bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined treatment with indomethacin and low-dose heparin after total hip replacement. A double-blind placebo-controlled clinical trial
Authors: Kristensen SS , Pedersen P , Pedersen NW , Schmidt SA , Kjaersgaard-Andersen P
Published: February 2018

We studied the safety of combining the postoperative use of a non-steroidal anti-inflammatory drug with low-dose heparin. In a double-blind, placebo-controlled clinical trial we reviewed the complications in 235 patients after total hip replacement, all treated with low-dose heparin and either indomethacin or a placebo. The incidence and type of complications in the two groups were nearly equal; indomethacin-treated patients had no increase in complications related to bleeding. Postoperative bleeding into drains was marginally greater in the indomethacin group, although the difference was not statistically significant. We conclude that treatment with indomethacin and low-dose heparin after hip replacement does not significantly increase the bleeding or other complications. We also found that patients receiving indomethacin were mobilised an average of one day before those on placebo.
Core decompression for early atraumatic osteonecrosis of the femoral head
Authors: Learmonth ID , Maloon S , Dall G
Published: February 2018

We performed 41 core decompressions in 32 patients for stage I or stage II osteonecrosis of the femoral head. The intra-osseous pressure at the intertrochanteric level was raised in 28 (68%) and there was histological confirmation of necrosis in 36 hips (88%). After a follow-up of 10 to 84 months (mean 31) nine of the 12 stage I hips (75%) showed significant clinical or radiological deterioration; no evidence of necrosis had been found in the core specimens of the other three hips. Of the 29 hips in stage II, 25 (86%) showed significant radiological deterioration, and only five (17%) had improved clinically. We believe that once necrosis has occurred, core decompression will not significantly influence the subsequent course of the disease.
Cementless uncoated polyethylene acetabular components in total hip replacement. Review of five- to 10-year results
Authors: Wilson-MacDonald J , Morscher E , Masar Z
Published: February 2018

We reviewed the results of 545 consecutive total hip replacements using a cementless non-coated high-density polyethylene acetabular component combined with a cemented Muller stem at five to 10 years. In all, 421 patients (445 hips) were available for review, 118 by questionnaire and 303 by examination and radiography. Of these, 86% had a good or excellent result. We found a high rate of radiological loosening of the cup after the sixth year, and a high rate of clinical loosening after the eighth year. Loosening was commoner in women, in younger patients and where a smaller size of acetabulum had been used. Calcar resorption was significantly related to loosening of the acetabulum. Loosening appeared to be mainly due to polyethylene debris produced by micro-movement of the acetabulum against the bone, which had resulted in a giant cell foreign body reaction and subsequent bone erosion. We have abandoned the use of this prosthesis and suggest that direct contact between bone and polyethylene should be prevented by a coating of metal or some other material.
Trochanter re-attachment in revision hip arthroplasty
Authors: Scher MA , Jakim I
Published: February 2018

We present a new method of trochanter stabilisation designed for use in difficult revision hip arthroplasties. A fixator is secured to the metaphysis of the femur, and its two malleable prongs encompass the trochanter fragment and stabilise it using the tension band principle. The fixator is versatile, simple to apply and has better mechanical properties than any technique using wires. We reviewed 49 revisions after a mean follow-up of 40 months. Patients had been mobilised early, but there were no detachments or displacements from the initial postoperative position. Although 31% of patients were osteoporotic and 16% had poor trochanter fragments, there was bony union in 46 of the 49 hips, the remaining three developing stable fibrous union.
Congenital snapping knee. Habitual anterior subluxation of the tibia in extension
Authors: Ferris BD , Jackson AM
Published: February 2018

We describe a rare form of congenital snapping knee. In six knees in four children, the tibia subluxed anteriorly on the femur when the knee was extended and reduced spontaneously on flexion. The abnormal movements were seen and felt as sudden snaps or clunks at about 30 degrees of flexion. All six knees showed similar dysplastic features, although the patients had different clinical syndromes. The mechanism of the subluxation and its management are discussed.
Humeral rotation osteotomy for chronic posterior dislocation of the shoulder
Authors: Porteous MJ , Miller AJ
Published: February 2018

Delay in the diagnosis of posterior shoulder dislocation is common. We present two such cases treated satisfactorily by rotation osteotomy of the surgical neck of the humerus and discuss the indications for this procedure.
Haemophilic arthropathy of the shoulder
Authors: MacDonald PB , Locht RC , Lindsay D , Levi C
Published: February 2018

Among 41 adult haemophiliacs 15 suffered from shoulder symptoms. We examined 12 patients by radiography and ultrasound. Four had bilateral symptoms making a total of 16 symptomatic shoulders. Of these, 10 had abnormal ultrasound scans with eight having evidence of rotator cuff tears. Evidence of bicipital tendonitis was found in two. Pain with loss of range of movement and a positive impingement sign was the most reliable clinical indicator of a cuff tear. Joint incongruity and superior migration of the humeral head were the best radiographic indicators. Rotator cuff tears are a common component of haemophilic arthropathy of the shoulder.
Date palm thorn synovitis
Authors: Ramanathan EB , Luiz CP
Published: February 2018

We have reviewed seven cases of synovitis caused by date palm thorns, six involving the knee and one the ankle. Five were satisfactorily treated by thorough irrigation of the joint with normal saline, but two required arthrotomy and synovectomy. All made a full recovery.
Benign synovioma causing internal derangement of the knee. A report of nine cases
Authors: Dandy DJ , Rao NS
Published: February 2018

Nine pedunculated benign synoviomata causing mechanical symptoms similar to those of a torn meniscus are described. The average age of the patients was 34.4 years. During the period of study, 2254 meniscal lesions causing mechanical symptoms were identified, giving an incidence of one benign synovioma for every 250 meniscal lesions. All the lesions were removed arthroscopically with relief of symptoms.
Primary migration of fully-threaded acetabular prostheses. A roentgen stereophotogrammetric analysis
Authors: Snorrason F , Karrholm J
Published: February 2018

We investigated the fixation of fully-threaded cementless acetabular prostheses in 20 patients with osteoarthritis, measuring the migration of the cup using roentgen stereophotogrammetric analysis (RSA). All the cups migrated proximally, 13 moved laterally or medially, and nine moved anteriorly or posteriorly in the first two postoperative years, the average migration being 1.1 to 1.4 mm in either direction. Rotatory movements of up to 5.7 degrees were found in nine of the 13 hips where this analysis could be performed. Movements of cobalt-chrome (12) and titanium alloy (8) cups did not differ significantly. Seventeen of the 20 patients had some pain two years after the operation. The migration of the prostheses indicates that 'osseointegration' had not occurred. The combination of this with persistent pain suggests that the long-term results will be unfavourable.
The use of a tissue expander in club-foot surgery. A case report and review
Authors: Atar D , Grant AD , Silver L , Lehman WB , Strongwater AM
Published: February 2018

Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method.
Tissue expansion in the lower limbs of children and young adults
Authors: Cole WG , Bennett CS , Perks AG , McManamny DS , Barnett JS
Published: February 2018

We report the successful use of tissue expansion in the lower limbs of five children and one young adult. It was possible to replace dense adherent skin grafts by expanded skin and subcutaneous tissue. Such expansion needs to be undertaken slowly, but expanded tissue matches the normal local tissue and has normal sensation. These qualities were particularly important in three amputations which were revised.
C-reactive protein in tibial fractures. Natural response to the injury and operative treatment
Authors: Kallio P , Michelsson JE , Lalla M , Holm T
Published: February 2018

Serial serum C-reactive protein (CRP) measurements were made, for three weeks, in 42 consecutive patients with solitary tibial fractures. The CRP response was related to the treatment: lower values were observed in 27 patients treated conservatively than in 15 operated patients. Open reduction and plating resulted in a greater response than closed intramedullary nailing. The timing of the CRP response was related to the timing of the treatment: the highest values were usually recorded two days after admission or operation. The timing of the operation did not affect the degree of CRP response. Neither the site, nor the type of fracture, nor the age of the patient played any role. Awareness of these natural CRP responses after fractures may help in the diagnosis of early post-traumatic and postoperative complications, especially infections.
The orthopaedic scooter. An energy-saving aid for assisted ambulation
Authors: Roberts P , Carnes S
Published: February 2018

The orthopaedic scooter is an alternative to crutches. It gives the patient greater freedom on level smooth surfaces and uses less energy.
The effect of improved cementing techniques on component loosening in total hip replacement. An 11-year radiographic review
Authors: Mulroy RD , Harris WH
Published: February 2018

Improved cementing techniques have been shown to decrease the rate of aseptic loosening of femoral components of cemented total hip replacements at five to seven years. We now report our results in 105 hips in 93 patients at 10 to 12.7 years (mean 11.2). The improved techniques included use of a medullary plug, a cement gun, a doughy mix of Simplex P and a collared stem of chrome cobalt. Only three femoral components had definitely loosened, none were probably loose and 24 were graded as possibly loose. In contrast, the incidence of radiographic loosening on the acetabular side was 42%. Improved cementing techniques have produced a marked reduction in the rate of aseptic loosening of the femoral component, but the incidence of acetabular loosening is unchanged.
Chiari pelvic osteotomy for osteoarthritis. The influence of the torn and detached acetabular labrum
Authors: Nishina T , Saito S , Ohzono K , Shimizu N , Hosoya T , Ono K
Published: February 2018

We assessed the results of Chiari pelvic osteotomy in 64 hips with early osteoarthritis in terms of acetabular labral detachment detected pre-operatively by arthrography. At an average follow-up of four years, assessment by the Merle d'Aubigne score showed 83% excellent or good results. These satisfactory results were achieved in only half the cases with a detached labrum, but in nearly all cases with normal or torn acetabular labra. Other factors such as the acetabular index, the level and angle of osteotomy, and the displacement following osteotomy did not affect the results. Chiari pelvic osteotomy is a worthwhile procedure for early osteoarthritis in selected cases, but a detached acetabular labrum increases the risk of clinical failure.
Blood loss reduced during hip arthroplasty by lumbar plexus block
Authors: Twyman R , Kirwan T , Fennelly M
Published: February 2018

We measured the blood loss during and after hip replacement in two groups of women, each consisting of 10 patients. In one group the lumbar plexus was infiltrated with bupivacaine, in the other it was not. The group in whom the plexus was blocked had significantly less blood loss.
The AO dynamic hip screw and the Pugh sliding nail in femoral head fixation
Authors: Richards RH , Evans G , Egan J , Shearer
Published: February 2018

We compared, under laboratory conditions, the resistance to cutting out of the AO dynamic hip screw and the Pugh sliding nail. The mean load at cut out, adjusted for bone strength, was 70% greater for the Pugh sliding nail. The reasons for this difference are discussed.
Femoral neck fracture fixation. Comparison of a sliding screw with lag screws
Authors: Clark DI , Crofts CE , Saleh M
Published: February 2018

The rigidity of a sliding compression screw and three cannulated lag screws in the treatment of subcapital fractures was compared in five pairs of female cadaver femora. There were no significant differences between the compressive strength, bone density, cortical thickness or Singh index of the bones in each pair. A subcapital fracture was standardised using a perpendicular saw cut across the femoral neck. A uniaxial 'load test system' with force and length measurement facilities was used to mimic cyclical stressing applied in vivo at a frequency of 0.5 Hz from 0 to 3 times body-weight. There was no significant difference between the fixation afforded by the sliding compression screw and three lag screws. Bone quality was the single most important factor in the stability of the bone implant unit.
Locked intramedullary nailing for displaced tibial shaft fractures
Authors: Alho A , Ekeland A , Stromsoe K , Folleras G , Thoresen BO
Published: February 2018

We analysed the results of 93 tibial shaft fractures treated with the Grosse-Kempf locked nail. Twenty-six fractures were comminuted, 19 were open grade I to II, and 54 were located outside the middle third of the tibia. The deep infection rate was 3.2%. There were only two poor results. The use of this method is recommended and discussed.
Healing of non-vascularised diaphyseal bone transplants. An experimental study
Authors: Nather A , Balasubramaniam P , Bose K
Published: February 2018

Four different experiments were performed to study the healing of a large, non-vascularised, diaphyseal, bone segment in adult cats. In the first experiment, a 4 cm segment of tibia with its periosteum was excised and replaced in its bed. The other experiments were similar, except that in the second, the periosteum of the segment was removed, in the third its medullary canal was blocked with a Silastic rod, and in the last group the segment was isolated from its muscle bed by a Silastic sheet. The reparative processes were quantified by estimating the resorption index, the cortical new bone formation index, the callus encasement index, and the osteocyte count. Bone resorption and apposition occurred in the segment even when the periosteum was absent or the medullary canal was blocked, with osseous union at both ends by eight to 12 weeks, provided the segment was not isolated from its muscle bed. Thus, the muscle bed played a significant role in these reparative processes.
The structure of the human subchondral plate
Authors: Clark JM , Huber JD
Published: February 2018

To study the anatomy of subarticular bone and cartilage, fresh specimens of cartilage on bone from the human shoulder, hip and knee were treated with bleach or papain, or were fixed and decalcified. All were compared using scanning electron microscopy. Papain digestion selectively removed cartilage to the tidemark. The tidemark contour was highly variable; irregularities were indirectly related to degenerative lesions and were most prominent in peripheral non-weight-bearing areas of joints with central fibrillation. Decalcification exposed the interface between the bone and calcified cartilage. Collagen fibrils in articular cartilage did not interdigitate with those of bone. The subchondral bone was appositional, avascular, smooth and very thin in most areas of human joints. Perforations through subchondral bone or calcified cartilage were rare. Bleach maceration destroyed important details.
Open transpedicular biopsy of the vertebral body
Authors: Fidler MW , Niers BB
Published: February 2018

We describe a method of obtaining a biopsy from the body of a vertebra by an open transpedicular route. This minimises the danger of contamination of tissue planes and spaces.
Perichondral grafting for cartilage lesions of the knee
Authors: Homminga GN , Bulstra SK , Bouwmeester PS , van der Linden AJ
Published: February 2018

Twenty-five patients with 30 chondral lesions of the knee were treated with an autogenous strip of costal perichondrium. The graft was fixed to the subchondral bone with Tissucol (Immuno, Vienna), a human fibrin glue. The leg was then immobilised for two weeks followed by two weeks of continuous passive motion. Weight-bearing was permitted after three months. The mean knee score (Ranawat, Insall and Shine 1976) changed from 73 before operation to 90 one year after; in 14 patients evaluated after two years there was no decrease. In 28 cases the defect was completely filled with tissue resembling articular cartilage. We conclude that in most cases perichondral arthroplasty of cartilage defects of the knee gives excellent results.
Development of the hip in multiple epiphyseal dysplasia. Natural history and susceptibility to premature osteoarthritis
Authors: Treble NJ , Jensen FO , Bankier A , Rogers JG , Cole WG
Published: February 2018

We have determined the natural history of hip development in 42 patients with multiple epiphyseal dysplasia (MED). Premature osteoarthritis was a frequent outcome and was almost inevitable before the age of 30 years in those with incongruent hips. There were two types of immature hips: type I, the more severe form, had a fragmented and flattened ossific nucleus and acetabular dysplasia, was misshapen at skeletal maturity and osteoarthritic by 30 years of age; the milder type II hip had a small, rounded, uniformly ossified nucleus and a more normal acetabulum. Type II hips were well formed at maturity and were less prone to premature osteoarthritis. Considerable variations were noted in the manifestations of MED between families but not within families. The prognosis of a child's hip could be predicted; in sporadic cases from the type of immature hip, and in familial cases by also taking into account the outcome of affected relatives.
Reduction of contamination at total hip replacement by special working clothes
Authors: Blomgren G , Hoborn J , Nystrom B
Published: February 2018

We assessed wound, air and operative field contamination at 50 total hip operations, performed in a zonal ventilation system. Theatre staff wore either a specially designed polypropylene non-woven coverall or conventional cotton shirt and trousers. The surgeons wore partially impermeable operating gowns. The polypropylene coverall was associated with significantly lower air and wound counts. The coverall was warmer than cotton but judged to be acceptable. The combined use of zonal ventilation and the coverall achieved ultra-clean air conditions.
On the problem of heat generation in bone cutting. Studies on the effects on liquid cooling
Authors: Toksvig-Larsen S , Ryd L , Lindstrand A
Published: February 2018

A saw blade was made from two standard oscillating blades which were fixed to each other with channels between, so that cooling fluid could be directed to the saw teeth. The blade was connected to a standard arthroscopy pump which delivered a flow of 80 ml/min through the blade. The performance of this blade was compared with that of a standard saw blade, cutting ox-bone in the laboratory. Irrigation of the standard saw blade with saline delivered by a syringe only slightly diminished the maximum temperature. Pumped irrigation was more effective but required large volumes of fluid. The heat generated by the internally cooled saw blade was negligible and the temperatures achieved (19 degrees C to 34 degrees C) fell well below the critical level for bone death (44 degrees C to 47 degrees C).
Scaphoid malunion
Authors: Nakamura P , Imaeda T , Miura T
Published: February 2018

We reviewed 10 patients with symptomatic malunion of a carpal scaphoid fracture. All had displacement with dorsiflexed intercalated segment instability, and suffered from pain, restricted range of movement at the wrist and decreased grip strength. The restriction of flexion-extension and the decreased grip strength correlated with the severity of the DISI deformity. Seven patients had a corrective osteotomy, using an anterior wedge-shape bone graft with internal fixation by Herbert screw, and all had satisfactory results. We believe that symptoms associated with scaphoid malunion are related to consequent carpal deformity.
Sensitivity to titanium. A cause of implant failure?
Authors: Lalor PA , Revell PA , Gray AB , Wright S , Railton GT , Freeman MA
Published: February 2018

Tissues from five patients who underwent revision operations for failed total hip replacements were found to contain large quantities of particulate titanium. In four cases this metal must have come from titanium alloy screws used to fix the acetabular component; in the fifth case it may also have originated from a titanium alloy femoral head. Monoclonal antibody labelling showed abundant macrophages and T-lymphocytes, in the absence of B-lymphocytes, suggesting sensitisation to titanium. Skin patch testing with dilute solutions of titanium salts gave negative results in all five patients. However, two of them had a positive skin test to a titanium-containing ointment.
Effect of stem modulus in a total hip arthroplasty model
Authors: Maistrelli GL , Fornasier V , Binnington A , McKenzie K , Sessa V , Harrington I
Published: February 2018

The purpose of this study was to determine the biological effects of the elastic modulus of the femoral stem in canine hip arthroplasty. Cementless total hip arthroplasty was performed in 12 dogs, six had a low elastic modulus polyacetal resin stem and six had a high modulus stainless steel stem. The components were otherwise similar. At six and 12 months after operation, radiographic and histomorphometric analysis showed that those with steel implants had more cortical porosity than did the other group (p less than 0.01). We suggest that the elastic modulus of the implant is an important factor in controlling cortical bone resorption. A low modulus femoral prosthesis can significantly decrease bone resorption which might otherwise eventually lead to implant failure.
A plaster-pylon technique for below-knee amputation
Authors: Harrington IJ , Lexier R , Woods JM , McPolin MF , James GF
Published: February 2018

We reviewed 83 patients after below-knee amputation. In 56 with 69 amputations early management was by plaster-pylon. A plaster cast is applied in the operating room, and a pylon added one week later, after which full weight-bearing is allowed. We compared these patients with 27 who had soft bandaging. The 'healing' time was reduced from 98 days to 40 days, and there were no major complications in the plaster-pylon group. The technique is simple and cheap and can be used by paramedical staff without specialised training or equipment.
Surgical treatment of the flail knee after poliomyelitis
Authors: Men HX , Bian CH , Yang CD , Zhang ZL , Wu CC , Pang BY
Published: February 2018

We report our experience of surgical treatment for instability of flail knees after poliomyelitis in 228 patients. We made carefully selective use of soft-tissue release, extension osteotomy of the femur, and a patellar bone block for hyperextension. After six to nine years follow-up, 87% of the patients had retained significant improvement in stability and walking ability.
Free vascularised fibular grafts for congenital pseudarthrosis of the tibia
Authors: Simonis RB , Shirali HR , Mayou B
Published: February 2018

We describe 11 patients with congenital pseudarthrosis of the tibia treated by a free vascularised fibular graft (FVFG) and followed up from 10 to 64 months (mean 38). Bony union was achieved in nine of the 11 cases: two failures required amputation. The mean time for union in the successful cases was five months. Nine of the 11 patients had had an average of four surgical procedures before the FVFG, so the graft was a salvage procedure for which the only alternative was amputation. FVFG is recommended as a primary procedure for the treatment of congenital pseudarthrosis of the tibia if there is a large tibial defect (over 3 cm) or shortening of more than 5 cm. The primary use of this operation is not advised for cases in which standard orthopaedic procedures are expected to succeed. For a small defect with a favourable prognosis (Boyd and Sage 1958), we recommend conventional bone grafting, intramedullary nailing and electrical stimulation.
Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. Indications and long-term results
Authors: Lack W , Windhager R , Kutschera HP , Engel A
Published: February 2018

Of 142 Chiari pelvic osteotomies for osteoarthritis in dysplastic hips, most performed by Chiari himself, we were able to review 82 and obtain information about 18 by questionnaire. All patients were over 30 years of age at operation; follow-up averaged 15.5 years. Twenty hips had undergone secondary total hip replacement. The outcome was good in 75%, fair in 9% and poor in 16%. High osteotomies all gave good results, and the result also depended on adequate medialisation. Statistics were worse for patients over 44 years of age at the time of operation. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement. In contrast to intertrochanteric osteotomy, it has the advantage of facilitating the implantation of an acetabular prosthesis should arthroplasty become necessary at a later stage.
The shoulder in multiple epiphyseal dysplasia
Authors: Ingram RR
Published: February 2018

One hundred shoulders were assessed in 50 patients with multiple epiphyseal dysplasia, of which one-third were found to have bilateral symptoms. Two distinct clinical and radiological groups emerged. Those with minor epiphyseal abnormalities developed painful osteoarthritis in middle age, but retained shoulder movement until the secondary changes were advanced. Those with 'hatchet head' shoulders likewise became painful in the fifth and sixth decades but had minimal glenohumeral movement from an early stage.
Bone weakness after the removal of plates and screws. Cortical atrophy or screw holes?
Authors: Rosson J , Egan J , Shearer J , Monro P
Published: February 2018

Bone weakness leading to refracture is a recognised complication of the removal of rigid fixation plates. We have used partially demineralised rabbit tibiae to simulate atrophic changes and to determine whether weakness is due to atrophy or to residual screw holes. Partial demineralisation and a screw hole each reduced maximum bending moment. However, energy absorbing capacity was little affected by demineralisation, but was reduced to 50% by a single drill hole. Residual screw holes are a considerably more important cause of bone weakness after plate removal than is cortical atrophy.
External fixation for intra-articular fractures of the distal radius
Authors: Jakim I , Pieterse HS , Sweet MB
Published: February 2018

In a prospective study of 132 patients with an average age of 35 years, unstable intra-articular fractures of the distal radius were treated by external fixator. Only 15 cases required limited open reduction. Follow-up was for a mean of 42 months. There were few complications and 83% of patients had good or excellent results. There was a statistically significant correlation between the severity of the fracture and the clinical outcome, irrespective of radiological restoration. Articular and soft-tissue damage following violent compressive forces may lead to a degree of functional impairment.
A lateral skin incision reduces peripatellar dysaesthesia after knee surgery
Authors: Berg P , Mjoberg B
Published: February 2018

In a series of 64 ligamentous injuries of the knee, 33 were explored through a medial incision and 31 through a long lateral incision. Sensibility of the skin, the occurrence of neuromas, and discomfort during kneeling were evaluated three and six years postoperatively. The lateral incisions produced less dysaesthesia, fewer neuromas and less discomfort on kneeling.
Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results
Authors: Ellman H , Kay SP
Published: February 2018

Subacromial decompression was performed arthroscopically on 65 patients who were evaluated two to five years after the procedure. None had full thickness rotator cuff tears. Patients with partial thickness cuff tears were included in this study in order to allow comparison of arthroscopic acromioplasty with open acromioplasty for stage II impingement. On the UCLA shoulder rating scale, 89% of the cases in this study achieved a satisfactory result. These results compare favourably with those reported following open acromioplasty. The arthroscopic procedure is technically demanding. When properly performed in patients with appropriate indications, hospitalisation is brief, return to activities is rapid, there is little risk of deltoid muscle complications, and the results are lasting.
Glenohumeral joint instability in normal adolescents. Incidence and significance
Authors: Emery RJ , Mullaji AB
Published: February 2018

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs.
Lengthening for congenital short femur. Results of different methods
Authors: Grill F , Dungl P
Published: February 2018

We have reviewed the results in 37 patients with unilateral congenital short femur (Pappas classes III to IX), treated by different lengthening procedures. The increase in the length of the femur varied from 15.6% to 142%, excellent or good results being obtained in 32 patients (86%). There was an average of 1.9 complications per case, most being seen earlier in the series when the Wagner technique was used. With the Orthofix and the Ilizarov techniques, we used callus distraction in all cases. We found that the proximal diaphysis of the congenitally abnormal femur healed less well, and we now prefer to perform corticotomy and callus distraction of the distal metaphysis. The Ilizarov method gave the best results, offering the possibilities of the simultaneous use of a Hoffmann fixator across the hip and the treatment of knee dislocation and instability.
Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting
Authors: Thakur AJ , Patankar J
Published: February 2018

Seventy-nine open tibial fractures were treated with unilateral uniplanar tubular external fixators. Excellent stability allowed early weight-bearing. All comminuted fractures, with or without bone loss, and some transverse or short oblique fractures with intermediate fragments were treated by early bone grafting through a posterolateral approach. The external fixator was dynamised as soon as periosteal callus was seen on the radiograph. Bone healing times ranged from 11 to 40 weeks (mean 20). Significant ankle stiffness occurred in 10.9% and leg shortening in 2.8%. Pin track infection was seen in 45.2% but was easily controlled with standard management. The external fixation frame allowed excellent functional freedom for Oriental patients to sit cross-legged and squat. Combined with early bone grafting, external fixation is an excellent method for the management of open tibial fractures.
The cubital tunnel and ulnar neuropathy
Authors: O'Driscoll SW , Horii E , Carmichael SW , Morrey BF
Published: February 2018

The anatomy of the cubital tunnel and its relationship to ulnar nerve compression is not well documented. In 27 cadaver elbows the proximal edge of the roof of the cubital tunnel was formed by a fibrous band that we call the cubital tunnel retinaculum (CTR). The band is about 4 mm wide, extending from the medial epicondyle to the olecranon, and perpendicular to the flexor carpi ulnaris aponeurosis. Variations in the CTR were classified into four types. In type 0 (n = 1) the CTR was absent. In type Ia (n = 17), the retinaculum was lax in extension and taut in full flexion. In type Ib (n = 6) it was tight in positions short of full flexion (90 degrees to 120 degrees). In type II (n = 3) it was replaced by a muscle, the anconeus epitrochlearis. The CTR appears to be a remnant of the anconeus epitrochlearis muscle and its function is to hold the ulnar nerve in position. Variations in the anatomy of the CTR may explain certain types of ulnar neuropathy. Its absence (type 0 CTR) permits ulnar nerve displacement. Type Ia is normal and does not cause ulnar neuropathy. Type Ib can cause dynamic nerve compression with elbow flexion. Type II may be associated with static compression due to the bulk of the anconeus epitrochlearis muscle.
The geometry of the humeral head and the design of prostheses
Authors: Roberts SN , Foley AP , Swallow HM , Wallace WA , Coughlan DP
Published: February 2018

The articular surface of the humeral head is usually described as facing posteromedially, making an angle of between 16 degrees and 35 degrees with the transepicondylar plane. At hemiarthroplasty the articular surface also appears to be offset posteriorly with respect to the humeral shaft. Coracoid impingement may occur if this offset is not accommodated. An analysis was made of 29 cadaveric humeri using an industrial co-ordinate measuring machine. The position of the centre of the head was defined with respect to the humeral shaft and transepicondylar plane. The humeral articular surface was found to be retroverted by 21.4 degrees and its centre offset posteriorly by 4.7 mm. Previous interpretation of retroversion did not take into account the posterior displacement, and this may be of importance in improving future prosthetic design.
Observer variation in the radiographic classification of ankle fractures
Authors: Thomsen NO , Overgaard S , Olsen LH , Hansen H , Nielsen ST
Published: February 2018

We recorded inter- and intra-observer variations in the classification of ankle fractures by the Lauge Hansen and Weber systems. Radiographs of 94 patients were classified independently by four observers. The observer variation was calculated by kappa statistics, which corrects the obtained values for the agreement expected by chance. There was an acceptable level of agreement for the overall classification into both systems. For the staging of supination-adduction and supination-eversion fractures in the Lauge Hansen system the agreement was poor. The results indicate that future classification systems should be subject to reliability analysis before they are accepted.
Prosthetic replacement of the distal femur for primary bone tumours
Authors: Roberts P , Chan D , Grimer RJ , Sneath RS , Scales JT
Published: February 2018

Over a 16-year period, 135 custom-made distal femoral prostheses, based on a fully constrained Stanmore-type knee replacement, were used in the treatment of primary malignant or aggressive benign tumours. Survivorship analysis showed a cumulative success rate of 72% at five years and 64% at seven years. Intact prostheses in 91% of the surviving patients gave good or excellent functional results. Deep infection was the major complication, occurring in 6.8% of cases; clinical aseptic loosening occurred in 6.0%. Revision surgery was carried out for loosening and infection, and the early results are encouraging. We conclude that prosthetic replacement of the distal femur can meet the objectives of limb salvage surgery.
Quantifying bone loss from the proximal femur after total hip arthroplasty
Authors: McCarthy CK , Steinberg GG , Agren M , Leahey D , Wyman E , Baran DT
Published: February 2018

To define the natural history of bone loss around a femoral prosthesis, the bone mineral content and bone mineral density were measured for each femur in 28 patients with unilateral total hip arthroplasty, 18 age-matched controls, and seven patients with unilateral osteoarthritis. The areas measured were inside the lesser trochanter and 4.8 cm distal to it. The contralateral hip served as the control. Three years after arthroplasty there was 40% loss in average bone mineral content inside the lesser trochanter, and 28% loss in average bone mineral content 4.8 cm distally in the medial cortex. At seven to 14 years after operation, patients had lost 40% of bone proximally and 49% distally. The data suggest that this may progress in a proximal-to-distal fashion, and could account for a 50% decrease in bone mass seven to 14 years after surgery.
Effect of hypotensive epidural anaesthesia on acetabular cement-bone fixation in total hip arthroplasty
Authors: Ranawat CS , Beaver WB , Sharrock NE , Maynard MJ , Urquhart B , Schneider R
Published: February 2018

We selected 20 matched pairs of patients who had had total hip arthroplasty by the same surgeon using the same cemented technique. Matching was by age, sex, height, weight and diagnosis. One of each pair had received hypotensive epidural anaesthesia, with less than 300 ml blood loss: the other had normotensive general anaesthesia with more than 500 ml of blood loss. Early postoperative radiographs were evaluated independently by three blinded observers, using a scoring criteria which assessed the quality of the cement-bone interface. The results showed that patients who had received epidural anaesthesia had significantly better radiographic scores (p less than 0.02). Our findings suggest that hypotensive anaesthesia facilitates penetration of cement into bone.
The odontoid process in Morquio-Brailsford's disease. The effects of occipitocervical fusion
Authors: Stevens JM , Kendall BE , Crockard HA , Ransford A
Published: February 2018

High definition computed cervical myelograms have been made in flexion and extension in 13 patients with Morquio-Brailsford's disease. We observed that: 1) odontoid dysplasia was present in every case, with a hypoplastic dens and a detached distal portion which was not always ossified; 2) atlanto-axial instability was mild, and anterior atlanto-axial subluxation was absent in most cases; 3) severe spinal cord compression, when present, was due to anterior extradural soft-tissue thickening; 4) this compression was not relieved by flexing or extending the neck and was manifested early in life; 5) posterior occipitocervical fusion resulted in disappearance of the soft-tissue thickening and normalisation of subsequent development of the dens. We conclude that the severity of neurological involvement at the craniovertebral junction was determined by soft-tissue changes, not by the type of odontoid dysplasia nor by subluxation. Posterior occipitocervical fusion proved to be an effective treatment.
Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management
Authors: Weatherley CR , Mehdian H , Berghe LV
Published: February 2018

We present a 26-year-old athlete with severe low back pain associated with a fracture of a lumbar pedicle and contralateral spondylolysis. The difficulties of diagnosis are discussed together with the subject of segmental pain referral. A technique of operative management is described involving instrumentation of the symptomatic level alone.
Fibular hypoplasia with absent lateral rays of the foot
Authors: Maffulli N , Fixsen JA
Published: February 2018

We describe 11 children with fibular hypoplasia and three- or four-ray feet, two bilaterally. This deformity is a less severe form of the better known congenital short tibia with absent or dysplastic fibula. If the leg-length discrepancy is minor, no treatment or a simple orthosis are used. Epiphysiodesis or leg lengthening by callotasis is appropriate for mild to moderate discrepancy. If the foot is non-functional, or the projected leg-length discrepancy is too great, early amputation and a prosthesis are advised.
Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front
Authors: Suzuki S , Kasahara Y , Futami T , Ushikubo S , Tsuchiya T
Published: February 2018

We describe a new technique for examining the infant hip using ultrasound. Both hips are imaged simultaneously via an anterior approach. The examination can be done with the hip either extended or flexed and abducted. The method has three advantages: 1) since both hips are imaged simultaneously, lines can be drawn to assist in determining the relationship between the femoral head and the pelvis; 2) proximal, anteroposterior and lateral displacement of the femoral head can all be demonstrated; 3) the method is applicable to the infant in a harness or a plaster cast to demonstrate maintenance of reduction of a dislocated hip. The usual direction of dislocation of the femoral head was anterior and lateral. Proximal migration was also observed in cases with more severe dislocation. In flexion, the dislocated head of the femur often moved posterior to the acetabulum. Of 1276 hips, in 638 infants aged from three weeks to one year, 49 showed congenital dislocation. The accuracy of our anterior method of sonography in diagnosing congenital dislocation of the hip compared well with the method of Graf and with radiography.
Ultrasonography in slipped capital femoral epiphysis. Diagnosis and assessment of severity
Authors: Kallio PE , Lequesne GW , Paterson DC , Foster BK , Jones
Published: February 2018

We used ultrasonography to study 26 hips with slipped capital femoral epiphyses. In recently slipped epiphyses the ultrasound image revealed a step at the anterior physeal outline (mean 6.4 mm), diminished distance between the anterior acetabular rim and the femoral metaphysis (mean 4.3 mm) and an effusion. As metaphyseal remodelling progressed the physeal step decreased. The femoral neck appeared straighter in hips which had been symptomatic for longer than three weeks. It was possible to measure posterior epiphyseal displacement without projectional errors and the method was accurate in diagnosing minimal slip and in staging displacement. The suggested criteria are, less than 7 mm for a mild slip, 7 to 11 mm for a moderate slip and more than 11 mm for a severe slip. We recommend ultrasonography for the diagnosis, staging and follow-up management of slipped upper femoral epiphysis.
Total hip replacement after failed hemiarthroplasty or mould arthroplasty. Comparison of results with those of primary replacements
Authors: Llinas A , Sarmiento A , Ebramzadeh E , Gogan WJ , McKellop HA
Published: February 2018

We compared the radiographic results of secondary total hip replacements, 99 following failed uncemented hemiarthroplasties and 21 following failed mould arthroplasties, with those of 825 primary cemented total hip replacements. The probability of occurrence of a number of radiological changes over time was calculated using survival analysis. The mean follow-up was 7.6 years (range one month to 20 years). The performance of the secondary total hip replacements varied with the preceding implant and was different for acetabular and femoral components. The incidence of radiological loosening was higher for femoral components implanted after failed hemiarthroplasties and for acetabular components after failed mould arthroplasties. However, the incidence of continuous radiolucent lines was lower for the acetabular components of converted hemiarthroplasties than for the primary replacements.
Disassembly of a one-piece metal-backed acetabular component. A case report
Authors: Beaver RJ , Schemitsch EH , Gross AE
Published: February 2018

We report a case of late dissociation of a one-piece metal-backed acetabular component, associated with a prolific soft-tissue reaction to the polyethylene debris. The polyethylene liner was not visible on the radiographs. The metal-backed shell could not be removed because of bone ingrowth. We recommend that modular systems be utilised in cementless arthroplasty of the hip and that radiographic markers be incorporated in the polyethylene of the acetabular cup.
Standing radiographs cannot determine the correction in high tibial osteotomy
Authors: Ogata K , Yoshii I , Kawamura H , Miura H , Arizono T , Sugioka Y
Published: February 2018

The use of standing radiographs to determine correction angles for high tibial osteotomy is not appropriate because the relative angle of the articular surfaces (condylar-plateau angle) in the weight-bearing knee changes after the osteotomy. This may give unpredictable results postoperatively. We found that the condylar-plateau angle in postoperative standing films is very similar to that seen in non-weight-bearing supine views, and suggest that these latter radiographs be used for pre-operative planning. We describe our early results, using a special osteotomy jig, in 140 knees.
Conservative management of transverse fractures of the sacrum with neurological features. A report of four cases
Authors: Phelan ST , Jones DA , Bishay M
Published: February 2018

Transverse fractures of the sacrum with neurological complications have been studied in four patients illustrating the following features: diagnosis is often delayed, there are radiological difficulties in making the diagnosis, and the indications for surgery are not well defined. Specific radiographic views are recommended. All the cases presented in this report responded well to conservative management.
Imaging of intramedullary tumour spread in osteosarcoma. A comparison of techniques
Authors: O'Flanagan SJ , Stack JP , McGee HM , Dervan P , Hurson B
Published: February 2018

The level of bone resection for osteosarcoma depends on the pre-operative evaluation of the extent of intramedullary tumour. We compared the accuracy of magnetic resonance imaging (MRI), computerised tomography (CT), and isotope bone scanning with the actual extent of the tumour in the resected specimens from 34 patients with primary osteosarcoma of a long bone. The extent of medullary tumour was defined accurately in 23 of 24 MRI scans (96%) and 24 of 32 CT scans (75%). A flexion contracture of a joint close to the tumour was an important cause for inaccurate measurements from both MRI and CT scans. Isotope bone scanning was inaccurate: its role is now confined to detecting skeletal metastases and skip lesions.
High calcitonin levels in unconscious polytrauma patients
Authors: De Bastiani G , Mosconi F , Spagnol G , Nicolato A , Ferrari S , Aprili F
Published: February 2018

We measured levels of calcitonin and other markers of calcium and phosphorus metabolism in both unconscious and conscious patients after multiple trauma. We found dramatic increases in calcitonin levels in unconscious patients, and smaller increases in conscious patients. In two cases, very high levels, more than 100 x normal, appeared to be related to more rapid healing of bone. Calcitonin levels were highest immediately after admission and decreased over the ensuing two weeks. The possible relationship between unconsciousness and the increased rate of healing of fractures is discussed.