1. French in 1946 presented eight cases of arachnoiditis complicating a lumbar disc lesion; five further cases are reported here. 2. It is suggested that repeated minor persistent trauma produces the strictly localised changes in the arachnoid, in the same sort of way that it may produce ulnar neuritis at the elbow. 3. The various causes of arachnoiditis are discussed. 4. The place of operation has been found difficult to assess

The results of excision of the head of the radius in forty-four elbows affected by rheumatoid arthritis are presented. Relief of pain was obtained in 90 per cent and an increase in the range of flexion and extension was seen in 70 per cent. Involvement of the humero-ulnar joint seen radiologically is no contra-indication to the operation; simple excision of the radial head often gives gratifying results; In our experience the relief of pain and increased range of movement have greatly reduced the need for total replacement arthroplasty

1. A case of spontaneous posterior interosseous paresis is reported. It is suggested that the cause was replacement fibrosis secondary to local ischaemic damage from unremembered minor trauma. 2. In a patient with a posterior interosseous nerve paresis examination may reveal a space-occupying lesion near the elbow along the course of the nerve thus compressing it. Recovery may be expected after its removal. Consequently the nerve should be explored before resort to tendon transfers

Aims

Acromial fractures following reverse shoulder arthroplasty (RSA) have a wide range of incidences in reported case series. This study evaluates their incidence following RSA by systematically reviewing the current literature.

1. Three families with the characteristic changes of the nail-patella syndrome are reported. In addition to the well established bone and nail defects they had soft-tissue contractures, web formation around the elbows and muscular hypoplasias. The literature on soft-tissue changes is reviewed and their importance emphasised. 2. Asymmetrical joint development is considered to be a characteristic feature of the syndrome. 3. The incidence of renal disease in our families is recorded. 4. The literature on the basic defect is reviewed. The likelihood of a primary alteration in connective tissue chemistry is considered

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

We reviewed 27 patients who had supracondylar closing wedge osteotomy for cubitus varus. There were 10 excellent and 12 good results. However, of these 22 patients, 14 had a significant bony prominence over the lateral condylar region caused by lateral displacement of the elbow when closing the osteotomy. This prominence was less obvious in patients who had their osteotomy at a young age, but worse after operations near or after skeletal maturity. This difference appeared to be due to remodelling

Bilateral posterior interosseous nerve palsy in a rheumatoid patient is described. Six previous case reports and our experience indicate that steroid injection into the elbow may not produce lasting recovery and may lead to unacceptable delay before surgical decompression. An anterolateral approach for division of the arcade of Frohse is effective in cases with diffuse synovitis; where there is a local cystic swelling a posterolateral approach provides better access. Good recovery of nerve function can be expected after early operation

Fifteen patients with identical symptoms of pain and tenderness at the tip of the greater trochanter are reviewed. Diagnosis by the referring doctor was usually osteoarthritis of the hip or sciatica, but localised tenderness and pain on resisted abduction were the only clinical signs. Radiographs were usually normal. Most cases were relieved by one or more local steroid injections. This disorder has much in common with tennis elbow, golfer's elbow, coccydynia and policeman's heel. We suggest that all these conditions may be traction syndromes

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

Supracondylar osteotomy for traumatic cubitus varus is usually considered to be difficult, and to have a significant incidence of complications. Most difficulty is in maintaining correction after operation. We report 20 osteotomies performed by a modification of French's technique and managed postoperatively with the elbow extended. When a plaster splint was used only three of seven cases had good or satisfactory results, two requiring revision. Postoperative management by straight arm traction maintained correction and achieved a good or satisfactory result in all 13 cases. This new technique is recommended

Cubitus varus is the most common complication of supracondylar fracture of the humerus in children. Although function of the elbow is not greatly impaired, the deformity is unsightly. It usually results from malunion, since growth disturbance of the humerus after this fracture is uncommon. The normal carrying angle can be restored by supracondylar osteotomy. This operation was done in 32 patients over a ten-year period, 16 of them using the technique described by French (1959). The results in 27 patients are reviewed in the light of previous reports. French's method proved safe and satisfactory

1. Sixty-one cases of compression of the ulnar nerve are reported, forty at the elbow and twenty-one at the wrist. Although contributory factors may include deformity, osteoarthritis, injury, ganglia and other tumours, the narrow anatomical confines of the nerve at these two levels are noteworthy and alone may produce nerve compression. 2. Careful clinical examination will usually determine the level of involvement if not the exact pathology. Surgical exploration is indicated both as a diagnostic and therapeutic procedure in most cases. 3. Following removal of the compressing agent rapid recovery occurred in most cases

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

We have carried out a retrospective review of 11 Souter-Strathclyde primary total elbow arthroplasties in ten patients with osteoarthritis, over a period of nine years. The diagnosis was primary osteoarthritis in nine elbows and post-traumatic arthritis in two. The mean follow-up was 68 months (15 to 117). Although no patient was symptomatic, radiological review revealed evidence of loosening affecting three humeral and two ulnar components, one of which subsequently failed and was revised at 97 months. There were no dislocations, deep infections or mechanical failures. Complications included two superficial wound infections and two neurapraxias of the ulnar nerve which resolved. This study shows that the unlinked Souter-Strathclyde total elbow arthroplasty can be considered for patients with osteoarthritis and gives good symptomatic relief and improvement in function

Aims

Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA).

Aims

The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery.

Objectives

Modern metal-on-metal (MoM) hip resurfacing arthroplasty (HRA), while achieving good results with well-orientated, well-designed components in ideal patients, is contraindicated in women, men with head size under 50 mm, or metal hypersensitivity. These patients currently have no access to the benefits of HRA. Highly crosslinked polyethylene (XLPE) has demonstrated clinical success in total hip arthroplasty (THA) and, when used in HRA, potentially reduces metal ion-related sequelae. We report the early performance of HRA using a direct-to-bone cementless mono-bloc XLPE component coupled with a cobalt-chrome femoral head, in the patient group for whom HRA is currently contraindicated.

Endoprosthetic replacement of the proximal humerus has been performed in our unit on 25 occasions between 1950 and 1982. The indication for surgery was destruction of the proximal half of the humerus so extensive that the only alternatives were reconstruction or amputation. Of the patients with tumours two died from metastases, and three from unrelated causes; local recurrence necessitated amputation in two patients. Minor complications were frequent, but there were no deep infections and, after 1964, no prosthesis became loose. Active shoulder movement after operation was considerably limited, but passive movement was good and function of the elbow and hand were preserved