A carefully planned operation may be expected to check increasing deformity without doing harm, and to make subsequent bony stabilisation easier. In favourable cases it may be possible to restore muscle balance and stability, making further surgery unnecessary. A longer follow-up is necessary to determine to what extent this ideal can be achieved

Sprain of the pisiform triquetral joint is a definite clinical entity. It presents as a "tenosynovitis" of the flexor carpi ulnaris muscle from which it can be distinguished by the tests described. The disability in most cases is such that operation is justifiable. Fusion of the pisiform-triquetral joint is preferred to excision of the pisiform because it restores stability to the wrist with the least disturbance to related structures

Three patients referred for rehabilitation of brachial plexus lesions and two referred with leg weakness associated with sciatica were found to have conversion paralysis. The diagnosis was made by demonstrating normal motor nerve conduction to the clinically weak muscles. The weakness was treated by intensive physical rehabilitation with complete and sustained recovery in all cases

1. The difficulties of obtaining myo-electric signals from the muscles in amputation stumps are discussed. 2. The requirements of a myo-telemetry system which could be implanted are discussed. 3. A description is given of a new approach to the problem in which the electrical unit is contained in an inert plastic and fitted into the bone in the amputation stump, using an external power source

Two cases are reported of the late diagnosis of compartment syndrome secondary to alcohol and drug overdose. Surgical decompression at two and a half days and at six days, respectively, produced worthwhile recovery. Other reports are reviewed and a case is made for the value of decompression even when performed late, and for delayed and minimal excision of apparently necrotic muscle

Ruptures of the calcaneal tendon which present late may be repaired using carbon fibre to induce a neotendon. The operative technique is described and the results of five cases reviewed. The average muscle power obtained was 88% of normal, and the thickness of the neotendon was 148% of that of the normal side. It would appear that this tendon formation in man is comparable to that previously described in sheep

1. A method of correcting poliomyelitic lateral rotation deformity of the thigh by transplant of one or more of the hamstring muscles to the femur is described. 2. The results in seven cases are recorded. 3. Though it is emphasised that this is no more than a preliminary communication and the number of patients so treated is small, the satisfactory results suggest that the procedure is mechanically and physiologically sound

In this retrospective study, we analysed the clinical features of neurilemoma when it is located in muscle. Twelve patients had an intramuscular neurilemoma as shown on magnetic resonance (MR) scans and confirmed at operation. In six it was located in the upper limb, in five in the lower limb, and in one in the back. The mean age of the patients was 41 years (12 to 58). Nine complained only of a palpable mass and the other three of a mass with slight tenderness. None had neurological symptoms or signs, such as radicular pain, a positive Tinel sign, or motor weakness. There were no postoperative complications or recurrence of the tumour after a mean follow-up of two years (1 to 10)

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle by a plate and screws. We treated seven patients with this unusual injury; all achieved an excellent functional result without deformity

Eight patients had symptoms from ganglia arising from the superior tibio-fibular joint with physical signs that resembled the anterior tibial and peroneal compartment syndromes. Five ganglia were in the peroneus longus muscle in which they produced only an ill-defined firmness. Histologically the ganglia showed much cellular activity which must not be mistaken for malignant change

1. Six patients are reported in whom ischaemic muscle contractures followed prolonged external pressure. 2. Systemic hypoxaemia may be a predisposing factor in patients with overdoses of central nervous system depressants. 3. If treatment is to be successful, early diagnosis is required, and the most important factor is an awareness of the condition. 4. The treatment of the late case is discussed

1. The arcade of Frohse, a fibrous arch over the posterior interosseous nerve, may well play a part in causing progressive paralysis of the posterior interosseous nerve, both with and without injury. 2. Paralysis of the muscles supplied by this nerve with no evidence of recovery after six weeks, either electromyographic or clinical, should be treated by exploration and splitting of the arcade of Frohse

We believe that this technique has several advantages. After poliomyelitis recovery in the clavicular head of pectoralis major may exceed that in the sternal head; there may be considerable but incomplete recovery in both heads and it is then desirable to use all the active muscle available. Girls and women dislike conspicuous scars; the incisions used in this technique are unobtrusive when the arm is by the side

Aims

We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency.

Fracture separation of the capital femoral epiphysis occurring during attempted closed reduction of a traumatic dislocation of the hip is described in two adolescents. Although this complication is extremely rare, the prognosis of fracture separation with dislocation of the epiphysis is known to be poor. Avascular necrosis subsequently developed in both cases. The importance of gentle manipulative reduction under general anaesthesia with complete muscle relaxation is emphasised

A rare case of intra-osseous glomus tumour is described, together with a review of eight other reported cases. Electron microscopic studies suggest that glomus cells, the histogenesis of which has not been completely resolved, originate from smooth muscle. Studies in this case support that hypothesis: they showed the important role of contraction of the glomus cells in eliciting the peculiar type of pain

Fifty cases of iliopsoas transfer have been reviewed. The indications for operation, operative technique and post-operative care have been described. It seems that the iliopsoas muscle transferred laterally through the ilium acts as a better hip stabiliser than it does in its original position. The operation should not be undertaken by a casual operator and should be performed first in the post-mortem room

Two cases are described in which a traction lesion of the brachial plexus was complicated by sensory loss and anhidrosis in the second, third, and fourth cervical dermatomes. Both patients recovered spontaneously, though in one the recovery of muscle power in the limb was incomplete. It is believed that both were examples of a traction lesion of the cervical plexus. No similar case appears to have been recorded

We report a case of anterior compartment syndrome in the ipsilateral leg after a revision total hip arthroplasty. Possible causes include postchaemic swelling after occlusion of the vessels during prolonged surgery and vigorous repetitive stretching of the muscles of the anterior compartment from the intraoperative use of electrical calf stimulators. Epidural infusions for postoperative analgesia may mask symptoms, but when there is clinical suspicion, we recommend measurement of the compartment pressures and early fasciotomy

1. The posterior interosseous nerve of the forearm is vulnerable to constriction in an aponeurotic cleft in the supinator muscle. 2. A case is presented of paresis of the nerve by an intramuscular lipoma which extended into this cleft. 3. A discussion is given of the possible relation of this feature to certain cases of occupational stress–"tennis elbow.". 4. An approach is described for decompressing the nerve in the rare cases which do not respond to conservative treatment