Current concepts of molecular aspects of bone healing.

Fracture healing is a complex physiological process. It involves the coordinated participation of haematopoietic and immune cells within the bone marrow in conjunction with vascular and skeletal cell precursors, including mesenchymal stem cells (MSCs) that are recruited from the surrounding tissues and the circulation. Multiple factors regulate this cascade of molecular events by affecting different sites in the osteoblast and chondroblast lineage through various processes such as migration, proliferation, chemotaxis, differentiation, inhibition, and extracellular protein synthesis.

L5 radiculopathy secondary to intrapelvic placement of acetabular cup fixation screw.

We report a case of L5 radiculopathy secondary to intrapelvic placement of an acetabular screw impinging on the lumbosacral trunk. A 43-year-old man underwent revision of an uncemented total hip replacement to a custom-made femoral component and uncemented cup. He subsequently developed hip pain, dysesthesia, and L5 radiculopathy.

Intraspinal lumbar synovial cysts: diagnosis and surgical management.

Background: Lumbar synovial cysts are a common association of facet joint degenerative disease. However, it is relatively rare for these cysts to cause symptoms of radiculopathy and nerve root compression.

Patients And Methods: We report a series of eight cases which were treated over a period of 20 months.

Impaction femoral allografting and cemented revision for periprosthetic femoral fractures.

We reviewed retrospectively the outcome of the treatment by impaction grafting of periprosthetic femoral fractures around loose stems in 106 patients with Vancouver type-B2 and type-B3 fractures. Eighty-nine patients had a cemented revision with impaction grafting and a long or short stem. The remaining 17 had cemented revision without impaction grafting.

Revision total elbow arthroplasty with impaction allografting and uncemented partially hydroxyapatite-coated custom-made prostheses.

Total elbow arthroplasty has become a relatively common procedure in the last decade, and the number of primary total elbow replacements performed is likely to continue to increase as the population ages. The incidence of technically demanding prosthesis revisions involving complex problems such as major bone loss is therefore expected to increase. We report 3 cases of total elbow revision arthroplasty, all of which represented patients with severe bone loss.

A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain.

To the best of our knowledge, this prospective study is the first to investigate the prevalence of acetabular labrum tears in athletes presenting with groin pain. Eighteen athletes who presented to our sports clinic with groin pain, underwent clinical assessment and magnetic resonance arthrography (MRa) to detect presence or absence of acetabular labrum tears. Ethical committee approval and informed consent was obtained from each patient.

"Pig Tail" technique in intradiscal electrothermal therapy.

To describe a new method of catheter insertion in intradiscal electrothermal therapy, which eliminates the need for reinsertion of the cannula and catheter from the contralateral side in those patients in whom optimal positioning is not achieved with the standard technique. This new technique has not been described before. In those patients in whom adequate catheter position cannot be achieved with the standard technique, instead of withdrawing the cannula after the initial treatment, we recommend rotating the cannula 180 degrees through its long axis.

Acetabular labrum and its tears.

Groin pain is a major cause of morbidity in athletes. Only in the last decade have acetabular labrum tears been recognised as a possible diagnosis. Awareness of this condition is important for appropriate management.

High-intensity zone, intradiscal electrothermal therapy, and magnetic resonance imaging.

Magnetic resonance imaging changes to the symptomatic intervertebral disc following intradiscal electrothermal therapy were determined in this prospective study. Magnetic resonance images before the intradiscal electrothermal therapy procedure were compared with those taken at 6 months postprocedure in 10 patients. The presence and absence of high-intensity zone, the disc height and hydration, and Modic changes were determined from the images.

Dall-Miles plates for periprosthetic femoral fractures. A critical review of 16 cases.

Fourteen patients with 16 periprosthetic femoral fractures around hip replacement were treated with Dall-Miles plates between June 1996 and February 2000. There were 10 Vancouver B3, three B1 and three type C fractures. In addition to a Dall-Miles plate, two of the fractures (one B3 and one C type) were also stabilised with one strut graft and nine B3 fractures were revised with impaction grafting.

The management of periprosthetic femoral fractures around hip replacements.

Periprosthetic femoral fractures are increasing in frequency and in complexity. They occur intra-operatively, or post-operatively, when they are frequently associated with loosening, with or without osteolysis. Periprosthetic femoral fractures usually occur at low energy levels, either after falls or spontaneously during activities of daily living.

Fresh frozen bone in femoral impaction grafting: can developments in bone regeneration improve on this?

Major advances in the understanding of bone regeneration have led to revolutionary applications of bone conduction and induction. Revision hip surgery is on the increase with an active, ageing population demanding increased quality of life. The technically demanding instrumentation and materials necessary for revision prosthetic hip replacements have been rapidly incorporated into clinical practice.

Avulsion fracture of the extensor carpi radialis brevis insertion.

Avulsion of the extensor carpi radialis brevis at wrist level is rare. We present a case of an avulsion fracture involving the extensor carpi radialis brevis insertion at the base of the middle finger metacarpal.

Diagnosing slipped upper femoral epiphysis.

The key to diagnosing slipped upper femoral epiphysis is a high index of suspicion. This article summarizes the important clinical features of the disorder and points out the pitfalls in diagnosis.