A total absence of acute compartment syndrome (ACS) was noted in 966 tibial fractures in African patients of diverse ethnic groups, reviewed retrospectively at our institution. According to general incidences reported in the literature, we should have experienced between 22 and 86 cases of acute compartment syndrome. The purpose of this prospective study was to confirm these findings and at the same time to try to find an explanation for this phenomenon.

During a period of 1 year and 4 months, 257 tibial fractures were prospectively analyzed for clinical signs and late sequelae of acute compartment syndrome. In 156 of these patients, presenting 158 fractures of the tibia, the pressure in the anterior compartment was systematically measured. Not a single case, nor late sequel of ACS was diagnosed.

The hypothesis we forward for this total absence of ACS is the effect of chronic high temperature surroundings in preventing ACS by safeguarding the arteriovenous gradient and lowering the vascular resistance. We propose that further investigation should be carried out to study this hypothesis.

We undertook a review of the literature relating to the two basic stem designs in use in cemented hip replacement, namely loaded tapers or force-closed femoral stems, and the composite beam or shape-closed designs. The associated stem fixation theory as understood from in vitro studies and finite element modelling were examined with reference to the survivorship results for each of the concepts of fixation.

It is clear that both design principles are capable of producing successful long-term results, providing that their specific requirements of stem metallurgy, shape and surface finish, preparation of the bone and handling of the cement are observed.

During a one-year period starting in October 2001, we analysed the intra-hospital cost of 102 primary elective total hip arthroplasty (THA) in a Belgian university hospital. Patients were treated according to age and general condition with an all cemented metal-poly THA (37), a uncemented cup and cemented metal-poly THA (40), an all uncemented ceramic-ceramic THA (18) or non-standard implants or combinations (7). On average patients stayed 14.4 days in the orthopaedic ward and intra-hospital cost was 9496 Euro (SD: 2178): 53.8% was related to hospitalisation, 21.3% to implants and material, 7.7% to surgery and 4.1% to anaesthesia. A multiple regression analysis was performed to identify possible influencing factors for intra-hospital cost and stay (pre-operative hip function, general health and dwelling as well as implant choice and intra-hospital complications). Overall, only the occurrence of complications during hospitalisation had a significant regression coefficient. In total 14 patients (13.7%) suffered at least one complication during hospitalization (dislocation: 4.9%, heamatoma or superficial infection: 2%, trochanter fracture: 1%, thrombosis with pulmonary embolism: 1%, general complications: 6.9%). This resulted in a significant higher cost (11823 versus 9125 Euro) and hospital stay (19.4 versus 13.6 days). For those patients who did not suffer complications, only implant choice and the place patients were discharged to had significant regression coefficients. The average implant cost for cemented metal-poly THA was 1444 Euro (16.1% of the total cost) compared to 2686 Euro (25.6% of the total cost) for uncemented ceramic-ceramic implants. Due to a chronic shortage of rehabilitation units in the Brussels region, discharged to these units led to both higher cost (10422 versus 9056 Euro) and longer hospital stay (16.5 versus 13.4 days). In the Belgian health insurance system, limitation of intra-hospital cost can best be achieved by shortening hospital stay after THA. This might include improved control of postoperative complications, faster rehabilitation programs and improved surgical techniques to reduce the needs for rehabilitation units and to allow earlier return to independency. Another option is to increase cost awareness regarding prolonged hospital stay of both, patients and medical staff.

Introduction Osteoarthritis of the knee is a very common disease.In 80 to 90% of the cases it starts in the medial compartment and tends to remain there.Therefore, the Oxford Unicondylar Knee Prosthesis (OUKP) is a attractive device as it only replaces the diseased parts of the knee.For the past 15 years, the results of the OUKP, especially those achieved by the designer’s group, have mostly been very good. However, reports about long-term follow-up are scarce. For the designer group, Murray reported a 98% ten year survival. The only independent research bij Svard an Price and by Lewold of the Swedish Arthroplasty Study showed a good survival of 95% at 10 years and a poor survival of 87% at 8 years respectively.Our independent study reviews a ten year follow up of 149 OUKP’s.

Methods and Results One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In 4 others, a lateral prosthesis was implanted subsequently to a medial one. One of these 4 was revised to a total knee prosthesis 6 years later. In another 4 cases, late complications of the meniscal bearing were treated with replacement of this bearing. In the group af patients older than 75 years, no revisions were recorded. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded.

This difference is significant (p=0,0000).

Conclusion These results are in line with those of the Swedish arthroplasty register and compare poorly to the survival of total knee arthroplasty, therefore this prosthesis is not the first choice for most cases. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in the relatively young patient.The survival rate in the group of patients older than 75 years is as good as or better than that for total knee arthroplasty.Since the OUKP can now be placed minimally invasive, it might have its place in this subgroup. It should not be used in osteotomized knees.

Aims: To assess the long-term results of the Oxford Uni-compartmental knee prosthesis for unicompartmental osteoarthritis and to discuss these results in comparison to other, scarce, long term follow-up. Methods: Sixty-þve medial and 6 lateral prostheses were placed in 67 patients. After an average of 10 years, they were evaluated with the Hospital for Special Surgery (HSS) knee score. Results: Fifteen patients died after a mean of 7 years, without need for revision. Eight prostheses were lost to follow-up. Ten (16%) revisions were noted: in 4 cases (6%) this was associated with an initially poor operative indication or a postoperative malalignment. The mean HSS score in 35 medial and 3 lateral prostheses was 164. (79% excellent or good, 10.5% moderate and 10.5% poor results) compared to 168 at 4.5-years of follow-up. There is no signiþcant difference between the score of patients older and patients younger than 65 years of age. Conclusions: Because this type of prosthesis preserves a maximum of bone stock and is revised to a total prosthesis without much difþculty it is the þrst choice prosthesis for medial unicompartmental osteoarthritis in the relatively young patient. In the light of other, very scarce long-term follow-up series, and compared to follow-up of total knee prostheses, the revision rate is high. Therefore, in spite of the very good and lasting HSS score in this group, this prosthesis is not the þrst choice in the elderly.

The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lower-demand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy.

There was a low incidence of secondary ACL and meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury.

We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions.

In a prospective trial, biodegradable polyglycolic acid rods were compared with Kirschner wires for fixation of wrist fractures (Frykman types I, II, V and VI). Fifteen patients were randomly assigned to each treatment group. There was no significant difference between the groups with regard to age, sex ratio and fracture type. Kapandji's pinning technique was used in all cases. There were no significant differences in the results obtained in both groups at final follow-up. At three months and six months the functional results of the Kirschner-wire group were, however, significantly better (p < 0.05), due to numerous transient complications from foreign-body reactions to the polyglycolic acid rods. The use of polyglycolic acid rods is therefore not recommended for the fixation of distal radial fractures.

We have investigated a prospective series of 100 acute traumatic haemarthroses of the knee in a general non-athletic population. All the patients had normal radiographs and an aspiration which confirmed the haemarthrosis, before undergoing ligament testing and an arthroscopic examination under anaesthesia. Only one patient had no serious pathology; in the other 99 a total of 193 lesions were recorded. Thirty knees had only one isolated lesion, 69 had combined lesions. This study confirms the serious nature of an acute traumatic haemarthrosis of the knee, even in non-athletic patients.

This paper presents four patients with injuries to the thoracolumbar spine assessed by computerised tomography. This technique enabled an easy, quick and accurate diagnosis to be made, avoiding dangerous manipulation of the patient. The scans were analysed using the anatomical classification of Louis to evaluate the instability of the lesions. Control CT scans were used to monitor progress and to provide an accurate prognosis within acceptable limits of irradiation.