The patterns of laxity of normal wrists subjected to dorsal and volar stresses were analysed. Dorsal and volar displacement tests were carried out on both wrists of 50 subjects under image-intensifier control. Lateral projections in neutral, and dorsal and volar stress positions were taken to analyse the behaviour of the carpal bones. Varying degrees of capitolunate subluxation under dorsal and volar stress were noted. Dorsal displacement of the capitate appeared to be more prominent than volar displacement. The lunate either extended or subluxed dorsally in response to a dorsal stress, suggesting a different pattern of laxity for the radiolunate joint. These observations provide a baseline for the interpretation of dorsal and volar stress views in the symptomatic wrist

Lateral oblique radiographs are considered important for the identification of spondylolytic lesions, but these projections will give a clear view only when the radiological beam is in the plane of the defect. We studied the variation in orientation of spondylolytic lesions on CT scans of 34 patients with 69 defects. There was a wide variation of angle: only 32% of defects were orientated within 15° of the 45° lateral oblique plane. Lateral oblique radiographs should not be considered as the definitive investigation for spondylolysis. We suggest that CT scans with reverse gantry angle are now more appropriate than oblique radiography for the assessment of spondylolysis. Variation in the angle of the defect may also need consideration when direct repair is being planned

We measured the scattered radiation received by theatre staff, using high-sensitivity electronic personal dosimeters, during fixation of extracapsular fractures of the neck of the femur by dynamic hip screw. The dose received was correlated with that received by the patient, and the distance from the source of radiation. A scintillation detector and a water-filled model were used to define a map of the dose rate of scattered radiation in a standard operating theatre during surgery. Beyond two metres from the source of radiation, the scattered dose received was consistently low, while within the operating distance that received by staff was significant for both lateral and posteroanterior (PA) projections. The routine use of lead aprons outside the 2 m zone may be unnecessary. Within that zone it is recommended that lead aprons be worn and that thyroid shields are available for the surgeon and nursing assistants

Aims

To investigate whether idiopathic osteonecrosis of the femoral head (ONFH) is related to impaired osteoblast activities.

1. Six cases of posterior dislocation of the shoulder are described. 2. In four cases the diagnosis was made on clinical grounds. 3. The important clinical signs are the adducted and medially rotated position of the arm, a hard mass posteriorly below the acromion representing the displaced humeral head, and limitation of movement, especially abduction and lateral rotation. 4. In two cases the dislocation was not recognised at the first examination. This confirms the statement of previous authors that posterior dislocation is easily missed. 5. The value of the vertical projection in the radiography of suspected posterior dislocation is emphasised. 6. Reduction was accomplished without difficulty in five cases and the subsequent progress of these was uneventful. In the remaining case reduction was difficult and unstable, and the final recovery incomplete. It is considered that this patient would have been better treated by early open reduction

Aims

The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction.

We used magnetic resonance (MR) myelography in ten patients with injuries to the brachial plexus and compared the findings with those obtained by conventional myelography and postmyelographic CT (CTM). In the presence of complete nerve-root avulsion (seven cases), a post-traumatic meningocele was detected by MR myelography. In injuries to the upper roots (three cases) MR myelography showed abnormal findings with a high signal intensity in the nerve root, obliteration of the damaged nerve root, or enlargement and obliteration of the root sleeve. No pseudomeningoceles were detected in these upper-root injuries by MR myelography and CTM. The overall accuracy of detection of damaged nerve roots or root sleeves was better with MR myelography than with conventional myelography and was similar to that of CTM. MR myelography is non-invasive, relatively quick, requires no contrast medium, provides imaging in multiple projections, and is comparable in diagnostic ability to the more invasive, time-consuming techniques of conventional myelography and CTM

We used ultrasonography to study 26 hips with slipped capital femoral epiphyses. In recently slipped epiphyses the ultrasound image revealed a step at the anterior physeal outline (mean 6.4 mm), diminished distance between the anterior acetabular rim and the femoral metaphysis (mean 4.3 mm) and an effusion. As metaphyseal remodelling progressed the physeal step decreased. The femoral neck appeared straighter in hips which had been symptomatic for longer than three weeks. It was possible to measure posterior epiphyseal displacement without projectional errors and the method was accurate in diagnosing minimal slip and in staging displacement. The suggested criteria are, less than 7 mm for a mild slip, 7 to 11 mm for a moderate slip and more than 11 mm for a severe slip. We recommend ultrasonography for the diagnosis, staging and follow-up management of slipped upper femoral epiphysis

Aims

The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version?

Aims

Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA.

1. Peroneal spastic flat foot is a term loosely and often inaccurately used to describe rigid valgus feet developing from widely different causes. 2. The most common causes are two anomalies of the bones of the tarsus—the calcaneonavicular bar, and the talocalcaneal bridge. The first was described in 1921 by Sloman and in 1927 by Badgley; the other is described for the first time in this paper as an etiological factor in rigid flat foot though it has been recognised by anatomists for fifty years as a skeletal variation. The term peroneal spastic flat foot, as applied to these cases, is inaccurate since there is no spasm of the peroneal muscles. The deformity is a fixed structural deformity due to anomalous bone structure, and the apparent spasm of peroneal muscles is in reality an adaptive shortening. A better term would be rigid flat foot due to talocalcaneal bridge or calcaneonavicular bar. 3. The smaller group of patients who suffer from inflammatory lesions of the tarsal joints, chiefly due to rheumatoid arthritis, do in fact develop valgus deformity from peroneal spasm. The resemblance between the two groups is superficial and it is limited to the apparent similarity of the deformity. Though it might be justifiable to designate this type as peroneal spastic flat foot, it would be better to use the more accurate title—arthritic flat foot with peroneal spasm. 4. Lipping of the upper margin of the talonavicular joint strongly suggests the existence of one or other of the congenital anomalies. Both anomalies are visualised only by special radiological projections

Aims

It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons.

One of the interesting aspects of spinal pathology having an important bearing on the treatment of backache is that the spine acts as an integrated whole and that damage sustained by one part frequently injures other structures in the spinal column. Thus disc degeneration may be associated with an extrusion of nuclear material; it may initiate degenerative changes in the posterior joints; it may predispose to tears of the posterior spinal ligaments; or it may give rise eventually to all of these lesions, any one of which may produce backache with or without sciatica. The sciatica may be referred pain or may be produced by nerve root pressure. Nerve root pressure in such instances is commonly due to an extrusion of nuclear material, but it may also be due to pressure on the nerve root within the foramen by a "squashed" disc or by a subluxated posterior joint. Radiographs are of great value in the diagnosis of disc degeneration and they are of greater value in the assessment of the secondary effects that have taken place. With the use of bending films evidence of early degenerative changes may be obtained, tears of the supraspinous ligament can be detected, and abnormal movements of the posterior joints can be seen. Careful study of the antero-posterior and lateral projections will reveal evidence of subluxation of the posterior joints, chip fractures and degenerative arthritis in the zygapophysial articulations, and will clearly demonstrate overriding of the facets. The investigation of subjective phenomena, such as backache, is fraught with many difficulties and it must be preceded by an investigation of the anatomy of the part and the anatomical variations, the normal and abnormal physiology and the pathological lesions that occur. Many of these changes of course may have no clinical significance, but it is only when armed with the knowledge of what may occur that we can tackle the problem of low back pain on a logical basis

Aims

The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture.

Aims

The purpose of this study was to report bone adaptive changes after anatomical total shoulder arthroplasty (TSA) using a standard-length hydroxyapatite (HA)-coated humeral component, and to report on a computer-based analysis of radiographs to determine changes in peri-implant bone density objectively.

1. The surface of mature adult human articular cartilage from the knee has been studied by electron microscopy in eleven patients ranging in age from thirty-seven to eighty-three years. The ultrastructural appearance varies from person to person and often from area to area in the same specimen. These variations range from an intact surface to one showing overt fibrillation visible with the light microscope. 2. In areas where the articular surface appears intact the underlying superficial matrix consists of closely packed collagen fibres with only a small amount of interfibrillary ground substance. The collagen fibres show a predominantly tangential orientation in this region of the cartilage. Osmophilic lipidic bodies are sometimes seen in the matrix very close to the joint surface. 3. The appearances under the electron microscope are altered in what is interpreted as an early ultrastructural change in the development of cartilage fibrillation. In the affected areas the collagen fibres show abnormally wide separation by an excessive amount of interfibrillary matrix. Collagen fibres become directly exposed to the joint cavity, and the surface can also show accumulations of finely granular material and sometimes tuft-like projections containing collagen fibres and fine fibrils. At a slightly later stage shallow clefts and steeply sloping curves are apparent at the surface. It is suggested that these various alterations precede the development of overt fibrillation visible under the light microscope. 4. Electron micrographs occasionally show small "blisters" at the articular surface. Electron microscopy has not given evidence of shedding of cells into the joint cavity from non-fibrillated areas of adult human articular cartilage. Cells can, however, sometimes become exposed at the surface in fibrillated areas

Aims

The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate ligament 360° tenodesis (SL 360) technique for treatment of scapholunate (SL) instability.