The results of Charnley stabilisation of the hip in forty-three patients observed for one to four and a half years are reported. The operation readily produced a bony
Fast bowling in the game of cricket requires repetitive spinal extension, lateral deviation, lumbar flexion and thoracodorsal rotation. Back pain is common, and it has been shown that pars interarticularis defects had occurred in over 50% of a group of teenage fast bowlers. Many of these defects will heal, but some cause chronic pain which prevents bowling, although other activities may be painless. We report the successful results of local screw
The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, using computer navigation, between 2010 and 2012. The mean age of the patients at the time of presentation was 51 years (10 to 77). The rates of local recurrence and mortality were calculated using the Kaplan–Meier method.Aims
Patients and Methods
We carried out a retrospective review of 155 patients with lumbar spinal stenosis who had been treated surgically and followed up regularly: 77 were evaluated at a mean of 6.5 years (5 to 8) after surgery by two independent observers. The outcome was assessed using the scoring system of Roland and Morris, and the rating system of Prolo, Oklund and Butcher. Instability was determined according to the criteria described by White and Panjabi. A significant decrease in low back pain and disability was seen. An excellent or good outcome was noted in 79% of patients; 9% showed secondary radiological instability. Surgical decompression is a safe and efficient procedure. In the absence of preoperative radiological evidence of instability,
Between June 1991 and May 1996 we carried out arthrodesis on 15 patients with flail or partially flail wrists using an AO/ASIF dynamic compression plate (DCP) without a bone graft. The wrist was approached through the second extensor compartment. The minimum follow-up was for 24 months with a mean of 34.2 months. All 15 wrists fused without major complications at a mean of 11.9 weeks. Stabilisation improved the function of the hand affected with paralysis and the appearance of the extensively paralysed upper limb with a flail hand. In the absence of bony abnormality
1. Forty-six cases of congenital spondylolisthesis (Newman's Group 1) have been studied. The diagnostic criteria were lumbo-sacral subluxation, deficient development of sacral neural arches and superior facets, and attenuation and elongation of the pars interarticularis, with or without a defect in continuity. 2. Intertransverse lumbo-sacral
1. Thirteen cases of traumatic separation of the upper femoral epiphysis have been studied. Four were previously reported and nine new cases are analysed. 2. This is a rare injury occurring in young children and is due to severe violence. 3. Separation occurred at the epiphysial plate, and severe posterior displacement was frequent. The fracture line does not penetrate the epiphysis. 4. Premature
1. A case of fracture-dislocation of the atlas on the axis is presented in which the neck had been manipulated under anaesthesia for "rheumatism.". 2. Despite marked displacement there were no important neurological complications. 3. One-stage reduction by traction was carried out very slowly and with radiographic control. It is believed that this is less distressing to the patient, and safer, than gradual reduction by prolonged traction. 4. Because of the instability of the atlanto-axial joint after reduction surgical
The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We hypothesize that FAI patients will experience less flexion at the lumbar spine and more flexion at the hip whilst changing from standing to sitting positions than subjects without FAI. This increase in hip flexion may contribute to symptomatology in FAI. Male subjects were prospectively enrolled to the study (n = 20). Mean age was 31 years old (22 to 41). All underwent clinical examination, plain radiographs, and dynamic imaging using EOS. Subjects were categorized into three groups: non-FAI (no radiographic or clinical FAI or pain), asymptomatic FAI (radiographic and clinical FAI but no pain), and symptomatic FAI (patients with both pain and radiographic FAI). FAI was defined as internal rotation less than 15° and alpha angle greater than 60°. Subjects underwent standing and sitting radiographs in order to measure spine and femoroacetabular flexion.Aims
Patients and Methods
Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in spinal surgery where there was no criticism of the surgical procedure itself. The fault that was identified was a failure to inform the patient of alternatives to, and material risks of, surgery, or overemphasizing the benefits of surgery. In one case, there was a promise that a specific surgeon was to perform the operation, which did not ensue. All of the faults in these cases were faults purely of the consenting process. In many cases, the surgeon claimed to have explained certain risks to the patient but was unable to provide proof of doing so. We propose a checklist that, if followed, would ensure that the surgeon would take their patients through the relevant matters but also, crucially, would act as strong evidence in any future court proceedings that the appropriate discussions had taken place. Although this article focuses on spinal surgery, the principles and messages are applicable to the whole of orthopaedic surgery. Cite this article:
We have reviewed 15 cases of triplane fracture of the distal tibia. The mechanism of injury is lateral rotation and the anatomical pattern of the fracture depends on the state of the growth plate at the time of injury. In seven of our cases the anteromedial part of the growth plate was fused, but in eight children the plate was completely open. In six of these eight children there was a hump or projection of the medial growth plate. It is suggested that this hump stabilises the anteromedial part of the epiphysis in a manner similar to the partial anteromedial
1. Thirty-seven cases of fracture of the dens have been studied. 2. The incidence of non-union was high: 64 per cent after apparently adequate closed treatment. 3. Possible causes of the high incidence of non-union have been studied : attention is drawn to the effect of displacement and to that of posterior displacement in particular. 4. Non-union of the dens with potential instability at the atlanto-axial joint is not acceptable in a patient who expects to lead a normal active life. 5. Atlanto-axial
The treatment of osteochondritis dissecans after Legg-Calvé-Perthes’disease hasnot been clearly determined. It may be either by simple observation or surgical removal of the osteochondral fragment. We studied the evolution of the lesion in 13 children and reviewed 92 hips reported in the literature. In our patients ten showed a tendency towards spontaneous healing, one required drilling + grafting to obtain
Arthrodesis of the wrist is a standard operation which is indicated for severe rheumatoid arthritis in which destruction is too advanced for more conservative procedures, or after failure of previous surgery. We have developed an L-shaped plate designed for this purpose. It provides rigid internal fixation with the wrist in the neutral position and utilises bone grafts obtained from the distal ulna and the carpal bones. We have carried out 29 successful
A study of spondylolysis and spondylolisthesis in 142 children and adolescents is reported. In twelve of the seventy-nine patients followed for over a year the affected vertebra slipped further by 10 per cent or more. Increasing slip occurred mainly during the adolescent growth spurt, and was greater when spinal bifida or other vertebral anomalies were present. If at presentation the slip is less than 30 per cent then further slip beyond 30 per cent is unlikely. Decompression posteriorly is advised when signs of nerve pressure are present. Indications for spinal fusion are suggested; the intertransverse method of
Four cases of slipped upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression are presented. Detailed endocrine studies in three cases showed severe deficiencies of growth hormone as well as of gonadotrophin and sex hormones. The literature is reviewed and the aetiology is discussed with special reference to Harris's hypothesis that an increase in growth hormone relative to oestrogen predisposes to slipping of the upper femoral epiphysis in humans, which these cases do not seem to support. In all cases the slip was bilateral, and it is emphasised that surgical treatment can provide only temporary fixation because
1. The treatment is described of a consecutive series of fourteen patients suffering from rheumatoid arthritis causing a slip of the cervical vertebrae, mainly at the C.1-2 level, and a cord lesion. 2. The importance of a change of symptoms and signs in these patients, especially the occurrence of the so-called "alarm signs", is stressed. 3. In twelve patients the combination of this kind of cervical instability with a cord lesion was treated by
1. In a severe crush fracture of the calcaneus part of the lateral cortex may be displaced to lie under the tip of the lateral malleolus. This may cause local pain and tenderness, either by direct bony abutment or by compression of the peroneal tendons. 2. Such pain is usually relieved by excision of the tip of the lateral malleolus, a minor procedure. 3. Four of the five patients reported were completely relieved of lateral pain, and the fifth has only slight residual discomfort. 4. It is important to be aware of this lesion and not to advise subtalar or triple
1. Seven cases of non-traumatic anterior atlanto-axial displacement in young people are recorded. 2. Four of the seven patients showed evidence of neurological compression. All cases improved symptomatically with treatment, but five still show persistent radiological displacement. 3. The mechanism of the displacement is thought to be due to acquired insufficiency of the transverse ligament. 4. The distance between the anterior arch of the atlas and the dens in children measured on lateral radiographs of the cervical spine, varies from two to more than three millimetres. 5. Skull traction followed by immobilisation in a collar or Minerva plaster is advised. 6. The place of cervical