Early femoral loosening in one design of cemented hip replacement.

We have studied aseptic loosening of the femoral component in 76 patients with primary total hip replacement using the Capital prosthesis. The mean follow-up was 26 months (10 to 37). Twelve femoral components (16%) were definitely and eight (10%) were possibly loose.

Adolescent disc protrusions. A long-term follow-up of surgery compared to chymopapain.

Study Design: This study compared chymopapain with primary surgery in the treatment of 60 radiologically proven adolescent lumbar disc protrusions and symptoms of low back pain and sciatica; the failures of intradiscal therapy were treated by surgical discectomy.

Objectives: To establish whether chymopapain is as good as primary surgery in treating adolescents with proven lumbar disc protrusions.

Summary Of Background Data: Symptomatic lumbar disc protrusions are rare in white adolescents; the reported incidence varies from 0.

Chronic contained rupture of an aortic aneurysm mimicking infective spondylitis.

Chronic contained rupture of an abdominal aortic aneurysm is rare. These aneurysms are small and affected patients are usually normotensive. The resultant pseudoaneurysmal sac may cause extensive vertebral erosion.

Femoral nerve palsy. An unusual complication of anterior lumbar interbody fusion.

Summary Of Background Data: Compression neuropathy of the femoral nerve has been reported as an uncommon complication of bleeding into the iliopsoas muscle.

Objective: The authors detected anatomic reasons of direct injury to the femoral nerve at the lower lumbar level.

Methods: Keeping the hip in extension during the course of carrying out anterior fusion on a previously failed posterior fusion was considered another causative factor of femoral nerve injury.

Pisotriquetral loose body. An unusual cause of wrist pain.

A loose body flicking in and out of the pisotriquetral joint was found to be the cause of intermittent wrist pain and locking in two patients. Appropriate X-rays gave the diagnosis and surgical removal provided a satisfactory cure.

Collapse in an accident and emergency department.

Collapse is a common presenting complaint to accident and emergency (A & E) departments. This retrospective study of 4180 new attendances at a district general hospital A & E showed that this accounted for 2.9%.

The role of anterior surgery for vertebral fractures with and without cord compression.

The indications for anterior surgery are well defined in the upper and lower cervical spine if one accepts the importance of early restoration of stability for improved patient rehabilitation. Cannulated screw fixation of Type II fractures of the odontoid peg is a highly specialized procedure that requires technical expertise still only available at a limited number of orthopaedic centers. The engineering improvements in internal fixation for the anterior cervical spine, allied with an increasing expertise in instrumentation, have increased the tendency toward anterior stabilization for all unstable lower cervical fractures, except irreducible dislocations, irrespective of the mechanism of injury.

Iliolumbar hernia following bone grafting.

A 40-year-old man developed a lumbar hernia through an iliac bone graft donor site. The defect was repaired using an autologous bone graft reinforced by titanium mesh.

Sciatic nerve palsy caused by haematoma from iliac bone graft donor site.

A 27-year-old woman developed a haematoma-related compressive neuropathy of the right sciatic nerve following the harvesting of a bone graft from the posterior aspect of the right iliac crest. The nerve was compressed in an enclosed compartment between the sciatic notch and the piriformis muscle, which is thought to be involved in the piriformis syndrome. The symptoms improved once the haematoma was evacuated, and this complication stresses the importance of adequate haemostasis of the area from which the bone graft is taken.

Injury patterns in motorcycle road racers: experience on the Isle of Man 1989-1991.

We report the first prospective study on the incidence of motorcycle accidents of the world's foremost motorcycle road-racing venue, the Isle of Man. Between 1989 and 1991 there were six meetings during which over 2500 riders took part. Racing on essentially normal country and town roads, the motorcycles can reach speeds in excess of 306 km/h and the average lap record is now 198 km/h.

Adolescent disc protrusions. A long term follow-up of chymopapain therapy.

The management of adolescent disc protrusions by chemonucleolysis has received little attention in the literature, and reports of the long-term outcome are lacking. Between May 1978 and July 1986 42 patients between the ages of 13 and 19 years with radiologically proven lumbar disc protrusions were treated at this institution with chymopapain. They were followed prospectively for 1 year, and the procedure was successful in 27 patients (64%).

Osteochondritis dissecans patellae : Is there a genetic predisposition?

The aetiology of Osteochondritis Dissecans Patellae remains controversial. We present a family suffering from the condition in all members of one generation. Clinical data support the hypothesis that the aetiology of the disorder in this family is recurrent subluxation of the patella, the inherited predisposing factor being an abnormality of the mechanics of the knee.

Undisplaced fractures of the distal third of the radius in children: an innocent fracture?

A series of 107 undisplaced or minimally displaced distal third radial fractures in children were assessed to try to identify the incidence and the factors associated with displacement. Of 27 fractures showing a volar (pronation) pattern, there were no cases of progression of the deformity. Of the 80 fractures showing a dorsal (supination) pattern, 22.

The 'whoosh' test. A clinical test to confirm correct needle placement in caudal epidural injections.

We describe a previously unreported test to confirm accurate needle placement in caudal epidurals. Of 26 patients undergoing caudal epidural, 19 (73%) had correct needle placement as determined by epidurography. All of these had a positive 'whoosh' test.

Osteochondritis dissecans patellae. Is there a genetic predisposition?

The aetiology of Osteochondritis Dissecans Patellae remains controversial. We present a family suffering from the condition in all members of one generation. Clinical data support the hypothesis that the aetiology of the disorder in this family is recurrent subluxation of the patella, the inherited predisposing factor being an abnormality of the mechanics of the knee.

Surgical treatment of fixed flexion contractures in the hands of institutionalised patients.

Three severely demented elderly patients had fixed flexion contractures of all fingers of one or both hands. This caused an unpleasant problem of hygiene and of nail ingrowth into the palm. A surgical solution to this problem is described, with good results.

A segmental analysis of thoracic shape in chest radiographs of children. Changes related to spinal level, age, sex, side and significance for lung growth and scoliosis.

Thoracic ratios (TRs) were measured segmentally (T1-12) in the chest radiographs of 412 children aged 0-17 years attending hospital with minimal disorder or diseases (boys 193, girls 219). A new method for measuring TRs was used which calculates the width of the left hemithorax, the right hemithorax and the total thorax relative to T1-T12 distance. The data were analysed in 3 age groups--infancy, childhood and puberty, after the classification of Karlberg (1989).

Anterior plate fixation in spine tumor surgery. Indications, technique, and results.

Anterior decompression by vertebrectomy is now well established as the procedure of choice to optimize neurologic recovery in patients with a deficit due to tumor involvement of the vertebral body. Fifteen patients with tumor involvement of the cervical or thoracic spine and neurologic deficit were treated by single-stage anterior decompression and AO plate stabilization. No patient suffered neurologic deterioration after surgery.

Trochanteric exostoses following total hip arthroplasty. A complication of trochanteric osteotomy.

Trochanteric osteotomy has long been a fundamental part of the technique of the Charnley low-friction arthroplasty. It is, however, not without its complications, the principal one of which is nonunion regardless of the type of fixation used. A previously undescribed complication requiring reoperation is reported with regard to eight cases of primary hip arthroplasty.

An analysis of the effect of the Zielke operation on S-shaped curves in idiopathic scoliosis. A follow-up study revealing some skeletal and soft tissue factors involved in curve progression.

This article analyzes the fate of S-shaped idiopathic spinal curves during follow-up in 18 patients having the Zielke VDS operation. The spinal radiographs were evaluated by Cobb angle, end-vertebra angles (EVAs), vertebral rotation, and by a new method using the tilt of the surgically fused spinal block in the frontal plane. Spinal growth was measured.

The operative treatment of progressive early onset scoliosis. A preliminary report.

Thirteen patients with progressive early onset scoliosis have been managed operatively in an attempt to achieve correction without bracing and to allow the spine to grow. All had posterior segmental spinal instrumentation (SSI) without fusion and 9 of 13 had anterior apical growth arrest as a separate additional procedure. At 2-year follow-up, curve correction averaged 46%.

Harrington-Luque and Cotrel-Dubousset instrumentation for idiopathic thoracic scoliosis. A postoperative comparison using segmental radiologic analysis.

This article reports a comparison of the Cotrel-Dubousset (CD) operation with the Harrington-Luque (HL) procedure for the treatment of adolescent idiopathic thoracic scoliosis. Thirty-nine patients were studied preoperatively and postoperatively using segmental radiologic measurements including Cobb angle, end-vertebra angles (EVAs), surgical flexibility index, vertebral rotation, displacement and tilt, convex and concave rib-vertebra angles (RVAs), and kyphosis and lordosis. Cotrel-Dubousset is not significantly different from HL with respect to Cobb angle (%), surgical flexibility index, apical vertebral displacement, apical vertebral rotation, apical rib-vertebra angles, kyphosis, and lordosis.