We describe a modified lateral approach to the hip which exploits the functional continuity of gluteus medius and vastus lateralis and their dense crescentic attachment to the greater trochanter. The gluteus medius is not incised or split, but is detached and mobilised with gluteus minimus as one unit. This facilitates reattachment of the glutei and helps to preserve abductor function

Aims

Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair.

Aims

Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN.

Aims

Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery.

Aims

The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma.

Premature closure of the growth plate of the femoral capital epiphysis associated with limitation of abduction and gluteal insufficiency is described. The indications for trochanteric advancement and the results obtained in the late treatment of Perthes' disease and of congenital dislocation are discussed. Nine hips treated after Perthes' disease had satisfactory results, in that all were improved; but in eight hips with deformity arising from congenital dislocation the outcome was less favourable

1. Sixteen cases of thenar paralysis are reviewed in which a bone graft was inserted between the first and second metacarpals to maintain fixed abduction and opposition of the thumb. 2. The technique of the operation is described and the causes of failure are discussed. 3. The operation is intended for those cases in which tendon transplantation to restore active opposition of the thumb is unsuitable. Rotation of the first metacarpal into full opposition is the most important feature of the operation

Aims

The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

A new approach to the hip is described that allows better exposure for difficult revision surgery without the need for trochanteric osteotomy. A V-shaped myofascial flap consisting of the proximal part of vastus lateralis and its fascia with gluteus medius and minimus, is reflected off the greater trochanter and proximal femur giving access to the entire capsule of the hip. If the leg has been significantly lengthened by the revision procedure, abductor tension can be adjusted at closure by altering the reattachment of the flap, analogous to a V-Y-plasty

Ultrasound was used to observe the entire course of spontaneous reduction of CDH in the Pavlik harness in nine infants. In six infants with Suzuki type-A dislocations, the femoral head settled slowly into the bottom of the acetabulum by gliding on its posterior wall. In type-B dislocations, passive abduction of the legs during sleep caused it to approach the entrance to the socket and then suddenly to slip in. Reduction with the Pavlik harness is due to passive mechanical factors, and occurs only during muscle relaxation in deep sleep: no active movement is involved

Abstract

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.

1. A case of compression of the deep palmar branch of the ulnar nerve by an accessory abductor minimi digiti muscle is described. 2. The morphology of abnormal muscles in the hypothenar region is discussed. 3. Five previously reported cases of ulnar nerve compression at the wrist by an anomalous muscle are reviewed. 4. When symptoms are produced by an anomalous hypothenar muscle, they seem to be related to the anatomical site of the muscle and the presence of muscle hypertrophy. Occupational factors may be important in producing this hypertrophy

1. In ten healthy young men an experimental paralysis of the supraspinatus muscle was induced with the aid of Xylocaine injected in or near the suprascapular nerve. 2. The completeness of the paralysis was checked by electromyography. 3. With the supraspinatus muscle completely eliminated, all subjects could move the arm against gravity through its full range in the shoulder joint, though the force and the power of endurance during abduction were diminished. 4. It is concluded that the role of the supraspinatus muscle is of a quantitative nature only

Exposure of the hip by osteotomy of the anterior part of the greater trochanter is described. This maintains the continuity of the tendinous junction between the anterior half of gluteus medius and the vastus lateralis and preserves intact the insertion of gluteus minimus into the anterior surface of the trochanter. The nerve supply to these muscles is not compromised and good abductor function is retained. The approach can be extracapsular or intracapsular. Reattachment of the osteotomised fragment is simple, and upward displacement after operation, as sometimes seen after complete osteotomy of the greater trochanter, cannot occur

Symptomatic impingement of the rotator cuff between the humeral head and the coracoid process has been studied and three varieties recognised: idiopathic, iatrogenic and traumatic. In all three the clinical findings consisted of pain in front of the shoulder, referred to the upper arm and forearm, and especially felt during forward flexion and medial rotation; the pain could be reproduced by medial rotation with the arm in 90 degrees of abduction, or by adduction with the shoulder flexed to 90 degrees. Patients were relieved of their symptoms by restoring adequate subcoracoid clearance

Fifteen patients with identical symptoms of pain and tenderness at the tip of the greater trochanter are reviewed. Diagnosis by the referring doctor was usually osteoarthritis of the hip or sciatica, but localised tenderness and pain on resisted abduction were the only clinical signs. Radiographs were usually normal. Most cases were relieved by one or more local steroid injections. This disorder has much in common with tennis elbow, golfer's elbow, coccydynia and policeman's heel. We suggest that all these conditions may be traction syndromes

A method for direct measurement of the local pressures in the acetabular cartilage is described. Pressure transducers were introduced into the subchondral bone and positioned there in contrast with the cartilage: the transducers were calibrated in situ. Twelve cadaveric hips were prepared in this way and the pressures were measured with the joint loaded in flexion, extension, abduction, adduction, and in lateral and medial rotation. The highest pressures were recorded in the anterior and posterior segments of the acetabulum; the lowest pressures were constantly found at the zenith of the joint. The relationship of these findings to the pathogenesis of osteoarthritis is considered

Traumatic tenosynovitis of the wrist extensors is a common and disabling condition associated with overuse. It has been found to be associated with hypertrophy of the bellies of abductor pollicis longus and extensor pollicis brevis where they overlie the radial extensor tendons in the forearm, compressing these tendons and their enveloping paratenons against the deep structures beneath. Simple surgical decompression of the sheath of these overlying muscles has been found to give quick relief of symptoms and to allow a more rapid return to strenuous work than the conservative treatments usually employed