A 16-year-old boy was involved in an agricultural accident in which he sustained a large wound to the right arm and forearm. Radiological examination showed loss of the distal half of the humerus. A posterior splint was applied and after two months there was regeneration of the distal humerus including the articular portion. He was able to use his arm at five months. Twenty years later, he had a painless elbow and a 70° range of movement

Aims

A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA).

The results of 10 patients with severe rigid drop-foot corrected by the Lambrinudi triple arthrodesis were studied. The average amount of correction was 47 degrees, as evaluated from standing radiographs taken before and after operation. Radiological features of osteoarthritis and of flattening of the talus were common, but the feet were painless when reviewed at an average of 70 months later. A satisfactory range of movement was obtained at the ankle joint

Eighty-seven feet have been reviewed after arthrodesis of the first metatarsophalangeal joint stabilised by chromic catgut. Radiological union was present in 90% of patients at the mean review time of six years. Twenty-four patients had significant metatarsalgia before operation and only two failed to improve afterwards. Excellent or good subjective results were reported in 94% of patients at review. Chromic catgut is advocated as a simple and effective method of stabilising an arthrodesis of the first metatarsophalangeal joint

1. Radiological investigation of cases of flat foot shows that they form three distinct anatomical types according to the precise level of the break in the arch. 2. When the break occurs at the naviculo-cuneiform joint alone, fusion of this joint in normal alignment should correct the deformity. 3. The results of operation on forty-six feet are analysed. Eighty-two per cent proved satisfactory. Failures are discussed and are considered avoidable by careful selection and operative technique

Using a simple method of quantifying fracture healing, 53 patients who had limb fractures and also severe head injuries were studied; they were compared with 30 patients who had limb fractures but no head injury. Those with head injuries had a greater healing response and united more rapidly. Radiological and histological analysis revealed that the terms "myositis ossificans" and "heterotopic bone" may be more appropriate than "fracture callus" to describe the healing response in these patients

1. Early recognition of femoro-pelvic instability in proximal femoral dysplasia is essential to rational management. 2. Certain radiological signs helpful in identifying such patients within the first year are described. 3. Early operation is recommended to prevent displacement of a pseudarthrosis and to encourage healing. Alternative methods are described for established defects. 4. Radiological signs are described which indicate that healing without loss of femoro-pelvic stability will occur. Such patients may be managed expectantly

We performed 45 wrist arthrodeses in 43 patients by a modification of the AO technique using the dynamic compression plate. Radiological follow-up was obtained in 41 wrists; all had united at a mean of ten weeks. Clinical follow-up was obtained in 32 wrists. Subjectively, the surgical outcome was satisfactory in 26, marginally satisfactory in two and unsatisfactory in four. This method is safe and reliable. The plate can be contoured to allow a variety of positions of fusion, and gives rigid immobilisation. The rate of union is higher than that for other techniques

We report the results of acetabular reconstruction using a bipolar prosthesis bearing on cancellous bone graft in 37 patients after a minimum of five years. There was a satisfactory clinical outcome in 58% when assessed by pain, range of movement and stability, with greater improvement in the pain score than of the other parameters. Radiological migration of the prosthesis was a frequent finding although this did not always correlate with symptoms. Better results were obtained in cases of primary or secondary protrusio acetabuli than after the revision of previous total arthroplasties

Radiological assessment of the cement mantle is used routinely to determine the outcome of total hip replacement. We performed a simulated replacement arthroplasty on cadaver femora and took standard postoperative radiographs. The femora were then sectioned into 7 mm slices starting at the calcar, and high-resolution faxitron radiographs were taken of these sections. Analysis of the faxitron images showed that defects in the cement mantle were observed up to 100 times more frequently than on the standard films. We therefore encourage the search for a better technique in assessing the cement mantle

Subluxation of the hip presenting for the first time in a child over the age of four years is rare. We report ten cases treated over nearly 11 years by the senior author (JAF). We describe the surgical procedures and the results, at maturity, of nine of the ten patients. At a mean follow-up of nearly nine years, the clinical outcome was good in all ten children by the criteria of Ponseti. Radiological assessment showed that three hips remained subluxed, and that four had avascular necrosis of the physis. We advise a one-stage procedure, correcting both the femur and acetabulum

Untreated anterior cruciate ligament injuries in 97 knees of 87 patients were reviewed after a mean interval of six years. After their initial recovery 63% of the patients were able to return to their pre-injury sport, but six years later 27% of them had deteriorated to the extent that they could not cope with the same level of sport. Radiological deterioration was maximal in those that had had a meniscectomy more than five years before review. Knees with intact menisci were often radiologically normal despite continuing instability

Three patients were reviewed seven, eight and fourteen years after delayed open reduction of traumatic posterior dislocation of the hip. The delay between injury and operation varied from twenty-eight to ninety-three days. At the time of review symptoms were minimal or absent, and in all cases the injured hip was clinically normal. Radiological examination showed loss of articular cartilage in one hip and trabecular changes in the bone of all three. On the basis of these three results the traditional pessimism about prognosis in such cases may not be justified

1. Radiological and histological observations of the tissue changes resulting from the implantation of various metals in the long bones of dogs are recorded. 2. Of the metals employed, tantalum, Vitallium, alloys "C" and "S" and F.M.B. steel were inert; silver and mild steel were reactive; F.S.T. steel occupied an intermediate position. 3. A correlation has been demonstrated between the anodic back E.M.F., the weight loss due to corrosion and the histological changes produced

1. A report is given of a family suffering from dystrophia myotonica and familial Paget’s disease of bone. 2. Radiological changes in the skull occur in both disorders, which are quite dissimilar. Thickening of the calvarium, however, may be common to both. 3. The serum alkaline phosphatase is high in Paget's disease and normal in dystrophia myotonica. 4. In one patient the Paget's disease was complicated by the development of multiple sarcomata. Sarcomatous involvement of the vertebral column, observed in one of the cases, has not been recorded before

Aims

The aim of this study is to test the hypothesis that three grades of sagittal compensation for standing posture (normal, compensated, and decompensated) correlate with health-related quality of life measurements (HRQOL).

We analysed the long-term clinical and radiological results of 63 uncemented Low Contact Stress total knee replacements in 47 patients with rheumatoid arthritis. At a mean follow-up of 12.9 years (10 to 16), 36 patients (49 knees) were still alive; three patients (five knees) were lost to follow-up. Revision was necessary in three knees (4.8%) and the rate of infection was 3.2%. The mean clinical and functional Knee Society scores were 90 (30 to 98) and 59 (25 to 90), respectively, at final follow-up and the mean active range of movement was 104° (55° to 120°). The survival rate was 94% at 16 years but 85.5% of patients lost to follow-up were considered as failures. Radiological evidence of impending failure was noted in one knee

Aims

Femoroacetabular impingement (FAI) describes abnormal bony contact of the proximal femur against the acetabulum. The term was first coined in 1999; however what is often overlooked is that descriptions of the morphology have existed in the literature for centuries. The aim of this paper is to delineate its origins and provide further clarity on FAI to shape future research.

Aims

Fibrinolysis plays a key transition step from haematoma formation to angiogenesis and fracture healing. Low-magnitude high-frequency vibration (LMHFV) is a non-invasive biophysical modality proven to enhance fibrinolytic factors. This study investigates the effect of LMHFV on fibrinolysis in a clinically relevant animal model to accelerate osteoporotic fracture healing.

Discrepancy in leg length after total hip replacement has been associated with patient dissatisfaction. We prospectively studied 200 consecutive patients undergoing unilateral Charnley hip replacements to identify whether there is a demonstrable association between such disparity and postoperative function. Radiological measurements between defined points on the pelvis and femur of the operated hip were compared with the same points on the contralateral joint. A lengthening index was derived and statistical analysis used to compare this with validated functional outcome scores (Harris hip score and the SF36 Health Survey) and patient satisfaction. Our results showed no statistical association between leg-length discrepancy after hip arthroplasty and functional outcome or patient satisfaction