Aims

We aimed to evaluate the utility of ⁶⁸Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic joint infection (PJI) and aseptic loosening (AL), and compare it with ^99mTc-methylene bisphosphonates (^99mTc-MDP) bone scan.

We present a patient with an arteriovenous fistula of the peroneal artery acquired after a left dome tibial osteotomy with midshaft fibular osteotomy. He had subsequently had a total knee replacement on that side. The arteriovenous malformation was only diagnosed when he represented with symptoms and signs of venous hypertension with sterile recurrent haemarthroses in the left knee. Percutaneous obliteration of the fistula, by a combination of coil embolisation and balloon occlusion, cured the symptoms

Eighteen patients with acute compartment syndromes below the knee were treated with four-compartment fasciotomies using the double-incision technique. Pre-operative tissue pressure measurements ranged from 28 to 47 mmHg. If fasciotomy was performed within 24 hours of the onset of clinical symptoms and signs, a good result was almost always achieved. It is recommended that tibial fractures complicated with a compartment syndrome should be treated with some form of operative stabilisation of the fracture at the time of surgical fasciotomies

Six patients with severe haemophilic arthropathy of the elbow have been treated by limited excision arthroplasty using a sheet of silicone rubber as an interposition membrane. There were no complications. The symptoms and signs before and after operation have been assessed using the grading system advocated recently by the World Federation of Haemophilia. In all cases there was relief of pain and increased movement. Moreover, the subsequent incidence of spontaneous haemorrhage into the elbow has been reduced with considerable cost benefit

The familiar picture of spinal tuberculosis is one of destruction of adjacent vertebral bodies and of the intervening disc. There are, however, other patients without these radiographic changes and with no clinical deformity who present with symptoms and signs of compression of the spinal cord or cauda equina. These patients fall into two different groups: those with tuberculosis of the neural arch; and those with extra-osseous extradural tuberculosis. Both may require laminectomy, but whereas the first has bony involvement and a cold abscess, the second has neither

In this retrospective study, we analysed the clinical features of neurilemoma when it is located in muscle. Twelve patients had an intramuscular neurilemoma as shown on magnetic resonance (MR) scans and confirmed at operation. In six it was located in the upper limb, in five in the lower limb, and in one in the back. The mean age of the patients was 41 years (12 to 58). Nine complained only of a palpable mass and the other three of a mass with slight tenderness. None had neurological symptoms or signs, such as radicular pain, a positive Tinel sign, or motor weakness. There were no postoperative complications or recurrence of the tumour after a mean follow-up of two years (1 to 10)

1. Of 456 patients with features of herniated intervertebral disc eight were under twenty years of age. 2. Differences in the pattern of clinical presentation of the herniated disc syndrome in adults and in adolescents are discussed. 3. Whereas in the adult conservative treatment is usually successful, this is not so in the adolescent, in whom the symptoms and signs tend to persist for many months. 4. It is suggested that in the adolescent conservative treatment should not be prolonged despite the absence of neurological deficit; operation should be undertaken early after confirmation of the diagnosis by myelography

1. Thirteen instances of compression of the lower trunk of the brachial plexus at the thoracic inlet are described. 2. In each case the cause of compression was an aponeurotic band passing from the seventh cervical transverse process to the first rib. 3. The symptoms, physical signs, radiological features and findings at operation are described. 4. Satisfactory results followed removal of the band. 5. The anatomical arrangements are compared with those of the "normal" thoracic outlet and with those obtaining in cases of "vascular" thoracic outlet syndrome

Two patients, a Japanese man and woman both aged eighteen, developed symptoms and signs of osteomalacia over a period of five years. Each of them had a benign osteoblastoma, one in the right fourth metacarpal and the other in the uppermost third of the right humerus. Resection of the tumours without any treatment by vitamin D resulted in rapid cure of the osteomalacia. Attempts to prove a phosphaturic humoral substance or vitamin D antagonist in the osteoblastoma of the humerus were unsuccessful, probably due to prompt excretion from the tumour cells

1. Nineteen patients with classical rheumatoid arthritis complicated by severe subluxation of the cervical spine are reported. 2. Thirteen patients had atlanto-axial subluxation. This was the only level ofinvolvement in ten. 3. The next most frequent level to be involved was C.4-5. This occurred in five patients. 4. Eleven patients required surgery for symptoms or signs of spinal cord compression or vertebral artery insufficiency. 5. Operations included six posterior fusions, three anterior fusions and two laminectomies. 6. The differential diagnosis, the radiological findings, the indications for surgery and the results of treatment are discussed

1. Twenty-seven patients with a Brown-Séquard syndrome resulting from trauma have been studied, fourteen of the left side of the cord and thirteen of the right. There were sixteen gunshot wounds and eleven closed injuries. 2. The prognosis for recovery is much better than the initial catastrophic nature of the symptoms and signs would indicate. 3. The pattern of recovery is discussed in detail and the long and rather tedious course of the treatment is indicated. 4. Spasticity on the side worse affected still presents a difficult problem, but a less severe one than that presented by flaccid paralysis

1. The treatment is described of a consecutive series of fourteen patients suffering from rheumatoid arthritis causing a slip of the cervical vertebrae, mainly at the C.1-2 level, and a cord lesion. 2. The importance of a change of symptoms and signs in these patients, especially the occurrence of the so-called "alarm signs", is stressed. 3. In twelve patients the combination of this kind of cervical instability with a cord lesion was treated by fusion, most frequently of occiput to C.2 and 3. 4. In the eleven patients who survived the operation the results with a follow-up period of one to eight years are considered highly gratifying. 5. Technical details and various problems associated with treatment are discussed

We reviewed 52 cases of osteomyelitis of the calcaneum. The clinical symptoms and signs were well defined, but different and less dramatic than those of long-bone osteomyelitis. Blood cultures were positive in 41% of cases and tissue cultures in 91%. Routine haematological tests were of little value, and radiological changes were often delayed, and were absent in 12%. With early diagnosis, treatment with antibiotics alone was usually effective, but complications and chronic disease were more likely if there was delay. Early diagnosis is the key to successful treatment. We describe a new physical sign and consider that diagnosis is almost always possible by clinical methods

Six boys with fragmentation of the proximal pole of the patella are reported; the condition was bilateral in one. Four of the six presented with symptoms of Osgood-Schlatter's disease or Larsen-Johansson disease of the same or of the contralateral knee, but they had no symptoms or signs relating to the proximal pole of the patella; one also had features suggesting minimal chondromalacia patellae. Two boys had no objective abnormality in either knee. It is suggested that the fragmentation may be a further form of traction osteochondritis of the attachments of the quadriceps mechanism. Attention is drawn to its characteristic radiographic appearance, its association with other forms of juvenile traction osteochondritis (which are commonly symptomatic), and to its occurrence in boys aged 10 or 11 years

Between 1948 and 1975 147 patients were treated surgically for developmental stenosis of the lumbar vertebral canal, measurement of the mid-sagittal diameters in the whole area of stenosis being performed in 116 patients. Ninety-two of these patients were followed up for periods varying between one and twenty years. About two-thirds were completely relieved fo symptoms and signs. Sciatica and intermittent claudication were more frequently cured than radicular deficit and lumbago, the latter being the most frequent persisting symptom. A permanent neural deficit as a result of the surgical procedure was noted in two cases. A detailed presentation of the technique, complications and results is given

Late degenerative changes are known to follow meniscectomy, but there is little agreement on their incidence or on which patients are most at risk. A total of 210 patients have been reviewed 10 to 22 years after meniscectomy, and long leg radiographs taken of both knees. Radiological degeneration was seen in 18%, while 7% had significant symptoms and signs. Statistical analysis showed increased changes in older patients, in those with abnormal leg alignment, and in those who had undergone lateral as against medial meniscectomy. Our findings emphasise the important mechanical function of the meniscus and support the current cautious approach to meniscectomy, especially for patients in high risk groups. They also indicate the value of early high tibial osteotomy for symptomatic varus deformity after medial meniscectomy

1. Thirty-four patients with severe lumbo-sacral subluxation have been studied. Twenty-nine of these came for advice between the ages of nine and nineteen, and of these, twenty-five developed symptoms and signs of a characteristic syndrome. 2. The details of the syndrome are described: the essential features are spinal stiffness, a lordotic gait, resistance to straight leg raising, and in some cases evidence of interference with cauda equina or nerve root. 3. The danger of attempted reduction by traction is stressed, as well as the difficulties to be encountered during posterior lumbo-sacral fusion. 4. The reasons for operating are given; the results of spinal fusion were satisfactory. 5. The traditional apprehension concerning the effect of severe subluxation on childbirth has probably been over-stressed. 6. The tendency to slip was almost completely arrested by spinal fusion

We investigated the incidence of evidence of irritation of the brachial plexus in 119 patients with whiplash injuries sustained in road-traffic accidents. We compared the symptoms, physical signs, autonomic status, psychological status and findings from radiographs of the cervical spine using examination charts and a modified Cornell Medical Index Health questionnaire, in patients in two distinct groups: those with irritation of the brachial plexus and those without. There were 45 patients (37.8%) in the first group. The ratio of women to men was significantly higher in patients with irritation of the plexus as was the incidence of symptoms other than neck pain. There was no significant difference between the two groups with regard to psychological status or findings in radiographs of the cervical spine. Symptoms and signs attributable to stretching of the brachial plexus do occur in a significant proportion of patients after a whiplash injury. Their presence and persistence are associated with a poor outcome

Thirty-five patients who had been surgically treated for major symptomatic isolated chronic anterior cruciate ligament deficiency by lateral extra-articular reconstruction alone were reviewed at an average of five years after operation. Seventy-seven per cent of patients reviewed were improved subjectively, and 83% of patients who were examined had objective evidence of only minor instability or none at follow-up. However, only a few patients had "normal" knees and many continued to have minor symptoms of instability with some restriction of activity. Most of the unsatisfactory results were in patients with significant chondral pathology at the time of reconstruction. While an extra-articular pivot-shift repair did not correct all the symptoms and signs completely, most patients were improved subjectively and objectively, and there were few complications

A series of 75 patients who had undergone anterior cervical fusion between 1965 and 1977 were reviewed. The patients were divided into two groups: those in Group A had had the level of fusion indicated by cine radiography, whereas in Group B the level had been determined by plain radiographs and clinical symptoms and signs. Results showed that cine radiography was the more accurate diagnostic technique. Accurate diagnosis of the level to be fused, the careful clinical selection of patients and sound bony union were found to be vital to the success of anterior cervical fusion. The incidence of pseudarthrosis was significant in single-level fusions and was even greater in double-level fusions and in patients with a history of trauma, especially whiplash injuries. It was rare to develop recurrence of symptoms in adjacent levels after fusion of a level localised by cine radiography