bluuebunny/crossref_metadata_2025 huggingface dataset:
DRUG-INDUCED ARTHROPATHY AND NECROSIS OF THE FEMORAL HEAD
Authors: Solomon L.
Published: February 2018

1. It is well known that the administration of corticosteroids may result in necrosis and progressive destruction of the femoral head. Identical changes have been found in chronic alcoholics, in South African negroes suffering from iron-overload osteoporosis and in patients with arthritis of the hip treated with non-steroid anti-inflammatory and analgesic preparations. The term "drug-induced arthropathy" is used to describe the common pathological lesion.

2. Seventy-two patients with this complication have been investigated and forty-two femoral heads were available for detailed study. The characteristic change is subchondral fragmentation and osteonecrosis, followed later by reactive bone formation and the typical increased radiographic density.

3. The frequent occurrence of fat occupying the Haversian canals in the affected femoral heads has not been adequately explained and its relationship to the destructive arthropathy remains obscure. The findings presented here do not support the theory that fat emboli are responsible for the subchondral bone changes.

4. More credence is given to the theory of subchondral microfracture in osteoporotic bone. The destructive arthropathy invariably follows the administration of some anti-inflammatory or analgesic preparation. It is postulated that a state of diminished sensibility predisposes to microtrauma in osteoporotic bone resulting in subarticular collapse of the femoral head.
PLATE FIXATION OF DISRUPTED SYMPHYSIS PUBIS
Authors: Sharp Ian K.
Published: February 2018

1. A technique for internal fixation of the disrupted symphysis pubis by an angled four-hole plate is described.

2. In five patients in whom internal fixation was used rapid relief of the severe discomfort caused by symphysial disruption was noted.
INTRAOSSEOUS LIPOMA
Authors: Hart J. A. L.
Published: February 2018

1. A case of intraosseous lipoma is reported.

2. The literature on this tumour is reviewed and possible theories as to its pathogenesis are discussed.

3. It is concluded that the lesion is a true benign tumour which cannot be recognised with certainty without operation.
MECHANICAL FACTORS INFLUENCING THE HOLDING POWER OF SCREWS IN COMPACT BONE
Authors: Uhthoff Hans K.
Published: February 2018

1. Cell differentiation around screws manufactured by two American and two Swiss companies and inserted into seventy femora in forty-one adult mongrel dogs has been observed over periods varying between two weeks and nine months.

2. This study reveals that, despite their excellent holding power, such screws are not everywhere in firm contact with the surrounding bone at the time of insertion. Indeed, only part of the thread surface facing the head of the screw touches the compact bone, all other surfaces being separated by a space up to 150 µ in thickness.

3. These spaces result both from the surgical technique employed and from the inaccurate measurements of drills, screws and taps.

4. Migrating cells invade these spaces during the first two weeks. In the absence of movement, these cells differentiate into osteogenic cells; movement leads to differentiation into fibroblasts, chondroblasts and osteoclasts, and failure of fixation ensues. In contrast, callus formation by osteogenic cells firmly anchors screws in four to five weeks, well before callus uniting the bone fragments has been established.

5. Extremities should be protected from undue stresses during those first few weeks after osteosynthesis, whatever the technique.

6. This study clearly demonstrates the importance oftesting screws in living bone to ascertain their holding power at all stages of fracture healing.
FRACTURE OF THE LATERAL PROCESS OF THE TALUS
Authors: Mukherjee Sadhan Kumar , Pringle Robert M. , Baxter Andrew D.
Published: February 2018

1. Thirteen cases of fracture of the lateral process of the talus seen over a period of thirteen months are reported.

2. The mechanism of the injury would appear to be inversion strain of the foot with dorsiflexion of the ankle.

3. The diagnosis would no doubt be made more often if the possibility of this fracture were kept in mind, and if radiographs of good quality were taken with the ankle at 0 degree and the leg rotated inwards 10 to 20 degrees.

4. With regard to treatment, early operation appears to give good results, a single large fragment being reduced accurately and small or comminuted fragments being removed.
THE TREATMENT OF PARALYTIC CONVEX PES VALGUS
Authors: Duckworth T. , Smith T. W.D.
Published: February 2018

1. Nineteen patients with spina bifida, myelomeningocele or lipoma of the cauda equina have been reviewed. Convex pes valgus was found in twenty-five feet. All patients had a neuromuscular imbalance between the evertors and invertors of the foot.

2. Results of release procedures only and of those which combine release procedures with tendon transfers are compared; they show that there is no consistently satisfactory operation for correction of the deformity when it exists with neuromuscular imbalance.

3. An operation in which release procedures are combined with the transfer of the peroneus brevis to the tibialis posterior and of the tibialis anterior to the neck of the talus is described. It has given satisfactory results in two out of three patients with paralytic convex pes valgus.
LEVELLING THE TREAD
Authors: Thomas F. Brian
Published: February 2018

1. Attention is drawn to a type of foot in which painful plantar callosities form under one or more metatarsal heads. The affected metatarsal heads are shown to be depressed, or dropped, and this dropping is not caused by toe deformities.

2. An operation is described which elevates a dropped metatarsal head by a wedge osteotomy through the base of the metatarsal.

3. The various deformities of the tread are described, and the possible causes of this condition are discussed.

4. It is stressed that corrective metatarsal osteotomy is not appropriate for patients with deformities of their toes, who require correction of the toe deformity.
BRUCELLOSIS OF THE CARPUS
Authors: Seal P. V. , Morris C. A.
Published: February 2018

1. A farmer who owned cattle infected with brucellosis presented with a painful, swollen wrist. Osteolytic lesions were seen radiologically. The wrist was explored. Histological features were those of a subacute granuloma. Brucella abortus biotype I was grown.

2. The clinical diagnosis, bone and joint radiology, pathology and microbiology are discussed.
SCOLIOSIS WITH PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA IN FOUR SIBLINGS
Authors: Crisfield R. J.
Published: February 2018

Four cases are presented of a syndrome of progressive external ophthalmoplegia and scoliosis occurring within one family. These patients were extensively investigated but no biochemical abnormality was detected.
POSTERIOR MALLEOLAR FRACTURES
Authors: Miller A. J.
Published: February 2018

1. A method of treatment of posterior malleolar fracture is described which restores the proximal surface of the ankle joint to its normal position.

2. Reduction is achieved with a special clamp and the position held with a strong plate. Early ankle movements may therefore be encouraged without fear of redisplacing the fracture.

3. Perfect reduction is necessary to avoid the later onset of arthritis, and this was achieved in five of six patients reported.
THE ROLE OF FATIGUE IN THE PATHOGENESIS OF SENILE FEMORAL NECK FRACTURES
Authors: Freeman M. A. R. , Todd R. C. , Pirie C. J.
Published: February 2018

1. Senile subcapital fractures in osteoporotic patients are due to fatigue, not to the impact of a fall, since they are preceded by the local accumulation of isolated trabecular fatigue fractures.

2. One pathological significance of the isolated trabecular fractures described by Todd, Freeman and Pirie (1972) has been demonstrated.
VARIATIONS IN THE NERVES OF THE THUMB AND INDEX FINGER
Authors: Wallace W. A. , Coupland R. E.
Published: February 2018

The digital nerves to the thumb and index finger have been studied by dissecting twenty-five embalmed upper limbs. The palmar digital nerves to the thumb were constant in position and course, with a short lateral cutaneous branch from the radial palmar digital nerve in 30 per cent of cases. The palmar digital nerves to the index finger had a variable pattern, the commonest arrangement, well described in Gray's Anatomy, occurring in 74 per cent of cases. The variations and their frequency are described. By examining histological cross-sections of the index finger it was found that of about 5,000 endoneurial tubes entering the finger, 60 per cent passed beyond the distal digital crease to supply the pulp and nail bed. The depth of the palmar digital nerves was about 3 millimetres, but less at the digital creases, and their diameter lay between 1 and 1·5 millimetres as far as the distal digital crease. Clinical applications of the findings are discussed.
Periosteal pedicle grafting in dogs
Authors: King KF
Published: February 2018

An experimental model was designed to find a theoretical solution to the clinical problem of congenital tibial pseudarthrosis in children. The osteogenic properties of periosteum having been accepted, paired pedicled flaps of periosteum were raised from the subcutaneous surface of the tibia, tubed and anastomosed in a series of young dogs. In the last twenty-four consecutive cases the rate of complete ossification in these tubes rose to one in three. In the later stages of the work, in addition to the construction of periosteal tube grafts, pseudarthroses were induced in the middle third of each canine tibia in order to see if hypertrophy would occur under the stress of weight-bearing. It was found that in each of twenty-four specimens some hypertrophy occurred in the ossified periosteal tube grafts, and in three of the specimens this hypertrophy was associated with complete ossification of the graft that by-passed the pseudarthrosis.
The importance of gastrocnemius recession in the correction of equinus deformity in cerebral palsy
Authors: Craig JJ , van Vuren J
Published: February 2018

Spasm or contracture of the gastrocnemius muscle is predominantly responsible for the equinus deformity of the foot in cerebral palsy. Its release is therefore logical in the treatment of all cases which do not respond to conservative measures. The authors have demonstrated, by the use of metal markers and radiographic control at operation, that adequate release cannot be achieved by severance of the calcaneal tendon alone, and that in order to ensure relaxation of the gastrocnemius muscle, the operation of choice is gastrocnemius recession by the method of Strayer, coupled with lengthening of the calcaneal tendon to deal with such degree of the deformity as may be attributable to shortening of the soleus. A survey of 100 limbs treated by this method revealed a recurrence rate of equinus of 9% and a degree of calcaneus deformity resulting in inadequate push-off in 3% of cases after an average follow-up period of six years.
Disability of the hindfoot after fracture of the tibial shaft
Authors: McMaster M
Published: February 2018

Hindfoot (subtalar) movement and disability after fracture of the tibial shaft have been studied. One hundred patients with soundly healed fractures of the tibial shaft treated by immobilisation in a long leg plaster cast were examined at least one year after the fracture had healed. Subtalar movement was accurately measured by a special technique and the patients were questioned specifically about any disability associated with their hindfoot. Subtalar movement was limited to some degree in 72% of patients. Forty-three per cent of patients complained of symptoms related to their subtalar joint and 12% found these symptoms troublesome.
Observations on the management of failed spinal operations
Authors: Crock HV
Published: February 2018

A system is presented for the analysis of failure after spinal operations: 1) outright failure; 2) temporary relief; 3) failure in spondylolisthesis; and 4) infections. With this system it is possible to trace the causes of failure and to correct some of them. When they are used as a guide before operation, the recommendations made should help to prevent many failures.
Mechanical function as an influence on the structure and form of bone
Authors: Lanyon LE , Baggott DG
Published: February 2018

Rosette strain gauges were attached to the cranial and caudal aspects of the proximal half of the radius in eight skeletally mature female sheep; The sheep's radius has a slight cranially convex curvature. During walking it was deformed so that the cranial surface was subjected to tension aligned along the bone's lon axis, and the caudal surface to compression similarly aligned. The compressive strain on the caudal aspect of the bone was consistently larger (X 1-9) than the tensile strain on the cranial aspect. The thickness of the cortex did not reflect this difference but in younger animals the process of osteonal remodelling seemed further advanced in the cortex which was customarily subject to the larger deformation. The relevance of these findings is discussed in relation to the technique of internal fixation and to our understanding of the basis of the mechanical adaptability of bone.
Orthopaedic aspects of spinal tumors in children
Authors: Fraser RD , Paterson DC , Simpson DA
Published: February 2018

A retrospective survey has been made of forty children with spinal tumours. Difficulties in establishing the correct diagnosis are mentioned and the value of radiological and cerebrospinal fluid investigations discussed. The major orthopaedic disabilities are spinal deformity or instability, and paraplegia. The main factor in the development of the former is the site of laminectomy: the higher the level the greater is the likelihood of deformity or instability developing. Measures to prevent this distressing complication are discussed. The role of the orthopaedic surgeon in the management of these children is emphasised.
Familial idiopathic hyperphosphatasia: a study of two young siblings treated with porcine calcitonin
Authors: Blanco O , Stivel M , Mautalen C , Schajowicz F
Published: February 2018

A study of two siblings with a severe infantile form of familial idiopathic hyperphosphatasia is reported. A girl aged one year was followed for two years while receiving intermittent treatment with porcine calcitonin. This induced a clinical remission, a reduction of both the high serum level of alkaline phosphatase and the raised urinary excretion of hydroxyproline, and a remarkable improvement in bone structure as seen radiologically. Her sister aged two months received porcine calcitonin for three weeks, during which clinical improvement, no change in the serum level of alkaline phosphatase and a marked decrease of the excretion of hydroxyproline were recorded.
Spondylolisthesis in children and adolescents
Authors: Blackburne JS , Velikas EP
Published: February 2018

A study of spondylolysis and spondylolisthesis in 142 children and adolescents is reported. In twelve of the seventy-nine patients followed for over a year the affected vertebra slipped further by 10 per cent or more. Increasing slip occurred mainly during the adolescent growth spurt, and was greater when spinal bifida or other vertebral anomalies were present. If at presentation the slip is less than 30 per cent then further slip beyond 30 per cent is unlikely. Decompression posteriorly is advised when signs of nerve pressure are present. Indications for spinal fusion are suggested; the intertransverse method of fusion was used in sixty-nine patients.
Perthes' disease of the hip in three regions of England
Authors: Barker DJ , Dixon E , Taylor JF
Published: February 2018

Throughout 1976 orthopaedic surgeons in three regions of England forwarded details of all new patients with Perthes' disease attending outpatient clinics or admitted as inpatients. The incidence in the Mersey region (11.1 per 100 000 children under fifteen years) was twice that in Wessex (5.5) with Trent having an intermediate incidence (7.6). The ratio of male to female incidence varied between the regions as did the age distribution of male cases. These findings point to the importance of environmental factors in the aetiology of the disease, and suggest the need for further epidemiological studies.
Adjuvant chemotherapy in the treatment of clinically localised Ewing's sarcoma
Authors: Bacci G , Campanacci M , Pagani PA
Published: February 2018

The results are presented of thirty-seven patients with Ewing's sarcoma; ten were treated by a combination of operation, radiotherapy and cyclic chemotherapy, the remainder by radiotherapy and chemotherapy but without operation. The drugs, vincristine, cyclophosphamide and adriamycin were used in combination and were continued for two years. The follow-up ranged from twelve to sixty-two months. The mortality rate and the incidence of metastases were both markedly lower than in a comparable previous series treated by radiotherapy alone, or by operation plus radiotherapy, but all without chemotherapy. The percentage of local recurrences and of metastases was much higher in the twenty-seven patients who had radiotherapy and adjuvant chemotherapy, than in the ten in whom operation was also performed. It is suggested that on the basis of these results (and on theoretical grounds) treatment should consist of radiotherapy combined with chemotherapy plus, whenever feasible, operative excision of the primary tumour.
The treatment of femoral fractures by cast-brace and early walking: a review of seventy-nine patients
Authors: Hardy AE , White P , Williams J
Published: February 2018

Seventy-nine cases of fracture of the femoral shaft treated by cast-brace and early walking have been reviewed. Discrepancy in femoral length was assessed by scanogram. The cases were analysed to relate the incidence of shortening greater than 2 centimetres to the type and site of the fracture, and the time which elapsed from injury until the cast-brace was applied. Such shortening was encountered most frequently when the cast-brace was applied within the first two weeks from injury or after six weeks and in those patients with comminuted fractures of the middle third of the femoral shaft.
The "small patella" syndrome
Authors: Scott JE , Taor WS
Published: February 2018

Twelve closely related members of one family were found to have small or absent patellae. Seven of these patients also had abnormalities of the pelvic girdle and upper femora. There was a resemblance to the nail--patella syndrome in the patellar abnormalities but not in the associated conditions, and it would therefore appear that the syndrome described is a new variety of congenital abnormality of the knee.
The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up
Authors: Scaglietti O , Marchetti PG , Bartolozzi P
Published: February 2018

The treatment of bone cysts by topical injection of methylprednisolone acetate was initiated at the end of 1973, and the late results are reported in this paper. In seventy-two cases followed up for one to three years favourable results have been obtained in about 90 per cent. The technique of local injection and the surgical equipment employed, in the case of focal recurrences, are considered. With this method, surgical treatment of bone cysts in youth is seldom necessary.
Reconstruction of the anterior talofibular ligament for the treatment of the unstable ankle
Authors: Sefton GK , George J , Fitton JM , McMullen H
Published: February 2018

Chronic instability of the ankle is frequently due to disruption of the fibres of the anterior talofibular ligament and the anterolateral capsule. This allows momentary subluxations at the ankle joint; the talus tilts into an abnormal varus position and rotates forwards and inwards about a vertical axis which passes through the medial malleolus. The use of a free tendon graft to reconstruct the anterior talofibular ligament restores the stability of the ankle without restricting movement at the subtalar level.
The natural history of congenital disease of the hip
Authors: Wedge JH , Wasylenko MJ
Published: February 2018

Fifty-four adults with eighty hips affected by congenital disease which had not been treated have been reviewed. Fifty-nine per cent of forty-two dislocated hips had fair or poor grading scores. The incidence of osteoarthritis was markedly increased in the presence of a well-developed false acetabulum. Unilateral dislocation led to valgus deformity and degenerative changes in the ipsilateral knee in seven of twenty-two patients. Dislocation did not increase the incidence of symptomatic lumbar spondylosis. The height of the dislocated head on the ilium was not found to be related to the prognosis for the hip, the knee or the lumbar spine and did not correlate with the development of the false acetabulum. Frank congenital subluxation eventually led to osteoarthritis of the hip.
The African neonatal hip and its immunity from congenital dislocation
Authors: Skirving AP , Scadden WJ
Published: February 2018

The hips of twenty full-term African neonates have been examined in detail to determine any anatomical factors which might explain the difference in the incidence of congenital dislocation of the hip in the African and in the Caucasian. Measurements included the degree of anteversion of the femoral neck and the acetabulum and the diameter and depth of the acetabulum. The acetabulum tended to be deeper and to vary within a much narrower range than that reported for Caucasians, lending indirect support to the theoretical role of acetabular dysplasia in the aetiology of congenital dislocation of the hip. Measurements of the anteversion of the acetabulum and femoral neck were similar to those given for Caucasians.
The results of reinsertion of a total hip prosthesis after sepsis
Authors: Hunter GA
Published: February 2018

Sixty-five total hip arthroplastics were reinserted after sepsis around the hip, positive cultures being obtained from fifty-six. Although 65 per cent of patients still have their implant in position, only sixteen of sixty-five (25 per cent) show an excellent or good result on a Harris rating. Twenty-three of sixty-five (35 per cent) subsequently required an excision arthroplasty. The indications and contraindications for this procedure are given.
A long-term review of shelf arthroplasty
Authors: Love BR , Stevens PM , Williams PF
Published: February 2018

Shelf arthroplasty is briefly reviewed in historical perspective and the results in 45 hips (39 patients) which had undergone this procedure at the Royal Children's Hospital are presented. The majority of these patients were adolescents who had previously been treated for congenital dislocation or subluxation of the hip. The indications for operation and the operative technique are discussed. Clinical examination was carried out upon 33 of the 39 patients at an average of 11 years after operation. The results suggested that where pain had been an indication for operation almost 80 percent of the hips remained relatively free of symptoms at the time of follow-up and in those patients where acetabular dysplasia had been an indication, the coverage remained good and pain had not appeared. It is concluded that the shelf operation is useful for dealing with both pain and dysplasia in the adolescent.
Idiopathic osteoporosis in the young
Authors: Smith R
Published: February 2018

Six patients are described with idiopathic osteoporosis which began between the ages of 4 and 16 years. In four children the disorder was mild with pain in the back, vertebral collapse, qualitatively normal iliac bone biopsies, variable calcium balance and spontaneous recovery. The two remaining patients had progressive bone disease with deformity. One with a previously normal skeleton developed changes similar to those of osteogenesis imperfecta; in the other patient, who rapidly developed structural collapse associated with severe metaphysial osteoporosis, treatment was ineffective and the histological appearances of the bone suggested osteoblastic failure. Quantitative bone histology in four patients showed no evidence of excessive active resorption; and the ratio of Type III to Type I collagen in the skin was normal, in contrast to the findings in osteogenesis imperfecta. The significance of this study in relation to previous accounts is reviewed.
A biomechanical study of cast-brace treatment of femoral shaft fractures
Authors: Wardlaw D , McLauchlan J , Pratt DJ , Bowker P
Published: February 2018

The off-loading characteristics of the cast-braces of 30 patients with fractures of the shaft of the femur have been investigated, during axial loading, using strain-gauge transducers. These were applied at the level of the fracture, where the cast was circumferentially split, and to the hinges of the brace at the knee. They measured the load transferred between the two portions of the thigh cast, and between the thigh cast as a whole and the below-knee cast; by subtraction from the total load on the limb, the skeletal force at the fracture level and at the knee could be calculated. In all patients there was an increase in the fracture load as union progressed which was thought to be due to physiological feedback mechanism from the fracture site. The load carried by the two portions of the thigh cast and by the thigh cast as a whole was proportionately high at first and stabilised at an average of 35 per cent of body weight.
Electrical studies in the diagnosis of compression of the lumbar root
Authors: Leyshon A , Kirwan EO , Parry CB
Published: February 2018

A series of 100 patients with pain in the leg was studied and the accuracy of electrical studies in the diagnosis of nerve root lesions was investigated before operation. The electrical studies which were performed on all the patients, included recordings of fibrillation potentials, H-reflex and ankle reflex latencies. This diagnosis technique was found to be more accurate than radiculography or clinical examination and did not give false evidence. Seventy patients were classed as having a lesion of the nerve root. Fifty of these patients were treated surgically. The operation revealed compression of the nerve root by osteophytes arising from degenerative and incompletely dislocated posterior facet joints in 43 patients.
Stress fractures of the lower limb in patients with rheumatoid arthritis
Authors: Young A , Kinsella P , Boland P
Published: February 2018

Thirteen patients suffering from rheumatoid arthritis had 19 stress fractures of the tibia or fibula. These patients characteristically presented with sudden, severe, unexplained pain with localised tenderness just below the knee or above the ankle. In seven patients examination of the adjacent joint indicated a flare-up of disease activity or a pyogenic arthritis. In six patients the diagnosis was delayed by the late appearance of callus in minute fractures. All patients had rheumatoid deformities of the ipsilateral lower limb: valgus deformities of the knee and subtalar joints occurred most frequently. All patients had osteoporosis; all except two had received steroid treatment and five had abnormalities of calcium metabolism. We suggest that deformities of the knee and ankle predispose patients with rheumatoid arthritis and osteoporosis to stress fractures of the tibia and fibula.
A new technique for the reduction and stabilisation of severe spondylolisthesis. A report of two cases
Authors: Sijbrandij S
Published: February 2018

The different methods described in the literature for the reduction of severe spondylolisthesis are reviewed. The case histories of two girls with neurological deficits in their legs due to Grade IV spondylolisthesis are described. Reduction and fusion by the posterior route in a one-stage operation were performed on these patients. For this purpose special instruments have been designed to exert a controlled force on the displaced vertebra in two perpendicular directions. Technical details of the procedure are reported. In both patients intervertebral and posterolateral fusion were carried out. Fusion was successful and redisplacement did not occur. There have been only few descriptions in the literature of a technique that reduces and stabilises spondylolisthesis in one stage. However, only patients with Grade III and IV spondylolisthesis require reduction and in less severe cases fusion without reduction is sufficient.
Localisation of the level of symptomatic cervical disc degeneration
Authors: Kikuchi S , Macnab I , Moreau P
Published: February 2018

There are many difficulties associated with the localisation of the symptomatic segment in patients presenting with cervicobrachial pain with no evidence of impaired conduction in the nerve root. Ancillary radiological investigations such as myelography, epidural phlebography, and epidural myelograms are of unreliable diagnostic value. However, discography can be of value if the technique described here is used. Infiltration of the cervical nerve root with local anaesthetic has also proved useful in the localisation of the symptomatic segment. The techniques used in cervical discography and infiltration of the nerve root are described and their reliability is assessed.
Traumatic spondylolisthesis of the axis
Authors: Francis WR , Fielding JW , Hawkins RJ , Pepin J , Hensinger R
Published: February 2018

A series of 123 patients suffering traumatic spondylolisthesis of the axis is reported. This lesion is associated with extension and axial loading injury, and there is a high incidence of injuries of the face or scalp and of associated fractures of the upper cervical spine. There is a low incidence of neurological injury, which seems paradoxical in the presence of what appears to be gross instability, but protection from extremes of flexion and extension may be adequate treatment. Union is usual regardless of displacement. Traction is a safe means of treatment, but early waking in a halo support reduces time in hospital without jeopardizing the result. Operation is needed only for chronic instability with or without pain, and anterior interbody fusion of C2--3 is than preferred in order to preserve rotation at the atlanto-axial joints.
Fractures of the ring of the axis. A classification based on the analysis of 131 cases
Authors: Effendi B , Roy D , Cornish B , Dussault RG , Laurin CA
Published: February 2018

The retrospective analysis of 131 patients suffering from a fracture of the ring of the axis is reported. The injury was classified into three types according to radiological displacement and stability. Associated injuries and neurological deficit are discussed and a theory of pathogenesis presented. Guidelines for the management of each type of fracture are proposed.
Partial undercutting facetectomy for bony entrapment of the lumbar nerve root
Authors: Getty CJ , Johnson  , Kirwan EO , Sullivan MF
Published: February 2018

Seventy-eight patients who had been operated on for bony entrapment of lumbar nerve roots were studied in an attempt to define the clinical syndrome, and to assess the results of a new technique of decompression which preserves spinal stability. The mean age of the patients was 45 years and 28 of them had previously undergone spinal operations. Pain in the leg was the predominant symptom, with evidence of motor involvement in half of the patients. Signs of nerve root tension were found in only one-third of the patients. The principal factor in the aetiology was degenerative change in the posterior facet joints. Decompression was achieved by a partial undercutting facetectomy. Fifty-nine per cent of the patients obtained a "good" result and 85 per cent were satisfied with the result of their operation. Successful partial facetectomy for bony entrapment of lumbar nerve roots produced rapid and lasting relief of pain.
Clinical studies of isolated disc resorption in the lumbar spine
Authors: Venner RM , Crock HV
Published: February 2018

Low lumbar pain with radiation into the leg is a common symptom pattern caused by a number of pathological processes. Isolated disc resorption is one such entity which can be readily identified and is amenable to surgical treatment. This study consisted of two groups of patients. Group I were 50 patients suffering from isolated disc resorption at L5--S1 with ill-defined low backache extending into the buttocks and down one or both legs, but not into the feet. Clinical signs of nerve root dysfunction were found in 16 per cent of patients. Radiographic changes with loss of disc height, facet over-riding and intrusion into the nerve root canal and intervertebral foramen were common and frequently associated with sclerosis of the vertebral end-plate. Group II were a series of 45 patients with isolated disc resorption independently reviewed an average of 45 months after surgical decompression of the S1 (98 per cent) or lower lumbar nerve roots. Based on objective grading by the clinician and subjective assessment by the patient complete success was achieved in 62 per cent of the patients and partial success in 24 per cent. Provided there is full appreciation of the pathological anatomy, strict diagnostic criteria and meticulous surgery, decompression of the nerve root canal is a useful surgical procedure in severely disabled patients suffering from isolated disc resorption.
The use of cast-bracing as treatment for fractures of the tibial plateau
Authors: Scotland T , Wardlaw D
Published: February 2018

A series of 29 patients with fractures of the tibial plateau were treated by means of a cast-brace. There were seven wedge fractures of the lateral tibial condyle, two dicondylar fractures and 20 compression fractures involving the lateral tibial plateau. The seven patients with wedge fractures were treated by skin or skeletal traction, followed as soon as possible by flexion exercises for the knee. Cast-braces were applied to all fractures as soon as possible after injury, and the patients allowed to bear weight freely. Early restoration of function of the injured limb was thereby achieved. The results of our study over a period of two and a half years indicate that cast-bracing is a very satisfactory method of treating fractures of the tibial plateau. All the fractures united, the movements and control of the knee were excellent, and valgus or varus deformity was unchanged before application and after removal of the brace.
Cine radiography in cervical spondylosis as a means of determining the level for anterior fusion
Authors: Brunton FJ , Wilkinson JA , Wise KS , Simonis RB
Published: February 2018

A series of 75 patients who had undergone anterior cervical fusion between 1965 and 1977 were reviewed. The patients were divided into two groups: those in Group A had had the level of fusion indicated by cine radiography, whereas in Group B the level had been determined by plain radiographs and clinical symptoms and signs. Results showed that cine radiography was the more accurate diagnostic technique. Accurate diagnosis of the level to be fused, the careful clinical selection of patients and sound bony union were found to be vital to the success of anterior cervical fusion. The incidence of pseudarthrosis was significant in single-level fusions and was even greater in double-level fusions and in patients with a history of trauma, especially whiplash injuries. It was rare to develop recurrence of symptoms in adjacent levels after fusion of a level localised by cine radiography.
The results of pantalar reduction in the management of congenital talipes equinovarus
Authors: Ghali NN , Smith RB , Clayden AD , Silk FF
Published: February 2018

One hundred and twenty-five patients with 194 feet affected by congenital talipes equinovarus were treated by the senior author during the period 1959 to 1980. Of these, 70 patients presented either at birth or in the early neonatal period, and 55 were seen later, having been referred from other centres. Seventy-five patients were subsequently reviewed by two of us; the remaining 50 were assessed from records and research files. Patients seen within four weeks of birth were termed "early", the remainder "late". Of the early group of 70 patients, 44 (with 68 affected feet) were reviewed and 26 (with 41 affected feet) were assessed from records. Excellent or good results were achieved in 94 per cent of feet treated conservatively and in 82 per cent of feet which required pantalar release. Of the 55 late referrals 32 patients (with 55 affected feet) were reviewed and 23 (with 30 affected feet) were assessed from records. Satisfactory results were slightly less frequent, but were achieved in 75 per cent of cases. There was no statistical correlation between early soft-tissue release and a good final outcome, but there was a positive statistical correlation between good clinical results and a high talocalcaneal index. Osseous correction (a laterally based wedge tarsectomy or a triple arthrodesis) was necessary at a later date in four feet (four per cent) of those who presented early and in 13 feet (15 per cent) of late referrals.
Osteogenesis imperfecta with dominant inheritance and normal sclerae
Authors: Paterson CR , McAllion S , Miller R
Published: February 2018

Most patients with dominantly inherited osteogenesis imperfecta have blue sclerae and relatively mild symptoms. However, in a small group of families the patients have normal sclerae and this disorder has been classified as Type 4 osteogenesis imperfecta. This paper reports the clinical and radiographical features of 48 patients from 16 families with Type 4 osteogenesis imperfecta and compares the findings with those of the classical disorder with blue sclerae (Type 1 osteogenesis imperfecta). The two types are similar in usually causing a mild disease but with a wide range of severity, and in both types the rate of fracture declines in adolescence. There are, however, some significant differences apart from the colour of the sclerae. In Type 4 the first fracture more commonly occurs at birth, dentinogenesis imperfecta is more frequent than in Type 1 and bruising and nose-bleeds are less common. As in Type 1, the radiographic appearances of the bones may be normal. It is important that Type 4 osteogenesis imperfecta should be recognised because of the need for competent genetic counselling, because the management may be different from that appropriate for Type 1 and because it may be mistaken for idiopathic juvenile osteoporosis or child abuse.
Reduction and stabilisation of severe spondylolisthesis. A report of three cases
Authors: Sijbrandij S
Published: February 2018

A modification of a previously reported one-stage technique for reduction and stabilisation of severe spondylolisthesis using a posterior route is described. Reduction is obtained by inserting Harrington rods to lift L5 vertically out of the pelvis and two double-threaded screws to pull it backwards. After reduction the rods are taken away and stabilisation achieved by means of screws and a sacral bar. With this modified technique lumbar vertebrae above L5 are never immobilised, compared with the previous method where the retention of the Harrington rods resulted in more lumbar vertebrae being immobilised than was necessary for fusion. Bone is resected from the sacrum and the fifth lumbar vertebra to avoid too much tension on the nerve roots. Bone grafts are not needed and lumbosacral fusion is achieved within six months due to close contact between the raw bone of the vertebral bodies. Three patients have been treated with this modified technique; there was no reslip, neither during the period when the metallic fixation was in situ nor after its removal.
Irreducible fracture-separations of the distal tibial epiphysis
Authors: Grace DL
Published: February 2018

Three cases of a rare complication of Salter Type II fracture-separations of the distal tibial epiphysis are described. Interposition of the anterior tibial neurovascular bundle between the displaced epiphysis and the lower tibia prevented reduction and, in two patients, the blood supply to the foot was compromised. Open reduction and internal fixation resulted in a satisfactory outcome in each case.
Treatment of intertrochanteric fractures of the femur. A comparison of the Richards screw-plate with the Jewett nail-plate
Authors: Heyse-Moore GH , MacEachern AG , Evans DC
Published: February 2018

One hundred and seven patients with intertrochanteric fractures of the femur treated with a Richards screw-plate were compared retrospectively with 103 patients treated with a Jewett nail-plate. The mortality and morbidity were similar in the two groups. In patients with comparable fractures, those treated with a Richards device mobilised more quickly and left hospital sooner, and more of them returned to their homes. Failures of stabilisation, both clinically and radiographically, were fewer in this group. The reliability of fixation with a correctly positioned Richards screw-plate could justify the omission of outpatient follow-up in all but a small group of patients with severe unstable fractures or grossly defective bone stock. The higher cost of a Richards implant and the slightly longer operative procedure were outweighed by savings in occupancy of acute and long-stay hospital beds.
The sagging rope sign: a critical appraisal
Authors: Clarke NM , Harrison MH , Keret D
Published: February 2018

Certain features of the sagging rope sign recently analysed by Apley and Weintroub (1981) are examined in detail. Evidence is presented to show that the line is a radiological shadow cast by the lateral edge of a severely deformed femoral head rather than a condensation of the spongiosa within the neck. An explanation is offered to explain the common association of the presence of this radiological sign with premature epiphysial fusion.
Burkitt's lymphoma in the appendicular skeleton
Authors: Fowles JV , Olweny CL , Katongole-Mbidde E , Lukanga-Ndawula A , Owor R
Published: February 2018

Of 290 Ugandan children and adolescents with proven Burkitt's lymphoma 11 had lesions in the long bones or the pelvis. These started in the medulla as small osteolytic foci which coalesced and penetrated the cortex causing subperiosteal new bone formation in layers or spicules, and giving rise to large soft-tissue masses. Common sites were the femoral and tibial diaphyses and the metaphyses around the knee. Five were in the epiphyses. Other sites were the pelvis, humerus and ulna. One patient had a lymphomatous synovial effusion of the knee. In the lower limbs the lesions were often bilateral and symmetrical. Five patients had pathological fractures. Radiologically the lesions mimicked Ewing's sarcoma, osteosarcoma, osteomyelitis, acute leukaemia, syphilis and yaws, but clinically they were relatively painless, an important differential diagnostic feature. In the five patients with sustained remissions after chemotherapy the lesions and fractures healed well and the growth plates were undamaged.
Dynamic musculotendinous transfer to replace the anterior cruciate ligament in the dog
Authors: Adelaar RS , Zuelzer W , Anthony S , Cardea JA , Lurie HI
Published: February 2018

Dynamic muscle-tendon substitution for acute anterior cruciate deficiency in the dog was studied using the semimembranosus muscle-tendon. Nineteen mongrel dogs each had a semimembranosus transfer in one knee; as a control, the anterior cruciate ligament and the semimembranosus were released in the opposite knee. No postoperative immobilisation was used. The anterior drawer sign was assessed before and after operation and when the dogs were killed five months later. Dogs were excluded from the study if they developed infections or contractures of the hind legs. At five months, 11 dogs were available for study. The operated knees were examined histologically and evaluated using a reproducible index of arthritis based on: the macroscopic discoloration of the articular cartilage, the cellularity of the cartilage, the microscopic appearance of the articular surface, the loss of proteoglycans, the formation of osteophytes and the degree of subchondral osteosclerosis. There was no significant difference in the anterior drawer sign or the degree of arthritic changes between knees with a semimembranous transfer and the controls. Examination showed that a muscle-tendon transfer into the tibia was equivalent to transferring the muscle into the posterior capsule--the intra-articular tendon being weak but histologically viable. The transfer did not prevent the anterior drawer sign becoming positive nor the development of osteoarthritis. A second control group, in which three dogs had an arthrotomy and semimembranosus release in both their hind legs, showed that a semimembranosus release alone did not cause osteoarthritis.
Primary subacute osteomyelitis of the talus
Authors: Skevis XA
Published: February 2018

In four children with primary subacute osteomyelitis of the talus seen one to five months from the onset of symptoms, the only constant complaints were of pain and a limp. All four were treated by curettage, immobilisation in plaster and appropriate antibiotics. All the bony cavities were healed within eight months of the operation and there were no growth disturbances nor any abnormalities of the adjacent joints.
Management of the fractured scaphoid using a new bone screw
Authors: Herbert TJ , Fisher WE
Published: February 2018

A new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid. This involves the use of a double-threaded bone screw which provides such good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. A classification of scaphoid fractures is proposed. The indications for operation included not only acute unstable fractures, but also fractures with delayed healing and those with established non-union; screw fixation was combined with bone grafting to treat non-union. In a prospective trial, 158 operations using this technique were carried out between 1977 and 1981. The rate of union was 100 per cent for acute fractures and 83 per cent overall. This method of treatment appears to offer significant advantages over conventional techniques in the management of the fractured scaphoid.
Multifocal avascular necrosis after short-term high-dose steroid therapy. A report of three cases
Authors: Taylor LJ
Published: February 2018

Avascular necrosis of bone is a well-recognised phenomenon in patients on long-term steroid therapy, especially after renal transplantation. There are only four cases reported in the literature of multifocal avascular necrosis after short-term high-dose steroid therapy, and three additional cases are reported in this paper. All the hips have needed reconstructive surgery within two and a half years of the onset of symptoms; in one patient, however, this has been prevented by other medical problems. In two of the three patients reported in this paper the shoulders also were affected; eventually they became pain-free but movement was restricted. Short-term high-dose steroid therapy has only recently been recognised as a cause of avascular necrosis and attempts should be made to prevent the incidence increasing.
Ruptured femoral vein. A complication of the use of gentamicin beads in an infected excision arthroplasty of the hip
Authors: Fiddian NJ , Sudlow RA , Browett JP
Published: February 2018

Despite widespread use of gentamicin beads in the treatment of chronic infections of bone and soft tissue, no serious complications have been reported. This report describes a rupture of the femoral vein which occurred during the attempted removal of a chain of beads after radical excision of a chronically discharging Girdlestone arthroplasty. The patient later had a disarticulation at the hip. In the light of our experience with this and other cases we offer some suggestions as to the positioning of gentamicin beads, as well as the timing and method of their extraction.