bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound examination of the irritable hip
Authors: Bickerstaff DR , Neal LM , Booth AJ , Brennan PO , Bell MJ
Published: February 2018

We made a prospective study of 111 children with acute hip pain to assess whether ultrasound can replace traditional radiography. An effusion was diagnosed in 71% by ultrasound but in only 15% by radiography. This effusion persisted for a mean of nine days; symptoms lasted for five days. Two patients found to have Perthes' disease had longer-lasting effusion and symptoms. Patients without an effusion had no obvious cause for their pain, so the pressure of an effusion from a transient synovitis does not account for all patients with irritable hips. Patients with an effusion persisting for over 24 days (the mean + 2 s.d. of our series) had more symptoms, a significantly larger effusion and greater limitation of movement. They may be more at risk for avascular necrosis. We found that radiographic examination influenced the immediate management of only two patients, those with Perthes' disease. We therefore propose a protocol of management for irritable hip, using ultrasonography at the first presentation of certain categories of patients. This would reduce the number of early radiographs by 75%.
Remodelling after pinning for slipped capital femoral epiphysis
Authors: Jones  , Paterson DC , Hillier TM , Foster BK
Published: February 2018

We assessed 70 hips at an average of 7.1 years after pinning for slipped upper femoral epiphysis to determine the frequency of remodelling, what factors influence it and its effect on the clinical outcome. Remodelling was defined by a new classification of the anterior femoral head-neck profile as seen on the lateral radiograph. Remodelling occurred in 50% of hips with a head-shaft angle of 30 degrees or more; the probability of remodelling was significantly less the greater the degree of slip, but was significantly increased if the triradiate cartilage was open at the time of presentation. We found no significant effect for age, sex, weight or length of symptoms. The range of internal rotation was significantly greater in those hips that remodelled. We support the treatment of moderate slips in skeletally immature patients by pinning in situ, since the probability of satisfactory remodelling was 75% for slips of 40 degrees or less.
Carbon fibre composite bone plates. Development, evaluation and early clinical experience
Authors: Ali MS , French TA , Hastings GW , Rae T , Rushton N , Ross ER , Wynn-Jones CH
Published: February 2018

We compared the mechanical properties of carbon fibre composite bone plates with those of stainless steel and titanium. The composite plates have less stiffness with good fatigue properties. Tissue culture and small animal implantation confirmed the biocompatibility of the material. We also present a preliminary report on the use of the carbon fibre composite plates in 40 forearm fractures. All fractures united, 67% of them showing radiological remodelling within six months. There were no refractures or mechanical failures, but five fractures showed an unexpected reaction; this is discussed.
Partial versus complete acute anterior cruciate ligament tears. The results of nonoperative treatment
Authors: Barrack RL , Buckley SL , Bruckner JD , Kneisl JS , Alexander AH
Published: February 2018

A study was undertaken to determine whether a significantly different clinical outcome could be expected following nonoperative treatment of acute partial anterior cruciate ligament (ACL) tears from that of complete tears. A detailed follow-up of 107 patients with arthroscopically confirmed tears was obtained; 72 were complete tears and 35 partial. The overall results in those with partial tears were 23% excellent, 29% good, 17% fair, and 31% poor; with complete tears the results were 11% excellent, 20% good, 15% fair, and 54% poor. The patients with partial tears had a lower incidence of associated meniscal tears, needed fewer reconstructions and more of them returned to sport than those with complete tears.
One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation
Authors: Crockard HA , Calder I , Ransford AO
Published: February 2018

An operation which combined anterior transoral decompression with posterior occipitocervical fixation was used in 68 rheumatoid patients with irreducible anterior neuraxial compression at the craniocervical junction. Fibre-optic laryngoscopy with nasotracheal intubation was less hazardous than tracheostomy. The patients underwent surgery in the lateral position to allow access both to the mouth and to the back of the neck without moving the head. Specially designed instruments allowed visualisation from the front without dividing the soft palate. Posterior stabilisation was achieved by a preformed contoured loop fixed to the occiput, the atlas and the axis by sublaminar wires. The procedure allowed immediate mobilisation and had a very low morbidity in such ill patients.
The diagnostic value of arthroscopy in glenohumeral instability
Authors: Mok DW , Fogg AJ , Hokan R , Bayley JI
Published: February 2018

Over a six-year period, 166 shoulder arthroscopies were performed in 153 patients with symptoms of subluxation, but no firm evidence of dislocation and no clear-cut clinical diagnosis. Arthroscopy confirmed the working diagnosis in 133 shoulders (80%), but changed it in 33 (20%). In 26 shoulders the presumed direction of instability was changed and in seven a different diagnosis was made. Arthroscopy was particularly helpful for patients with shoulder instability of uncertain type or direction.
Transfer of the trapezius for flail shoulder after brachial plexus injury
Authors: Aziz W , Singer RM , Wolff TW
Published: February 2018

Shoulder arthrodesis is often used to treat flail shoulder after a brachial plexus injury, but has a high complication rate and entails loss of passive mobility. We have reviewed 27 patients with brachial plexus injury treated by transfer of the trapezius to the proximal humerus at an average time from injury of 31.3 months. Pre-operatively, all 27 shoulders were subluxated, with an average abduction of 3.5 degrees. Postoperatively, shoulder abduction averaged 45.4 degrees, and subluxation was abolished. All patients were satisfied with their improvement in function. Trapezius transfer is recommended as a simple procedure that requires only a brief period in hospital, allows early rehabilitation, and gives a satisfactory outcome, while retaining passive mobility of the shoulder.
Radiographic appearances in lumbar disc prolapse
Authors: MacLean JG , Tucker JK , Latham JB
Published: February 2018

The pre-operative lumbar spine radiographs of 200 consecutive patients who had undergone discectomy for prolapsed intervertebral disc were reviewed. Prolapse was recognized as bulging or sequestration of the disc with consequent root compromise. Measurement of the lumbar level of the interiliac line was shown to correlate with the level of disc prolapse and the incidence of transitional vertebrae at the lumbosacral junction was significantly higher than normal. A pathological value for the lumbosacral angle could not be identified.
The incidence of deep vein thrombosis after cementless and cemented knee replacement
Authors: Kim YH
Published: February 2018

The incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied. In 120 the prosthesis was cemented and in 124 it was cementless. In all cases the replacement was primary and a porous-coated prosthesis with a porous-coated central tibial stem was used. Deep vein thrombosis was diagnosed by venography, and pulmonary embolism by perfusion scanning. The incidence of deep vein thrombosis in the cementless knees (23.8%) and in the cemented (25%) was approximately the same. The only significant predisposing factors for deep vein thrombosis in both groups were obesity, prolonged postoperative immobilisation, previous venous disease and hyperlipidaemia.
Mechanism of the pivot shift
Authors: Matsumoto H
Published: February 2018

The mechanism of the pivot shift was investigated by analysing movements under valgus torque in 29 fresh cadaveric knees. The movements were measured in three dimensions, using biplanar photography, when all the ligaments were intact, and then after the ligaments were sequentially divided. When only the anterior cruciate ligament was sectioned, the pivot shift occurred in seven out of 20 knees examined. In the other 13, though the pivot shift was not observed, an abnormal internal rotation occurred at between 10 degrees and 50 degrees of flexion. Division of the iliotibial tract in addition to division of the anterior cruciate ligament stopped the pivot shift, as the tibia remained internally rotated throughout the range of flexion. The axis of rotation of the pivot shift was located at the medial collateral ligament, which was kept tight by the applied valgus torque. The sudden movement in the pivot shift was caused by a complex interaction between the geometry of the knee and the valgus torque applied.
Surgical treatment for severe slipping of the upper femoral epiphysis
Authors: Clarke HJ , Wilkinson JA
Published: February 2018

We have used a modified technique of cervical osteotomy to treat a consecutive series of 23 patients with chronic slip of the upper femoral epiphysis. It has been successful in correcting both moderate and severe deformities with a low incidence of avascular necrosis, comparable to that seen after subtrochanteric osteotomies. We describe the operative details and discuss the features which make cervical osteotomy technically superior to intertrochanteric and subtrochanteric procedures.
Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon
Authors: Magnussen PA , Harvey FJ , Tonkin MA
Published: February 2018

We reviewed 21 patients with 22 ruptures of the extensor pollicis longus at a mean of 5.3 years after transfer of the extensor indicis proprius tendon. Of these, 19 with 21 transfers described the result as good, and two as fair. The mean deficit of extension between the operated and unoperated thumbs was 1.4 cm, and the mean flexion deficit 0.6 cm. Pressure gauge measurements showed that the strength of the transfer was 51% of that of the uninjured extensor. The two fair results had an extensor lag of over 1.5 cm. Independent extension of the index was maintained in all patients, none having a discernible lag, but the strength of index extension was reduced to 49% of that of the normal finger. There was no evidence of functional loss. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon is a simple and reliable procedure with few complications. It gives satisfactory long-term extension of the thumb.
Replacement of the lumbar vertebrae of sheep with ceramic prostheses
Authors: Yamamuro T , Shikata J , Okumura H , Kitsugi T , Kakutani Y , Matsui T , Kokubo T
Published: February 2018

We prepared a prosthesis for the replacement of the lumbar vertebrae of sheep, using apatite- and wollastonite-containing glass-ceramic. The material is stronger than human cortical bone and has the special feature of chemical bonding to bone. Ten sheep underwent replacement of L3 and L4 vertebrae, without bone grafting. The animals were killed at intervals from three months to 27 months after operation, and the interface between the prosthesis and bone was examined radiologically, histologically and crystallographically. Bone bonding with the prosthesis had occurred in half the implants. It took at least one year for bonding to be complete, but an apatite layer on the surface of the prosthesis was observed as early as three months after the operation, suggesting the possibility of much earlier bone bonding if more rigid fixation of the prosthesis had been provided.
Biomechanics of a double prosthetic ligament in the anterior cruciate deficient knee
Authors: Radford WJ , Amis AA
Published: February 2018

We have assessed the biomechanical properties of a 'double-bundle' prosthetic ligament replacing the anterior cruciate in cadaver knees. We compared the results with those of single bundle 'over-the-top' and 'through-the-condyle' techniques, performing anterior drawer tests at 20 degrees and 90 degrees knee flexion. The over-the-top reconstruction gave better anteroposterior stability at 20 degrees, while the through-the-condyle repair was more stable at 90 degrees. The double-bundle reconstruction gave practically normal anterior stability at both 20 degrees and 90 degrees.
Modified Van Nes rotationplasty for osteosarcoma of the proximal tibia in children
Authors: de Bari A , Krajbich JI , Langer F , Hamilton EL , Hubbard S
Published: February 2018

Above-knee amputation has been the traditional treatment for osteosarcoma of the proximal tibia. Recent advances in chemotherapy have encouraged the development of limb-salvage techniques. Van Nes rotationplasty for malignant lesions of the distal femur has increased in popularity as a reconstructive technique, but no similar procedure has been described for lesions of the proximal tibia. We have developed a modified rotationplasty for this lesion and have performed it in four children. The surgical technique, postoperative management and results of the procedure are described. Two patients had delayed wound healing. No other complications have developed and our patients were disease-free at follow-up, while the appearance of the leg was well accepted by the patients and their parents. This procedure is a useful addition to the armamentarium of the tumour surgeon for the treatment of malignant lesions of the proximal tibia.
Bone lysis in well-fixed cemented femoral components
Authors: Maloney WJ , Jasty M , Rosenberg A , Harris WH
Published: February 2018

We have reviewed 25 cases of focal femoral osteolysis in radiographically stable, cemented femoral implants. In three hips retrieved at post-mortem from two patients, we have been able to make a detailed biomechanical and histological analysis. The interval between arthroplasty and the appearance of focal osteolysis on clinical radiographs ranged from 40 to 168 months, and in over 70% of the cases this did not appear until after five or more years. Few had significant pain and there was no relation to age, sex or original diagnosis. The most common site for osteolysis were Gruen zones 2 and 3 on the anteroposterior radiograph and zones 5 and 6 on the lateral radiograph. In 15 cases (60%), the area of osteolysis corresponded to either a defect in the cement mantle or an area of very thin cement. The rate of progression of these lesions was variable, but to date only one has progressed to gross loosening of the femoral component. The back-scatter scanning electron microscopic examination of serial sections and biomechanical testing of the post-mortem specimens demonstrated focal cement fracture around implants that were otherwise rigidly fixed. In eight cases from which tissue was available, histology showed a histiocytic reaction with evidence of particulate polymethylmethacrylate. We consider that this local fragmentation was the stimulus for local osteolysis in an otherwise stable cemented femoral component.
Aggressive granulomatous lesions in cementless total hip arthroplasty
Authors: Santavirta S , Hoikka V , Eskola A , Konttinen YT , Paavilainen T , Tallroth K
Published: February 2018

We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the acetabular component in five of the patients; one had a large solitary granuloma in the proximal femur. Revision was performed on average 4.8 years after the cementless arthroplasty. At that time all granulomas had grown large in size; while waiting for revision operation, two femoral stem components fractured. All the granulomas showed a uniform histopathology, which included histiocytosis; the cause for these lesions was thought to be plastic debris from the acetabular socket.
Macrophages stimulate bone resorption when they phagocytose particles
Authors: Murray DW , Rushton N
Published: February 2018

We investigated in vitro a mechanism by which particulate debris may induce bone resorption and cause implant loosening. We first studied two standard particles: latex, which is considered to be inert, and zymosan, which is inflammatory. Macrophages that phagocytosed either particle became activated, and stimulated 15 times as much bone resorption as did control macrophages. For activation to occur, 100 times more latex than zymosan had to be phagocytosed. We also found that bone cement and polyethylene particles activated macrophages in a similar manner, and that the necessary amounts of these were intermediate between those of latex and zymosan. None of the particles were toxic. It was concluded that implant loosening may result from bone resorption stimulated by mediators released by macrophages that have phagocytosed particles of bone cement or polyethylene.
Why use drains?
Authors: Cobb JP
Published: February 2018

There is no firm published evidence to support the use of closed suction drains. Over 20 years ago, large studies by the Public Health Laboratory Service and the National Research Council found that drains were risk factors for wound infection. A prospective randomised study of the use of closed suction drains after surgery for fractured neck of femur in 70 patients failed to show that drains improved wound healing. Drained cases had more complications.
The Klippel-Trenaunay syndrome
Authors: Sooriakumaran S , Landham TL
Published: February 2018

The Klippel-Trenaunay Syndrome is a triad of congenital anomalies characterized by a vascular naevus, varicose veins and hypertrophy of soft tissue and bone. A number of patients affected with this rare syndrome need amputation. In this paper the systemic problems, stump complications and prosthetic difficulties of four amputees with Klippel-Trenaunay syndrome are outlined. The period of follow-up ranged from 10 to 24 years after amputation.
The coracohumeral ligament. Anatomy of a substantial but neglected structure
Authors: Edelson JG , Taitz C , Grishkan A
Published: February 2018

We dissected 60 shoulders to demonstrate the anatomy of the coracohumeral ligament. The role of this structure in clinical problems of the shoulder is discussed.
Internal fixation of femoral neck fractures. Two methods compared
Authors: Olerud C , Rehnberg L , Hellquist E
Published: February 2018

In a prospective randomised study, the Hansson pin technique for internal fixation of fractures of the femoral neck was compared with the Uppsala screw technique. The series consisted of 115 consecutive patients, 97 women and 18 men, with a mean age of 80 years. There were 56 patients treated with Hansson pins and 59 with Uppsala screws. After one year 22 patients had died, eight in the Hansson pin group and 14 in the Uppsala screw group (p = 0.28). Twenty-four complications had occurred, 18 in the Hansson pin group and six in the Uppsala screw group (p = 0.008). After exclusion of those with complications, the patients in the Hansson pin group had significantly more pain, less mobility, and a smaller proportion were living in their own homes.
The use of a tourniquet when plating tibial fractures
Authors: Salam AA , Eyres KS , Cleary J , el-Sayed HH
Published: February 2018

Sixty closed fractures of the tibia were treated by open reduction and internal fixation with plates and screws. Half the operations were performed with a thigh tourniquet and half without. In the tourniquet group, there were six cases with erythema and induration of the wound; in the other group there were no such complications. Despite negative bacterial cultures, superficial infection of the inflamed wounds was suspected. It is suggested that a tourniquet may predispose tissues to infection, and its use is not recommended during operations for internal fixation of the tibia.
Tibial torsion measured by ultrasound in children with talipes equinovarus
Authors: Krishna M , Evans R , Sprigg A , Taylor JF , Theis JC
Published: February 2018

Previous clinical studies have studied tibiofibular torsion by measuring the angular difference between a proximal (often bicondylar) plane and a distal bimalleolar plane. We measured the angular difference between the proximal and distal posterior tibial planes as defined by ultrasound scans. We found no significant torsional difference between the right and left tibiae of 87 normal children, nor between their different age groups. The mean external torsion of 58 legs with congenital talipes equinovarus was 18 degrees; significantly less than the mean 40 degrees in the normal children and 27 degrees in the clinically normal legs of the 22 patients with unilateral congenital talipes equinovarus. We did not confirm the previously reported increase in external torsion with increasing age. The relative internal tibial torsion we have demonstrated in patients with congenital talipes equinovarus must be differentiated from the posterior displacement of the distal fibula observed by others and which may result from manipulative treatment. The relative internal tibial torsion we found in the clinically normal legs of children with congenital talipes equinovarus is further evidence that in this condition the pathology is not confined to the clinically affected foot.
Sequential magnetic resonance imaging in Perthes' disease
Authors: Bos CF , Bloem JL , Bloem RM
Published: February 2018

Forty-eight images using magnetic resonance imaging (MRI) in 16 hips with Perthes' disease were evaluated over a mean period of two years. MRI depicted exactly the infarcted zone in the femoral head before typical radiological changes were evident. Early determination of the extent of the infarcted bone on MRI benefits those patients who require treatment. Follow-up MRI scans at six-monthly intervals, reflected the chronological stages of the repair process in each group classified according to Catterall.
Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries
Authors: Amis AA , Dawkins GP
Published: February 2018

This work studied the fibre bundle anatomy of the anterior cruciate ligament. Three functional bundles--anteromedial, intermediate, and posterolateral--were identified in cadaver knees. Their contributions to resisting anterior subluxation in flexion and extension were found by repeated tests after sequential bundle transection. Changes of length in flexion and extension and in tibial rotation were measured. None of the fibres were isometric. The posterolateral bundle was stretched in extension and the anteromedial in flexion, which correlated with increased contributions to knee stability and the likelihood of partial ruptures in these positions. Tibial rotation had no significant effect. The fibre length changes suggested that the 'isometric point' aimed at by some ligament replacements lay anterior and superior to the femoral origin of the intermediate fibre bundle and towards the roof of the intercondylar notch.
The treatment of Colles' fracture. Immobilisation with the wrist dorsiflexed
Authors: Gupta A
Published: February 2018

In a prospective study, 204 consecutive patients with displaced Colles' fractures had closed reduction then plaster immobilisation. Three different positions of the wrist in plaster were randomly allocated: palmar flexion, neutral and dorsiflexion. The results in the three groups were compared. Fractures immobilised with the wrist in dorsiflexion showed the lowest incidence of redisplacement, especially of dorsal tilt, and had the best early functional results. Immobilisation of the wrist in palmar flexion has a detrimental effect on hand function; it is suggested that it is also one of the main causes for redisplacement of the fracture. This is discussed in relation to the functional anatomy of the wrist and the mechanics of plaster fixation.
Surgical repair of rotator cuff ruptures. The importance of the subacromial bursa
Authors: Uhthoff HK , Sarkar K
Published: February 2018

We examined biopsy specimens obtained during surgery on 115 patients with complete rotator cuff rupture. The vascularised connective tissue covering the area of rupture and the proliferating cells in the fragmented tendons reflected more of the features of repair than of degeneration and necrosis. The main source of this fibrovascular tissue was the wall of the subacromial bursa. These features clearly indicated a vigorous reparative response which might play an important role in tendon reconstitution and remodelling. We therefore suggest that extensive debridement along with subtotal bursectomy, commonly practised during surgical repair of rotator cuff rupture, should be avoided. Although strong suture margins are essential for good operative results, debridement should be judicious and preserve as much as possible of the bursa and the associated fibrovascular tissue.
Thromboprophylaxis by low-molecular-weight heparin in elective hip surgery. A placebo controlled study
Authors: Torholm C , Broeng L , Jorgensen PS , Bjerregaard P , Josephsen L , Jorgensen PK , Hagen K , Knudsen JB
Published: February 2018

In a double-blind, randomised study of thromboprophylaxis in patients undergoing total hip replacement, we compared a low-molecular-weight heparin with a placebo. Of the 120 patients enrolled, 112 completed the trial; 58 in the treatment group and 54 in the placebo group. Nine (16%) patients in the treatment group and 19 (35%) in the placebo group developed deep venous thrombosis, diagnosed by the 125I-fibrinogen uptake test (p < 0.02). Verification was obtained by phlebography in 86% of the patients. Prolonged surgery increased the risk of thrombosis in the placebo group but not in the treatment group (p < 0.05). There were significantly more cases of deep venous thrombosis in the placebo group during the first four postoperative days (p < 0.02). The groups did not differ with respect to peroperative and postoperative bleeding. Low-molecular-weight heparin offers safe and easily administered thromboprophylaxis in total hip replacement.
Dysplasia epiphysealis capitis femoris. Meyer's dysplasia
Authors: Khermosh O , Wientroub S
Published: February 2018

We made a prospective longitudinal clinical and radiological study of 18 children diagnosed as having dysplasia epiphysealis capitis femoris. Half the cases were bilateral. Boys were affected five times more often than girls. There were no symptoms or clinical signs in most but some of the bilateral cases had an inconsistent waddling gait. The imaging studies suggest that the cartilaginous proximal femoral epiphysis is hypoplastic, with delayed appearance of single or multiple ossification centres. Progressive improvement occurred and at an average age of five years and six months, there was complete fusion of all the ossific nuclei and normal density and texture of the epiphyseal bone. The end result was a round epiphysis with a slightly diminished height. The dysplasia is attributed to focal hypoplasia of the proximal femoral epiphysis.
The initiation of failure in cemented femoral components of hip arthroplasties
Authors: Jasty M , Maloney WJ , Bragdon CR , O'Connor DO , Haire T , Harris WH
Published: February 2018

We studied 16 femora retrieved at post-mortem from symptomless patients who had a satisfactory cemented total hip arthroplasty from two weeks to 17 years earlier, with the aim of delineating the initial mechanisms involved in loosening. Only one specimen showed radiographic evidence of loosening; the other 15 were stable to mechanical testing at 17.0 Nm of torque. In all 16 specimens, the cement-bone interface was intact with little fibrous tissue formation. By contrast, separation at the cement-prosthesis interface and fractures in the cement mantle were frequent. The most common early feature was debonding of the cement from the metal, seen at the proximal and distal ends of the prosthesis. Specimens which had been in place for longer also showed circumferential fractures in the cement, near the cement-metal interface, and radial fractures extending from this interface into the cement and sometimes to the bony interface. The most extensive cement fractures appeared to have started at or near sharp corners in the metal, or where the cement mantle was thin or incomplete. Fractures were also related to voids in the cement. The time relationship in this series suggested that long-term failure of the fixation of cemented femoral components was primarily mechanical, starting with debonding at the interface between the cement and the prosthesis, and continuing as slowly developing fractures in the cement mantle.
Metal wear and tissue response in failed titanium alloy total hip replacements
Authors: Witt JD , Swann M
Published: February 2018

Thirteen total hip replacements with titanium alloy femoral components required revision for loosening at an average of two years after implantation. At revision the soft tissues around the implant were darkly stained and a proliferative membrane had invaded the cement-bone interface. The femoral components showed polishing of parts of their shot-blasted surfaces. Histology showed a fibroblastic reaction with abundant titanium lying free and within histiocytes, and a scanty foreign-body giant-cell reaction. Surface analysis of the removed femoral components and chemical analysis of the excised tissues is described. Tissue reaction in response to the metal-wear debris may have contributed to the early failure of these implants.
Corrosion of modular hip prostheses
Authors: Mathiesen EB , Lindgren JU , Blomgren GG , Reinholt FP
Published: February 2018

Nine uncemented hip prostheses of modular design were revised because of late infection (2 cases), femoral stem loosening or fracture (2), loosening of threaded cups (3) and protrusion of bipolar cups (2). At surgery we found tissue discoloration and macroscopic corrosion in four of the nine prostheses, located at the head-neck junction. Histological examination in most cases showed extensive necrosis associated with metal particles, indicating metal toxicity. Metallographic examination of the prosthetic heads revealed structural imperfections and inhomogeneity of the metal. We suggest that the crevice between the head and neck is a potential site of corrosion in modular designs.
Rhabdomyolysis following total hip arthroplasty
Authors: Lachiewicz PF , Latimer HA
Published: February 2018

We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the gluteal muscle compartments, rhabdomyolysis, myoglobinuria, and sciatic nerve palsy. The risk factors for such complications include obesity, prolonged operative time, and positioning in the lateral decubitus position. The laboratory and clinical findings are consistent with a gluteal muscle crush-injury with consequent compartment syndrome. The patients should be treated conservatively as symptoms can be expected to resolve.
Transverse ligament rupture and atlanto-axial subluxation in children
Authors: Floman Y , Kaplan L , Elidan J , Umansky F
Published: February 2018

We report four children aged two to nine years with traumatic tears of the transverse ligament of the atlas and atlanto-axial subluxation. This is extremely rare in this age group since trauma usually causes a skeletal rather than a ligamentous injury. The injuries resulted from falls or motor vehicle accidents, with considerable delay in diagnosis. Flexion radiographs showed atlas-dens intervals (ADI) of 6, 7, 8 and 13 mm; all four patients were treated by posterior fusion at C1-C2 after the failure of conservative treatment. In one child with quadriparesis and a fixed ADI of 13 mm, transoral anterior resection of the odontoid was performed before the fusion. Diagnosis of this traumatic lesion requires a high level of suspicion. Conservative treatment is likely to fail; surgical stabilisation is indicated.
Survivorship analysis and confidence intervals. An assessment with reference to the Stanmore total knee replacement
Authors: Lettin AW , Ware HS , Morris RW
Published: February 2018

Survivorship analysis is a useful way of expressing the long-term results of joint replacement: it provides a means of comparing the life span of one type of prosthesis with another. However, such studies should include a full life-table and the confidence intervals for the survival rates at given times. At least 40 surviving prostheses are required to provide reliable results.
Arthroscopic stapling for detached superior glenoid labrum
Authors: Yoneda M , Hirooka A , Saito S , Yamamoto T , Ochi T , Shino K
Published: February 2018

Superior labral tears of the shoulder involve the biceps tendon and labrum complex which may be detached, displaced inferiorly, and interposed between the glenoid and the humeral head. We have treated ten young athletes with painful shoulders due to this lesion by arthroscopic stapling. Arthroscopy at the time of staple removal, after three to six months, showed that all the lesions had been stabilised. Clinical review at over 24 months showed an excellent or good result in 80%. The two relative failures were due in one to residual subacromial bursitis, and the other to multidirectional shoulder instability. Arthroscopic stapling can restore the shoulder anatomy, and it is recommended for active adolescent athletes with this lesion.
Vascularised fibular graft for congenital pseudarthrosis of the tibia. Long-term results
Authors: Uchida Y , Kojima T , Sugioka Y
Published: February 2018

Five children with congenital pseudarthrosis of the tibia treated by free vascularised fibular grafts were followed up until skeletal maturity. The ipsilateral fibula was used in four cases, the contralateral fibula in one. All our cases achieved bone union, but leg length discrepancy, atrophy of the foot and ankle stiffness were frequent complications, due perhaps to the many previous operations. Vascularised fibular grafting might achieve better results if it were done as the primary procedure.
Progressive noninfectious anterior vertebral fusion
Authors: Andersen J , Rostgaard-Christensen E
Published: February 2018

We reviewed 26 patients with progressive spinal kyphosis due to anterior fusion between the vertebrae. No patient had back pain or any neurological defect. The kyphosis appeared to be progressive until the fusion had included all of the disc. Progression was faster during the adolescent growth-spurt. Kyphosis increased with the number of discs involved, from one to six, and the extent of fusion within each disc. In six of the nine cases treated by spinal bracing, progression of the kyphosis was arrested.
Metatarsus primus varus. A statistical study
Authors: Kilmartin TE , Barrington RL , Wallace WA
Published: February 2018

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.
Atlanto-axial fusion with transarticular screw fixation
Authors: Grob D , Jeanneret B , Aebi M , Markwalder TM
Published: February 2018

We reviewed 161 patients, from four centres in Switzerland, who had undergone posterior fusion of the upper cervical spine with transarticular screw fixation of the atlanto-axial joints. They were followed up for a mean 24.6 months. The vertebral artery and the medulla escaped injury and only 5.9% of the complications were directly related to the screws. The rate of pseudarthrosis was 0.6%.
Diagnosis and assessment of pectoralis major rupture by dynamometry
Authors: Scott BW , Wallace WA , Barton MA
Published: February 2018

Four patients with pectoralis major ruptures underwent clinical and dynamometric assessment and one patient underwent late surgical repair. The operation is described. Dynamometry proved a useful and objective method of estimating the loss of strength and indicating patients who might benefit from surgical repair.
Partial versus total meniscectomy. A prospective, randomised study with long-term follow-up
Authors: Hede A , Larsen E , Sandberg H
Published: February 2018

Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total meniscectomy in a random manner. The results were compared at one year and at 6.3 to 9.8 years (median 7.8). After one year more patients with partial meniscectomy (90%) than with total meniscectomy (80%) had no complaints. At the later review these figures were 62% and 52%, respectively (p = 0.18). However, patients with partial meniscectomy had higher functional scores. The deterioration in function between the first review and the second showed no significant difference in the two treatment groups. The incidence of mediolateral instability rose from 8% to 47% and was more frequent after total than after partial meniscectomy. Between the two reviews the radiological signs of knee degeneration increased with no difference between the two treatment groups.
Ultrasonographic monitoring of limb lengthening
Authors: Maffulli N , Hughes T , Fixsen JA
Published: February 2018

Limb lengthening in nine patients was monitored by radiographs and by ultrasound scans. The distraction gap appeared as a sonolucent area within which echogenic foci developed soon after distraction commenced. By seven weeks a new cortex was detected, and medullary canal began to develop between seven and eight weeks. Ultrasound scanning can be used to measure distraction, but it was not as useful as radiographs in detecting angulation. Its use in patients undergoing limb lengthening could reduce their exposure to radiation.
A quantitative histological study of the vascularity of the rotator cuff tendon
Authors: Brooks CH , Revell WJ , Heatley FW
Published: February 2018

Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture.
The morphology of the proximal femur. A three-dimensional radiographic analysis
Authors: Rubin PJ , Leyvraz PF , Aubaniac JM , Argenson JN , Esteve P , de Roguin B
Published: February 2018

Biological fixation of cementless femoral implants requires primary stability by optimal fit in the proximal femur. The anatomy of the bone must then be known precisely. We analysed in vitro the accuracy of bone measurements of 32 femurs and compared the dimensions obtained from radiographs and CT scans with the true anatomical dimensions. Standard radiographs gave only a rough approximation of femoral geometry (mean difference: 2.4 +/- 1.4 mm) insufficiently accurate to allow selection of the best fitting prosthesis from a range of sizes and altogether inadequate to design a custom-made prosthesis. CT scans give greater accuracy (mean difference: 0.8 +/- 0.7 mm) in our experimental conditions, but in clinical practice additional sources of error exist.
Thrombo-embolic prophylaxis in total knee replacement. Evaluation of the A-V Impulse System
Authors: Wilson NV , Das SK , Kakkar VV , Maurice HD , Smibert JG , Thomas EM , Nixon JE
Published: February 2018

We performed a prospective randomised controlled trial of a new mechanical method of prophylaxis for venous thrombo-embolism in 60 patients undergoing knee replacement surgery. The method uses the A-V Impulse System to produce cyclical compression of the venous reservoir of the foot. The overall incidence of deep-vein thrombosis was 68.7% in patients receiving no prophylaxis and 50% in those using the device. The difference was not significant. There was, however, a reduction of the extent of thrombosis in the treated group. There were 13 major calf-vein thrombi and six proximal-vein thrombi in the control group compared with only five major calf-vein thrombi in the treated group. This difference was significant (p = 0.014). No patient developed clinical features of a pulmonary embolism.
The histology of the radiolucent line
Authors: Kwong LM , Jasty M , Mulroy RD , Maloney WJ , Bragdon C , Harris WH
Published: February 2018

The radiographic and histological features of radiolucent areas at the cement-bone interface were correlated in 15 specimens retrieved at post-mortem from patients who had undergone cemented total hip arthroplasty, two weeks to 15 years prior to death. All but one of the components were securely fixed, as demonstrated by direct measurements of micromotion. Extensive radiolucencies were present in all but one case. In 11 of the 14 specimens with radiolucencies, histological examination showed that the radiolucent areas represented regions of osteoporosis and bone remodelling. The remodelling changes were characterised by osteoporosis, cancellisation and thinning of the endosteal cortex, and osteopenia of the trabecular bone. In two specimens the appearance of radiolucency was found to be due to fibrous tissue at the cement-bone interface and in one specimen there was a mixed picture of osteolysis and fibrosis. The study demonstrates that radiolucent lines can occur with well-fixed components and that they may commonly represent osteoporosis rather than the presence of a fibrous membrane at the cement-bone interface.
Culture of human osteoblasts on demineralised human bone. Possible means of graft enhancement
Authors: Nolan PC , Nicholas RM , Mulholland BJ , Mollan RA , Wilson DJ
Published: February 2018

We cultured human osteoblasts from trabecular bone explants and confirmed their phenotype by alkaline phosphatase assay, increased cyclic adenosine monophosphate production in response to prostaglandin E2 and radiographic micro-analysis of nodules of calcification. The osteoblasts were seeded on to demineralised human bone fragments and examined at ten-day intervals over a 50-day period by scanning electron microscopy. During this time the bank bone became progressively repopulated by the cultured osteoblasts. This system may offer a means of graft enhancement in elective orthopaedic and maxillofacial surgery by delivery of cultured autologous human osteoblasts to bone defects.
Salvage of limbs with vascular trauma
Authors: Dhal A , Varghese M
Published: February 2018

In an eight-year period we treated 51 cases of vascular injury associated with fractures and/or dislocations or soft-tissue injuries of the limbs. We relied on a clinical diagnosis and immediate exploration of blood vessels rather than the time-consuming procedure of arteriography. All patients were operated on by the orthopaedic residents on duty and not by vascular surgeons. Only 17 (33%) were repaired within six hours of injury. Limb viability with good function was obtained in 38. Complications included six deaths, four amputations, two renal failures and delayed occlusion in one case.
Spinal stabilisation in Duchenne muscular dystrophy
Authors: Galasko CS , Delaney C , Morris P
Published: February 2018

Of 55 patients with Duchenne muscular dystrophy offered surgical stabilisation of the spine, 32 accepted and 23 refused. We compared both groups pre-operatively and at six-month intervals in respect of survival, forced vital capacity, peak expiratory flow rate and severity of scoliosis. In the nonoperated patients, the forced vital capacity deteriorated by a mean of 8% per annum; in the operated group it remained static for 36 months and diminished slightly thereafter. Spinal stabilisation resulted in an improvement in the peak expiratory flow rate which was maintained for up to five years. In the nonoperated patients the scoliosis progressed from a mean of 37 degrees to a mean of 89 degrees at five years; in the stabilised spines it was improved from a mean of 47 degrees to a mean 34 degrees at five years. There was significantly improved survival in the patients who had undergone spinal stabilisation.
Heterotopic ossification after spinal cord injury. Epidemiology and risk factors
Authors: Wittenberg RH , Peschke U , Botel U
Published: February 2018

From 1981 to 1986 we treated 413 patients for acute spinal-cord injuries. We reviewed 356 patients followed for a minimum of two years of whom 71 (20%) developed heterotopic ossification around one or more joints. Heterotopic ossification occurred more often in male patients (23%) than in female (10%), and was most frequent in the 20- to 30-year age group. It was also more common after injuries of the lower cervical or thoracic spine than after those of the lumbar spine. Patients with severe neurological deficits (Frankel grades A and B) showed significantly more heterotopic ossification but there was no correlation with the number or severity of associated head and limb injuries. Serum calcium levels did not change significantly in either group for 30 weeks after injury, but the erythrocyte sedimentation rate and the alkaline phosphatase level were significantly increased at six weeks in patients with heterotopic ossification.
Proximally cemented versus uncemented Freeman-Samuelson knee arthroplasty. A prospective randomised study
Authors: Albrektsson BE , Carlsson LV , Freeman MA , Herberts P , Ryd L
Published: February 2018

We studied the effect of a layer of cement placed under the tibial component of Freeman-Samuelson total knee prostheses with a metal back and an 80 mm intramedullary stem, using roentgen stereophotogrammetry to measure the migration of the tibial component during one year in 13 uncemented and 16 cemented knees. The addition of cement produced a significant reduction in migration at one year, from a mean of 1.5 mm to one of 0.5 mm (p less than 0.01), including a significant reduction in pure subsidence. One year postoperatively the clinical results were similar between the groups, but, at three years, one uncemented knee had required revision.
The press-fit Kinemax knee arthroplasty. High failure rate of non-cemented implants
Authors: Nafei A , Nielsen S , Kristensen O , Hvid I
Published: February 2018

We report the results of 75 consecutive primary press-fit Kinemax arthroplasties with an average follow-up of 14 months (three to 28). We reviewed 26 cemented and 49 non-cemented tibial components implanted into 72 patients (30 men and 42 women, median age 70 years). At the latest follow-up the overall evaluation (Hospital for Special Surgery knee rating scale) for cemented cases was excellent in 54%, good in 42% and poor in 4%. No cemented prosthesis loosened. Of the non-cemented cases 55% were excellent, 23% good, and 2% fair. Ten tibial implants (20%) loosened and required revision. Residual pain marred the result in 24% of the non-cemented prostheses and in 4% of the cemented group. We do not recommend the press-fit, smooth-surfaced Kinemax prosthesis for non-cemented use.