We prospectively studied the outcome of a protocol of prophylaxis for deep vein thrombosis (DVT) in 103 consecutive patients undergoing surgical stabilisation of pelvic and acetabular fractures. Low-molecular-weight heparin (LMWH) was administered within 24 hours of injury or on achieving haemodynamic stability. Patients were screened for proximal DVT by duplex
We describe a symptomatic, progressive restriction
of knee flexion due to an accessory quadriceps femoris in a nine-year-old
girl. There was no history or findings of post-injection fibrosis,
nor any obvious swelling of the affected quadriceps. At arthroscopy
no intra-articular pathology was found. An accessory ‘quinticeps
femoris’ was diagnosed by
Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The Oxford Shoulder Score (OSS), pain score, and range of motion (ROM) were recorded preoperatively and at one year and a mean of 9.1 years (7.0 to 12.5) postoperatively.Aims
Methods
Arteriovenous fistula formation after a closed
extremity fracture is rare. We present the case of an 11-year-old
boy who developed an arteriovenous fistula between the anterior
tibial artery and popliteal vein after closed fractures of the proximal
tibia and fibula. The fractures were treated by closed reduction
and casting. A fistula was diagnosed 12 weeks after the injury.
It was treated by embolisation with coils. Subsequent angiography
and
Objective. Mortality rates reported by the National Joint Registry for England
and Wales (NJR) were higher following cemented total knee replacement
(TKR) compared with uncemented procedures. The aim of this study
is to examine and compare the effects of cemented and uncemented
TKR on the activation of selected markers of inflammation, endothelium,
and coagulation, and on the activation of selected cytokines involved
in the various aspects of the systemic response following surgery. Methods. This was a single centre, prospective, case-control study. Following
enrolment, blood samples were taken pre-operatively, and further
samples were collected at day one and day seven post-operatively.
One patient in the cemented group developed a deep-vein thrombosis
confirmed on
Objectives. We aimed to examine the characteristics of deep venous flow in
the leg in a cast and the effects of a wearable neuromuscular stimulator
(geko; FirstKind Ltd) and also to explore the participants’ tolerance
of the stimulator. Methods. This is an open-label physiological study on ten healthy volunteers.
Duplex
Glomus tumours are rare and benign, arising from a neuromyoarterial glomus body, most commonly in the hand. We report a patient with such a tumour in an atypical site, the right vastus lateralis. Pain was aggravated by muscle contraction, and
We report six patients with isolated paralysis of the infraspinatus and discuss the diagnosis, pathology, treatment, and outcome over a mean follow-up period of 33 months. Four patients were shown to have space-occupying lesions at the spinoglenoid notch by MRI or
We describe in 30 feet the occurrence of a tarsal tunnel syndrome caused by a ganglion. The presenting symptom was numbness or pain in the toes and the sole with paraesthesiae in the distribution of the medial plantar nerve in 63% of the patients. Swellings which were not palpable were detected by
Both knees of 50 normal children aged from birth to 18 years were examined by
Total knee replacement and high tibial osteotomy are common orthopaedic operations with low complication rates. Such surgery is in close proximity to the popliteal artery (PA), the behaviour of which during flexion of the knee is poorly understood. We used Duplex
It has been shown that raised intracapsular pressure causes avascular necrosis of the femoral head in experimental animals, but the relevance of this to clinical fractures of the femoral neck is controversial. We have studied 19 patients with intracapsular fractures of the femoral neck by pressure measurement and by
Ultrasound (US)-guided injections are widely used in patients with conditions of the shoulder in order to improve their accuracy. However, the clinical efficacy of US-guided injections compared with blind injections remains controversial. The aim of this study was to compare the accuracy and efficacy of US-guided compared with blind corticosteroid injections into the glenohumeral joint in patients with primary frozen shoulder (FS). Intra-articular corticosteroid injections were administered to 90 patients primary FS, who were randomly assigned to either an US-guided (n = 45) or a blind technique (n = 45), by a shoulder specialist. Immediately after injection, fluoroscopic images were obtained to assess the accuracy of the injection. The outcome was assessed using a visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV) and range of movement (ROM) for all patients at the time of presentation and at three, six, and 12 weeks after injection.Aims
Methods
After total hip (THR) or knee replacement (TKR), there is still an appreciable risk of developing deep-vein thrombosis despite prophylaxis with low-molecular-weight heparin (LMWH). In a prospective, randomised study we examined the efficacy of LMWH in combination with intermittent pneumatic compression in patients undergoing primary unilateral THR or TKR. We administered 40 mg of enoxaparin daily to 131 patients combined with either the use of intermittent pneumatic compression or the wearing of graduated compression stockings. Compression
We report a case in which the popliteal artery was divided during upper tibial osteotomy performed with the knee in 90 degrees of flexion. This position is believed to allow it to fall safely back from the tibia, but we could find no published confirmation. We used duplex
We performed a prospective randomised controlled trial of the A-V Impulse System in 82 patients treated by hemiarthroplasty for subcapital fracture of the femoral neck. The incidence of proximal deep-vein thrombosis as assessed by Doppler
We report two cases of epicondylitis of the elbow occurring after treatment with fluoroquinolone antibiotics. Both patients had intense pain which appeared very shortly after the first dose of the drug and was not relieved by conservative treatment.
The ultrasonic findings in 38 children with osteomyelitis of the limb bones were analysed in four time-related groups based on the interval between the onset of symptoms and the ultrasonic examination. Deep soft-tissue swelling was the earliest sign of acute osteomyelitis; in the next stage there was periosteal elevation and a thin layer of subperiosteal fluid, and in some cases this progressed to form a subperiosteal abscess. The later stages were characterised by cortical erosion, which was commonly present in those who had had symptoms for more than a week. Concurrent septic arthritis was revealed in 11 patients, most frequently in association with osteomyelitis of the proximal femur or the distal humerus. Four weeks after clinical cure, ultrasonic examination showed no abnormalities.
Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple clinical manoeuvre called the 'lift-off test', reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon. Confirmation of the clinical diagnosis was best achieved by