Abstract

Aim: To assess the efficacy of percutaneous needle bursting and limited percutaneous pulley division in the treatment of seed ganglia.

Methods: A prospective cohort study was run. All patients in the study had ganglia bursting by lignocaine injection. If this failed a limited percutaneous release was performed as at open release for trigger finger.

Results: There were 52 patients treated over a four-year period. 31 were female and 21 male with an average age of 37 years. The fingers involved were: index (6), middle (21), ring (19), little (5) and thumb (1)

Complications were 3 patients with mild stiffness at review (6 months, 1year and 2years), and one digital nerve injury.

Conclusions: Burst alone works in 50% of patients. Percutaneous release is effective in 69% of patients. It appears to be a safe and reliable alternative to open surgery, especially if restricted to midline lesions.

Aims: To determine the usefulness of isotope bone scintography in investigating skeletal pain in children. Methods: We reviewed bone scans, notes and radiographs requested for children under 16 years presenting to two teaching hospitals in the city. Results: There were 229 patients with and average age of 11 years.

139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton.

There were positive scans in 13 patients with back pain and 22 with pain elsewhere.

The management was altered in only 3 children with back pain and 6 with other skeletal pain. Conclusions: Isotope bone scintigraphy is a low yield, and non-speciþc investigation that imparts a signiþcant dose of radiation. Its role in the investigation of skeletal pain should be re-evaluated.

Aims: To evaluate the radiological evidence of graft incorporation in the femur following impaction bone grafting. Methods: Consecutive patients that underwent femoral impaction bone grafting using two stem designs were identified. Radiographs were taken post-op and at 3, 6 and 12 months then yearly. They were evaluated for radiological signs of graft incorporation and the results plotted against time and according to Gruen zones. Results: 28 patients over a 4-year period underwent femoral impaction grafting. 16 had a double tapered polished stem (Exeter), 12 had a non-polished stem (Charnley Elite). There were 17 male and 11 female patients with an average age of 62.6 years.

There is little radiological evidence of incorporation before 6 months, but by one year 75% of patients show some graft incorporation in some or all Gruen zones. Graft incorporation in the Exeter stems is seen first in zones 4 and 5. In the Charnley stems it is first seen in zones3, 5 and 6. The majority of subsidence occurs within the first year following surgery. Conclusions: Graft incorporation is seen first in those zones that may be expected to experience greater load. Differences in the pattern of graft incorporation may reflect differences in stress distribution between the two stem designs. Some load appears to promote graft incorporation. The construct must have sufficient stability to withstand subsidence whilst graft incorporation occurs.

We undertook a review of bone scans requested for children to determine the usefulness of isotope bone scintigraphy in investigating skeletal pain in this population.

We reviewed the bone scans, plain radiographs and clinical notes of consecutive children under 16 years of age presenting to children’s orthopaedic surgeons at two teaching hospitals in one city.

There were 229 patients, of which 40% were boys and 60% girls. They had and average age of 11 years. 139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton. They were investigated for a variety of conditions including idiopathic back and skeletal pain, scoliosis, Scheuermann’s disease, spondylolysis and stress fractures, osteomyelitis and post-operative pain.

There were positive scans in 4 out of 78 patients with idiopathic back pain, 1 of 25 patients with scoliosis and 1 out of 5 with spondylolysis and 11 out of 70 with idiopathic skeletal pain.

Of all patients with back pain the management was altered in only 3 children. Of all those investigated for appendicular skeletal pain the management was altered in 6 children.

Conclusion: Isotope bone scanning is a low yield, and non-specific investigation that imparts a significant dose of radiation to the patient. It should not be used as a first line investigation for idiopathic back or skeletal pain in children. Other tools such as MRI should be considered initially.

The role of isotope bone scanning in the investigation of skeletal and joint pain in children should be reevaluated.