1. The posterior Monteggia fracture usually conforms to a typical pattern. 2. Its incidence is greatest among middle-aged women. 3. The mechanism of the injury is probably similar to that of the dislocated elbow. Excessive rotation of the forearm plays no part in its production. 4. Internal fixation of the ulna combined with excision of the whole radial head, or of its detached segment, is suggested as the treatment of choice. 5. The functional results after operation are excellent, but some slight permanent restriction of movement is to be expected

Aims

The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff.

Between 1998 and 2002, 37 neuropathies in 32 patients with a displaced supracondylar fracture of the humerus who were referred to a nerve injury unit were identified. There were 19 boys and 13 girls with a mean age of 7.9 years (3.6 to 11.3). A retrospective review of these injuries was performed. The ulnar nerve was injured in 19, the median nerve in ten and the radial nerve in eight cases. Fourteen neuropathies were noted at the initial presentation and 23 were diagnosed after treatment of the fracture. After referral, exploration of the nerve was planned for 13 patients. Surgery was later cancelled in three because of clinical recovery. Six patients underwent neurolysis alone. Excision of neuroma and nerve grafting were performed in four. At follow-up, 26 patients had an excellent, five a good and one a fair outcome

Radiopharmaceuticals have been successfully used to detect occult neoplasms and infective lesions. Bone scans using 99mTc-labelled methylene diphosphonate located osteoid osteomas accurately in a series of 30 symptomatic patients. A portable radiation detector system has been designed to help intra-operative localisation and facilitate complete excision of the lesions with minimal damage to normal tissue. A sodium iodide detector with a fibre-optic link was used at first, but a cadmium telluride system has provided a more durable, reliable and sensitive sterilisable probe

We report a rare case of Albright's syndrome associated with both a soft-tissue myxoma and hypophosphataemic osteomalacia. Renal tubular function was preserved, except for glycosuria. Serum levels of 1,25(OH)2 vitamin D3 were normal. Excision of the myxoma did not influence the biochemical abnormalities, nor did standard doses of vitamin D3 or 1 alpha-OH vitamin D3. The previously reported cases of hypophosphataemic osteomalacia associated with fibrous dysplasia and mesenchymal tumours are reviewed and the underlying mechanism discussed

In rabbits, repair of incisions in the central part of the meniscus has been demonstrated after surgical excision of the peripheral rim. Healing took place via a highly cellular but relatively avascular fibrous tissue stroma which proliferated from the synovial margin and invaded along the cut edge of the meniscus. Suturing facilitated this healing process by providing stability and possibly by supplying bridges for synovial cells to migrate onto the meniscus. Transformation of fibrous tissue into fibrocartilage has also been observed

Simple decompression of the extensor tendons at the wrist was carried out on fifty-four wrists in a total of forty-one patients with rheumatoid disease. This procedure was combined with excision of the ulnar head in forty-five wrists. Complete resolution of the synovitis occurred in 81.5 per cent of the wrists. In two patients the tendons ruptured soon after operation and in both cases this was due to prolapse of the ulnar stump after an associated Darrach procedure. The clinical results of decompression compare favourably with those of the widely accepted operation of dorsal tenosynovectomy

An operative technique for correction of the severe kyphosis that may develop in cases of myelomeningocele is described. It includes excision of the apical vertebrae, correction of the full length of the kyphotic segment and of rigid compensatory curves, and extensive fusion aided by internal fixation with longitudinal threaded wires. The technique evolved during the management of eleven children. Of these, in the first two the internal fixation employed was inadequate; two others died; and in the remainder good correction was maintained up to the time of review one to six years later

1. Haemophilic cysts are a rare but serious complication of bleeding ilito the musculo-skeletal system. Five cases are reported. 2. The cysts may arise from bleeding into muscle, under periosteum, or into bone. 3. In early cases conservative treatment by immobilisation and replacement therapy should produce resolution. 4. When alarming increase in size or progressive neurovascular compression occurs, excision of the cyst or amputation should be carried out to prevent the dangerous consequences of rupture, sinus formation or chronic infection

1. The results are recorded of radical excisional surgery for spinal tuberculosis in eighty-five patients. 2. Clinically satisfactory results were obtained in 97 per cent of seventy-one patients followed up. Radiologically the disease was deemed to be cured in 71 per cent of cases. 3. The average period of rest after operation was three and a half months, and the average hospital stay was five and a half months. 4. Total recovery from paraplegia occurred in 84 per cent of patients so affected

1 . An epileptic patient with Dupuytren's contracture of the palms, severe plantar fibromatosis, prominent knuckle pads, periarthritis of the shoulders and hyperplasia of the gums is described. 2. The plantar lesions recurred despite radical excision. The knuckle pads on one hand disappeared after radiotherapy. 3. The association of each of these conditions with epilepsy and with Dupuytren's contracture is reviewed, and it is suggested that the hyperplasia of the gums may be a hitherto unrecognised feature. 4. The characteristic histological appearances of the plantar lesions are described and the risk of confusion with fibrosarcoma is emphasised

Aims

Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses.

Local treatment with phenol is often used after intralesional excision of chondroblastomas and giant-cell tumours which involve bone near joints, and has been shown to reduce the rate of recurrence. The ideal concentration of phenol is uncertain, but may be important because of the high rate of absorption and toxicity. We have studied the effectiveness of different concentrations on standard sarcoma cell lines. Our results suggest that a 5% solution of phenol is effective against dispersed single cells, and that higher concentrations give no significant advantage, but create problems due to lack of homogeneous mixing, temperature and safety

Thirty-three patients with impingement syndrome of the rotator cuff were studied before and at operation. It was shown that the rotator cuff lengthens and twists during elevation of the arm. Elevation is achieved by early glenohumeral abduction and continuous flexion and external rotation. The range of free rotation at the glenohumeral joint diminishes progressively during elevation. Rotator cuff impingement occurs towards the end of the early glenohumeral abduction. Excision arthroplasty of the acromioclavicular joint and anterior acromioplasty is highly effective for impingement under the acromion, but only moderately effective where impingement is under the acromioclavicular joint

A series of 81 patients has been reviewed to determine the value of endoprosthetic replacement of the proximal femur and hip in the treatment of bone tumours. Standard statistical methods were used to evaluate the survival of the replacements and the patients. Taking removal of the prosthesis, irrespective of the cause, as the criterion for failure the survival of the replacements was found to be 63 per cent after 10 years. If deaths are regarded as failures, then the survival value falls to 48 per cent. The survival of patients with chondrosarcoma and osteoclastoma treated by endoprosthetic replacement compares favourably with survival after amputation or excision of the tumour

Eleven patients underwent disarticulation for infected arthroplasty of the hip. Exchange total hip arthroplasty or conversion to a Girdlestone excision arthroplasty had been undertaken previously an average of 2.9 times. The indications for disarticulation were as a life-saving measure, or as a result of severe infection of soft tissue and bone, loss of bone stock, or vascular injury. While the indications for this drastic operation were highly individual, there were instances where disarticulation could have been avoided if repeated exchange operations had been eschewed in deference to a Girdlestone procedure

1. Tumoral calcinosis and lipocalcinoma-granulomatosis are synonymous terms for the same entity. 2. The condition justifies inclusion as an important type of calcinosis and is to be differentiated from calcinosis universalis and calcinosis circumscripta. 3. It occurs during the first or second decades, large dense nodular masses forming in the periarticular tissues at the hips, shoulders and elbows. Smaller masses may have a wider distribution. 4. It has been reported to be a metabolic disease of obscure etiology. 5. The course is benign but excision of the masses should be undertaken early to avoid operative difficulties and secondary infection

1. Two cases of costal chondritis are presented. The special features and treatment of this condition are described and the literature is reviewed. 2. Early diagnosis and energetic treatment of costal chondritis obviates serious morbidity. 3. Treatment with antibiotics is of value in curing the condition before cartilage necrosis has occurred and in controlling the spread of infection to neighbouring tissues. 4. Excision of all necrotic cartilage is essential for cure, if cartilage necrosis has occurred. 5. Secondary infection with organisms of low virulence, notably pseudomonas pyocyanea, is nowadays the commonest cause of chronicity