Little information is available about the incidence
and outcome of incidental dural tears associated with microendoscopic
lumbar decompressive surgery. We prospectively examined the incidence
of dural tears and their influence on the outcome six months post-operatively
in 555 consecutive patients (mean age 47.4 years (13 to 89)) who
underwent this form of surgery. The incidence of dural tears was
5.05% (28/555). The risk factors were the age of the patient and
the procedure of bilateral decompression via a unilateral approach.
The rate of recovery of the Japanese Orthopaedic Association score
in patients with dural tears was significantly lower than that in
those without a tear (77.7% Cite this article:
Of 250 patients scheduled for meniscectomy 50 had symptoms which subsided and operation could be deferred; of the remaining 200 only 73 per cent were found to have a significant tear. It is shown that the risks of removing a normal meniscus far exceed those of leaving a tear in the posterior third. Statistical analysis of clinical features revealed no reliable diagnostic pattern.
We describe the findings at six years in an ongoing prospective clinicoradiological and metal ion study in a cohort of 26 consecutive male patients with unilateral Birmingham Hip Resurfacing arthroplasties with one of two femoral head sizes (50 mm and 54 mm). Their mean age was 52.9 years (29 to 67). We have previously shown an early increase in the 24-hour urinary excretion of metal ions, reaching a peak at six months (cobalt) and one year (chromium) after operation. Subsequently there is a decreasing trend in excretion of both cobalt and chromium. The levels of cobalt and chromium in whole blood also show a significant increase at one year, followed by a decreasing trend until the sixth year.
We report a prospective trial of 66 patients with intraarticular fractures of the calcaneum. All fractures were assessed by CT. Patients with displaced fractures were randomised to receive either conservative (n = 31) or operative treatment (n = 25). Undisplaced fractures (n = 10) were treated conservatively. Operation involved open reduction of the posterior subtalar joint, and fixation with Kirschner wires. All 66 patients were reviewed at a minimum of one year (mean 23 months). After conservative treatment the undisplaced fractures had slightly better results than the displaced fractures. There was no significant difference in outcome between the operatively and the conservatively treated displaced fractures. We have also documented prospectively the natural history of the injury, which is of use in assessing prognosis for both clinical and medicolegal purposes.
Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases.
Two cases of burst fracture of the upper lumbar spine are reported. In both cases the narrowing of the spinal canal shown by CT scans was progressively relieved by natural remodelling. The need for operative decompression should be assessed clinically and not from CT scans only.
Twenty-four hips in twenty children affected by Group 1 Perthes' disease have been reviewed to assess the radiographic result after a minimum follow-up of four years. The children were allocated to Group 1 prospectively after examination of the early radiographs and no specific treatment of the affected hip was provided. The radiographic end results assessed by three methods were good even in those cases in which the additional stress of containment splintage of the contralateral hip was applied.
We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%.
Exposure to blood is a hazard for all surgeons. We assessed the incidence of glove perforation and needlestick injury from a new blunt taperpoint needle designed to penetrate tissues other than skin with the minimum of force. We performed a prospective, randomised trial comparing the incidence of perforations of surgical gloves with the new needle and a standard cutting needle during wound closure after hip arthroplasties. There was at least one glove perforation in 46 of 69 such procedures (67%). The use of the taperpoint needle produced a significant decrease in perforations (p = 0.049).
We studied the use of gadolinium diethylenetriaminepentaacetic acid-enhanced MRI in the detection of pathological changes in the nerve roots of 25 patients with unilateral sciatica due to lumbar disc herniation. Enhancement was observed in the affected nerve roots within the root sleeve at the caudal edge of the herniation and was classified into three categories: grade 0, none; grade 1, enhancement restricted to a focal region within the sleeve; and grade 2, diffuse and homogeneous. The grade of enhancement correlated well with the severity of the sciatica, and was considered to be due to a disruption of the blood-nerve barrier, leading to oedema.
Refobacin Bone Cement R and Palacos Overall, 75 patients were included in the study and 71 were available at two years postoperatively. Prior to surgery, they were randomized to one of the three combinations studied: Palacos cement with use of the Optivac mixing system, Refobacin with use of the Optivac system, and Refobacin with use of the Optipac system. Cemented MS30 stems and cemented Exceed acetabular components were used in all hips. Postoperative radiographs were used to assess the quality of the cement mantle according to Barrack et al, and the position and migration of the femoral stem. Harris Hip Score, Oxford Hip Score, Forgotten Joint Score, and University of California, Los Angeles Activity Scale were collected.Aims
Methods
Both conservative and operative forms of treatment
have been recommended for patients with a ‘floating shoulder’. We
compared the results of conservative and operative treatment in
25 patients with this injury and investigated the use of the glenopolar
angle (GPA) as an indicator of the functional outcome. A total of
13 patients (ten male and three female; mean age 32.5 years (24.7
to 40.4)) were treated conservatively and 12 patients (ten male
and two female; mean age 33.67 years (24.6 to 42.7)) were treated
operatively by fixation of the clavicular fracture alone. Outcome
was assessed using the Herscovici score, which was also related
to changes in the GPA at one year post-operatively. The mean Herscovici score was significantly better three months
and two years after the injury in the operative group (p <
0.001
and p = 0.003, respectively). There was a negative correlation between
the change in GPA and the Herscovici score at two years follow-up
in both the conservative and operative groups, but neither were
statistically significant
(r = -0.295 and r = -0.19, respectively). There was a significant
difference between the pre- and post-operative GPA in the operative
group (p = 0.017). When compared with conservative treatment, fixation of the clavicle
alone gives better results in the treatment of patients with a floating
shoulder. The GPA changes significantly with fixation of clavicle
alone but there is no significant correlation between the pre-injury
GPA and the final clinical outcome in these patients. Cite this article:
We report a prospective, randomised, controlled trial of 50 severely displaced comminuted Colles' fractures treated by either external fixation or manipulation and plaster. Each patient was assessed radiographically throughout treatment, and functionally by an independent observer at three and six months. The functional result correlated with the anatomical result, which was significantly better in patients treated by external fixation. This resulted in significantly improved function especially in young patients, and also a lower complication rate. We recommend the use of external fixation for young patients with comminuted displaced Colles' fractures unless manipulation and plaster show excellent reduction.
Aims. Surgery is often indicated in patients with metastatic bone disease (MBD) to improve pain and maximize function. Few studies are available which report on clinically meaningful outcomes such as quality of life, function, and pain relief after surgery for MBD. This is the published protocol for the Bone Metastasis Audit — Patient Reported Outcomes (BoMA-PRO) multicentre MBD study. The primary objective is to ascertain patient-reported quality of life at three to 24 months post-surgery for MBD. Methods. This will be a
We report the results of a
Excessive foot pronation has been considered to be related to anterior knee pain. We undertook a
We undertook a
