Thirty-four bony specimens of isthmic spondylolysis were examined and, in a significant number (32%), stenosis of the intervertebral foramen was noted. Although not emphasised in previous reports, this finding may be an important factor in the aetiology of nerve root compression when this is associated with spondylolysis and spondylolisthesis. Anatomical guidelines for adequate surgical decompression are suggested

Aims

The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation.

1. Two cases of an unusual forefoot injury are recorded in which dislocation of the base of a metatarsal bone is associated with, and tends to perpetuate, dislocation of the metatarsophalangeal joint of the adjacent toe. 2. The anatomical and mechanical relationships between these linked dislocations are discussed, as are the principles of treatment. 3. The concept of segmental injuries to the forefoot is introduced

Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the supraspinatus tendon occurred. Overall, 20 patients (95%) were either very satisfied (n = 18) or satisfied (n = 2) with the outcome. Significant differences (p < 0.0001) were found for all categories of the Constant and Murley score pre- and post-operatively. The mean Constant and Murley score increased from 24.1 points (10 to 45) to 64.5 points (39 to 93), and the relative score from 30.4% (11% to 50%) to 83% (54% to 116%). No clinical or radiological signs of loosening of the implant were seen. For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term

1. Dissections have been made of the cervico-brachial region. 2. The possible causes of the scalenus anterior syndrome are discussed and an attempt is made to relate them to the anatomical findings. 3. It is suggested that a more suitable description is the "first rib syndrome," and that the most logical treatment is to remove part of the offending first rib

Aims

The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder.

1. Forty-four patients with tuberculous tenosynovitis have been reviewed. 2. The lesions (fifty-two in all) are classified and described according to their anatomical sites. 3. Particular reference is made to the natural history of the condition and the results of treatment. 4. Early and extensive excision of the affected tendon sheaths combined with the use of anti-tuberculous drugs is recommended

Aims

The aim of this study was to determine the stability of a new short femoral stem compared with a conventional femoral stem in patients undergoing cementless total hip arthroplasty (THA), in a prospective randomized controlled trial using radiostereometric analysis (RSA).

1. Dislocation and subluxation of the hip has been produced in young rats by application of splints reaching from the hip to the foot, bringing the hip into extension. 2. Progressive acetabular dysplasia and anatomical abnormalities of the head and neck of the femur occurred. 3. Results of the experiments suggest that post-natal extension of the hip is of importance in the pathogenesis of congenital dislocation of the hip in man

Three-dimensional CT was used to examine the atlantoaxial joint of a nine-year-old girl who presented with fixed rotation of the head 3.5 months after an apparently spontaneous acute torticollis. The method provided clear, anatomical images to show the site, extent and direction of the type-I rotatory fixation (Fielding and Hawkins 1977). The 3-D reconstructions helped to guide manipulation which was successful in this late case

Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity

Seventy-two Mitchell distal metatarsal osteotomies for hallux valgus performed over a period of 10 years have been reviewed. Sixty-six (92 per cent) were graded as excellent or good. Retrospective radiographic analysis of 29 of these cases showed that the operation had reduced the intermetatarsal angles to within normal anatomical limits. No patient experienced a worsening of symptoms as a result of the operation

Thirty hips affected by congenital dislocation or subluxation underwent surgical treatment between the ages of five and fifteen years, and the results are presented. Reduction was aided by concurrent femoral shortening in seventeen. An aggressive approach in older children not only relieves the presenting symptoms in most, but also, by improving the anatomical relationships, increases the prospect of success should total replacement become indicated in the future

1. A case of compression of the deep branch of the ulnar nerve is described. 2. Anatomical evidence is presented that the reason for the special liability of the deep branch to be compressed by ganglia in this region is its relationship to a ligamentous band which passes from the pisiform bone to the hamate superficial to the deep branch of the ulnar nerve. 3. This band, though constant, has not been well recognised

This paper presents four patients with injuries to the thoracolumbar spine assessed by computerised tomography. This technique enabled an easy, quick and accurate diagnosis to be made, avoiding dangerous manipulation of the patient. The scans were analysed using the anatomical classification of Louis to evaluate the instability of the lesions. Control CT scans were used to monitor progress and to provide an accurate prognosis within acceptable limits of irradiation

1. Rotational deformity of a finger caused by malunion of a phalangeal fracture has been corrected by metacarpal osteotomy. 2. Because of the anatomical arrangement of the metacarpo-phalangeal joint this method gives good control of the distal phalanges. 3. Division through the metacarpal rather than through the phalanx avoids adhesions in the flexor and extensor mechanisms and in the joints of the fingers, allows early mobilisation and is an easier procedure

We have reviewed 30 patients who had been treated conservatively for acromioclavicular dislocation between 1979 and 1982 at an average of 12.5 years after the injury. All except one had a good outcome as did five others contacted by telephone. In all patients reviewed the acromioclavicular joint remained subluxed or dislocated. With conservative treatment a good long-term outcome can be expected without restoration of the anatomical configuration of the joint