The anatomy of the mortise of the Lisfranc joint between the medial and lateral cuneiforms was studied in detail, with particular reference to features which may predispose to injury. In 33 consecutive patients with Lisfranc injuries we measured, from conventional radiographs, the medial depth of the mortise (A), the lateral depth (B) and the length of the second metatarsal (C). MRI was used to confirm the diagnosis. We calculated the mean depth of the mortise (A+B)/2, and the variables of the lever arm as follows: C/A, C/B and C/mean depth. The data were compared with those obtained in 84 cadaver feet with no previous injury of the Lisfranc joint complex. Statistical analysis used Student’s two-sample The mean medial depth of the mortise was found to be significantly less in patients with Lisfranc injuries than in the control group. Stepwise logistic regression identified only this depth as a significant risk factor for Lisfranc injuries. The odds of being in the injury group is 0.52 (approximately half) that of being a control if the medial depth of the mortise is increased by 1 mm, after adjusting for the other variables in the model. Our findings show that the mortise in patients with injuries to the Lisfranc joint is shallower than in the control group and the shallower it is the greater is the risk of injury.
We report a prospective study of 55 patients with acute primary patellar dislocation, all treated by operation and followed up for at least two years. Diagnosis was based on the history of a lateral displacement, with medial tenderness and a positive apprehension test; redislocations were excluded. Before operation, the difference in lateral shift on skyline views of the injured and control patellae was highly significant. At operation, rupture of the medial retinaculum of the patella was seen in all but one case. There were medial marginal fractures of the patella in 23 cases. Subjective results of the operation were excellent or good in 44 of the 55 at two years with a redislocation rate of only 9%. Most patients were able to return to the same level of sporting activity as before the injury.
One-hundred newborn children at high risk of hip instability were prospectively assessed clinically and by ultrasound. The decision to treat was based only on the clinical examination. At the age of three months all the children were evaluated clinically and with an anteroposterior radiograph of the pelvis. None of the standard ultrasound measurements of acetabular depth and femoral head cover correlated with the outcome at three months. Dynamic assessment of stability was the only ultrasound technique that had a significant relation with outcome.
The Denis Browne abduction harness was used in the management of 127 abnormal hips in 104 children at Queen Mary's Hospital for Children from 1966 to 1980, both as the initial treatment for unstable hips recognised soon after birth, and for children presenting later and whose hips first required reduction by gradual abduction in traction. The incidence of significant avascular necrosis was 3.1%, and occurred only in the primary treatment group, emphasising again the need for gentle care of infant hips. There have been no other significant complications and the appliance has functioned well.
