bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure sores in elderly patients. The epidemiology related to hip operations
Authors: Versluysen M
Published: February 2018

The prevalence and onset of pressure sores was studied in 283 patients admitted to a general hospital with either fracture of the proximal femur or for elective hip surgery. Ninety patients developed pressure sores, of which 60 are reported in detail. Most were in women aged 70 or more who had been admitted with hip fractures. The majority of pressure sores started soon after admission, particularly on the day of operation, after which the numbers of new cases decreased. Half the patients had more than one pressure sore and the commonest sites were the sacrum, heels, and buttocks. The mortality in patients with pressure sores was 27% and their mean length of stay in hospital far exceeded that of other patients. The prevention of pressure sores in elderly patients requires more skill and attention than the nurse alone can offer; it demands the help of the whole orthopaedic team.
Avascular necrosis of the femoral head in sickle-cell disease. A series from the Guinea Savannah of Nigeria
Authors: Iwegbu CG , Fleming AF
Published: February 2018

Of 899 patients with sickle-cell disease, aged between 6 and 28 years, who attended clinics in the Guinea Savannah of Nigeria in 1982 and 1983, 29 had symptoms of avascular necrosis of the femoral head. This group was studied in detail. Twenty-eight patients had haemoglobin-SS electrophoretic patterns and one had haemoglobin-SC. The male to female ratio was 1 to 1.6, and most of the patients were aged between 6 and 15 years at the onset of hip symptoms. These symptoms correlated with the radiographic lesions, but were not related to the age or sex of the patient. The radiographic lesions varied widely and were related to the age at onset of hip symptoms. A new radiological classification is proposed.
Fracture-separation of articular cartilage in the adult knee
Authors: Johnson-Nurse C , Dandy DJ
Published: February 2018

Seventy-six knees with fracture-separations of articular cartilage are described. The lesion involved the full thickness of the articular surface with exposed subchondral bone in 28 knees and only part of the thickness in 48. The clinical features and distribution of the lesions within the knee are described.
Congenital contractural arachnodactyly. Report of a case and of an operation for knee contracture
Authors: Langenskiold A
Published: February 2018

A patient with typical congenital contractural arachnodactyly followed up from the age of 12 years to the age of 48 is reported. He had spiderlike fingers and toes and marked contractures of the knees, ankles, toes, shoulders, elbows and fingers; the mobility of the hips and wrists was almost normal. Persistent knee contractures prevented him from walking. In his twenties he had an osteotomy of both femora and shortening of the patellar tendons which enabled him to walk for the first time in an upright position without external support. When seen at the age of 48 the range of movement of his knees was 0 to 90 degrees. He was working as a turner and had been doing so for almost 20 years.
Entrapment of the superficial peroneal nerve. Three case reports
Authors: Kernohan J , Levack B , Wilson JN
Published: February 2018

Entrapment of the superficial peroneal nerve is an unusual cause of pain in the ankle and foot. In such cases decompression of the nerve at the point of exit from the deep fascia will produce a good result. Three cases are described.
A technique for lumbar spinal osteotomy in ankylosing spondylitis
Authors: McMaster MJ
Published: February 2018

Fourteen patients with ankylosing spondylitis had an extension osteotomy for severe flexion deformity of the spine. The Smith-Petersen technique was modified by using a compression device which allows a slow, finely controlled closure of the osteotomy, and provides rigid internal fixation. There were no serious neurological complications. All the patients were able to see straight ahead after operation, and all had solid fusion at nine months, having maintained good correction.
Bilateral hip and knee replacement for rheumatoid arthritis
Authors: McElwain JP , Sheehan JM
Published: February 2018

A series of 19 patients with severe rheumatoid arthritis had replacement of both hips and both knees. They are reviewed after a mean follow-up of 27 months. The preferred programme is to replace hips before knees. Pain was relieved in all the patients and function was improved in all but two. Severe rheumatoid disease and prolonged immobilisation before the operations were not contra-indications to a successful outcome, but the presence or the development of cervical myelopathy combined with gross upper limb deformity militated against a good result.
Periosteal chondroma of the humerus leading to shortening. A case report
Authors: Pazzaglia UE , Ceciliani L
Published: February 2018

We report a case of periosteal chondroma of the proximal humerus with multiple cartilaginous masses extending around two-thirds of the metaphysial circumference. The humerus was short, presumably because the tumour interfered with growth at the epiphysial plate.
Congenital subluxation of the hip. A long-term review
Authors: Sherlock DA , Gibson PH , Benson MK
Published: February 2018

In 1957 Somerville and Scott described their "direct approach" to the management of established congenital dislocation of the hip; arthrography after a period of traction served to distinguish the dislocated from the subluxated hip. We review the long-term outcome of hips which, using their criteria, were subluxated; 72 hips have been reviewed at periods ranging from 15 to 37 years after treatment by traction, closed reduction and femoral osteotomy. The results have been classified clinically and radiologically according to Severin's criteria. There was progressive deterioration with age in both clinical function and radiographic appearance: 48.5% of hips showed evidence of dysplasia or subluxation at review. The results are similar to those found in a series treated by open reduction and limbectomy, differing only in the much lower incidence of degenerative changes after closed reduction.
Tibiofemoral alignment and the results of knee replacement
Authors: Tew M , Waugh W
Published: February 2018

We examine the hypothesis that a knee replacement is most likely to survive successfully if it is stable with a coronal tibiofemoral angle close to 7 degrees of valgus, the accepted normal. The records of 428 knee replacements followed up for one to nine years were analysed. The highest success rate was indeed found in those so aligned at operation and such knees were most likely to remain stable. Nevertheless, half of the failures occurred in knees correctly aligned at operation and two-fifths in knees which had remained stable in this alignment; many failures must have been caused by factors other than malalignment. Some knees, well aligned at operation, deteriorated into severely varus or valgus positions; their failure rate was significantly higher than that for knees which remained normally aligned and higher also than for knees severely varus or valgus from operation onwards. Malalignment, in itself, may not be the most important cause of failure, though it probably does compound failure from other causes.
A repair operation for recurrent dislocation of peroneal tendons
Authors: Das De S , Balasubramaniam P
Published: February 2018

A lesion similar to that described by Bankart in recurrent dislocation of the shoulder was seen in seven patients with recurrent dislocation of the peroneal tendons. Detachment of the periosteum had resulted in the formation of a false pouch on the surface of the lower end of the fibula; into this pouch the peroneal tendons could easily dislocate. Reattachment of the periosteum to drill holes in the fibula prevented dislocation, and this anatomical method of repair is described. This lesion is one of the causes of recurrent dislocation of the peroneal tendons.
Non-union of a fractured coracoid process after dislocation of the shoulder. A case report
Authors: Garcia-Elias M , Salo JM
Published: February 2018

A patient with a fractured coracoid process in association with a dislocation of the shoulder is reported. The fracture was not recognised initially, and early mobilisation was encouraged; the widely separated fracture did not heal and a painful pseudarthrosis developed. We believe that this association may not be as rare as generally supposed, and emphasise the importance of careful clinical examination in patients with shoulder dislocation. If a coracoid fracture is suspected, lateral or oblique radiographs should be taken to confirm the diagnosis. A further radiograph after reduction is a useful precaution.
Long-term results of early surgical release in club feet
Authors: Hutchins PM , Foster BK , Paterson DC , Cole EA
Published: February 2018

One-hundred and seventy patients with 252 club feet treated by early posterior release were reviewed after a follow-up averaging 15 years 10 months. The feet were assessed both functionally and clinically and the results related to any bony deformity found radiographically; a satisfactory result was obtained in 81%. Lateral tibial torsion was examined and found to be less than in a normal population. The relationship between primary bone deformity and eventual functional result was examined, and a classification of talar dome deformity introduced. The range of ankle movement was a major factor in determining the functional result, and this in turn was influenced by the degree of talar dome flattening. It is suggested that the primary bone deformity present at birth dictates the eventual result of treatment.
Multiple epiphysial dysplasia in one family. A further review of seven generations
Authors: Amir D , Mogle P , Weinberg H
Published: February 2018

A family of 114 people in six generations, of whom 45 were affected by multiple epiphysial dysplasia, was described in this Journal in May 1960. We have been able to review them again 23 years later, and also to report on the type and incidence of the disease in more children and in a further generation. The relative severity of the disease in different branches of the family has been unchanged through the generations. Patients who were previously hopelessly crippled can today be rehabilitated by total hip replacement. Genetic counselling and birth control have reduced the relative and absolute numbers of affected children; this is tending to make the disease self-limiting.
Strength of carbon and polyester fibre tendon replacements. Variation after operation in rabbits
Authors: Amis AA , Campbell  , Miller JH
Published: February 2018

The calcaneal tendons of rabbits were excised and either replaced with a carbon or polyester fibre implant, or left as controls. The strength of the neotendons and their mode of failure under tension were examined at intervals up to six months after operation. Return to near normal strength took six months to develop, suggesting that patients having ligament or tendon reconstructions should not resume normal activity for several months. Carbon fibre-based neotendons showed progressive elongation which, unless avoided by a sufficient period of immobilisation, would affect the functional result.
Idiopathic hyperphosphatasia with dermal pigmentation. A twenty-year follow-up
Authors: Dohler  , Souter WA , Beggs I , Smith GD
Published: February 2018

Hyperphosphatasia, or hereditary bone dysplasia with hyperphosphatasaemia, is a rare genetic disorder which is characterised by failure to transform woven into lamellar bone. Clinical, radiological and histological features establish the diagnosis, fractures, deformities, diffuse sclerosis on radiographs and high serum alkaline phosphatase being characteristic. We report the case of a 27-year-old man with follow-up at the same hospital for 20 years. Attempts at treatment with calcitonin and disocium etidronate (EHDP) failed, but stapling of the growth plates at the knee was successfully performed. Transverse "brittle" fractures of the humerus, lower leg and ribs healed normally, but internal fixation and late bone grafting were required for a subtrochanteric stress fracture of the femur at the age of 24 years. At present the patient has no clinical problems and leads a normal life.
External fixation of the tibia. Basic concepts and prospective evaluation
Authors: Behrens F , Searls K
Published: February 2018

External fixation of fractures of the leg may give uneven results and a high rate of complications. We postulate that three basic principles can govern the optimal use of these devices. The external fixation frame should avoid damage to vital anatomical structures, it should allow access to the injured area and it should meet the mechanical demands of the patient and the injury. From 1978 to 1981 these principles were evaluated prospectively in 75 consecutive cases of complex tibial injury treated with an external frame. Most were open fractures. The study confirmed that the principles were safe and effective; they have general application and do not depend on the use of a particular frame or device. By following them we have eliminated the majority of complications seen after traditional methods of external fixation.
Triple arthrodesis. A critical long-term review
Authors: Angus PD , Cowell HR
Published: February 2018

The results of triple arthrodesis performed in 80 feet and followed for an average of 13 years are reviewed. Although the majority of patients were very pleased, the results of objective assessment were less favourable. There was a high incidence of degenerative joint changes in the ankle and midfoot and also of pseudarthrosis, avascular necrosis of the talus and residual deformity. Pre-operative rigid equinovarus deformity produced the majority of the poor results. It is suggested that bony resection alone might not be the best means of correcting severe equinus.
Mechanical and biochemical properties of human articular cartilage in osteoarthritic femoral heads and in autopsy specimens
Authors: Roberts S , Weightman B , Urban J , Chappell D
Published: February 2018

We studied the mechanical and biochemical properties of articular cartilage from 22 osteoarthritic femoral heads obtained at operation and 97 femoral heads obtained at autopsy. Cartilage from the zenith and from the antero-inferior aspect of each head was tested both in tension and in compression. Water content, swelling ability and proteoglycan content were measured, the cartilage was examined histologically and the density of the underlying bone was assessed. Fifty-five of the autopsy specimens were defined as macroscopically normal because they exhibited no progressive fibrillation patterns on staining with Indian ink; but significant changes in water content, bone density and tensile strength related to age were seen in this group. In 20 pairs of femoral heads which were both macroscopically normal, we found, surprisingly, that cartilage from the left and right sides of the same patient was sometimes very different. Compared with the normal autopsy specimens the osteoarthritic specimens had a significantly increased swelling ability, a lower proteoglycan content and impaired mechanical properties, being both weaker in tension and softer in compression. Abnormal autopsy specimens had values intermediate between those of osteoarthritic and normal groups. Results from this abnormal group suggest that there is no primary loss of proteoglycan in early osteoarthritis.
The tricho-rhino-phalangeal syndrome. A report of 14 cases in 7 kindreds
Authors: Howell CJ , Wynne-Davies R
Published: February 2018

Tricho-rhino-phalangeal syndrome is probably not so much uncommon as unrecognised. Its significance to orthopaedic surgeons, apart from the functionally unimportant minor finger deformities, lies in its mimicking both Perthes' disease and diaphyseal aclasis. The 14 cases analysed in this paper illustrate the wide range of clinical variation.
Radical excision of an osteoblastoma of the cervical spine. A combined anterior and posterior approach
Authors: Weatherley CR , Jaffray D , O'Brien JP
Published: February 2018

We report and discuss a combined anterior, anterolateral and posterior approach to the lower cervical spine. This was used for the radical resection of a recurrent osteoblastoma which involved the lateral mass, pedicle, and lamina of the sixth cervical vertebra.
Vascularised rib grafts for stabilisation of kyphosis
Authors: Bradford DS , Daher YH
Published: February 2018

The results of vascularised rib graft transfers are analysed in 25 patients followed up for more than two years (average 34 months). Radiographs showed early and rapid incorporation of the grafts in 4 to 16 weeks (average 8.5 weeks); external immobilisation averaged 11 weeks (range 5 to 24 weeks). The technique seems a useful alternative to allografts or homografts employing an avascular rib or fibula since it promotes rapid healing without needing microsurgical techniques.
Magnetic resonance imaging and discography in the diagnosis of disc degeneration. A comparative study of 50 discs
Authors: Gibson MJ , Buckley J , Mawhinney R , Mulholland RC , Worthington BS
Published: February 2018

The lumbar spines of 22 patients were examined for disc degeneration by magnetic resonance imaging (MRI) and by discography. The results from 50 intervertebral discs visualised by both techniques were independently assessed and graded on a five-point scale from normality to gross degeneration and then compared. In 44 discs the results agreed. Of the six discs which gave differing results, four discrepancies were due to observer error and two to incorrect placement of the discographic needle. MRI was shown to be more accurate than discography in the diagnosis of disc degeneration. It has several major advantages, which should make it the investigation of choice.
Compression of the biceps-brachialis compartment after trivial trauma
Authors: Jenkins NH , Mintowt-Czyz WJ
Published: February 2018

We report a case of post-traumatic compartment syndrome of the biceps-brachialis compartment after a minor injury. The condition is well recognised after a drug overdose, but surgeons should be aware that a compartment syndrome may also be caused by apparently trivial trauma, and that it may develop in regions other than the anterior compartments of the leg and forearm.
Treatment of femoral neck fractures with a cancellous screw and fibular graft
Authors: Nagi ON , Gautam VK , Marya SK
Published: February 2018

Twenty-six patients with femoral neck fractures were treated by open reduction, cancellous screw fixation and free fibular grafting. The patients were between 14 and 50 years of age. There were 16 old and 10 fresh fractures. Four patients had radiological signs of avascular necrosis before the treatment was instituted. Bony union was achieved in all patients except one, where the failure occurred because of a technical error. The patients were followed up for at least two years. No new case of avascular necrosis was detected after treatment, and there was clinical and radiological improvement in all four patients with pre-operative avascular necrosis.
Mechanical and biochemical properties of human articular cartilage from the femoral head after subcapital fracture
Authors: Roberts S , Weightman B , Urban J , Chappell D
Published: February 2018

Articular cartilage from the femoral heads of 27 patients having an arthroplasty for subcapital fracture was studied, and its mechanical and chemical properties compared to those of a group of 33 age-matched macroscopically normal autopsy specimens. Water and proteoglycan contents were measured, as were swelling ability, compressive and tensile strength of the cartilage, and the density of the underlying bone. Cartilage from the fracture specimens had a significantly reduced proteoglycan content, as measured by fixed charge density, and increased swelling ability. These results indicate that this group differs from the "normal" population and care should be taken before they are accepted as control material for studies on osteoarthritic cartilage. Another finding was that bone density was much the same in the fracture and the normal group. This casts some doubt upon the concept that patients who sustain subcapital fractures are more osteoporotic than the average for the same age range.
Recurrent stress fractures in military recruits. One-year follow-up of 66 recruits
Authors: Giladi M , Milgrom C , Kashtan H , Stein M , Chisin R , Dizian R
Published: February 2018

Of 66 recruits who sustained stress fractures during basic training and returned to training after a period of rest, seven (10.6%) suffered recurrent fractures within one year. None of the recurrences was at the original anatomical site. All of the recruits with recurrent stress fractures had had at least one of their initial stress fractures in the femur. This suggests that a femoral stress fracture carries a high risk of recurrence at other sites.
Slipped upper femoral epiphysis. A potential for spontaneous recovery
Authors: Clarke NM , Harrison MH
Published: February 2018

Evidence is presented to support the contention that after slipping of the upper femoral epiphysis there is a potential for the bony epiphysis to grow back to its pre-slipped position. A suggestion is made as to how this recovery may occur.
Chondrodiatasis-controlled symmetrical distraction of the epiphyseal plate. Limb lengthening in children
Authors: De Bastiani G , Aldegheri R , Renzi Brivio L , Trivella G
Published: February 2018

We describe a technique for slow, progressive, symmetrical distraction of the growth plate using a lightweight dynamic axial fixation system. Results are given for the elongation of 40 bony segments in children with limb-length discrepancies and 60 segments in children with achondroplasia or hypochondroplasia. Increases in limb length of up to 36% were obtained in non-achondroplastic and up to 64.5% in achondroplastic patients. There were no nerve or vascular lesions or bony infections and no case required a bone graft. Pin-track complications occurred in only 1.5%.
Trochanteric fractures of the femur. A randomised prospective trial comparing the Jewett nail-plate with the dynamic hip screw
Authors: Esser MP , Kassab JY , Jones DH
Published: February 2018

In a randomised prospective trial 98 elderly women with trochanteric fractures of the femur were treated with either a 135 degrees Jewett nail-plate or a 135 degrees Dynamic hip screw. The results at six weeks, three months and six months were statistically analysed. There were no significant differences in the two groups with regard to pain, length of hospital stay, morbidity or mortality. Although operative difficulties and open reduction were more common with the Dynamic hip screw, at the end of six months more patients in this group were mobile and there was significant radiological evidence of better compression without loss of fixation.
Nerve root compression in spondylolysis and spondylolisthesis
Authors: Edelson JG , Nathan H
Published: February 2018

Thirty-four bony specimens of isthmic spondylolysis were examined and, in a significant number (32%), stenosis of the intervertebral foramen was noted. Although not emphasised in previous reports, this finding may be an important factor in the aetiology of nerve root compression when this is associated with spondylolysis and spondylolisthesis. Anatomical guidelines for adequate surgical decompression are suggested.
Spondylo-epiphyseal dysplasia tarda. The X-linked variety in three brothers
Authors: Iceton JA , Horne G
Published: February 2018

Three brothers with the X-linked variety of spondylo-epiphyseal dysplasia tarda are presented. Their clinical courses differed: one was relatively free of symptoms, the second had slowly progressive osteoarthritis of the hip, and the third had an acute, disabling arthritis necessitating total hip arthroplasty. The clinical features of this disorder are reviewed.
A reappraisal of acute traumatic central cord syndrome
Authors: Merriam WF , Taylor TK , Ruff SJ , McPhail MJ
Published: February 2018

A review of 77 patients with traumatic central cord syndrome revealed that atypical variations are more common than the existing literature suggests and that these may be seen in a wide variety of acute injuries to the cervical spine. In general the outcome is good; a favourable prognosis on admission is suggested by good hand function, hyperpathia, Lhermitte's sign and normal perianal sensation. The study has highlighted the value of regular muscle charting and has cast doubt on previous neuroanatomical assumptions about the syndrome.
The changes in the intervertebral disc after chemonucleolysis demonstrated by magnetic resonance imaging
Authors: Gibson MJ , Buckley J , Mulholland RC , Worthington BS
Published: February 2018

Magnetic resonance imaging (MRI) of the spine produces images which reflect the chemical composition of the intervertebral disc. We have conducted a prospective study of the serial changes in the MRI appearance of the intervertebral disc after chemonucleolysis with the enzyme chymopapain. Fourteen patients were studied after single-level chemonucleolysis and the results compared with a control group of 17 discs in six patients who had diagnostic discography without enzyme insertion. A consistent pattern of gradual loss of signal from the nucleus pulposus culminating in complete loss of nuclear signal was seen in all cases after chemonucleolysis. Chymopapain therefore produced MRI changes analogous with premature gross disc degeneration. The rate at which this occurred varied; complete loss of signal took at least six weeks. Transitory minor end-plate changes were present in five patients, probably representing a mild chemical discitis. No similar changes were seen in the discography group.
Reconstruction of the anterior cruciate ligament by allogeneic tendon graft. An operation for chronic ligamentous insufficiency
Authors: Shino K , Kimura T , Hirose H , Inoue M , Ono K
Published: February 2018

We describe the use of allogeneic human tendon as an intra-articular replacement for the anterior cruciate ligament. Depending on the type and degree of functional instability we recommend the addition, in some cases, of supplementary extra-articular procedures. We have reviewed 31 patients at least two years after operation and have found that 30 of them had been able to return to full sporting activities. The indications for operation and the techniques are discussed and the use of allogeneic tendon is recommended.
St Georg modular knee prosthesis. A two-and-a-half to six-year follow-up
Authors: Olsen NJ , Ejsted R , Krogh P
Published: February 2018

The St Georg modular knee replacement has been studied in 59 cases with an observation period ranging from 28 to 73 months. In 47% of the knees both compartments were replaced; five of the six poor results were in this group. These were revised to a hinge arthroplasty or, in one case, to an arthrodesis. Other complications were few and insignificant. There were no infections. We concluded that unicompartmental knee arthroplasty can be recommended when joint involvement is localised to one compartment only. With more generalised joint disease we prefer a semiconstrained total condylar prosthesis.
The osteocutaneous free fibular graft
Authors: Harrison DH
Published: February 2018

Free osteocutaneous fibular grafts, revascularised by microvascular anastomoses, have been used for one-stage reconstruction of extensive bone and skin loss in the lower leg in seven patients. The addition of an integral skin flap to a vascularised fibular graft makes reconstruction of bone defects with significant skin loss possible, and the technique for designing and raising such a flap is presented. The advantages of this transfer over other microvascular osteocutaneous flaps are the available length of straight cortical bone, the large thin skin flap, the good diameter of the vascular pedicle and the fact that dissection is carried out under a tourniquet.
Urinary retention after total hip replacement. A prospective study
Authors: Waterhouse N , Beaumont AR , Murray K , Staniforth P , Stone MH
Published: February 2018

We report a prospective study of the factors associated with acute urinary retention after total hip replacement in 103 consecutive male patients. Eleven patients (10.7%) developed retention after operation. Of the factors investigated before operation three had predictive value: inability to pass urine into a bottle whilst lying in bed, urinary peak-flow rates indicative of obstruction, and a history of previous bladder outflow problems. This study suggests that patients showing one or more of these factors should be assessed and if necessary treated by a urologist before arthroplasty, so as to avoid the need for catheterisation, and the consequent risk of deep infection.
Diagnostic ultrasound in haemophilia
Authors: Wilson DJ , McLardy-Smith PD , Woodham CH , MacLarnon JC
Published: February 2018

Ultrasound examination has been recommended for the evaluation of acute haemorrhages into soft tissues or joints in haemophilic patients. We have reviewed the notes of all such patients admitted during one calendar year and find that in 47 separate admissions the ultrasound examination assisted management decisions on 27 occasions. The technique is described with an analysis of the ways in which ultrasound observations may influence the clinician.
The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties
Authors: Ford DJ , Khoury G , el-Hadidi S , Lunn PG , Burke FD
Published: February 2018

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed.
Fat embolism and the fat embolism syndrome. A double-blind therapeutic study
Authors: Lindeque BG , Schoeman HS , Dommisse GF , Boeyens MC , Vlok AL
Published: February 2018

Fifty-five adults who had sustained a tibial fracture, or a femoral fracture, or both, were subjected to a double-blind randomised study to determine the efficacy of methylprednisolone in treating the fat embolism syndrome. This drug maintained arterial oxygen levels, stabilised or reduced the serum level of free fatty acids, and decreased the risk of the fat embolism syndrome in a statistically significant proportion of patients. Gurd's criteria for the diagnosis of the fat embolism syndrome were found inadequate. Other more sensitive criteria for early diagnosis and effective management were determined. There were no deaths or serious morbidity in our series.
Combined chemotherapy and surgery for hydatid bone disease
Authors: Szypryt EP , Morris DL , Mulholland RC
Published: February 2018

Surgical treatment of hydatid bone disease is rarely completely successful because radical excision is only possible at certain sites and secondary infection frequently occurs. Antihelmintic drugs have in the past been only palliative due to poor absorption and consequent low concentration in serum or cysts. We report five patients with Echinococcus granulosus infestation treated with a new chemotherapeutic agent albendazole; in two it was given postoperatively, in two pre-operatively and one child is being followed expectantly. We believe that a combination of chemotherapy and surgery may be efficacious in the treatment of hydatid bone disease.
Discitis after discography
Authors: Fraser RD , Osti OL , Vernon-Roberts B
Published: February 2018

Infection after intradiscal injections has been recognised as a distinct entity, but discitis after discography has often been attributed to an aseptic process or a chemical reaction to the contrast material. We examined the hypothesis that discitis after discography is always due to infection, and report a clinical review and an experimental study. Part I. We reviewed the case records and radiographs of 432 patients who had undergone lumbar discography. When an 18-gauge needle without a stilette had been used, discitis was diagnosed in 2.7% of 222 patients but stiletted needles and a two-needle technique at each level reduced the incidence to 0.7%. Seven patients with discitis after discography had undergone anterior discectomy and fusion; in them the histopathological findings were of a chronic inflammatory response. Bacteria were isolated from the discs of three of the four patients who had open biopsy less than six weeks from the time of discography. These findings suggest that bacteria were initiators rather than promoters of the response. Part II. Multiple level lumbar discography was carried out in mature sheep, injecting contrast material with or without various concentrations of bacteria. Radiographs were taken and the discs and end-plates were examined histologically and cultured for bacteria at intervals after injection. None of the controls showed any evidence of discitis but all sheep injected with bacteria had typical radiological and histopathological changes by six weeks, though cultures were almost all negative. However, at one and two weeks after injection, but usually not after three weeks, bacteria could be isolated. We suggest that all cases of discitis after discography are initiated by infection, and that a very strict aseptic technique should be used for all injections into intervertebral discs.
Computerised axial tomography for tibial plateau fractures
Authors: Dias JJ , Stirling AJ , Finlay DB , Gregg PJ
Published: February 2018

Sixteen consecutive patients with tibial plateau fractures were investigated by standard radiography, biplanar tomography and computerised axial tomograms (CT scans). It was found that CT scanning proved most helpful for classifying the type of fracture, for evaluating the degree of comminution, and for measuring displacement. Moreover, because a single position was maintained throughout the investigation, the patients felt less discomfort than during other assessment procedures. For these reasons CT scanning is recommended for evaluating this type of fracture.
Prosthetic anterior cruciate ligaments in the rabbit. A comparison of four types of replacement
Authors: Thomas NP , Turner IG , Jones CB
Published: February 2018

Four types of prosthetic replacement for the anterior cruciate ligament (carbon fibre, carbon fibre and Dacron composite, Dacron alone and bovine xenograft) were assessed at three, six and 12 months after implantation in the knees of New Zealand white rabbits. The synovium and both intra-articular and intra-osseous portions of the ligaments were examined macroscopically, by light microscopy and by scanning electron microscopy. All the knees showed mild synovitis, and there was no significant growth into the intra-articular part of any ligament. Carbon fibre and xenograft did not appear to be suitable materials in this animal model. The composite ligament showed short-term ingrowth of fibrous tissue only into the periphery of the sheath in its intra-osseous portion, whereas the Dacron ligament showed progressive fibrous tissue ingrowth with some bony incorporation of its outer fibres.
The rib deformity in adolescent idiopathic scoliosis. A prospective study to evaluate changes after Harrington distraction and posterior fusion
Authors: Weatherley CR , Draycott V , O'Brien JF , Benson DR , Gopalakrishnan KC , Evans JH , O'Brien JP
Published: February 2018

A prospective study to investigate changes in the rib hump or rib deformity after correction of the lateral curvature in adolescent idiopathic scoliosis is reported. The operative treatment for 47 patients was by a Harrington distraction rod and posterior fusion. Before operation and at follow-up, measurements of the Cobb angle, of vertebral rotation, and of the rib deformity were taken. Despite operative correction of the lateral curve, there was a progression of the rib deformity in 64% of the cases after four years. Correction of the lateral curve may thus have no effect on vertebral rotation and cannot be guaranteed to effect a permanent reduction of the rib hump.
Splintage for congenital dislocation of the hip. Is it safe and reliable?
Authors: Bradley J , Wetherill M , Benson MK
Published: February 2018

Two-hundred and fifteen children with 288 unstable hips have been treated by splintage during the first nine months of life. A simple treatment protocol was followed and the aim was to test the safety and reliability of this protocol as well as of the Von Rosen splint and the Pavlik harness. A vascular necrosis occurred in 3.8% of the splinted hips. Despite splintage, a proportion of children needed operation at a later date.
Sarcoma at the site of a single hip screw. A case report
Authors: Hughes AW , Sherlock DA , Hamblen DL , Reid R
Published: February 2018

We report a case of malignant fibrous histiocytoma of the hip which occurred 30 years after the insertion of a single chrome-cobalt alloy screw for a slipped femoral epiphysis. The possible aetiological association between malignant tumours and metallic implants is discussed.
The late results of tarsometatarsal joint injuries
Authors: Brunet JA , Wiley JJ
Published: February 2018

The late results of tarsometatarsal injuries in 33 patients have been reviewed. The average follow-up period was 15 years (range 11 to 20 years). Methods of treatment included cast immobilisation, and closed or open reduction with or without internal fixation. All patients noted diminishing symptoms after injury and all but six returned to their former occupation. Neither the initial fracture type nor the treatment had any apparent bearing on subsequent function; nor was there any correlation between radiographic assessment of the injury and the patient's symptoms.
Prediction of survival in patients with femoral neck fractures
Authors: Ions GK , Stevens J
Published: February 2018

A prospective study of factors which might help to predict mortality in patients with intracapsular fractures of the femoral neck has been undertaken. A multivariate analysis technique was used to analyse the collected data, and it was found that mental ability was the most significant variable; this factor had the greatest effect on outcome.
The short-term effects of chymopapain on intervertebral discs
Authors: Dolan P , Adams MA , Hutton WC
Published: February 2018

Cadaveric lumbar discs were injected with chymopapain and subjected to a series of mechanical tests over a period of up to 19 hours. Discs from the same spine injected with saline were used as controls. The results showed that chymopapain had no measurable effect on the mechanical properties of the disc apart from the increased height and stiffening caused by fluid injection. Another series of tests on isolated pieces of disc material showed that chymopapain could reduce the size of prolapsed nuclear material by 24% in one hour and by 80% in 48 hours. It is concluded that, in the short-term, chymopapain has a negligible effect on the mechanics of a disc but it can reduce the size of any prolapsed nuclear material with which it comes in contact.
The effect of head injury on fracture healing. A quantitative assessment
Authors: Spencer RF
Published: February 2018

Using a simple method of quantifying fracture healing, 53 patients who had limb fractures and also severe head injuries were studied; they were compared with 30 patients who had limb fractures but no head injury. Those with head injuries had a greater healing response and united more rapidly. Radiological and histological analysis revealed that the terms "myositis ossificans" and "heterotopic bone" may be more appropriate than "fracture callus" to describe the healing response in these patients.
Contact pressures in the human hip joint
Authors: Afoke NY , Byers PD , Hutton WC
Published: February 2018

The pressure distribution between the cartilaginous surfaces in the human hip joint was measured using pressure-sensitive film. Five cadaveric hip joints (aged between 58 and 87 years) were measured at three positions and loads, representing three instants in the stance phase of the walking cycle. The pressure distribution was not uniform, indicating that the cartilage did not, to any great extent, distribute the applied load. The maximum pressures recorded were about 10 MN/m2. The anterosuperior surface of the cartilage was identified as an area of high pressure.
A surgical approach to the upper thoracic spine
Authors: Turner PL , Webb JK
Published: February 2018

We describe a surgical approach to the upper thoracic spine which allows an adequate exposure of the vertebral bodies from T1 to T3. The approach causes little functional disturbance and is especially useful in older patients with spinal tumours causing spinal cord compression.
Late reduction of the dislocated lunate. A method using distraction by an external fixator
Authors: Vegter J
Published: February 2018

The management of carpal dislocation after a late diagnosis is difficult. Open reduction is the usual treatment but collapse of the carpus may be hard to overcome without extensive dissection and consequent damage to the blood supply, ligaments and articular cartilage. A technique of distraction by an external fixator followed by semi-closed reduction is described and its successful use is reported in two cases.
The penetration of antibiotics into the normal intervertebral disc
Authors: Gibson MJ , Karpinski MR , Slack RC , Cowlishaw WA , Webb JK
Published: February 2018

The role of antibiotics in the treatment of disc-space infection is controversial. This study assessed the tissue penetration of flucloxacillin and cephradine into the normal intervertebral disc after intravenous administration of a bolus dose of antibiotic. Twenty-five discs were removed from 12 adolescent patients having anterior spinal surgery to correct scoliosis; antibiotic had been administered between 30 minutes and four hours before operation. Despite high blood levels, no antibiotic could be detected by bioassay or by high-pressure liquid chromatography (h.p.l.c.) in any of the specimens from the nucleus pulposus or the annulus fibrosus.
Reflex sympathetic dystrophy of the knee
Authors: Ogilvie-Harris DJ , Roscoe M
Published: February 2018

Reflex sympathetic dystrophy of the knee has been studied in a series of 19 patients. Those diagnosed and treated early (at less than six months) did much better than those diagnosed and treated late. Nevertheless, when these patients were followed up at an average of 3.4 years from onset, not one was completely normal to objective tests with the Cybex II dynameter, an indication of the adverse prognosis with current methods of treatment.
Impact-absorbing properties of the human knee
Authors: Hoshino A , Wallace WA
Published: February 2018

A biomechanical study has been carried out on 20 cadaveric knees to investigate their load-absorbing mechanism. The impact load was applied using a weight falling onto the transected proximal femur and the force transmitted through the knee was measured at the transected distal tibia using a load transducer. The peak force transmitted increased as, sequentially, meniscus, articular cartilage and subchondral bone were damaged or removed. The most striking result was found in an implanted knee replacement where the transmitted force reached 180% of that in the intact knee. The results show that the joint has an impact-absorbing property in each segment and that in the osteoarthritic knee there is less absorption of shock than in the normal knee. The high impact force in an implanted knee suggests that microfractures of the cancellous bone might be expected and may produce loosening.
Dorsal wedge osteotomy of the proximal phalanx for hallux rigidus. Long-term results
Authors: Citron N , Neil M
Published: February 2018

Eight women had 10 toes treated for hallux rigidus by dorsal wedge osteotomy of the proximal phalanx and were reviewed after an average follow-up of 22 years. Five toes were symptom-free, four others did not restrict walking, and only one had required metatarsophalangeal fusion. We conclude that dorsal wedge osteotomy affords long-lasting benefits for hallux rigidus in the adolescent female.
Ingrowing toenails: is there a nail abnormality? A prospective study
Authors: Pearson HJ , Bury RN , Wapples J , Watkin DF
Published: February 2018

Ingrowing of the nail of the hallux has been ascribed to an abnormality of the shape of the nail; our prospective study was planned to test this association. Twenty-three consecutive patients and 23 age-matched controls were assessed by caliper measurement and standard photographs, before a first operation for ingrowing toenail. We found no differences in shape between the toenails of the patients and those of the controls, both groups showing great variation. Our results suggest that the ingrowth is not commonly associated with an abnormal shape of the nail.
Reconstruction for chronic anterior cruciate instability. A comparison of two methods after six years
Authors: Bray RC , Flanagan JP , Dandy DJ
Published: February 2018

Forty-seven patients with disabling instability due to isolated anterior cruciate deficiency are described. None had responded to conservative measures or to attempted correction of internal derangements. Eighteen patients were treated by extra-articular MacIntosh lateral substitution alone, the other 29 were treated by the same procedure combined with carbon-fibre replacement of the anterior cruciate ligament. No statistically significant difference was found between the two groups at six years. A satisfactory outcome was found in 44% of the extra-articular group and 55% of the carbon-fibre group at last review; however, the latter group had more complications. There was a marked deterioration in the quality of results between three and six years in both groups.
Torn acetabular labrum in young patients. Arthroscopic diagnosis and management
Authors: Ikeda T , Awaya G , Suzuki S , Okada Y , Tada H
Published: February 2018

Arthroscopy of the hip revealed a torn acetabular labrum in seven young patients. Three of them had had an acute onset of symptoms during sporting activities. On examination all seven patients had pain on passive flexion and medial rotation of the joint. All but one of the tears were located on the posterosuperior portion of the labrum, and, in the acute cases, vascular dilatation around the tear was observed. In these cases, repeated arthroscopy several months later showed that the vascular changes had disappeared, but the tear was still present. The aetiology, diagnosis and treatment of the torn acetabular labrum are discussed.
A new prosthesis for the upper limb
Authors: Lamb DW , Dick TD , Douglas WB
Published: February 2018

We describe the development of a body-powered upper limb prosthesis fitted with a cosmetic functioning hand. The features and advantages of the new design--the PMR (Princess Margaret Rose) prosthesis--are discussed and the clinical results in 15 patients fitted with the prosthesis after above-elbow amputation are described.
Lengthening of the lower limbs in achondroplastic patients. A comparative study of four techniques
Authors: Aldegheri R , Trivella G , Renzi-Brivio L , Tessari G , Agostini S , Lavini F
Published: February 2018

We report our experience of lengthening by over 30% a total of 117 lower limbs in achondroplastic patients. We have compared four methods: transverse osteotomy, oblique osteotomy, callotasis of the shaft and chondrodiatasis of the epiphysis. Chrondrodiatasis of the femur and callotasis of the tibia are the techniques which gave fewest complications.