A fracture of the neck of the radius when the head is not ossified can be difficult to assess and treat. In a four-year-old child we suspected from the radiographs that there was an O’Brien type-III injury after trauma. Partial manual reduction of the non-ossified radial head was completed using the Métaizeau technique of intramedullary Kirschner (K-) wiring aided by intraoperative arthrography. The child had a full range of movement at the elbow and wrist when reviewed 11 weeks after the injury, three weeks after removal of the K-wire. We suggest that intraoperative arthrography is a useful complement to the Métaizeau technique for successful reduction of fractures of the radial neck in the presence of a non-ossified radial head

A cortical bone graft on a muscle pedicle was taken from the ulna and transferred to bridge a complete defect of the radius in 16 dogs. In 14 control dogs a free graft was used, that is, one without a muscle pedicle. Union in the group with pedicle grafts was far superior to that in the group with free grafts, mainly because in those with pedicle grafts there was good subperiosteal new bone formation from active viable periosteum. In six of the pedicle grafts the viability of some osteocytes was retained over a 12-week period and in five the graft was almost completely replaced by new bone

Dysfunction of the distal radio-ulnar joint caused by traumatic, congenital and inflammatory onditions is usually treated by excision of the head of the ulna. This operation can induce ulnar carpal shift, with complications such as instability with poor grip, pain and clumsiness of the wrist, if the lower articular surface of the radius is normally inclined, or overinclined towards the ulna. These complications can be avoided by use of an operation producing pseudarthrosis of the distal part of the ulna, with fusion of the radio-ulnar joint (Lauenstein) if there is dislocation, radio-ulnar discrepancy or arthritis, or without fusion (Baldwin) if the joint, in spite of keeping normal articular surfaces, has its movement blocked by malunion of a radial fracture

1. The natural history of cryptococcal infection is discussed in relation to the findings in a woman of fifty-six with lesions in the right radius and right fourth metatarsal. A diffuse lesion found in the right lung with a calcified gland at the right hilum was believed to represent the initial site of infection. 2. There was a general tendency for normal bone architecture to be restored after the destructive phase of the disease had finished. 3. Specific treatment with the fungicide amphotericin B had to be stopped because of severe systemic reaction. 4. The significance of the rare association of Boeck's sarcoid with torulosis is discussed

We treated 37 patients with chronic osteomyelitis of the tibia (25), femur (9), radius (2) and humerus (1) by a two-stage technique, comprising radical debridement of all infected bone and soft tissue with the provision of soft-tissue cover, and delayed autogenous bone grafting when necessary. All patients were reviewed at an average of 49 months (12 to 121). Infection-free bone union was achieved in 34. No patient required amputation. Wide excision of all compromised tissue and the closure of bone within a healthy vascularised soft-tissue envelope are essential if infection is to be eradicated. The combined assessment and management of such patients by an orthopaedic surgeon and a plastic surgeon are advocated

1. Nine cases of disturbance of the relationship between the scaphoid and the radius and between the scaphoid and the lunate bones are described. 2. Persistent dislocation of the scaphoid bone may follow reduction of perilunar dislocations or of other dislocations of the proximal row of the carpus. It may be obvious, as in waist-deep dislocation, or may be solely a rotational dislocation which may be difficult to diagnose. 3. Uncorrected rotational dislocation of the scaphoid bone caused significant disability in six of seven cases. 4. Aids to the diagnosis of this condition are described and a vigorous approach to the problem of correction is advocated. 5. The experience of other workers in this field is reviewed and discussed

Fractures of the distal forearm are widely regarded as the result of “fragility”. We have examined the extent to which patients with Colles’ fractures have osteopenia. We measured the bone mineral density (BMD) in the contralateral radius of 235 women presenting with Colles’ fractures over a period of two years. While women of all ages had low values for ultra-distal BMD, the values, in age-matched terms, were particularly low among premenopausal women aged less than 45 years. This result was not due to the presence of women with an early menopause. This large survey confirms and extends the findings from earlier small studies. We consider that it is particularly important to investigate young patients with fractures of the distal forearm to identify those with osteoporosis, to seek an underlying cause and to consider treatment

We studied 55 patients who had undergone elective removal of forearm plates between 1980 and 1986; 44 plates were removed from the radius and 37 from the ulna. Before removal only 20 patients (36%) had definite symptoms attributable to the plates, but 44 patients (80%) were advised by the surgeon to have the plates removed. In 22 cases (40%) the operation was followed by a significant complication. The complication rate was higher with junior surgeons and was permanent in 50% of cases. It is recommended that forearm plates should be removed only if they are causing significant symptoms, and that the operation should not be delegated to the most junior surgeon

A case is reported in which fractures of the radius and ulna were fixed with Vitallium plates and screws. Seven years later a painful swelling appeared over the extensor aspect of the forearm. After eight years sarcoma was suspected and a pale tumour infiltrating muscle was found at operation. However, the histology excluded neoplasia and showed massive fibrosis and patchy necrosis of muscle, with chronic inflammatory changes peripherally. After the removal of the metal the swelling disappeared. A sinus down to the ulna followed operation and was not cured two years later. At this stage standard patch testing showed skin sensitivity to cobalt. Metal sensitivity is proposed as the cause of this extraordinary reaction in muscle

We report the technique and results of a new method of debridement arthroplasty for advanced primary osteoarthritis of the elbow. Triceps and the periosteum of the olecranon are reflected towards the ulnar side and the joint is opened by dividing the radial collateral ligament. Osteophytes are removed, the olecranon and coronoid fossae are deepened and the fibrosed anterior joint capsule is excised. The degenerative changes are always more advanced on the radial side, with erosion of the capitellum, and it is usually necessary to remodel the head of the radius. In 29 elbows reviewed at a mean of 64 months, the average gain of range of motion was 34 degrees, with good pain relief and improved grip in most patients. Two elbows required reoperation but there were no other serious complications

We present a prospective study of the treatment of 32 unstable Colles’ fractures by external fixation and cancellous grafting with minimal exposure. We inserted an external fixator between the radius and the second metacarpal, and maintained ligamentotaxis for five weeks. In 27 patients the result was good or excellent, but five fractures healed with malunion. All patients made a satisfactory functional recovery. At a mean follow-up of three years (1 to 5) after injury none had pain in the wrist and all were satisfied with the result. The average grip strength was 95% of normal. Seven patients had algodystrophy with mild impairment of finger movements in four. We conclude that the combination of cancellous grafting and external fixation is effective for the treatment of unstable Colles’ fractures

1. A medial approach is preferred for arthrodesis of the wrist in reconstructive surgery because there is no interference with the extensor tendons. 2. The value of pre-operative assessment by a trial period in plaster is mentioned. 3. The technique of operation is described. 4. In the absence of active pronation, screwing the ulna to the radius in 45 degrees of pronation is advised. 5. The necessity for securing haemostasis before closing the wound is emphasised. 6. Thirty-four cases are reviewed. The shortest follow-up was one year and the longest twelve years. The result was satisfactory in all cases. Most patients were discharged from hospital after the plaster had been changed two weeks after operation. Union occurred in about sixteen weeks

We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure

Thirteen patients with dyschondrosteosis from eight families are reviewed and their clinical and radiographic variation noted. Inheritance is likely to be autosomal dominant but with only 50 per cent penetrance. Stature was moderately reduced, due to shortening of the bones of the leg. Radio-ulnar shortening could either involve both bones equally or the radius predominantly, in which case a typical Madelung deformity was seen. Tibio-fibular disproportion was present in half the patients, two of them having severe deformity associated with tibia varum and a long fibula. The treatment of one of these patients is described. It is recommended that patients with dyschondrosteosis should be kept under surveillance during the growing period. Problems in the limbs, especially the legs, may require operations to equalise the length of the two bones

We have developed a new drug-delivery system using reconstituted bone xenograft to treat chronic osteomyelitis. This material, which has the capabilities of osteoinduction and osteoconduction, was supplemented with up to 2000 times the minimum inhibitory concentration of gentamicin against Staphylococcus aureus to prepare a gentamicin-reconstituted bone xenograft-composite (G-RBX-C). In a rabbit model, we evaluated the release of gentamicin from this composite in vivo, its capability for induction of ectopic bone and the repair of segmental defects of the radius. There was a high level of concentration of antibiotics, which was sustained for at least ten days. In the study of induction of ectopic bone, there was abundant woven bone in the G-RBX-C group two weeks after operation. At 16 weeks after implantation of G-RBX-C the radial defects had been repaired, with the formation of lamellar bone and recanalisation of the marrow cavity. Our findings suggest that G-RBX-C may be useful in the treatment of chronic osteomyelitis

We have examined whether the rotatory subluxation of the scaphoid which is seen in patients with advanced Kienböck’s disease is associated with scapholunate advanced collapse (SLAC) wrist. We studied 16 patients (11 men, 5 women) who had stage-IV Kienböck’s disease with chronic subluxation of the scaphoid. All had received conservative treatment. The mean period of affection with Kienböck’s disease was 30 years (14 to 49). No wrist had SLAC. In eight patients, 24 years or more after the onset of the disease, the articular surface of the radius had been remodelled by the subluxed scaphoid with maintenance of the joint space. The wrists of six patients were considered to be excellent, nine good, and one fair according to the clinical criteria of Dornan. Our findings have shown that rotatory subluxation of the scaphoid in Kienböck’s disease is not a cause of SLAC wrist and therefore that scaphotrapezio-trapezoid arthrodesis is not required for the management of these patients

A case of the Jansen type of metaphysial dysostosis, followed for fifteen years from childhood to the age of nineteen, is reported. Radiographs taken at five years revealed the characteristic metaphysial changes in all the tubular bones, especially those of the hands and feet. The acetabular and glenoid areas, the costochondral junctions and the sternal ends of the clavicles were also involved. Radiographs taken at nineteen years, however, showed only marked deformities, which shows that the involvement of the metaphyses can regress by the end of growth. Biopsy of the lower end of radius at the age of twelve revealed changes in the growth plate or physis, especially in the zone of resting cartilage. This finding suggests that cellular function in this zone is disturbed by some unknown mechanism. Hence, the term physial dysostosis may be more accurate than metaphysial dysostosis