Carpal-tarsal osteolysis with elbow involvement.

Carpal-tarsal osteolysis is a rare condition that manifests as the progressive resorption of carpal and tarsal bones in young children. The diagnosis of this condition is often difficult and delayed as the initial clinical presentation is non-specific. Radiographic changes occur gradually, are often not seen at presentation and depend on recognising loss of bone in the ossification centres of the carpus and tarsus.

MR imaging of acute anterior cruciate ligament injuries.

MRI of the knee has become an indispensable clinical tool in the management of chronic knee conditions. MRI for acute knee injuries is less well established but is becoming increasingly prevalent. MRI in acute ACL injuries is particularly useful for identifying associated injuries that will influence the early management of the patient.

Improved outcome in femoral revision arthroplasty with tapered fluted modular titanium stems.

Many techniques have been advanced to achieve reliable femoral stem fixation in revision total hip arthroplasty. In a cross-sectional study, we compared quality of life in 220 patients with two femoral stem designs: a modular tapered and fluted titanium stem design and a cylindrical extensively coated chrome-cobalt stem with single modularity (head size and neck length alone). We matched cohorts based on age decade and gender.

Stereolithographic models for biomechanical testing.

Variable properties and limited availability are pitfalls in using cadaveric bones for implant stability tests. Artificial bones avoid these, but tailoring them to specific studies may be difficult. Stereolithography (SLA) techniques produce tailor-made bones with realistic geometries, but their lower Young's modulus might affect outcomes.

Optimally invasive exposure in revision total hip arthroplasty: a guide to selection and technique.

Revision total hip arthroplasty requires a careful surgical plan. Selection of the appropriate exposure is an essential step for success. Exposure is important not only for the complete and safe visualization and extraction of components and cement, but also for the achievement of a stable construct at the end of the procedure.

The limited incision, anterolateral, intermuscular technique for total hip arthroplasty.

Limited incision total hip arthroplasty has potential advantages over traditional techniques. Many new approaches have been advocated, however, each new approach has a number of drawbacks. A technique using a single incision with an anterolateral, intermuscular approach offers attractive advantages including the use of the more familiar lateral positioning for the patient and a short learning curve for the surgeon.

Minimally invasive or limited incision hip replacement: clarification and classification.

The goal of total hip replacement is to provide a pain-free, well-fixed, stable, long-lasting arthoplasty. Length of hospital stay, recovery time, and incision length are important factors related to the success of the procedure. As the procedure has evolved, the use of limited incision surgery has grown.

Building an anonymized catalogued radiology museum in PACS: a feasibility study.

The aim of this study was to test the feasibility of a software application that would allow the anonymization and cataloguing of whole DICOM datasets in order to build searchable radiology museums within PACS. The application was developed on a dedicated networked PC, using C# and HL7 coding. Whole DICOM datasets were pushed from PACS to a networked PC on which the application, Museum Builder, was developed.

Reconstruction of femoral defects in revision hip surgery: risk of fracture and stem migration after impaction bone grafting.

The use of impaction bone grafting during revision arthroplasty of the hip in the presence of cortical defects has a high risk of post-operative fracture. Our laboratory study addressed the effect of extramedullary augmentation and length of femoral stem on the initial stability of the prosthesis and the risk of fracture. Cortical defects in plastic femora were repaired using either surgical mesh without extramedullary augmentation, mesh with a strut graft or mesh with a plate.

Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients.

Objective: The purpose of this study was to analyze the radiologic characteristics of lipofibromatous hamartomas affecting upper limb peripheral nerves.

Conclusion: Although there are pathognomonic features that characterize lipofibromatous hamartoma on MRI, the range of appearances is broad. Sonography appears to show equally characteristic features and may be a useful tool for assessing this condition.

Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty.

The use of a pneumatic tourniquet in total knee arthroplasty has been linked to complications caused by local tissue hypoxia. Fat necrosis is a rare condition that presents as an ill-defined subcutaneous lesion. The clinical features resemble that of a lipoma but histological appearance is characteristic.

Novel multisubstrate inhibitors of mammalian purine nucleoside phosphorylase.

In an effort to develop potent multisubstrate-analog inhibitors of purine nucleoside phosphorylase (PNP), three nucleoside phosphonates were designed utilizing structural information from the previously reported structures of complexes of bovine PNP with substrates and products. The nucleoside phosphonates contain an acetal linkage at the O2' and O3' positions and a two-C-atom spacer between the ribose and phosphate moieties. The linkage enables the compounds to simultaneously occupy the purine-, ribose- and phosphate-binding sites.

Mechanical testing of impaction bone grafting in the tibia: initial stability and design of the stem.

Clinical experience of impaction bone grafting for revision knee arthroplasty is limited, with initial stability of the tibial tray emerging as a major concern. The length of the stem and its diameter have been altered to improve stability. Our aim was to investigate the effect of the type of stem, support of the rim and graft impaction on early stability of the tray.

Imaging the post-operative meniscus.

Considerable developments have occurred in meniscal surgery, and consequently in the imaging of post-operative menisci, over the last 15 years. A drive to preserve meniscal physiologic function for as long as possible, in order to delay osteoarthrosis, has resulted in limited partial meniscectomies, meniscal repairs and meniscal transplants. Each of these techniques affects the imaging appearance of the meniscus, reducing the accuracy of conventional MRI in predicting recurrent tears.

Regional migratory osteoporosis: a review illustrated by five cases.

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized.

Structural characterization of the regulatory proteins TenA and TenI from Bacillus subtilis and identification of TenA as a thiaminase II.

Bacillus subtilis gene products TenA and TenI have been implicated in regulating the production of extracellular proteases, but their role in the regulation process remains unclear. The structural characterization of these proteins was undertaken to help provide insight into their function. We have determined the structure of TenA alone and in complex with 4-amino-2-methyl-5-hydroxymethylpyrimidine, and we demonstrate that TenA is a thiaminase II.

Metastatic bone disease--the orthopaedic workload.

Background: In 1999, the British Association of Surgical Oncology (BASO) published its guidelines for the management of metastatic bone disease in breast cancer in the UK, highlighting the role of the orthopaedic surgeon as an integral part of the multidisciplinary team.

Aim: To establish the workload to our department of metastatic bone disease.

Methods: A prospective study was performed over a 6-month period aiming to study factors affecting length of stay, whether BASO recommendations were being adhered to for metastatic breast disease and whether BASO recommendations could be extended to other forms of metastatic bone disease.

Impaction bone-grafting in revision joint replacement surgery.

The standard graft material for impaction bone-grafting is fresh-frozen femoral head allograft morselized to a particle size as large as is practical to ensure stability and allow new bone formation. The graft must be sufficiently compacted to provide immediate mechanical stability; this requires containment of the graft and substantial impaction energy. Diaphyseal bone fracture and excessive implant migration are the most common complications of the operation.

Evolutionary links as revealed by the structure of Thermotoga maritima S-adenosylmethionine decarboxylase.

S-adenosylmethionine decarboxylase (AdoMetDC) is a critical regulatory enzyme of the polyamine biosynthetic pathway and belongs to a small class of pyruvoyl-dependent amino acid decarboxylases. Structural elucidation of the prokaryotic AdoMetDC is of substantial interest in order to determine the relationship between the eukaryotic and prokaryotic forms of the enzyme. Although both forms utilize pyruvoyl groups, there is no detectable sequence similarity except at the site of pyruvoyl group formation.

Percutaneous plating of distal tibial fractures.

We studied 20 patients (mean age 47.9+/-3.9, range 25-85 years) undergoing percutaneous plating of the distal tibia for 43A or 43C fractures in the period 1999-2002.

The current management of tibial fractures: are clinical guidelines effective?

Background: The production of clinical guidelines is increasing and will continue to do so with the introduction of clinical governance. In 1997, the British Orthopaedic Association (BOA) and the British Association of Plastic Surgeons (BAPS) published joint guidelines on the management of open tibial fractures. It is not known whether these guidelines reached their target audience, or indeed influenced clinical practice.