The migration of a Harrington rod after cervical fusion.

A patient was treated for an anterior dislocation of C4 on C5 with an open reduction and Harrington rod hook fixation. The compression rod dislodged and migrated through the foramen magnum into the cerebellum 4 years later. This case represents an unusual complication of Harrington rod instrumentation in the cervical spine.

Nerve root recovery in complete injuries of the cervical spine.

Thirty-six patients with complete quadriplegia were reviewed. Twenty-two underwent surgery, and 14 did not. There were 11 burst fractures and 3 extension fracture-dislocations, which were treated with anterior decompression and rigid plate fixation.

Acute ascending myelopathy of the spine.

Ascending myelopathy of the cervical spine is a clinical condition in which ascending paralysis manifests itself from 24 hours to 4 weeks after the initial injury. One hundred thirty-four patients with spinal cord injury were reviewed; 80 underwent surgery and 54 were treated conservatively. Ten of the 54 patients who did not have surgery ascended one to four levels, whereas only 4 of the 80 patients who underwent surgery ascended to similar levels.

Reconstruction of malunited fractures of the lateral malleolus.

The cases of twenty-six patients who had a reconstructive surgical procedure for treatment of a malunion of a displaced fracture of the fibula were evaluated. In these patients, who had pain, swelling of the ankle, and stiffness at an average of six years after the injury, the malunions were classified radiographically as either occult (eighteen patients) or overt (eight patients). An occult malunion was one in which the talus remained in its normal position, but the lateral malleolus showed residual displacement, characterized by external rotation and shortening.

Occult malunion of ankle fractures--a cause of disability in the athlete.

Occult malunion of the ankle is a condition in which the talus appears to be situated in its normal position on standard radiographs. The lateral malleolus, however, is incompletely reduced. This causes a subluxation of the distal tibiofibular joint and some degree of talar instability.

Pyogenic sacroiliitis. An absolute indication for computerized tomographic scanning.

Pyogenic sacroiliitis (PSI) resulted from direct injection of a foreign substance, pumice, in a 32-year-old woman and was complicated by iliopsoas abscess. The symptoms of PSI are unspecific, and similar complaints may accompany such conditions as herniated disc and arthritis. Results of physical examination may be misleading, especially if movements that stress the sacroiliac joint are omitted.

Treatment of ankle malunion.

Surgery of the ankle has reached the stage where reconstruction of malunions are not only possible but advisable. It is becoming more evident that if done early, and if done before the onset of arthritic changes, good results can be obtained. Certainly it is far more preferable to restore a malunited ankle to a functional level than to allow the patient to continue to experience pain and to wait until degenerative arthritis requires that an arthrodesis be performed.

Matrix antigens in allografts. II. The cell-mediated response.

The cell-mediated response of link proteins (LP) and proteoglycan monomer (PG), the matrix antigens of articular cartilage, was investigated in the late rejections of joint allografts in dogs. Cell-mediated immunity was present as determined by the Macrophage Inhibition Test and by skin sensitivity, which was present at 26 and 52 weeks after allografting. The Migration Inhibition was 70% at 12 weeks, and 50% at 26 and 52 weeks after allografting.

Matrix antigens in allografts. The humoral response.

The roles of matrix antigens, link proteins (LP) and proteoglycan monomer (PG) were investigated with regard to the late rejection of joint allografts. Antisera to these antigens were produced in the rabbit. With the use of immunofluorescent techniques, these antigens can be detected in host synovium as early as six weeks after transplantation.

Acid hydrolase activity following allografting.

The synovium of dogs receiving an osteochondral allograft of the distal femur has similar characteristics to a rheumatoid synovium. Since it is generally believed that the cartilage destruction in rheumatoid arthritis is related to the release of hydrolases from lysosomes, the following study was performed to determine whether a similar phenomenon is responsible for the destruction of transplanted articular cartilage. Host synovium revealed an almost threefold increase in acid phosphatase activity at 26 and 52 weeks after transplantation when compared to controls.

Isolated fracture of the lateral malleolus.

Isolated fractures of the lateral malleolus are stable only if no other ligaments are torn. These fractures are unstable if accompanied by a tear of the deltoid or anterior tibiofibular ligament and it may be necessary to demonstrate the resulting talar instability by stress radiographs. Stable fractures are best treated by the application of a short-leg walking cast.

Acute bilateral anterior dislocation of the shoulders.

In 3 cases of simultaneous bilateral anterior dislocation of the shoulders, considering the forces which predispose to anterior dislocations, it is postulated that in each case forced abduction and external rotation or abduction with hyperextension causes these injuries to occur.

The preservation of articular cartilage.

Slivers of articular cartilage were stored in Ham's medium, plasma, polyvinyl pyrrolidone, and dimethyl sulphoxide at 0, -20, 4, and 38C. Survival was monitored by potassium determinations and autoradiography using S-35 and by matrix staining. Survival of 48 days was obtained in Ham's medium at 4C.

Destruction of joint homografts. An experimental study.

The host synovium undergoes a striking transformation at about 26 weeks after joint homografting. Histologically the synovium invaded and destroyed the graft with which it came in contact, becoming markedly hypercellular; the infiltrate consisted mainly of plasma cells and lymphocytes. The synovium at this stage closely resembled a rheumatoid pannus.

The key role of the lateral malleolus in displaced fractures of the ankle.

The reason why late degenerative arthritis developed in some patients who had sustained displaced bimalleolar fractures of the ankle was investigated. The roentgenograms indicated that incomplete reduction of the lateral malleolus and a residual talar tilt were present. When bimalleolar fractures were created in cadavera the talus could be anatomically repositioned only when the lateral malleolus was accurately reduced.

Recent advances in the treatment of pathological fractures.

Pathological fractures present challenging and difficult management problems. Conservative treatment frequently results in non-union, while open reduction and internal fixation usually involves prolonged immobilization and bed rest with attendant medical complications. The use of methylmethacrylate as an adjunct to conventional forms of internal fixation represents a recent advance in the management of unstable, pathological fractures.

The augmentive use of methyl methacrylate in the management of pathologic fractures.

Methyl methacrylate is a useful adjunct to obtain secure internal fixation in the treatment of comminuted pathologic fractures. This method was used in 73 patients with 81 pathologic fractures of whom only four failed to regain function in the extremity which was operated upon. While it is probable that methyl methacrylate may have an adverse effect on fracture healing, the fixation achieved when applied to only one surface appears adequate and was observed to last for as long as nine years.

The effect of methylmethacrylate on fracture healing.

Fractures were created in the femur of dogs by dividing the midshaft with an airdriven saw. Immobilization was achieved with a four-hole compression plate. No methylmethacrylate supplementation was used in the control groups.

Limp in childhood.

A method is presented to assist the physician in diagnosing the cause of a limp in a child. This is based on how diseases alter locomotion. The normal gait can be affected in any one of five ways: shortened extremity, contracture, loss of supporting structures, pain, and paralysis.