In a prospective, randomised trial of 81 patients with fractures of the ankle of AO types A, B and C we compared two regimes of postoperative management after internal fixation. The patients were mobilised either non-weight-bearing with crutches or weight-bearing in a below-knee walking plaster. We found a temporary benefit in subjective evaluation only (65 v 50 points, Mann-Whitney test, cft, p = 0.02) for those with a below-knee walking plaster. There were no significant differences between the groups in the loaded dorsal
Patients suffering from generalised convulsions may dislocate their shoulders either anteriorly or posteriorly. Those with anterior dislocation are likely to have recurrent episodes because of secondary bony damage to the anterior rim of the glenoid and head of the humerus. In such patients there is high rate of failure of the standard soft-tissue stabilisation procedures. We have therefore devised a bone buttress operation in which autograft or allograft is secured to the deficient anterior glenoid and shaped to form an extension of its articular surface. We report our experience in 14 patients with grandmal epilepsy and recurrent anterior dislocation of the shoulder. After the bone buttress operation there were no further dislocations and all patients were satisfied despite a small restriction in their
Surgical release of the elbow was performed in 27 patients with post-traumatic stiffness at a mean of 14.5 months after the initial injury. The outcome was related to whether there had been heterotopic ossification, which had occurred in 18 elbows and to whether, if there had been a fracture, it had involved the articular surface, which had occurred in 13 elbows. The final
We compared two treatments for tears of the rotator cuff of 1 to 4 cm in size. One group of 22 patients had an arthroscopic subacromial decompression and rotator-cuff debridement; the other comparable group of 23 patients had open repair and acromioplasty. Review was at 2 to 5 years postoperatively. Both groups had similar pain relief and range of active forward flexion, with significant improvement from the preoperative condition. The open repair group scored better for function, strength and overall score, but patient satisfaction was similar in the two groups. We recommend the use of arthroscopic subacromial decompression and debridement for low-demand patients who require mainly pain relief and
We performed a prospective study of 54 patients (76 knees) who underwent Osteonics series 3000 cruciate-retaining cementless total knee arthroplasty between December 1990 and June 1993. Five patients (seven knees) were lost to follow-up (90.7% completion). One patient required revision at 10.5 years after operation. The rate of survival was 100% at ten years and 96.7% at 13 years. The mean ten-year knee and function scores were 79 and 59 respectively. Both were significantly better than the pre-operative scores. The
The conventional treatment of comminuted fractures in the distal radius has been unsatisfactory. We therefore made a prospective study using the principle of ligamentotoxis and primary cancellous bone grafting as the uniform method of treatment. Ligamentotaxis was maintained by using an external fixator for three weeks only, after which a carefully monitored programme of rehabilitation was given. We have reviewed 72 consecutive distal radial fractures after a follow-up of 7 to 40 months (average 11 months). Reduction had been maintained during healing and over 80% of patients regained full
The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported ‘giving way’ and all except one had good
The results of total knee replacement in five patients aged between 22 and 37 with severe haemophilia A or B are described. All patients had been managed conservatively without success. Frequent bleeds, severe pain and limitation of movement were the indications for operation. Despite close haematological surveillance, bleeding problems occurred in three of the patients and large quantities of plasma concentrates were required. Review of the patients over a period of 25 to 48 months after operation showed dramatic lessening of pain and maintenance of a satisfactory
The work capacity of 26 women after a Chiari pelvic osteotomy for symptomatic unilateral subluxation of the hip was assessed using two simple exercise tests: the maximal walking speed during a 12-minute test and the time taken to climb stairs. A significant linear decline in walking speed occurred with increasing age, despite the operation, and only one patient over the age of 25 years was able to walk at a normal rate. Compared to the results in a control group of women of similar age the stair climbing time was increased in 54 per cent of the patients and showed a significant negative correlation with the maximal walking speed. Age-adjusted walking speed was closely associated with the degree of pain experienced but there was no relationship between observed function and conventional clinical assessment based on the
The results of 757 intertorchanteric osteotomies for osteoarthritis of the hip carried out between 1958 and 1970 were reviewed. After osteotomy the joint space in two thirds of the hips was increased and a similar proportion experienced relief of pain lasting at least five years. However, the effect of the osteotomy declined after some ten years; only a quarter of the hips had a lasting "good result" as defined in this investigation. The best results were obtained in active patients under 70 years of age with unilateral hip disease in which a fair
1. A method of denervating the elbow joint, based upon observations on the articular branches of the main nerve trunks, is presented. 2. In a small group of cases with post-traumatic arthritis and osteoarthritis, relief of pain and restoration of painless movement has been gained. 3. There was recurrence of pain after six months in one patient with acute rheumatoid arthritis; in such cases denervation is not recommended until further study is completed. 4. Denervation must be as complete as possible and full exposure with stripping of nerve trunks is recommended. There have been no complications. 5. The results in this small series of cases are encouraging, but patients should be warned that there will be no significant increase in the
We examined clinically and radiologically the knees of 46 patients (27 females and 19 males) with diastrophic dysplasia. The age of the patients varied from newborn to 38 years. A total of 18 patients was followed during their growth until adolescence. The knees of two legally aborted fetuses appeared on examination to be macroscopically normal and congruous. Excessive valgus deformity of the tibiofemoral weight-bearing angle with a mean of 14° was noted in infancy. Most of the patients had marked instability of the knees. The
We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active
Revision of a total knee arthroplasty may require an extensile approach to permit a satisfactory exposure without compromising the attachment of the patellar tendon. It has been assumed that a rectus snip is a relatively benign form of release, but the effect of using this approach on function, pain and patient satisfaction is not known. From January 1997 to December 1999, 107 patients who underwent revision of total knee arthroplasty were followed up at a minimum of two years (mean 40.5 months) and assessed by the Oxford Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short-Form (SF)-12 and patient satisfaction. Co-morbidity, surgical exposure, the Hospital for Special Surgery (HSS) knee scores and the
We report the results in 33 patients who had nerve grafting of the axillary or the suprascapular nerve or of both. There were 32 men and one woman; their mean age was 21 years and the average interval between injury and operation was three months. At a mean follow-up of 27 months, the deltoid had recovered to M3 or better in 23 of 30 patients (77%) and the infraspinatus in 18 of 25 patients (72%). Shoulder elevation had reached 120° or more in 27 patients (82%), with external rotation of 30° or more in 27 (82%). Twenty-six patients (79%) could reach to the top of their head with their hand. Recovery of muscle strength,
Our aim was to determine whether children with buckle fractures of the distal radius could be managed at home after initial hospital treatment. There were 87 patients in the trial: 40 had their short-arm backslab removed at home three weeks after the initial injury, and 47 followed normal practice by attending the fracture clinic after three weeks for removal of the backslab. Clinical examination six weeks after the injury showed no significant difference in deformity of the wrist, tenderness,
We used electrogoniometers to measure the
We randomised 31 patients with acute tears of the anterior cruciate ligament (ACL) to receive either early (within 2 weeks) or delayed (8 to 12 weeks) reconstruction using a quadruple hamstring graft in order to determine if there was any functional advantage to early reconstruction. Outcome measures included return of knee movement, muscle dynamometry, International Knee Documentation Committee (IKDC) scores and Tegner activity levels. Two cases of symptomatic deep-venous thrombosis occurred in the early group. The mean
We treated 22 children (28 limbs) with diplegic cerebral palsy who were able to walk by the Baumann procedure for correction of fixed contracture of the gastrosoleus as part of multilevel single-stage surgery to improve gait. The function of the ankle was assessed by clinical examination and gait analysis before and at two years (2.1 to 4.0) after operation. At follow-up the ankle showed an increase in dorsiflexion at initial contact, in single stance and in the swing phase. There was an increase in dorsiflexion at initial push-off without a decrease in the
Seven patients with chronic insufficiency of the triceps were treated by either a rotation flap using anconeus (4) or an allograft of tendo Achillis (3). The latter procedure was selected for patients with a large defect in whom the anconeus muscle had been devitalised. Five disruptions were in patients who had previously undergone an elbow replacement. The patients were assessed for subjective satisfaction, pain,