bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptomatic ossicles of the lateral malleolus in children
Authors: Griffiths JD , Menelaus MB
Published: February 2018

We describe three children with symptoms of damage to the attachment of an anomalous ossific centre of the lower fibular epiphysis. All three were aged 8 to 10 years at the time of the initial injury, had suffered recurrent ankle sprains and had well localised and consistent tenderness precisely at the site of the anomalous ossific centre. All their symptoms were relieved by excision of the ossicle with reconstitution of the fibular collateral ligament. Whilst a separate secondary centre of ossification at the lower fibula is present in 1% of healthy children between the ages of 6 and 12 years, the condition described is extremely uncommon. Excision of the fragment should be reserved for those patients with recalcitrant symptoms and with consistent tenderness precisely at the site of the accessory ossicle.
The long-term prognosis of unilateral Perthes' disease
Authors: Ippolito E , Tudisco C , Farsetti P
Published: February 2018

We have attempted to identify the most important long-term prognostic factors in Perthes' disease by studying 61 patients affected unilaterally. The average age at diagnosis was 7 years 5 months and at follow-up it was 32 years, an average interval of 25 years. The age at diagnosis, age at follow-up, Catterall group, acetabular coverage, femoral head subluxation and the other head-at-risk signs were statistically correlated with Stulberg, Cooperman and Wallensten (1981) radiographic classes and the Iowa hip score. Statistically significant correlations were found between Stulberg class and Iowa hip score; age at diagnosis and Stulberg class; age at follow-up and Iowa hip score; and between lateral subluxation of the femoral head and Iowa hip score. Three age-groups of patients were found to carry different long-term prognoses. Those below five years of age at diagnosis showed a statistically significant correlation between Catterall group and Stulberg Classes I and II. Patients between five and nine years of age at diagnosis showed a significant correlation between Catterall group and Stulberg Classes I, II, III and IV while in patients diagnosed after nine years of age there was no statistical correlation between Catterall group and Stulberg class, all having a poor prognosis and ending up in Stulberg Classes III, IV and V.
Bone scanning for suspected hip fractures. A prospective study in elderly patients
Authors: Fairclough J , Colhoun E , Johnston D , Williams LA
Published: February 2018

Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases.
Distal femoral replacement by custom-made prostheses. Clinical follow-up and survivorship analysis
Authors: Bradish CF , Kemp HB , Scales JT , Wilson JN
Published: February 2018

We report the long-term clinical follow-up and survivorship analysis of 40 distal femoral replacements performed between 1964 and 1980 for traumatic, locally aggressive and malignant conditions. Custom-made prostheses with fully-constrained knee joints were used to replace a mean of 42% of the length of the femur. Survivorship analysis showed a cumulative success rate of 80% at eight years, with no subsequent deterioration at 18 years. Clinical assessment revealed 78% excellent or good results. Failure was due to infection in three cases, and in two to fracture of a now-outmoded femoral stem.
Wedge resection of amputation stumps. A valuable salvage procedure
Authors: Hadden W , Marks R , Murdoch G , Stewart C
Published: February 2018

We describe the technique of wedge resection for revision of an amputation stump, and report the results of this at below-knee level in 57 patients with peripheral vascular disease; healing occurred in 42 of these (74%).
Percutaneous intramedullary rod interchange in osteogenesis imperfecta
Authors: Middleton RW , Frost RB
Published: February 2018

This paper describes the design, development and early surgical experience with a stereotactic device to allow closed retrieval and interchange of intramedullary rods in children with osteogenesis imperfecta. This relatively atraumatic procedure may allow more frequent rod interchange than with other techniques, lessening the likelihood of deformity and fracture in the unsupported skeleton when the bone has outgrown the intramedullary rod. The procedure was developed by design studies in vitro followed by intramedullary rodding of tibiae of New Zealand white rabbits. It has been used in children 12 times, in six tibiae and six femora: 11 rods have been successfully retrieved, with rod interchange in eight of these cases.
Anterior and posterior displacement of the hip after innominate osteotomy
Authors: Fixsen JA
Published: February 2018

Ten patients were treated for anterior or posterior displacement of the hip after an innominate osteotomy for congenital dislocation of the hip. All required a repeated open reduction with an additional procedure, either at the same time as reduction or as a second stage. Stable reduction was achieved in eight cases, but in two the initial attempt failed and the operation had to be repeated. The clinical features of hips with this complication are described and the technique of the salvage operation is discussed.
Ring uncemented hip replacements. The results of revision
Authors: Patterson M
Published: February 2018

Since 1964, 3573 uncemented Ring total hip replacements of all types have been performed; 194 (5.4%) have required revision for infection, loosening or breakage. Of these, 102 were available for review; 81 had satisfactory results five years after operation. These results are better than many of those reported after revision of cemented hip replacements. It is suggested that the absence of cement makes revision easier because bone erosion rarely occurs.
Effect of knee replacement on flexion deformity
Authors: Tew M , Forster IW
Published: February 2018

One of the objectives of knee replacement is to correct flexion deformity, the frequent consequence of rheumatoid arthritis and osteoarthritis. A review of 697 primary and revision replacements carried out between 1969 and 1985 and followed up from 1 to 16 years found that such deformity was present in 61% of knees before the primary operation. Replacement reduced this to 17% and the improvement was usually maintained. The deformity was present in only 21% of the replacements which required revision and the second operation reduced this to 8%. Flexion contractures affected rheumatoid knees more often and more seriously than osteoarthritic knees, but arthroplasty was more successful in correcting the deformity in the former. All of the 11 types of prosthesis used achieved some degree of correction, but the Walldius hinge and the variants of the Freeman condylar design were the most successful. Surprisingly, the best outcome, in terms of pain and reduced need for revision, was found in the rheumatoid knees most seriously deformed before operation, but this association was absent in the osteoarthritic knees. Postoperative deformity in knees without pain or extreme weakness did not appear to influence the patients' ability to walk or to use stairs or a chair, as measured by unexacting tests in the clinic.
Does the use of the operating microscope improve the results of peripheral nerve suture?
Authors: Marsh D , Barton N
Published: February 2018

Twenty-four cases of complete division of median or ulnar nerves were assessed on two occasions after direct suture, with an interval of three years between assessments. Clinical, electrophysiological and timed functional tests were used. All the operations had been performed by one surgeon, using the operating microscope for approximately half the cases but not for the other half. The results were analysed, and the patient's age, any delay between injury and suture, and the duration of follow-up were all found to exert strong and consistent effects on the scores obtained. After controlling for these factors, there was no consistent difference between the results of the two surgical methods. It is concluded that, at least in the hands of one particular surgeon, the use of the operating microscope gives no better results than careful epineural suture performed without it.
The long-term results of the Howse total hip arthroplasty. With particular reference to those requiring revision
Authors: Roberts JA , Finlayson DF , Freeman PA
Published: February 2018

We present the results of 506 consecutive Howse hip arthroplasties with a minimum follow-up of 10 years. The mortality within one month of surgery was 0.79%. The early dislocation rate was 1.38%, two hips requiring revision. Nine hips developed deep sepsis (1.78%), eight of which required revision. At 10 years 42 hips (8.3%) had required revision, including 14 with aseptic acetabular loosening and 11 with femoral stem fractures. We feel that as judged by the dislocation rate and the need for subsequent revision, the Howse arthroplasty is an acceptable form of total hip replacement, particularly in the older patient and in those requiring total replacement for femoral neck fractures.
A posterior approach for the excision of sacral chordoma
Authors: Gennari L , Azzarelli A , Quagliuolo V
Published: February 2018

We report eight cases of sacrococcygeal chordoma treated by high sacral resection through S2 by a posterior approach, with the intention of achieving radical removal. The technique we describe is easier than the combined abdominosacral approach, and there have been no serious intra-operative or postoperative complications. The major technical problems were the margins of excision in the sacrum itself (one recurred) and in the perirectal soft tissues (four recurred), and the preservation of sacral nerve roots. When both S2 roots were preserved, sphincter problems were mild and reversible. One patient died from recurrence 32 months after operation and one was lost to follow-up at eight months. Six patients are alive with a median survival of three years; three of them are free of disease after 22, 36 and 80 months respectively. These results indicate the possibility of surgical cure of this malignant tumour.
Experimental structural scoliosis
Authors: Smith RM , Dickson RA
Published: February 2018

Progressive structural scoliosis in growing rabbits has been produced. Tethering the thoracic spine into the form of an asymmetric lordosis produces a slowly progressive structural scoliosis by purely mechanical means. The addition of a contralateral release of the paraspinal muscles leads to a very progressive deformity with early cardiorespiratory failure. This release, however, was performed with an electric soldering iron and subsequent study showed that in those animals with severe progressive deformity there was localised spinal cord damage. We suggest that it is this neural damage and not the muscle release which leads to rapid progression. The clinical implications are important in that neurological dysfunction seems to render the spinal column less able to resist mechanical buckling and may be the crucial factor differentiating severely progressive from more benign curves.
Double patella. A case of duplication in the coronal plane
Authors: Gasco J , Del Pino JM , Gomar-Sancho F
Published: February 2018

A case of duplication of the patella in the coronal plane is reported. Previously reported cases of double patella have shown sagittal or vertical duplication, and some have been associated with multiple epiphyseal dysplasia. In our case, excision of one patella and realignment of the extensor mechanism relieved symptoms of giving-way.
Three years after Colles' fracture. A prospective review
Authors: Villar RN , Marsh D , Rushton N , Greatorex RA
Published: February 2018

A prospective study was made over a three-year period of 900 consecutive unilateral Colles' fractures. The radiographic features at the time of fracture, after reduction and one week later were measured and correlated with grip strength and range of movement at three years. The most significant radiographic feature to influence the outcome was the presence of shortening of the radius one week after reduction of the fracture. Persistent dorsal tilt, radiocarpal joint involvement and ulnar styloid fracture were each associated with reduced range of movement, but had no effect on grip strength. Extension of the fracture into the distal radio-ulnar joint was associated with reduced grip strength but had no effect on range of movement. Radial tilt of the radial fragment did not correlate with any aspect of the result after three years.
Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna
Authors: Hirayama T , Takemitsu Y , Yagihara K , Mikita A
Published: February 2018

Nine children with chronic post-traumatic dislocation of the head of the radius were treated by an osteotomy of the ulna with over-correction of the angular deformity and with elongation of the bone. Satisfactory results were obtained in eight cases, the only poor outcome following a three-year delay between the initial injury and the reposition. The interosseous membrane of the forearm appeared to be the most important structure in maintaining the corrected position of the radial head.
Response of the growth plates to tibial osteotomy in rats
Authors: Taylor JF , Warrell E , Evans RA
Published: February 2018

The parameters of cellular proliferation and growth in the growth plates of immature rats were measured after unilateral tibial osteotomy and used to calculate growth rates. Distal osteotomy of one tibia was followed by a bilateral increase in the calculated growth rate of the distal growth plates. However, the ipsilateral distal growth plate grew faster than the contralateral between 12 and 18 days after operation, which appeared to be related to increased cell proliferation and height. Proximal osteotomy led to an increase in growth rates proximally which was more marked on the contralateral side. The lesser response of the ipsilateral growth plate may have been due to local impairment of blood supply, or to greater local release of metabolites after bony damage. Distal tibial osteotomy gave similar results to circumferential release of the distal tibial periosteum. Proximal osteotomy, however, produced a relative impairment of growth on the operated side. This may be of importance in the correction of childhood deformities associated with inequality of leg length.
Operation for acromioclavicular dislocation. A review of 29 cases treated by one method
Authors: Warren-Smith CD , Ward MW
Published: February 2018

The place and effectiveness of surgery for acromioclavicular dislocation is disputed. We have reviewed 29 patients all treated by an operation which holds the clavicle down to the coracoid process. This was effective in both acute and late cases, with rapid return to work, a low incidence of complications and no requirement for secondary procedures. We consider it to be the method of choice when operation is indicated.
Anterolateral decompression for neural involvement in thoracolumbar fractures. A review of 78 cases
Authors: Riska EB , Myllynen P , Bostman O
Published: February 2018

Of a total of 905 patients with fracture or fracture-dislocation of the thoracolumbar spine admitted from 1969 to 1982, a neurological deficit was present in 334 (37%). All unstable injuries were initially treated by reduction and posterior fusion. In 79 of these patients, an anterolateral decompression was undertaken later because of persistent neurological deficit and radiographic demonstration of encroachment on the spinal canal. One patient died of pulmonary embolism; 78 were reviewed after a mean period of four years. Of these 78 patients 18 made a complete neurological recovery while 53 appeared to have benefited from the procedure; 25 remained unchanged. The best results were obtained in burst fractures at thoracolumbar and lumbar levels when a solitary detached fragment of a vertebral body had been displaced into the spinal canal. These results indicate that anterolateral decompression of the spinal canal should be considered, after careful evaluation, for certain injuries of the spine in which there is severe neural involvement.
The Ring uncemented polyethylene cup in the abnormal acetabulum
Authors: Nunn D
Published: February 2018

The results of using the Ring uncemented polyethylene-to-metal (UPM) prosthesis in patients with protrusio acetabuli or dysplasia are reported. Fifty-four cases of protrusio were analysed and a modified method of measuring the deformity is described; after operation, remodelling of the medial wall had improved, on average, by 29.6%. For the dysplastic acetabulum the main difficulty is the lack of lateral support for the cup. In order to test the hypothesis that this support improves with an uncemented prosthesis, 38 hips with an average follow-up of 31 months were studied. Lateral support, measured radiographically, showed an average increase of 21%. The remodelling effect may be attributed to the biomechanical design of the prosthesis.
Recurrent dislocation of the patella. Histochemical and electromyographic evidence of primary muscle pathology
Authors: Floyd A , Phillips P , Khan MR , Webb JN , McInnes A , Hughes SP
Published: February 2018

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella.
Arthroscopic surgery for chondral flaps in the knee
Authors: Hubbard MJ
Published: February 2018

A retrospective review of 50 knees in 46 patients treated by arthroscopic removal of chondral flaps is reported. There was a relationship between the site of the flap and the type of symptoms; patellofemoral flaps produced anterior knee pain, posterior condylar flaps produced instability. At review after 18 to 36 months, after a second arthroscopy in eight cases, 44 of the 50 knees had retained significant improvement and 33 were symptom-free.
Congenital talipes equinovarus: I. Resolving and resistant deformities
Authors: Porter RW
Published: February 2018

Comparisons were made between 54 children with resolving congenital talipes equinovarus deformity and 81 children whose feet required surgical correction. There was a significant difference in the incidence of bilateral deformity, sex ratio and family history of congenital talipes in the two groups. The children with resolving deformity had feet which were indistinguishable from the normal side of unilaterally affected children in their calf muscle measurements at six weeks of age, and in the range of movement and radiographs at four years of age. Those requiring surgery had varying degrees of muscle reduction, and although often well corrected, had a reduced range of movement and altered joint anatomy at four years of age. This suggests that they are two distinct populations.
Spondylothoracic and spondylocostal dysostosis. Hereditary forms of spinal deformity
Authors: Roberts AP , Conner AN , Tolmie JL , Connor JM
Published: February 2018

Two siblings with spondylothoracic dysostosis, and two siblings and three unrelated children with spondylocostal dysostosis are described. Both conditions are inherited and characterised by malformed thoracic and lumbar vertebrae. Spondylothoracic dysostosis produces "crab-like" deformities of the ribs, and is usually fatal during early infancy due to respiratory failure. Spondylocostal dysostosis causes short-trunked dwarfism but does not usually reduce life expectancy. These clinical features are distinct from congenital scoliosis, although all three conditions are associated with a particular group of malformations.
Split-thickness skin excision in severe open fractures
Authors: Ziv I , Zeligowski A , Mosheiff R , Lowe J , Wexler MR , Segal D
Published: February 2018

Split-thickness skin excision can be used as a one-stage procedure for the accurate diagnosis of flap viability and the immediate treatment of friction-avulsion injuries in severe open fractures. After cleaning the wound, the avulsed flap is temporarily sutured back to its original bed and a split thickness graft is taken from it and meshed to a 1:3 ratio. Surface dermal capillary bleeding then serves as an indicator of viability, clearly displaying a line for the excision of devascularized skin and correlating well with a concomitant fluorescein test. The wounds are re-opened and, after fixation of the fracture, the viable part of the flap is returned to its original bed and the remaining defects are covered with the meshed graft. We have treated 16 patients with extensive degloving injuries in this way, 15 needing only the single surgical procedure. All retained flaps survived, no other donor sites were needed and the split-thickness grafts took with 90% to 100% success.
The Ring uncemented plastic-on-metal total hip replacement. Five-year results
Authors: Nunn D
Published: February 2018

The Ring plastic-on-metal total hip replacement was introduced with the intention of combining the advantages of the cemented low-friction arthroplasty with those of a cementless system. Fourteen hundred and eighty-eight of these procedures have been reviewed. The results of a two to seven-year follow-up, and of a group which has completed at least five years are presented. There was an excellent clinical result in 93% of the whole series, and in 87% of the five-year group. When graded on the Charnley scale there was an average score of 5.86 for pain, 5.96 for function and 5.9 for range of movement, which compares favourably with cemented replacements. The deep infection rate was zero, and the revision rate 1.5% for the whole series. Erosive problems occurred with the smaller acetabular components and the reasons are discussed. The ease and success of exchange have been maintained.
Traumatic partial foot amputations in adults. A long-term review
Authors: Millstein SG , McCowan SA , Hunter GA
Published: February 2018

A retrospective study of 260 industrial amputees was undertaken to determine the long-term functional results of partial foot amputations following trauma. Follow-up ranged from 1 to 68 years with a mean of 16 years. Of 113 partial foot amputees (118 amputations) who had retained their original amputation, the functional end-results were 43% good, 38% fair and 19% poor. Lisfranc and Chopart amputations were better than those at transmetatarsal or digital levels. Of 260 initial amputations 49 (19%) were revised to a Syme's or a below-knee amputation.
Growth disturbance lines after injury of the distal tibial physis. Their significance in prognosis
Authors: Hynes D , O'Brien T
Published: February 2018

We reviewed 26 fractures involving the distal physis of the tibia to identify the patterns of formation and displacement of the subsequent growth disturbance lines. Twenty-one patients showed a regular "normal" pattern of line and healed with no deformity. Three patients had medical physeal arrest revealed by abnormal lines. Two other cases had a minor central physeal arrest without subsequent deformity. The pattern and character of the growth disturbance line can provide an early warning of potential deformity.
Computerised tomographic assessment of the subtalar joint in calcaneal fractures
Authors: Lowrie IG , Finlay DB , Brenkel IJ , Gregg PJ
Published: February 2018

Thirty-six patients with 39 fresh fractures of the calcaneus were investigated by standard radiography and by computerised tomography. It was found that the size and disposition of the fracture fragments and the degree of involvement of the posterior facet of the subtalar joint were more clearly shown by CT scanning. We recommend this technique for assessment and particularly for pre-operative planning.
Epidural buprenorphine for pain relief after spinal decompression
Authors: Wilde GP , Whitaker AJ , Moulton A
Published: February 2018

We report a prospective double-blind trial of the efficacy of a single epidural dose of buprenorphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain chart and by the additional requirement for analgesia. The patients receiving buprenorphine were significantly more comfortable (p less than 0.005) and required less analgesia in the first 12 hours after operation (p less than 0.05) than the control group. This simple procedure is recommended as an effective and safe method of reducing pain.
Loosening of the porous coating in total knee replacement
Authors: Cheng CL , Gross AE
Published: February 2018

We reviewed 40 cementless Porous Coated Anatomic knee replacements in 34 consecutive patients. The average follow-up was 12.9 months (range 6 to 36 months). At review, loose beads were identified in 23 knees, in 11 on the femoral side and in 16 on the tibial side (in five knees on both sides). One loose bead was adjacent to the patella. In four knees there were intra-articular beads. Radiolucent lines at the interface between bone and prosthesis were seen in 19 knees, in six on the femoral side and in 16 on the tibial side (in three knees on both sides). In relation to the tibial component loose beads were associated with a radiolucent line in all except one case. Progressive loosening with an increasing number of loose beads was seen in three knees. At this early stage of follow-up there was no correlation between the clinical results and the presence of loose beads.
Fibroblastic healing of grade II ligament injuries. Histological and mechanical studies in the sheep
Authors: Laws G , Walton M
Published: February 2018

A method is described which produces an isolated Grade II injury in the medial collateral ligament of the sheep's knee. The untreated injury was followed in 32 animals for up to six weeks. Histology revealed progressive healing of the lesions by a cellular response mediated by fibrocytes rather than by the classically described inflammatory response. Mechanical testing showed that the tensile strength of the ligament was initially reduced to 13% of normal but that strength and compliance were regained after six weeks.
Lateral substitution for chronic isolated anterior cruciate ligament deficiency
Authors: Frank C , Jackson RW
Published: February 2018

Thirty-five patients who had been surgically treated for major symptomatic isolated chronic anterior cruciate ligament deficiency by lateral extra-articular reconstruction alone were reviewed at an average of five years after operation. Seventy-seven per cent of patients reviewed were improved subjectively, and 83% of patients who were examined had objective evidence of only minor instability or none at follow-up. However, only a few patients had "normal" knees and many continued to have minor symptoms of instability with some restriction of activity. Most of the unsatisfactory results were in patients with significant chondral pathology at the time of reconstruction. While an extra-articular pivot-shift repair did not correct all the symptoms and signs completely, most patients were improved subjectively and objectively, and there were few complications.
Joint laxity in idiopathic adolescent scoliosis
Authors: Binns M
Published: February 2018

Joint laxity was quantified by measuring the distance from the thumb tip to the forearm during passive apposition in 500 normal Southern Chinese women. Joint laxity was found to have a normal distribution throughout the population and to decrease with age. When 109 Chinese girls with idiopathic adolescent scoliosis were similarly tested they were found to have significantly more laxity, suggesting that the two conditions are associated.
The management of congenital dislocation of the hip in the newborn
Authors: McKibbin B , Freedman L , Howard C , Williams LA
Published: February 2018

We describe the results of a policy of highly selective splintage for CDH, using knee plasters. No child suffered because splintage was withheld. In those who were treated the results were satisfactory and the proportion who required a subsequent operation was extremely low. Avascular necrosis was not a significant problem. The method, although a little more time consuming, appears to offer significant advantages over current alternatives.
Predicting amputation in severe ischaemia. The value of transcutaneous PO2 measurement
Authors: Bongard O , Krahenbuhl B
Published: February 2018

The predictive value of the pedal transcutaneous oxygen tension (tcPO2) and of the distal systolic blood pressure (SBP) in forecasting the necessity for later amputation has been studied in 26 patients suffering from severe chronic ischaemia of the lower limbs. In all these patients vascular surgery had failed or not been possible, and they were threatened by amputation; they suffered from trophic lesions, or pain at rest, or both. The great toe SBP averaged 10 mmHg (range 0 to 60 mmHg) and the pedal tcPO2 10 mmHg (range 2 to 45 mmHg). After six minutes of oxygen inhalation there was an increase in pedal tcPO2 of 9 mmHg (0 to 50 mmHg). After a follow-up period averaging 7 months (range 10 days to 13 months), 13 patients underwent an amputation and nine (five of whom had been amputated) died. The great toe SBP in the patients who required amputation was initially lower than in those who did not. The pedal tcPO2 also was lower in amputated than in non-amputated patients. There was no amputation in the group showing an increase of at least 10 mmHg after six minutes of oxygen inhalation; and conversely, all patients in whom the pedal tcPO2 increased less than 10 mmHg were amputated. Thus increase in the pedal tcPO2 after oxygen inhalation appears the best criterion for estimating the prognosis of severely ischaemic limbs.
Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum
Authors: Kojimoto H , Yasui N , Goto T , Matsuda S , Shimomura Y
Published: February 2018

The histology and mechanics of leg lengthening by callus distraction were studied in 27 growing rabbits. Tibial diaphyses were subjected to subperiosteal osteotomy, held in a neutral position for 10 days and then slowly distracted at 0.25 mm/12 hours, using a dynamic external fixator. Radiographs showed that the gap became filled with callus having three distinct zones. Elongation appeared to occur in a central radiolucent zone; this was bounded by two sclerotic zones. Histologically, the radiolucent zone consisted of longitudinally arranged cartilage and fibrous tissue while the sclerotic zones were formed by fine cancellous bone. New bone occasionally contained islands of cartilage, suggesting it had been formed by endochondral ossification. After completion of distraction, the two sclerotic zones fused, shrank and were eventually absorbed, leaving tubular bone with a new cortex. When the periosteum had been removed at the operation, callus formation was markedly disturbed and there was failure of bone lengthening. Scraping of endosteum, in contrast, did not have a pronounced effect. These results suggest that the preservation of periosteum is essential if bone lengthening by callus distraction is to succeed, and that preservation of the periosteum is more important than careful corticotomy.
Mechanical loosening of the stem in Charnley arthroplasties. Identification of the "at risk" factors
Authors: Pacheco V , Shelley P , Wroblewski BM
Published: February 2018

A retrospective review of 72 cases of Charnley low friction arthroplasty revised for stem loosening, has identified a number of "at risk" factors. These were: previous hip surgery and, in radiographs taken at one year, demarcation of the distal cement and fracture of the cement near the tip of the stem. Separation of the back of the stem from the cement, as an isolated feature, was not considered significant. Endosteal cavitation of the femoral shaft, rare in the first year, indicated loosening of some duration. Patients whose radiographs show the "at risk" changes, should be followed-up indefinitely in order to plan timely revision and avoid gross loss of the femoral bone stock.
Failure of bone induction by bone matrix in adult monkeys
Authors: Aspenberg P , Lohmander LS , Thorngren KG
Published: February 2018

Extraskeletal bone formation can be induced in rodents by implantation of demineralised bone matrix and such implantation has been used to treat bone defects in man, but it is uncertain if induction or merely conduction occurs. We studied bone induction in primates by excising segments of the fibulae of adult squirrel monkeys, defatting and demineralising them before reimplanting them into the quadriceps of the same animal. As a control experiment, rat matrix was prepared in exactly the same way and implanted in rats. After six weeks the implants were harvested and either ashed and analysed for calcium content or prepared for histology. In the rats, the calcium content indicated that about 20% of the original matrix had been replaced by new bone. In the monkeys the calcium content was about the same as that in normal body fluid and no bone was seen in histological sections. This result casts doubt on the use of demineralised human bone matrix as a bone inductor, although it may function by other mechanisms.
Anterior cruciate ligament replacement. Biocompatibility and biomechanics of polyester and carbon fibre in rabbits
Authors: Amis AA , Kempson SA , Campbell  , Miller JH
Published: February 2018

The anterior cruciate ligament was replaced in rabbits, using implants of carbon or polyester filaments with known mechanical properties. The biocompatibility of the implants was assessed in detail using light microscopy, and scanning and transmission electron microscopy. Mechanical tests were made of stability, in comparison with normal joints and controls after excision of the ligament. Some carbon fibre implants broke down in vivo, allowing instability; the fragments caused chronic inflammation. Intact carbon implants did not induce the formation of neoligaments; they were covered by tissue, but there was no ingrowth. Polyester did not degrade mechanically and supported early collagenous ingrowth within the implant, even in the mid-joint space. It was concluded that there was no justification for the use of carbon fibres as anterior cruciate replacements; polyester appeared to be suitable.
Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining
Authors: Fahrer H , Rentsch HU , Gerber NJ , Beyeler C , Hess CW , Grunig B
Published: February 2018

In order to investigate the difficulty of quadriceps training in the presence of an effusion into the knee we examined 13 patients with chronic effusions by recording isometric muscle strength. Maximal strength was markedly lower in the presence of an effusion, and aspiration of the effusion produced a 13.6% increase in strength (p less than 0.01). A further, small increase of 8% was recorded after intra-articular lignocaine injection. Isometric strength and surface integrated EMG correlated well in six patients. Two reflex mechanisms seem to inhibit quadriceps innervation in the presence of a persistent knee effusion, one mediated by pressure sensitive receptors, the other still unknown. Joint aspiration and systemic or intra-articular anti-inflammatory drug treatments are advised before any programme of quadriceps training to allow maximum effects to be achieved.
Primary total hip replacement for displaced subcapital fracture of the femur
Authors: Greenough CG , Jones
Published: February 2018

The results of primary total hip arthroplasty for sub-capital femoral neck fracture in previously normal hips are reported. Thirty-seven patients aged 70 or less at the time of surgery were reviewed at an average follow-up of 56 months. Eighteen (49%) had undergone or were awaiting revision surgery. A further four (11%) had definite radiological signs of loosening. Harris hip scores were calculated and correlated well with the results of gait analysis; these suggested that it was the more vigorous patients that were more liable to early failure. Consequently, primary total hip replacement is not recommended for subcapital fractures in the younger patient without pre-existing hip pathology.
Traumatic atlanto-axial subluxation
Authors: De Beer JD , Thomas M , Walters J , Anderson P
Published: February 2018

Traumatic atlanto-axial subluxation is a rare injury which may not be revealed on routine radiographs, especially when there is muscle spasm. We report on seven patients with atlanto-axial subluxation as a result of neck injury; only two of them had significant head injuries. Three patients presented with a neurological deficit attributable to the injury, one immediate and two with delayed onset. Traumatic atlanto-axial instability, occurring in an otherwise healthy patient, has a potential for neurological disaster; early consideration of operative treatment is indicated.
Circulating vitamin K levels in patients with fractures
Authors: Bitensky L , Hart JP , Catterall A , Hodges SJ , Pilkington MJ , Chayen J
Published: February 2018

It is now clear that vitamin K1 is part of a biochemical cycle that is essential for the conversion of specific bone peptides into a form that can bind calcium. We have used a recently described procedure for assaying vitamin K1 in plasma to test the involvement of this vitamin in fracture healing. Markedly depressed circulating levels were found in patients with fractures and the time taken for this level to return to normal appeared to be influenced by the severity of the fracture.
Interscapulothoracic resection. A case report and review of the literature
Authors: Mackinnon J , Aziz T , Dixon JH
Published: February 2018

There is a trend away from amputation for limb cancer; salvage procedures are becoming more widespread. We describe one case of interscapulothoracic resection of the shoulder and discuss methods of maximising the residual function of the arm. The procedure is recommended for patients with the correct indications.
Silent avascular necrosis of the femoral head in haemophilia
Authors: Paton RW , Evans DI
Published: February 2018

Haemophilia is a rare cause of avascular necrosis of the femoral head. We report three cases from one centre, an incidence of 2.8%. All three cases presented "silently", and this makes the early diagnosis difficult. Awareness of the condition should lead to examination of the hips of haemophiliac patients at every outpatient visit and admission in the hope that hip disease can be diagnosed at an early stage. This may allow earlier treatment, less femoral head deformity, and an improvement in the long-term prognosis.
Cementless hip replacement for arthritis. Problems with a smooth surface Moore stem
Authors: Phillips TW , Messieh SS
Published: February 2018

We have analysed the clinical results of a cementless hip replacement using a Moore stem with a smooth surface, and correlated these results with the radiological changes. Forty-two consecutive arthroplasties in 41 patients were studied prospectively and reviewed at a minimum of two and up to six years; 63% had a good clinical result, 18.5% a fair result, and 18.5% a poor result. Thigh pain on weight-bearing was the main problem and was due to loosening of the stem. We caution against the use of this implant in arthritic patients, in whom a good result can be obtained more predictably with cement fixation.
Charnley low friction arthroplasty in tuberculosis of the hip. An eight to 13-year follow-up
Authors: Kim YY , Ko CU , Ahn JY , Yoon YS , Kwak BM
Published: February 2018

We report 60 patients with tuberculosis of the hip treated by Charnley low friction arthroplasty and followed for eight to 13 years. Eight of them had active tuberculosis of the hip at the time of operation, and all were covered by relatively short courses of antituberculous drugs. Our study suggests that arthroplasty can be recommended for these patients provided that adequate chemotherapy is given both before and after operation.
Knee ligament injuries in adolescents. Eight year follow-up of conservative management
Authors: Kannus P , Jarvinen M
Published: February 2018

We have reviewed 32 patients who sustained a substantial knee ligament injury during adolescence when their knee epiphyses were open. They were all treated non-operatively and re-examined and evaluated in detail after an average of eight years. There were 25 Grade II partial tears and seven Grade III complete tears. After Grade II injuries the functional results were excellent or good, though static instability had not improved from the initial post-traumatic examination. The long-term results of Grade III injuries were poor, because of chronic functional instability, with continuous symptoms and some post-traumatic osteoarthritis. The results of non-operative treatment for Grade III ligament injuries were not acceptable.
Short term continuous passive motion. A feasibility study
Authors: Laupattarakasem W
Published: February 2018

Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. The optimum duration of treatment, however, is not known, though a period of one to three weeks is usual. This may be unnecessarily long and a programme lasting only three days has been tried in 34 patients: in 22 (Group A) treatment was designed to increase movement in stiff joints which had been operated on or manipulated, and in 12 (Group B) it was to prevent stiffness after an injury. A specially designed CPM device was used. In Group A, the range by the third day of treatment was significantly greater than before manipulation or operation and this increase was maintained until the latest follow-up at an average of 24 weeks. In Group B, the pre-injury range was almost retained and thereafter there was a gradual increase. Patient compliance in the first 12 hours of CPM was relatively poorer than that described in previous reports, and in five patients treatment had to be discontinued.
Pronator quadratus pedicled bone graft for old scaphoid fractures
Authors: Kawai H , Yamamoto K
Published: February 2018

Delayed union or non-union of the scaphoid was treated by a bone graft on a pronator quadratus pedicle in eight cases. This produced earlier union than the Russe procedure. The procedure is simple and is recommended for old un-united scaphoid fractures.
Stress injury of the distal radial growth plate
Authors: Carter  , Aldridge MJ
Published: February 2018

We report 21 cases of stress injury of the distal radial growth plate-occurring in gymnasts before skeletal maturity. The injury appears to be caused by inability of the growth plate to withstand rotational and compressive forces. Our observations have confirmed that the skeletal age of gymnasts is retarded, which increases the length of time during which the epiphysis is at risk of damage.
Arthroscopy under local anaesthesia
Authors: Buckley  , Hood GM , Macrae W
Published: February 2018

Sixty patients underwent arthroscopy of the knee as day cases using a local anaesthetic technique. This provided satisfactory operating conditions and high patient acceptability.
Epiphyseolysis for partial growth plate arrest. Results after four years or at maturity
Authors: Broughton NS , Dickens DR , Cole WG , Menelaus MB
Published: February 2018

We reviewed 13 children with partial growth plate arrest who had been treated by epiphyseolysis. Eight were followed to skeletal maturity and five for at least four years. In three cases the affected limb was restored to normal and in five the operation was successful in improving angular deformity and leg length discrepancy such that further surgery was not necessary. In the five failures, angular deformity had progressed or limb length discrepancy had increased. There were no significant complications and the procedure did not prevent subsequent osteotomy or limb length equalisation. Epiphyseolysis was most effective for small bars and those affecting only the central area of the plate.
Entrapment of the superficial peroneal nerve. Diagnosis and results of decompression
Authors: Styf J
Published: February 2018

Entrapment of the superficial peroneal nerve was treated in 24 legs of 21 patients by fasciotomy and neurolysis; 19 of the patients were reviewed after a mean period of 37 months. Nine were satisfied with the result, another six were improved but not satisfied because of residual limitation of athletic activity, three were unchanged and one was worse. Conduction velocity in the superficial peroneal nerve had increased after operation, but the change was not significant. In five patients the nerve had an anomalous course and in 11 there were fascial defects over the lateral compartment. Chronic lateral compartment syndrome is an unusual cause of nerve entrapment. Operative decompression produces cure or improvement in three-quarters of the cases, but is less effective in athletes.
Soft tissue surgery in Charcot-Marie-Tooth disease
Authors: Roper BA , Tibrewal SB
Published: February 2018

Ten patients with Charcot-Marie-Tooth disease have been reviewed at an average of 14 years after soft tissue procedures to correct foot deformities. No patient has so far required triple arthrodesis and the overall results as regards function, appearance and symptoms are satisfactory in all patients. It is concluded that soft tissue procedures can certainly postpone the need for triple arthrodesis and in many cases may obviate it altogether.
Dynamic inversion of the forefoot and dorsiflexion of the big toe treated by transfer of extensor hallucis longus
Authors: Fulford GE , Veldman HJ , Stewart K
Published: February 2018

Dynamic hyperextension of the big toe and supination of the forefoot may occur in the swing phase of walking in children with various neurological disorders. Symptoms arising from this have been successfully corrected in 13 feet of 11 children by transfer of extensor hallucis longus to the insertion of peroneus brevis.
The effect of centrifuging bone cement
Authors: Davies JP , Jasty M , O'Connor DO , Burke DW , Harrigan TP , Harris WH
Published: February 2018

We have tested the porosity and fatigue life of five commonly used bone cements: Simplex P, LVC, Zimmer regular, CMW and Palacos R. Tests were conducted with and without centrifugation and with the monomer at room temperature and, except for LVC, at 0 degrees C. We found that the fatigue life of different specimens varied by a factor of nearly 100. It did not depend on porosity alone, but was more influenced by the basic composition of the cement. Simplex P when mixed with monomer at 0 degrees C and centrifuged for 60 seconds had the highest fatigue life and was still sufficiently liquid to use easily.
Anterior approach to the upper thoracic vertebrae
Authors: Charles R , Govender S
Published: February 2018

The anterior exposure of the upper thoracic spine using standard methods is often difficult and limited. We report our experience using a technique described by Sundaresan et al. (1984) in which the medial portion of one clavicle and part of the manubrium sterni are excised. In 10 cases we found this to be a useful and safe procedure.
Ipsilateral sciatica on femoral nerve stretch test is pathognomonic of an L4/5 disc protrusion
Authors: Christodoulides AN
Published: February 2018

The straight leg raising test and the femoral nerve stretch test exert traction on the sciatic and femoral nerve, and the lumbosacral plexus and roots. In 40 patients with a suspected L4/5 disc protrusion, ipsilateral sciatica was induced by the femoral nerve stretch test. We believe that this is a pathognomonic sign of a lateral protrusion at L4/5 level.