New operative technique for treatment of arthroscopically-confirmed injury to the scapholunate ligament by volar capsuloplasty augmented with a free tendon graft.

We report how scapholunate (SL) lesions found during arthroscopy were treated using a new palmar operation based on the use of a tendon loop formed using the palmaris longus tendon, with promising preliminary results. Scapholunate instability induced by hyperextension injury was diagnosed and graded arthroscopically. Volar capsuloplasty was then done by free tendon graft in the same session in 31 patients with grades II-IV scapholunate instability.

Correction of chronic lunotriquetral instability using extensor retinacular split: a retrospective study of 26 patients.

Arthroscopy offers a welcome and reliable supplement to the current tool set for the diagnosis of lunotriquetral (LT) instability. This study reports the findings of LT-lesions during arthroscopy and the clinical results obtained after using dorsal stabilisation in its surgical management using extensor retinacular split. LT-instability of grade I-III was diagnosed in 26 patients.

Femoral component fixation with and without intramedullary plug. A 6-year follow-up.

A total of 113 patients underwent a cemented total hip replacement (THR) operation involving femoral component fixation either without the use of a distal intramedullary plug (n = 57, group 1) or with the plug (n = 56, group 2). We studied the femoral component fixation radiographically at on average 6 years after THR. The cement coating was assessed as technically good in 86% and 95% of groups 1 and 2, respectively.

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data.

Objective: To determine the acute injury profile in each of six sports and compare the injury rates between the sports.

Design: Analysis of national sports injury insurance registry data.

Setting: Finland during 1987-91.

Local immune inflammatory response to infected total hip and knee replacements.

We studied the tissue response for periprosthetic pseudosynovial tissue in seven patients with a purulent endoprosthetic infection and six patients with common prosthesis loosening, using specific monoclonal antibodies in avidin-biotin-peroxidase complex staining. In infected cases, proline 4-hydroxylase positive fibroblasts dominated the stroma of the vascularized periprosthetic connective tissue, whereas diffuse local infiltrations of mononuclear cells characterized the cellular histological overview. Local cellular response consisted of CD11b and MHC locus II antigen-positive immunoreactive monocytes/macrophages and of T lymphocytes, mostly of the CD4 subset.

The role of overlength of the leg in aseptic loosening after total hip arthroplasty.

A study was done on the role of postoperative leg length inequality (LLI) in aseptic loosening after total hip arthroplasty (THA). Data on 405 McKee-Farrar hip replacements performed at the Invalid Foundation, Helsinki, Finland were available for the study. The mean lengthening of the operated leg was 0.

Immunoreactive neuropeptide nerves in ligamentous tissue in chronic shoulder pain.

Coracoacromial ligament and periligamentous fatty and loose connective tissue obtained during Neer's acromioplasty in patients with chronic painful rotator cuff tendinitis/impingement syndrome was studied for possible signs of inflammatory involvement and for the presence of neuropeptide-containing nerves, using routine histology and immunoperoxidase staining. No accumulations of inflammatory cells were found in the tissues studied. The dense ligamentous tissue proper was practically aneural, as was seen in staining for the generalized neuronal markers protein gene product 9.

Inflammation of the subacromial bursa in chronic shoulder pain.

Subacromial bursal tissue was studied in 12 patients operated on for painful (10 patients with constant pain and 2 patients with pain on motion) rotator cuff tendinitis/impingement syndrome. The Neer acromioplasty technique was used. Six patients had moderate inflammatory changes and one had a slight inflammation.

Disc degeneration and angular movement of the lumbar spine: comparative study using plain and flexion-extension radiography and discography.

A study was made of the association between disc degeneration observed in plain radiographs, in discograms (Adams' classification), and instability expressed as abnormal angular movement of lumbar vertebrae. The series included 169 discs in 77 consecutive patients (42 men, 35 women) whose mean age was 34 (range 16-46) years. Discography was more sensitive than plain radiography in the diagnosis of disc degeneration was more common in men than in women (Chi square test, chi 2 = 9.

Total hip replacement after intertrochanteric osteotomy.

Forty-five hips were analyzed in 42 patients treated with total hip replacements (THR) after earlier intertrochanteric osteotomies. At time of osteotomy, the patients' mean age was 50 years (range: 14 to 65). Total hip replacement was performed at a mean interval of 11.

Three cancellous bone screws versus a screw-angle plate in the treatment of Garden I and II fractures of the femoral neck.

A consecutive clinical series of 33 patients with either an undisplaced (Garden I) or minimally displaced (Garden II) femoral neck fracture was randomly divided into two operative protocols. Half of the fractures were treated with three cannulated cancellous bone screws, while the other half were treated with a standard screw-angle plate device. After a mean follow-up of 2 years, 4 patients had died, while 20 of the remaining 29 hips showed excellent or good, 3 fair and 6 poor functional results.

Ten-year results of operations for rheumatoid cervical spine disorders.

The outcome of operations performed on 38 patients for rheumatoid disorders of the cervical spine were analysed 10 or more years later. The mean age of the patients at the time of operation was 56 years (35 to 77); 32 had seropositive disease. The mean duration of the disease was 17 years (four to 36).

Premedication and short term complications in iohexol discography.

In 52 patients 0.5-3.0 ml of iohexol, 180 mg/ml, was injected using lateral injection technique and fluoroscopy control.

A comparison between cemented and cementless implants in revision arthroplasty of the hip following resection arthroplasty.

Twenty patients underwent hip re-arthroplasty following resection arthroplasty due to former prosthetic infection, aseptic loosening, or TBC coxitis. In 9 cases Gentamycin-loaded cement was used. In 11 the re-arthroplasty was cementless.

Clinical relevance of discography combined with CT scanning. A study of 100 patients.

Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and 64% specificity of the discogram for pain.

Neuroimmunohistochemical analysis of peridiscal nociceptive neural elements.

Twenty-three perioperative tissue samples from lumbar disc operations on 11 patients were studied immunohistochemically using the sensitive avidin-biotin-peroxidase complex (ABC) method and specific heterologous antisera for the presence of neurofilament-positive neural elements containing nociceptive neuropeptides substance P (SP) and/or calcitonin gene-related peptide (CGRP). Histologically, neural elements were especially abundant in the posterior longitudinal ligament, there being also a few demonstrable nerves in the peripheral anulus fibrosus. These nerves often showed a co-localization of cytoskeletal neurofilaments together with SP and/or CGRP immunoreactivity.

Hip arthroplasty infection. Current concepts.

Due to systemic or local antibiotic treatment and other preventive procedures, the incidence of deep hip-prosthetic infections in Scandinavia is less than 1 percent, with the majority hematogenous. Coagulase-negative staphylococci and anaerobes are involved in more than half of the cases. The diagnosis is sometimes difficult; preoperative aspiration often gives misleading results; and granulocyte scanning usually adds valuable information.

Fibroblasts in synovitis in rheumatoid arthritis but not in noninflammatory synovial tissue in meniscus lesions express the carboxyterminal domain of procollagen type I.

Synovial tissue (ST) sections from patients with rheumatoid arthritis (RA) and meniscus lesions were stained using monoclonal antibodies against the carboxyterminal domain of human type I procollagen (alpha-pC) in avidin-biotin-peroxidase complex (ABC) staining. This gave a good signal-noise ratio and identified some synovial B-type lining cells and stromal fibroblasts in inflammatory RA ST but not in noninflammatory ST from patients with meniscus lesions. The authors' findings provide immunohistochemical evidence that the local fibroblasts in inflammatory ST in RA are activated, probably as a result of various humoral mediators produced in situ (by inflammatory mononuclear cells) in RA but not in normal noninflammatory ST.

[Strategy in endoprosthesis infections].

Infection in total hip replacement, its definition, normal history and treatment are reviewed. A case with a two stage revision with the use of a cementless resection prosthesis is presented.

Severe frostbite of the upper extremities--a psychosocial problem mostly associated with alcohol abuse.

In the catchment area of Helsinki University Central Hospital (in total 16 surgical hospitals) amputation was performed on 9 patients with frostbite in the upper extremities during 1984-1985. The population during the study period in this area was 1.165,000 inhabitants, corresponding to 24% of the whole population in Finland.

Outcome of the infected hip arthroplasty. A retrospective study of 36 patients.

We report the outcome after revision for deep infection in 34 total and two hemiarthroplasties of the hip. Excision arthroplasty was carried out in 26 cases a median of 1 (0-8) years after the infection was diagnosed. Thirteen of these cases later underwent rearthroplasty, and in 3 of them the infection recurred.

Concentration and degree of polymerization of hyaluronate in equine synovial fluid.

In addition to its well-known physicochemical properties, hyaluronate (HA) has recently been shown to have important biological and pathophysiologic regulatory effects on granulocytes, monocytes, fibroblasts, and endothelial cells, as well as on the healing of wounds and various joint disorders. Many of these effects depend on or are reflected in the concentration and degree of polymerization of HA. Therefore, high-performance liquid chromatography with size-exclusion column was used to characterize the concentration and degree of polymerization of HA in equine synovial fluid (SF).

Presence of platelet glycoproteins Ib and IIb-IIIa in inflammatory and noninflammatory synovium.

Rheumatoid synovial tissue and noninflammatory synovial tissue from patients with meniscus lesions were stained using monoclonal antibodies against platelet 150 kDa Ib glycoprotein (gp Ib) and against 140/110 kDa IIb-IIIa glycoprotein complex (gp IIb-IIIa) applied with the avidin-biotin-peroxidase complex method. Gp Ib and gp IIb-IIIa positive intravascular platelet aggregates were not seen, except locally in the capillary blood vessels of one rheumatoid synovial sample. This suggests that the platelets and the clotting sequence are not activated in inflamed synovial tissue.