment of choice for the painful stiff arthritic ankle, regardless of the underlying pathological process.
Evaluation of sensibility after sensory reconstruction of the thumb
Authors: Hirasawa Y , Katsumi Y , Tokioka T
Published: February 2018

We have studied the restoration of sensation in 24 patients after operations involving the digital nerves of the thumb. These comprised 10 neurorrhaphies, two nerve graftings, five replantations, one toe-to-thumb transfer and six neurovascular island flaps. The average follow-up period was 46 months. Greater sensitivity was found in the moving two-point discrimination (2PD) test than in the static 2PD test. The results of the Semmes-Weinstein test showed good correlation with the static 2PD test. Porter's letter test showed correlations with both 2PD tests, and the pulp-writing test showed good correlation with the moving 2PD test. The neurorrhaphy cases had the best results using the static 2PD and Semmes-Weinstein test, and had good restoration of sensation; the replantation cases were next best. After neurovascular island flaps, patients exhibited hypersensitivity, double sensation and distorted images on the pulp-writing test. Using this same test the nerve grafting cases had distorted touch perception and perceived a straight line as a curve. The pulp-writing test, using moving touch, is one method of examining mechanoreceptors and shows to what extent the patient perceives what touches the finger pulp; it gives a better indication of higher functions than the 2PD test.
A comparison of Keller's arthroplasty and distal metatarsal osteotomy in the treatment of adult hallux valgus
Authors: Turnbull T , Grange W
Published: February 2018

A prospective trial is reported which compares distal osteotomy of the first metatarsal with Keller's arthroplasty in the treatment of adult hallux valgus. A total of 33 patients attended for review at least three years after operation. Symptomatic improvement, as assessed by patient satisfaction, pain relief, cosmetic improvement and restoration of function, was similar in the two groups. Objective measurement showed that the range of movement of the metatarsophalangeal joint was better maintained after osteotomy, as was the relationship of the sesamoid bones to the head of the first metatarsal. Correction of the valgus deformity also was significantly better in the patients who underwent osteotomy and in these patients the first intermetatarsal angle was reduced to within normal limits. There was no evidence that initial degenerative changes or subluxation at the metatarsophalangeal joint compromised a successful result from osteotomy.
An investigation into contamination of operative suction
Authors: Greenough CG
Published: February 2018

A study of the contamination of suckers used during total hip replacement has been undertaken. Thirty suckers used throughout the operation had their tips cultured: from 11 of these bacteria were grown. The organisms found were those which have previously been implicated in deep infection of total hip replacements. In subsequent operations a further 31 suckers were used for cleaning only the femoral shaft; of these only one was contaminated. This suggests that sucker contamination is related to how long the sucker is in use; consequently it is recommended that a new sucker be used for the preparation of the femoral shaft.
Tectoplasty for painful dislocation or subluxation of the hip. Long-term evaluation of a new acetabuloplasty
Authors: Saito S , Takaoka K , Ono K
Published: February 2018

Tectoplasty is a new acetabuloplasty which aims to provide an extra-articular weight-bearing surface in cases of dysplastic acetabulum, hip subluxation or dislocation with a false acetabulum. The lateral wall of the iliac bone at the lateral edge of the affected acetabulum is raised as a proximally-based flap and massive bone grafts are inserted to provide a congruous, non-absorbable roof for the capsule and femoral head. An advantage is that the weight-bearing surface can be formed away from the original acetabulum, wherever the dislocated or subluxated femoral head may lie. Of 34 hips with congenital dislocation or severe subluxation treated by this method, 27 were evaluated after an average follow-up of 12 years. At review the patients averaged 35 years of age and satisfactory results with good relief of pain had been obtained in 78%. The results were unsatisfactory when degenerative changes had already developed before operation. Tectoplasty is indicated for pain due to congenital subluxation or dislocation of the hip under the age of thirty, in the absence of advanced osteoarthritis.
Experimental methods of repairing injured menisci
Authors: Ghadially FN , Wedge JH , Lalonde JM
Published: February 2018

A longitudinal incision resembling a bucket-handle tear was made in the menisci of 8 rabbits, 6 dogs, 11 pigs and 12 sheep. In some of the animals of each species the cut was repaired by suturing, and in others it was not. Gross inspection, as well as examination by light and electron microscopy, showed that no healing had occurred after six months in the sutured or the unsutured wounds and that the meniscus was incapable of significant intrinsic repair. In a second experiment longitudinal, transverse and T-shaped cuts were made in the menisci of 12 sheep, and a flap of synovium was sutured into the wound. Three months later there was clear evidence of healing by the formation of cartilaginous tissue. Examination by light and electron microscopy showed that the newly formed repair tissue, possibly derived by metaplasia from the synovium, had a morphology intermediate between hyaline cartilage and fibrocartilage. Synovial implantation may therefore be considered as an alternative to meniscectomy in the management of the torn meniscus.
The Batchelor-Grice extra-articular subtalar arthrodesis
Authors: Hsu LC , Jaffray D , Leong JC
Published: February 2018

A new technique is described for extra-articular subtalar arthrodesis; it combines the main elements of the Batchelor and the Grice procedures. Results were reviewed after a minimum of three years. Of the 25 feet treated 24 had solid fusion and had maintained the operative correction of the valgus deformity; the one non-union was due to deep infection.
Symptomatic calcaneonavicular bars. The results 20 years after surgical excision
Authors: Inglis G , Buxton RA , Macnicol MF
Published: February 2018

Eleven patients were reviewed an average of 23 years after they had been treated by excision of a symptomatic calcaneonavicular bar in 16 of their feet. Of these feet 69% (11 feet) had a good or excellent result. Of the five failures, three feet had good results after subsequent triple arthrodesis, but two treated by repeated excision of the bar were still unsatisfactory. Beaking of the talus seen before operation correlated with poor results.
Thermographic diagnosis in athletes with patellofemoral arthralgia
Authors: Devereaux MD , Parr GR , Lachmann SM , Thomas DP , Hazleman BL
Published: February 2018

Pain in front of the knee is common in athletes and is often called patellofemoral arthralgia, but it is difficult to prove that the pain arises in that joint. Thermograms of 30 athletes clinically considered to have patellofemoral arthralgia were compared with those of a similar number of unaffected athletes matched for age and sex. A comparison was also made with thermograms of two older groups of 30 patients with knee involvement from either rheumatoid arthritis or osteoarthritis. Twenty-eight of the athletes with patellofemoral arthralgia had a diagnostic pattern on thermography. The anterior knee view showed a rise in temperature on the medial side of the patella and the medialis knee view showed that this temperature rise radiated from the patellar insertion of the vastus medialis into the muscle itself. The possible aetiological role of quadriceps muscle imbalance in athletes with patellofemoral arthralgia is discussed in relation to these findings.
Conservative management of distraction-type stress fractures of the femoral neck
Authors: Aro H , Dahlstrom S
Published: February 2018

Four military recruits with complete distraction-type stress fractures of the femoral neck were treated conservatively. The radiographic diagnosis was made within two weeks of the onset of symptoms and the activities of the patients were matched to the clinical and radiographic progress of fracture healing. None of the fractures displaced and union occurred uneventfully. Our experience suggests that prophylactic internal fixation of these fractures is not necessary.
Compression screw fixation for displaced subcapital fracture of the femur. Success or failure?
Authors: Skinner PW , Powles D
Published: February 2018

We report a prospective study of 198 cases of subcapital fracture of the femur treated by closed reduction and fixation with a sliding compression screw-plate. This was done without regard to the patient's age or the Garden stage of the fracture. Early weight-bearing was encouraged. Of the displaced fractures 23% failed in the first year because of non-union or infection. Of the fractures which united 27% had developed avascular necrosis after three years. Despite this we believe that the sliding compression screw-plate, of proven value in the treatment of intertrochanteric fractures, is also useful for the fixation of subcapital fractures.
Costectomy as the first stage of surgery for scoliosis
Authors: Owen R , Turner A , Bamforth JS , Taylor JF , Jones RS
Published: February 2018

Preliminary costectomy before Harrington instrumentation and fusion for idiopathic scoliosis allows direct excision of the rib prominence and better correction at the second-stage operation. The excised rib fragments are used as grafts, thus avoiding the need for a separate pelvic incision. The management regime and the technique of costectomy are described. The results in 42 children, most suffering from adolescent idiopathic scoliosis and all treated by this method, have been reviewed. Respiratory function in a group of these children has been compared with that of a group treated by Harrington instrumentation alone. Costectomy produced a significantly greater reduction in total lung capacity and peak expiratory flow rate but, providing the preliminary lung function tests were reasonably normal, the cosmetic and psychological effects of costectomy were very rewarding.
Osteosarcoma arising in relation to an enchondroma. A report of three cases
Authors: Smith GD , Chalmers J , McQueen MM
Published: February 2018

Three cases are reported in which an osteosarcoma developed in relation to an enchondroma in a long bone. Two of the cases were in the proximal femur whilst one occurred in the proximal humerus, both recognised sites for old calcified enchondromas or "cartilage rests". The ages of the patients at presentation were 55, 63 and 84 years and all were women. Two patients died with pulmonary metastases within six months of the onset of clinical symptoms. Despite their intimate relationship to the enchondromas, none of the osteosarcomas could be shown histologically to have arisen from tumour cartilage. It appears probable that these are cases in which independently arising tumours have merged to form a so-called "collision" tumour, but the possibility that they could have been derived by dedifferentiation of a previously benign neoplasm cannot be discounted.
The fate of fat transplants in operations for partial closure of the growth plate. Clinical examples and an experimental study
Authors: Langenskiold A , Videman T , Nevalainen T
Published: February 2018

The cavities left after resection of bone bridges for partial closure of growth plates in children have commonly been filled with free fat grafts. Such cavities have been seen to elongate and thus enlarge during growth after the operation, but the fate of the grafts has been unknown. Similar cavities, made in the tibiae of growing pigs were filled with autogenous fat and studied by radiography for periods of up to 9 1/2 months. These cavities elongated in a manner similar to those in the clinical cases, and histological section showed them to be filled with living adipose tissue. The volume of this tissue had continuously increased in parallel with the growth in length of the bone. The fate of the grafts used in children may be similar to that seen experimentally.
The significance of spasticity in the upper and lower limbs in myelomeningocele
Authors: Mazur JM , Stillwell A , Menelaus M
Published: February 2018

One hundred and nine children with myelodysplasia were evaluated and classified according to the level and type of paralysis and its effect on functional ability. Thirty-one per cent of the patients were paralysed at the thoracic level, 26% at the upper lumbar level, 30% at the lower lumbar level and 13% at the sacral level. Fifty-four per cent of these patients demonstrated the classic flaccid paralysis in the lower limbs with normal upper limbs; 9% were flaccid in the lower limbs, but were spastic in the upper; 24% were spastic in the lower limbs; 13% were spastic in the upper and lower limbs. Patients with spastic lower limbs required more orthopaedic procedures, more days in hospital and in casts, and were less likely to walk than those with flaccid paralysis. Patients with spastic upper limbs were less likely to be independent in activities of daily living and were more likely to require special schools than patients with normal upper limbs. In addition to the spinal cord level of the lesion, the degree of spasticity is important in the evaluation, treatment and prognosis of myelodysplastic patients.
Total hip replacement in children with juvenile chronic arthritis
Authors: Ruddlesdin C , Ansell BM , Arden GP , Swann M
Published: February 2018

The results of 75 total hip replacements in 42 children with juvenile chronic arthritis are reported after a mean follow-up of 5.4 years. Their ages ranged from 11 to nearly 17 years at operation and many had active disease. Severe pain and marked stiffness of the hips were limiting their independence. At least half of the children were still growing and continued to grow after operation. The patients were carefully selected and gratifying results were obtained, but pre-operative assessment and overall supervision by a rheumatologist are important. Technical difficulties related to the size and maldevelopment of the hip are discussed. There was no infection and the single case of loosening of a femoral component after nine years has been successfully revised.
The outcome of infected arthroplasty of the knee
Authors: Johnson DP , Bannister GC
Published: February 2018

In order to define the predisposing factors and outcome of infected arthroplasty of the knee, a retrospective analysis of a consecutive series of 471 knee arthroplasties was performed. There were 23 cases of superficial wound infection and 25 of deep infection. Superficial wound infection alone resulted in a painfree gait, with little limitation of movement. Rheumatoid arthritis, the use of constrained prostheses and the presence of a superficial wound infection, all predisposed to deep infection. Deep infection was eradicated by long-term antibiotics in only two patients in whom skin cover was successfully provided by a gastrocnemius musculocutaneous flap. Excision of a sinus track, wound debridement and exchange arthroplasty were universally unsuccessful. Arthrodesis, however, in 11 out of 12 cases, provided the painfree gait these patients desire.
Radiographic assessment in patellar instability and chondromalacia patellae
Authors: Dowd GS , Bentley G
Published: February 2018

Minor degrees of malalignment of the patella and anatomical abnormalities including a flattened sulcus angle and an increased ratio between patellar tendon length and patellar length (PT:P) have been suggested as predisposing factors in the causation of chondromalacia patellae, as well as patellar instability. In order to confirm or refute this hypothesis a prospective study has been performed comparing the congruence and sulcus angles and the PT:P ratio in a group of 35 patients with chondromalacia confirmed by arthroscopy and a group of 33 patients with instability, with those of a group of 50 knees in normal volunteers. While there was a statistically significant correlation between an increased sulcus and congruence angle and a high-riding patella in patients with instability, no correlation could be identified in patients with idiopathic chondromalacia.
Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation
Authors: Crockard HA , Pozo JL , Ransford AO , Stevens JM , Kendall BE , Essigman WK
Published: February 2018

Cervical myelopathy is an uncommon but potentially fatal complication of rheumatoid atlanto-axial subluxation. Computerised myelotomography with three-dimensional reconstruction shows that rheumatoid pannus, together with the odontoid peg, contributes significantly to anterior cervico-medullary compression. These findings were the basis for treatment by transoral anterior decompression and posterior occipitocervical fusion, which removes both bony and soft-tissue causes of compression and allows early mobilisation without major external fixation. We report encouraging results from this combined approach in 14 patients who had progressive neurological deterioration.
Anteversion of the acetabular cup. Measurement of angle after total hip replacement
Authors: Ackland MK , Bourne WB , Uhthoff HK
Published: February 2018

We describe a new method for the accurate measurement of the angle of anteversion of an acetabular cup from standard anteroposterior radiographs, and provide the conversion tables required. The effect of the centering of the radiograph is discussed and a method of distinguishing between anteversion and retroversion by using a caudally directed x-ray beam is described.
Avascular necrosis in congenital hip dislocation. The significance of splintage
Authors: Pool RD , Foster BK , Paterson DC
Published: February 2018

Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by adductor tenotomy and the splint no case of avascular necrosis was encountered. In the whole series the incidence of significant long-term growth disturbance in children treated in this splint was 0.7%. The great majority of our cases of avascular necrosis were attributable to manipulation and plaster, not to the subsequent use of a splint.
Anterior cruciate ligament injuries. To counsel or to operate?
Authors: Satku K , Kumar VP , Ngoi SS
Published: February 2018

Untreated anterior cruciate ligament injuries in 97 knees of 87 patients were reviewed after a mean interval of six years. After their initial recovery 63% of the patients were able to return to their pre-injury sport, but six years later 27% of them had deteriorated to the extent that they could not cope with the same level of sport. Radiological deterioration was maximal in those that had had a meniscectomy more than five years before review. Knees with intact menisci were often radiologically normal despite continuing instability.
Lengthening the ulna in patients with hereditary multiple exostoses
Authors: Pritchett JW
Published: February 2018

Deformity of the forearm is common in patients with hereditary multiple exostoses, producing cosmetic and functional impairment in which shortening of the ulna is a significant factor. The results of ulnar lengthening in 10 forearms of eight patients are reported. Lengthening was performed by osteotomy of the shaft followed immediately by a bone graft and internal fixation, or by gradual distraction with an external fixator. In all patients the appearance was improved and the range of radial deviation at the wrist was increased. In most patients forearm movement and radial head stability were improved. Partial recurrence of the deformity was seen during the follow-up of skeletally immature patients, but in general ulnar lengthening was found to be a useful operation.
Overgrowth of the femur after fracture in childhood. An increased effect in boys
Authors: Clement DA , Colton CL
Published: February 2018

Forty-four children, treated conservatively for fracture of the shaft of a femur, were studied radiographically to assess the consequent increase in longitudinal growth of the bone. Overgrowth averaged 8.1 mm and was shown to be significantly greater in boys than in girls. Overgrowth did not appear to be influenced by the age of the patient, the type of injury, the type or site of the fracture, the amount of overlap of the fragments or by the handedness of the patient.
Metastatic osteosarcoma and multiple lung resection. A case report
Authors: Blasier D , Mayba I , Ferguson C , DeSa D , Bishop A , Letts M
Published: February 2018

The existence of pulmonary metastases in patients presenting with osteosarcoma is known to indicate a poor prognosis. Lung resection of solitary lesions is now a standard treatment approach, but with limited successful long-term results. We report the progress of a 16-year-old girl with osteosarcoma of the proximal tibia who underwent 11 lung resections for pulmonary metastases over a two-year period, and who has since then been free of disease for seven years.
Angulation of the radius in children's fractures
Authors: Roberts JA
Published: February 2018

A study of 79 children with malunion of forearm fractures is presented. Age at the time of injury, the site of the fracture and the degree and direction of angulation at union were correlated with loss of forearm rotation at review 3.5 to 6 years later. Some guidelines are proposed for the acceptability of angular deformity at union, importance being placed on the avoidance of radial deviation of the radius, and the maintenance of the interosseous gap between the shafts of the radius and ulna.
Supracondylar fractures of the humerus. Assessment of cubitus varus by the Baumann angle
Authors: Worlock P
Published: February 2018

A simple method of radiological assessment has been used to measure the angle between the long axis of the humeral shaft and the growth plate of the capitellum (the Baumann angle). In the normal arm a significant relationship was found between the Baumann angle and the carrying angle. The Baumann angle was also measured after reduction of supracondylar fractures of the humerus and was found to correlate well with the final carrying angle measured at follow-up. There was no significant difference between the Baumann angle after reduction and that measured at follow-up; and it is suggested that this angle after reduction can be reliably used to predict accurately the final carrying angle.
Acute carpal tunnel syndrome. Complications of delayed decompression
Authors: Ford DJ , Ali MS
Published: February 2018

Five patients suffered injuries around the wrist complicated by acute tunnel syndrome. Pain associated with median nerve paraesthesia or hypo-aesthesia are indications for urgent treatment; in four patients where operation was delayed, the outcome was poor.
The Robert Jones bandage
Authors: Brodell JD , Axon DL , Evarts CM
Published: February 2018

A bulky compression dressing (the Robert Jones bandage) is often used by orthopaedic surgeons. We have reviewed its history and monitored intramuscular compartment pressure under it after total knee replacement. We found that it increased compartment pressure and helped to reduce bleeding, tissue oedema and the size of effusions and haemarthroses.
Anterior midline or medial parapatellar incision for arthroplasty of the knee. A comparative study
Authors: Johnson DP , Houghton TA , Radford P
Published: February 2018

Early mobilisation after arthroplasty of the knee sometimes results in wound breakdown. The two commonly used incisions, the anterior midline and the medial parapatellar incisions, were compared in order to determine which had the best potential for wound healing. Study of the cleavage lines around the knee demonstrated that the medial parapatellar incision lies parallel to the lines, whilst the anterior midline incision lies perpendicular to them. In addition, the medial parapatellar wound was found to be subjected to significantly less tension during flexion; after arthroplasty it can be expected to heal faster and to be less liable to disruption during early mobilisation.
Repeat compartment decompression with partial fasciectomy
Authors: Bell S
Published: February 2018

After having had a standard decompression for anterior compartment syndrome, five patients presented with persistent symptoms and pressure values above normal. A repeat procedure combined with fasciectomy relieved their pain; postoperative pressure values were normal.
Regeneration of the sciatic nerve in rats. The effect of muscle basement membrane
Authors: Glasby MA , Gschmeissner S , Hitchcock RJ , Huang CL
Published: February 2018

An orientated substratum has been implicated in the development and regeneration of axons and synapses. We prepared a basement membrane matrix from autogenous striated muscle, used it to repair the sciatic nerve in rats, then investigated the results by histology and electrophysiology. When treated grafts were coaxially aligned with the nerve fascicles functional recovery appeared within 30 days, with good growth of axons into the distal nerve. Grafts with myotubes at right angles to the nerve fascicles supported nerve regeneration but at a slower rate. Grafts of coaxially aligned but untreated muscle allowed axon penetration only through naturally degenerated muscle fibres, with minimal axon penetration of the distal nerve. It is concluded that in the rat a treated graft with correctly orientated empty myotubes can facilitate and guide the regeneration of peripheral nerve after injury and so lead to recolonisation of the distal stump with functional recovery.
Genesis of the ball-and-socket ankle
Authors: Takakura Y , Tamai S , Masuhara K
Published: February 2018

Ball-and-socket ankle is a rare deformity associated with such pre-existing conditions as congenital shortening of the lower limb, coalition of tarsal bones, absent digital rays and aplasia or hypoplasia of the fibula. We have observed seven patients with this deformity for an average of six years from initial examination at 20 days to 3.5 years. Arthrography showed that the configuration of the ankle was apparently normal in patients under 10 months of age and that a ball-and-socket joint develops by four to five years of age, possibly in compensation for the loss of inversion and eversion caused by tarsal coalition. Ball-and-socket joint is therefore probably not congenital, but is an acquired deformity secondary to various pre-existing congenital conditions.
The Elephant Woman. Neurofibromatosis associated with pseudarthrosis of the humerus
Authors: Floyd A , Percy-Lancaster R
Published: February 2018

A woman with neurofibromatosis (von Recklinghausen's disease) presented with a giant plexiform neuroma of the arm and chest wall, with dysplastic scoliosis and a pseudarthrosis of the humerus. Her arm resembled that of the "Elephant Man" described by Sir Frederick Treves.
The Magnuson-Stack operation for recurrent anterior dislocation of the shoulder. A review of 38 cases
Authors: Ahmadain AM
Published: February 2018

The modified Magnuson-Stack procedure of lateral and distal transfer of the insertion of the subscapularis muscle was used in 38 consecutive patients with recurrent anterior dislocation of the shoulder, all of whom have been followed-up for a minimum of three years. There was only one failure; the other 37 patients had an excellent or satisfactory result with an adequate range of movement. Bankart and Hill-Sachs lesions were not a constant finding but subscapularis laxity was detected in almost every case, an observation that helps to confirm its central role as a cause of recurrence.
A prospective study of parachute injuries in civilians
Authors: Amamilo SC , Samuel AW , Hesketh KT , Moynihan FJ
Published: February 2018

A prospective study of 33 civilian parachutists with 41 injuries is presented. Because the training for civilians is less rigorous than that for military parachutists, the hospital admission rate for severe injuries was high (81.8%). Most injuries occurred during landing and the ankle was most frequently involved. The types and possible mechanisms of injury are discussed, as well as recommendations for modifying the civilian training programme.
Anterior and posterior instrumentation and fusion of thoracolumbar scoliosis due to myelomeningocele
Authors: McMaster MJ
Published: February 2018

Twenty-three patients with severe paralytic thoracolumbar scoliosis due to a myelomeningocele were treated by a two-stage procedure. Before operation the mean scoliosis was 98 degrees: after the first-stage procedure, an anterior spinal fusion and correction with Dwyer instrumentation, this was reduced to a mean of 45 degrees. Approximately two weeks later a posterior spinal fusion with Harrington instrumentation was performed, further reducing the scoliosis to a mean of 29 degrees. The pelvic obliquity also was reduced from a mean of 32 degrees to 6 degrees. Although such management carries risks (one patient died of cardiorespiratory failure after the first stage and one patient was made worse), 21 of the 23 patients had improved posture and function.
Femoral anteversion. A clinical assessment of idiopathic intoeing gait in children
Authors: Gelberman RH , Cohen MS , Desai SS , Griffin PP , Salamon PB , O'Brien TM
Published: February 2018

Hip rotation in extension and flexion was studied in 23 patients with idiopathic intoeing gait. In extension all the hips had markedly increased medial rotation and limited lateral rotation, fulfilling the criteria of excessive femoral anteversion. In flexion, however, rotation varied widely; in one group of patients medial rotation remained greater than lateral, but in the second group lateral rotation was equal to or greater than medial. CT scans showed that the hips in the first group were significantly more anteverted than those in the second. Clearly measurement of hip rotation in extension alone does not provide a dependable indication of femoral anteversion in children with intoeing gait; rotation in flexion also needs to be measured.
Osteochondritis dissecans of the ankle. A 20-year follow-up study
Authors: Bauer M , Jonsson K , Linden B
Published: February 2018

Thirty patients with osteochondritis dissecans of the ankle have been followed up for an average of 21 years. The histories and radiographs were reviewed, and it was found that most patients had only minor radiographic changes and symptoms. Two patients had developed osteoarthritis but in only one was this severe. Osteochondritis dissecans in the ankle thus seems to differ from the same lesion in the knee where late osteoarthritis often occurs. Two lesions were located on the joint surface of the distal tibia, a site not previously reported.
Sonography and joint pressure in synovitis of the adult hip
Authors: Wingstrand H , Egund N , Forsberg L
Published: February 2018

Sonography was successfully used to diagnose an effusion in the hips of three adults with septic arthritis and four with aseptic synovitis. The effusions were confirmed by aspiration. All the patients had markedly increased intracapsular pressure which, in the extended position, exceeded the systolic blood pressure and could well compromise the blood supply to the head of femur. Aspiration reduced pain and intracapsular pressure, as did flexion of the hip to 45 degrees.
Ultrasound assessment of femoral anteversion. A comparison with computerised tomography
Authors: Berman L , Mitchell R , Katz D
Published: February 2018

The calculation of femoral anteversion using a static ultrasound scanner has been compared with results obtained by computer tomographic (CT) scanning. Assuming the CT results to be accurate, the ultrasound method was frequently found to be unreliable.
Scoliosis in juvenile chronic arthritis
Authors: Ross AC , Edgar MA , Swann M , Ansell BM
Published: February 2018

Structural scoliosis occurs more commonly in patients with juvenile chronic arthritis than in the normal population. We have reviewed 32 patients with both juvenile arthritis and a scoliosis and suggest that structural curves may arise from postural curves associated with asymmetrical involvement of lower limb joints.
Myelopathy hand. New clinical signs of cervical cord damage
Authors: Ono K , Ebara S , Fuji T , Yonenobu K , Fujiwara K , Yamashita K
Published: February 2018

A characteristic dysfunction of the hand has been observed in various cervical spinal disorders when there is involvement of the spinal cord. There is loss of power of adduction and extension of the ulnar two or three fingers and an inability to grip and release rapidly with these fingers. These changes have been termed "myelopathy hand" and appear to be due to pyramidal tract involvement. The characteristic nature of the signs permit the distinction between myelopathy and changes due to nerve root or peripheral nerve disorder. The clinical significance of these signs has been assessed against other tests and their value in management is discussed.
Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome
Authors: Styf J , Korner L , Suurkula M
Published: February 2018

In nine patients with chronic compartment syndrome, the intramuscular pressure and muscle blood flow during constant dynamic exercise was studied by the microcapillary infusion method and by the 133-xenon clearance technique. Although muscle blood flow was normal at the start of exercise, pain and impaired muscle function eventually developed; muscle blood flow decreased while muscle relaxation pressure increased. The changes of muscle blood flow could not be correlated with any change of mean muscle pressure during exercise. Eight months after fasciotomy the exercise test was repeated. Patients experienced no symptoms and the muscle relaxation pressure and blood flow during exercise were normal. It is suggested that chronic compartment syndrome is due to increased muscle relaxation pressure during exercise which causes decreased muscle blood flow, leading to ischaemic pain and impaired muscle function.
Osteochondritis dissecans of the patella
Authors: Desai SS , Patel MR , Michelli LJ , Silver JW , Lidge RT
Published: February 2018

We reviewed 13 cases of osteochondritis dissecans of the patella followed-up for 18 months to 19 years. Two were treated conservatively with excellent results, and 11 by operation with six excellent, four good and one fair result. There was complete radiographic healing of the defect in 10 cases and partial healing in three. The size of the osteochondritic lesion appeared to be of prognostic significance. Osteochondritis dissecans of the patella is the result of repeated minor injuries to the articular surface. Operation is indicated for persistent pain, intra-articular loose bodies and subchondral sclerosis; excision of the fragment and curettage of the crater, with or without drilling, is recommended.
Rupture of the calcaneal tendon. The early and late management
Authors: Carden DG , Noble J , Chalmers J , Lunn P , Ellis J
Published: February 2018

We have reviewed 106 patients after treatment for spontaneous rupture of the calcaneal tendon, and assessed the clinical results including the power of plantarflexion. In patients treated within 48 hours of injury the result was very similar in conservatively and in operatively treated patients. The incidence of major complications was higher after operation (17%) than in those treated conservatively (4%). Patients who were treated more than one week after injury, however, had an inferior result with respect to power of plantarflexion after conservative management. It is therefore recommended that calcaneal tendon rupture is treated conservatively with a plaster in full equinus when it is diagnosed within 48 hours of injury, and by operation when diagnosis has been delayed for more than one week.
Intramedullary haemorrhage as a possible cause of avascular necrosis of the femoral head. The histology of 16 femoral heads at the silent stage
Authors: Saito S , Inoue A , Ono K
Published: February 2018

We have studied core biopsy specimens from 16 femoral heads affected by idiopathic avascular necrosis at the silent stage, when there were no clinical or radiographic manifestations but scintigraphy was positive. All the specimens showed necrosis of trabeculae and of bone marrow, but the most common and characteristic feature was evidence of old and new haemorrhage in the marrow. In the areas of intramedullary haemorrhages, trabeculae and bone marrow were completely necrotic, with a transitional area of incomplete necrosis between these areas and those without haemorrhagic lesions, where the trabeculae and bone marrow were normal. There was good correlation between necrosis and haemorrhagic episodes, and it was concluded that repeated intramedullary haemorrhage at the silent stage is probably related to the pathogenesis of idiopathic avascular necrosis of the femoral head.
Deep infection in Charnley low-friction arthroplasty. Comparison of plain and gentamicin-loaded cement
Authors: Lynch M , Esser MP , Shelley P , Wroblewski BM
Published: February 2018

A retrospective review of 1542 Charnley low-friction arthroplasties was carried out to compare the incidence of deep infection arising after plain and gentamicin-containing acrylic cement. There was no significant difference between the two series in primary operations, the infection rate being 1.72% and 1.65% respectively. However, in secondary operations (conversions and revisions) the gentamicin-containing cement gave significantly better results--a 0.81% infection rate as compared with 3.46%. All operations were performed in a clean air enclosure using total-body exhaust suits. Radiological diagnosis of deep infection was possible within one year of operation in all cases. Late haematogenous infection occurred in one case and was related to a skin lesion.
Changes in local bone density after knee arthroplasty. The use of quantitative computed tomography
Authors: Seitz P , Ruegsegger P , Gschwend N , Dubs L
Published: February 2018

Loosening is a serious problem in total arthroplasty and early detection of bone loss in the vicinity of an implant would help in its investigation. We present a method for the objective evaluation of bone adjacent to metallic implants in which a modified technique of quantitative computed tomography (QCT) is used to reconstruct cross-sectional images with few artefacts. We have used this technique in 19 patients with knee arthroplasties to monitor the changes in bone density around the tibial stem of the prosthesis. In the first weeks after operation all patients showed a decrease in bone density ranging from 0.4% to 3.6% per month. One year after arthroplasty bone density had stabilised and only minor changes were observed. Our work indicates that modified QCT is a sensitive method for the long-term monitoring of the anchorage of implants and allows the early detection of osteolytic changes.
Triplane fracture of the distal tibia. A variant in cases with an open growth plate
Authors: Clement DA , Worlock PH
Published: February 2018

We have reviewed 15 cases of triplane fracture of the distal tibia. The mechanism of injury is lateral rotation and the anatomical pattern of the fracture depends on the state of the growth plate at the time of injury. In seven of our cases the anteromedial part of the growth plate was fused, but in eight children the plate was completely open. In six of these eight children there was a hump or projection of the medial growth plate. It is suggested that this hump stabilises the anteromedial part of the epiphysis in a manner similar to the partial anteromedial fusion seen in older children, and that this accounts for the occurrence of triplane fracture in the presence of an open growth plate.
The value of early mobilisation in the treatment of Colles' fractures
Authors: Dias JJ , Wray CC , Jones JM , Gregg PJ
Published: February 2018

Unilateral Colles' fractures in 187 patients over the age of 55 years were studied in a randomised prospective trial: 97 fractures were minimally displaced and were treated either conventionally or in a crepe bandage; 90 displaced Colles' fractures were reduced and of these 47 were treated conventionally while 43 were encouraged to mobilise the wrist in a cast which restricted extension. Early wrist movement hastened functional recovery and led to earlier resolution of wrist swelling. Discomfort was no greater than in patients who were treated conventionally. The bony deformity, which recurred irrespective of the method of treatment, was not adversely affected by early mobilisation.
Elastofibroma of the hand
Authors: Kapff PD , Hocken DB , Simpson RH
Published: February 2018

A 69-year-old man presented with a 20-year history of a slowly enlarging mass of the left index finger dating from a hammer injury. The mass was excised, and seen to have the characteristic histological appearance of an elastofibroma, a benign tumour-like growth usually found in the soft tissue of the back. Such a lesion has not previously been documented in the hand, which we consider surprising in view of the generally accepted traumatic aetiology of this entity and the susceptibility of the hand to injury.
Cervical cord compression from ossification of the posterior longitudinal ligament in non-orientals
Authors: McAfee PC , Regan JJ , Bohlman HH
Published: February 2018

We report 14 cases of symptomatic ossification of the posterior longitudinal ligament (OPLL) diagnosed in non-oriental men between 1978 and 1985. All 14 patients had incomplete spinal cord syndromes due to OPLL in the cervical spine and had been referred undiagnosed from other institutions. Twelve had severe myelopathy and seven were wheelchair-bound before OPLL was diagnosed, while six patients had had operations elsewhere for their neurological dysfunction. There was a close association between OPLL and diffuse idiopathic skeletal hyperostosis (Forestier's disease) on plain radiographs, seven patients having both disorders. Enhanced CT scans proved to be the best diagnostic method for the localisation of cord compression, and magnetic resonance imaging, used on four recent cases, provided the best visualisation of the extent of involvement in the sagittal plane. We aim to heighten awareness of OPLL in non-orientals, in whom the clinical features, histological characteristics, and radiographic patterns are very similar to those of oriental patients.
Callus formation and the rate of healing of femoral fractures in patients with head injuries
Authors: Perkins R , Skirving AP
Published: February 2018

Callus formation and the rate of union of nailed fractures of the femur has been determined in 22 patients with associated head injuries and compared with that in a group of patients with similarly treated fractures but without head injuries. The comparison confirms the widely held view that, in patients with head injuries, fractures frequently heal with excessive callus and at a faster rate than normal.
Fractional necrosis of the femoral head epiphysis after transient increase in joint pressure. An experimental study in juvenile rabbits
Authors: Vegter J , Lubsen CC
Published: February 2018

Ischaemia resulting from increased joint pressure may play a role in the pathogenesis of necrosis of the femoral head epiphysis. We studied the effect of temporary vascular occlusion on this epiphysis in young rabbits. Occlusion for six hours resulted in necrosis of trabecular bone and of intertrabecular marrow and vascular tissue, later followed by revascularisation and repair, as has been demonstrated previously. In contrast, raised intra-articular pressure lasting for only two hours resulted in a more complex picture: trabecular osteocytes were dead, whereas the bone-forming marrow was shown by fluorochrome labelling to remain viable, and to form appositional repair bone throughout the epiphysis. We concluded that transient vascular occlusion may cause the death of trabeculae despite intact perfusion of the bone. This type of change may be important in the pathogenesis of Perthes' disease.