Aims.
Aims.
To address the natural history of severe post-tuberculous (TB)
kyphosis, with focus upon the long-term neurological outcome, occurrence
of restrictive lung disease, and the effect on life expectancy. This is a retrospective clinical review of prospectively collected
imaging data based at a single institute. A total of 24 patients
of Southern Chinese origin who presented with spinal TB with a mean
of 113ยฐ of kyphosis (65ยฐ to 159ยฐ) who fulfilled inclusion criteria
were reviewed. Plain radiographs were used to assess the degree
of spinal deformity. Myelography, CT and MRI were used when available
to assess the integrity of the spinal cord and canal. Patient demographics,
age of onset of spinal TB and interventions, types of surgical procedure,
intra- and post-operative complications, and neurological status
were assessed. Aims
Patients and Methods
We report a case of peri-prosthetic
INTRODUCTION.
Aim. Extraspinal osteoarticular
The dismal outcome of
Aim. At our tertiary orthopaedic centre, mycobacterial cultures are routinely performed on bone and joint samples sent for bacterial culture. We have previously described the prevalence Mycobacterium
Bone localization of
A prospective series of 32 cases with
Vertebral disease constitutes approximately 50% of all skeletal
In the knee, involvement is mainly synovial, with local extension eroding the bone. Pure tuberculous osteitis is rare, with a few occasional reports. Patella
The case histories of these Black Notley patients show that no serious harmful effects have been caused by pregnancies going to full term. Most of the patients had normal confinements; Caesarian sections were few and were usually done for obstetric reasons, not for fear of reactivation of the disease. This experience bears out a remark made to me by Marcel Galland. When asked if Caesarian sections were required for women who became pregnant after treatment at Berck for skeletal
Background. The discussion over the duration, type of therapy and regimen to be used in osteoarticular
After
We retrospectively reviewed 52 children treated for
A series of 14 patients suffering from
Introduction and Aims: Solitary osseous lesions of
There has been an increase in the incidence of bone and joint
Introduction: The incidence of
Among the extra pulmonary forms of
Purpose. The hip region is the second most common site for
High cervical
Streptomycin and iso-nicotinic acid hydrazide are two powerful drugs lethal to tubercle bacilli, when access to the infected tissues is free. For early disease, before ischaemia and necrosis become established, they are curative: afterwards they are not. In this paper the use of surgery to augment their action has been discussed. The development of such methods may well revolutionise the treatment of skeletal
Skeletal
1. Nine hundred and fourteen cases of
Tuberculous sacro-iliitis occurs in fewer than 10% of cases of skeletal
Among the variety of differential diagnoses for chronic patellar tendinopathy, isolated
The diagnosis of painful heel syndrome is quite common in any busy orthopaedics OPD. Though neoplasm and infections are not uncommon in calcaneum, the surgeon does not suspect infection unless there is an obvious history of punctured wound or constitutional symptoms. As such till date there is no series of large number of cases of calcaneal
Abstract. Objectives. to evaluate the efficacy and safety of topically applied tranexamic acid (TXA) in thoracolumbar spinal tuberculosis surgery, posterior approach. Methods. Thoracolumbar spine
Aims. The surgical treatment of
Of the 4172 patients in a survey of all cases of
Craniovertebral
The lack of an accurate, rapid diagnostic test
for mycobacterium
1. Experience in the treatment of tuberculous disease of the spine, hip and knee by combined constitutional, antibiotic and operative measures is described. 2. In patients with
We report 79 cases of bone and joint
The timing of total hip replacement (THR) in
patients with active
In two centres in Korea 350 patients with a diagnosis of
The immigrant Asian population of Bradford has a relatively high incidence of bone and joint
1. Thirty-eight cases of
1. Three hundred and twenty cases of
We have reviewed six patients with old
We retrospectively reviewed 10 children treated for
We treated 13 children with histologically confirmed cystic
Over a four-year period, nine patients with
Subacromial corticosteroid injections are a well-recognised management for chronic shoulder pain and are routinely used in general practice and musculoskeletal clinics. Mycobacterium
Femoral head aseptic necrosis is a common complication after HSCT. In allogeneic HSCT recipients, hip
We report the results of cementless total joint replacement in 18 patients with old
1. A case of osteochondritis of the cuboid, with co-existing
Aim. Skeletal
Aim:. Historically, anterior decompression followed by posterior fusion has been the surgical management of choice in spinal tuberculosis. Due to theatre time being at a premium, we have evolved to performing anterior only debridement, allograft strut reconstruction and instrumentation for
One hundred and fifty patients in Hong Kong with a diagnosis of
We studied 51 patients with osteo-articular
In 44 patients with
Two hundred and eighty-three patients with
1. Eleven cases of
1. Thirty-one cases of
The localisation of acute haematogenous pyogenic osteomyelitis following a local injury is well known. Whilst there is often a history of trauma in patients developing bone and joint
We report 60 patients with
Six patients, aged between 3 and 51 years, with
1. The previous literature in English on
As in other high-income countries,
We reviewed 33 children with
1. A case of multiple pseudo-cystic
1. A case of multiple pseudo-cystic
Twelve adult patients with confirmed
The results obtained from combined chemotherapy and radical surgery in eighteen patients with trochanteric
Streptomycin and the newer antibiotics have already belied the pessimistic agnosticism of 1947. In certain instances, notably in disease of the knee and hip and in some cases with draining sinuses, it appears that they are sufficient to produce a quiescence which may be a cure. For the rest it remains to map out in detail what has in part been explored. In particular it is essential to confirm how far antibiotics enable surgeons to treat
1. Fifty cases of arthrodesis of the hip joint in tuberculous arthritis are analysed; in forty cases the late end-result has been ascertained two or more years after operation. 2. The indications for arthrodesis are discussed. The operation should not be performed when disease is active; it should not be undertaken before the age of twelve to thirteen years; it is not advisable in elderly patients; it may be contra-indicated when there are multiple foci of infection. Subject to these limitations every patient with unsound ankylosis after adequate conservative treatment should be treated by arthrodesis; painful fibrous ankylosis and late onset of deformity are definite indications. 3. Three types of operation have been used: intra-articular arthrodesis; extra-articular ilio-femoral arthrodesis; combined intra- and extra-articular arthrodesis. Extra-articular ilio-femoral arthrodesis is preferred, deformity being first corrected by traction or osteotomy. 4. Post-operation complications were few; the mortality rate was low (2 per cent.). 5. There was bone ankylosis with solid incorporation of the graft in 87รยท5 per cent., failure of union of the graft (to the trochanter) in 10 per cent., and destruction of the graft in 2รยท5 per cent. 6. Late end-results show full working capacity in 87รยท5 per cent. of patients, part working capacity in 2รยท5 per cent. and inability to work in 7รยท5 per cent. The writer wishes to express his thanks to Professor Harry Platt and Professor T. P.. McMurray for criticism and advice in the preparation of this paper, and to Dr F. C. S. Bradbury, Central Consultant
Amputation or post-mortem specimens from eight cases of joint
Background:
Fresh-frozen allografts from the humerus were used to help to stabilise the spine after anterior decompression for
Arthroplasty of the hip using an interposed multi-layered cap of amniotic membrane is reported in 28 patients with tuberculous arthritis. The disease had been present from one to seven years, and five patients had multiple discharging sinuses. Follow-up was from 30 to 46 months. Amniotic tissue caused no inflammatory reaction, or obvious rejection, and 25 patients were free of symptoms, with a good range of movement and a stable joint. The three failures were caused by dislocation, fracture of the femoral neck and extra-articular bone formation respectively. Amniotic arthroplasty seems to be capable of providing a painless, mobile and stable joint in patients with
Clear-cell sarcoma is a very rare tumor, and is almost always associated with tendons or aponeuroses or is metastatic from other organs. Sporadic cases only have been reported involving primarily the bone or extending from soft tissues to surrounding bones. To our knowledge, the ilium has not been previously reported as the primary site for clear cell sarcoma. We report a rare case of Primary clear cell sarcoma involving right ilium region in a 18-year-old boy presented with a painful swelling over right ilium and limp on right lower limb of ten month duration. He was initially suspected having
We reviewed 64 anterolateral decompressions performed on 63 patients with
Purpose: A descriptive cohort study of the surgical treatment of spinal tuberculosis in a single unit in the United Kingdom.
This is an evaluation of outcomes in 12 patients with
Of 37 consecutive patients suffering from
1. The operation of "dynamic" osteotomy is designed to secure a stable and freely mobile pseudarthrosis in cases of quiescent
We present a prospective study of patients with
1. Details are given of sixty-three consecutive cases with a history of pleural effusion seen at an orthopaedic hospital. 2. Twenty-four of these were post-primary effusions occurring before the onset of symptoms of the orthopaedic lesion. The bone and joint lesions ultimately developing in this group of patients were widely scattered throughout the skeleton. 3. Three others were secondary to adult-type pulmonary lesions. 4. Thirty-six patients had a pleural effusion after the beginning of their orthopaedic tuberculous history. Seven were certainly secondary to operative intervention, six in the thorax near the parietal pleura (costotransversectomy or antero-lateral decompression of the cord) and one from a haematogenous dissemination after fusion of a hip joint. 5. The remainder of this group with pleural effusion during the history of their orthopaedic tuberculous disease numbered twenty-nine. Of these, twenty-five suffered from disease of the thoracic spine; in two more details are defective. Only two definitely had neither pulmonary nor thoracic spinal disease; their lesions were in the lumbar spine. The conclusion is drawn that the overwhelmingly common cause of pleural effusion in patients with orthopaedic
Forty patients with
Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes.Aims
Patients and Methods
The final results up to 15 years are reported of clinical trials of the management of
1. Two hundred young Korean patients with a diagnosis of
We retrospectively reviewed eight children with idiopathic chondrolysis (IC) of the hip and nine with atrophic
We have reviewed 80 children who were involved in the Medical Research Council (UK) trial of surgical treatment for
After exclusions, 265 patients with
1. The long-term results of 740 European patients suffering from spinal tuberculosis and treated without and with specific anti-tuberculous drugs have been surveyed. 2. The results of treatment by conservative methods and by conventional surgical methods have been compared in the two periods. The attainment of spinal stability as judged by serial examination of radiographs was the main criterion in assessing healing. 3. Although the results of conventional treatment have improved since the advent of chemotherapy, the credit is mainly due to the influence of more frequently and more expertly applied operations. 4. With chemotherapy the well tried medical and surgical procedures produce stable spines in three-quarters of cases. With early operation on the lesion the results are better and more quickly obtained. Of eighty spines on which focal surgery was performed during the past twelve years before the lesions had become extensive, seventy-seven (9ยท62 per cent) healed by bone. The average duration of hospitalisation after such operation was four and a half months. No patient has had to be readmitted. 5. The difficulties and possible dangers of these methods must be emphasised. The operations are difficult and dangerous when the lesions have been allowed to get out of hand and become unduly extensive. They are contra-indicated in cases where there is very marked deformity. 6. Training in special techniques of operation is necessary. Duplicated drainage of the hemithorax after thoracotomy is essential, and skilled after-care is important if good results are to be obtained.
40% Of the cases of tuberculous (TB) spondylitis involve the lumbar spine. Despite the large forces borne by the lumbar spine and subsequent disability that may result from the TB infection, no studies have reported on the functional outcome. We review the clinical, radiological and patient-orientated functional outcomes using the Oswestry Disability index (ODI) following treatment of lumbar spine TB. The final radiological and ODI assessment was undertaken at follow-up during October 2005 and March 2006 in 37 patients, treated non-operatively for TB of the lumbar spine. The diagnosis was established following a closed needle biopsy. The mean age at follow-up was 35 (range 16 to 76 years). The average duration of symptoms prior to presentation was 9 months (range 2 to 24 months). All patients presented with low backache and night pain but only 42% had constitutional symptoms. 92% had 2-body involvement and L3/4 segment was most commonly involved (35%). The kyphosis measured 130 (range 400 kyphosis to 130 lordosis) and the mean overall lumbar curve was +10 (range 260 kyphosis to 360 lordosis). Ten patients had coronal plane deformity averaging 100 (00 to 220). All patients had a minimum of 6 months of anti-TB treatment (6 to 24 months), 76% used spinal brace for a mean of 5 months (2 to 24 months). At the last follow-up the kyphosis was 170 (380 kyphosis to 80 lordosis) with overall average lumbar curve of +30 (180 kyphosis to 360 lordosis). 11 Had mean coronal deformity of 90 (00 to 140). 34 Of the patients showed full radiological fusion. The mean ODI was 19% (0 to 55%). We conclude that a favourable functional outcome can be expected with conservative treatment of lumbar spine TB, despite the deformity.
In spinal tuberculosis MRI can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. We propose a classification system, using information provided by MRI, to help to plan the appropriate surgical treatment for patients with thoracic spinal tuberculosis. We describe a series of 47 patients, divided into four groups, based on the surgical protocol used in the management. Group A consisted of patients with anterior lesions which were stable with no kyphotic deformity, and were treated with anterior debridement and strut grafting. Group B comprised patients with global lesions, kyphosis and instability who were treated with posterior instrumentation using a closed-loop rectangle with sublaminar wires, and by anterior strut grafting. Group C were patients with anterior or global lesions as in the previous groups, but who were at a high risk for transthoracic surgery because of medical and possible anaesthetic complications. These patients had a global decompression of the cord posteriorly, the anterior portion of the cord being approached through a transpedicular route. Posterior instrumentation was with a closed-loop rectangle held by sublaminar wires. Group D comprised patients with isolated posterior lesions which required posterior decompression only. An understanding of the extent of vertebral destruction can be obtained from MRI studies. This information can be used to plan appropriate surgery.