The
We studied the late outcome of 40 ankles (from a consecutive series of 42) treated by a modified Evans procedure. The peroneus brevis tendon was used to fashion a static tenodesis. All the patients had suffered from persistent lateral instability following an ankle sprain. The follow-up period was between nine and 12 years. Excellent or good results were achieved in 33 ankles (82.5%), three had a fair result, and four were poor. The clinical results were matched by the
We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time
Upper femoral osteotomy is a recognised treatment for selected patients with Perthes' disease. The results of this procedure were investigated at skeletal maturity in 44 patients (48 hips). The indication for operation was Catterall group II, III, and IV hips with 'head-at-risk' signs. Harris and Iowa scores were calculated clinically, and each hip was assigned radiographically to one of the five Stulberg classes, its initial Catterall grading checked and other relevant indices measured. Results showed excellent clinical function. Shortening was present in 14 hips (29%) and a positive Trendelenburg's sign was seen in 12 (25%). On
Biodegradable rods of polyglycolide or lactide-glycolide copolymer were used in the internal fixation of a variety of fractures and osteotomies in 516 patients. A clinically manifest foreign-body reaction occurred in 41 patients (7.9%), producing a fluctuant swelling at the implantation site after an average of 12 weeks. Spontaneous sinus formation or surgical drainage yielded a sterile exudate containing liquid remnants of the degrading implants. After prompt drainage this discharge subsided within three weeks. Histological examination showed a typical nonspecific foreign-body reaction with abundant giant cells both in patients with the reaction and in some patients with an uneventful clinical course. The factors determining the nature of the reaction were probably related to the local capacity of the tissues to clear the polymeric debris. The reactions did not influence the clinical or
We reviewed 134 primary noncemented porous-coated total hip replacements in 125 patients: 64 were DePuy AML prostheses, 20 were Howmedica PCA and 50 were Implant Technology LSF. The prostheses had been in situ for an average of 36 months, 40 months and 24 months respectively. The average pre-operative Harris hip scores were 38.2 for AML, 33.2 for PCA, and 41.0 for the LSF prostheses. The average postoperative scores were 80.7 for AML, 83.8 for the PCA, and 91.5 for LSF. Thigh or groin pain associated with the prosthesis was present in 30% of AML, 30% PCA and 8% of the LSF cases. The clinical and
Forty-four patients who had undergone 50 capsular arthroplasties for congenital dislocation of the hip were reviewed after a mean follow-up of 20 years. Their average age at operation was 5.9 years; 31 of the operations were undertaken because of late presentation, the remainder because of the failure of previous surgery. In all, 70% of the hips showed good function despite a reduced range of movement, but patients with bilateral arthroplasties fared poorly. Excellent containment within the acetabulum was found in 80%, but the femoral head was always abnormally high though not unduly lateral or medial. This configuration had remained unchanged during follow-up. The accuracy of reduction along the mediolateral axis was the only variable found to influence the outcome significantly. Functional deterioration, associated with pain, was noted to be more common after 20 years than before, and was associated with
We report the results of a prospective longitudinal study of 147 athletes who had had a meniscectomy for an isolated meniscus injury. The patients were reviewed in detail after median periods of 4.5 years and 14.5 years and the results analysed. The frequency of complaints related to the operation increased from 53% at 4.5 years to 67% at 14.5 years, while demonstrable knee instability increased from 10% to 36%. The incidence of
Moire topography was added to school scoliosis screening in Singapore in 1982. The results from 1342 topographs, assessed in isolation, were used to study the accuracy of the method in predicting the
Direct measurements were made on 2,166 lumbar vertebrae of 433 adult negro and caucasoid skeletons. On statistical analysis, forty-five vertebrae in twenty-seven skeletons were found to be stenotic, the mid-sagittal diameter being the significantly reduced dimension. Whereas spinal stenosis syndromes are rare in South African negroes, the lumbar canal is marginally narrower in the negro. There is a uniformity of configuration and capacity of the lumbar spinal canal, which transcends race and sex. By a new method of determining the dorsal limit of the lumbar canal on lateral plain
One hundred normal fingers were dissected and arthrographs obtained by injection of a chromopaquegelatin mixture, allowing comparison between the
1. One hundred and twenty-three patients with rheumatoid arthritis who had synovectomy and excision of the head of the radius performed on 154 elbows have been reviewed one to six years after operation. 2. The severity of the disease process at the time of operation was graded radiologically and an attempt made to relate this to the results. 3. Overall, the clinical results were most satisfactory; more than 70 per cent of the patients were pleased with the outcome. When
1. One hundred and eight osteotomies were reviewed with regard to union, and fourteen were found to be ununited. In only one was non-union detected clinically; the others required
1. Experiments are described in which total infarction of the epiphysis was produced in the metatarsal bones of growing rabbits. 2. After operation both proliferation and normal maturation of the cells of the growth plate were slowed or stopped. Cartilage destruction on the metaphysial side of the growth cartilage continued with consequent thinning of the cartilage. Localised areas of cell death appeared in the growth cartilage as early as the second day after operation. These increased in size and led to revascularisation of the epiphysis by metaphysial vessels which grew through the growth cartilage, reaching the epiphysis seven days after operation. The main, central part of the growth cartilage survived intact and its normal structure was restored after epiphysial revascularisation took place. Vessels growing into the bone from outside also contributed to revascularisation of the epiphysis. After revascularisation occurred, new bone formation led to increased
1. There seem to be two distinct methods of destruction of the foot, once pain sensibility has been lost: the first is a slow erosion and shortening associated with perforating ulcers under the distal weight-bearing end of the foot. The second is a proximal disintegration of the tarsus in which mechanical forces often determine onset and progress of the condition. 2. Once the tarsus begins to disintegrate it is difficult to halt the rapid destruction of the foot. 3. It is possible to detect early stages of this condition in time to take preventive measures. Routine palpation of anaesthetic feet will reveal patches of warmth localised to bones and joints which are in a condition of strain.
1. A long-term follow-up of eighty-four patients with talipes equinovarus is reported. 2. A detailed examination was made to ascertain the nature of the residual deformity and assess the function of the deformed foot. 3. Radiographic technique in infants and adults is described. 4. Results showed that: 1) In many cases there was a dysplasia of the whole limb. 2) The dysplasia was no more marked in the patients treated in the early 1930's by multiple forceful under anaesthetic, than in the more recent patients treated by gentler means. 3) Nearly half the cases had only a false correction of the deformity in that the foot was "broken" at the talo-navicular level, leaving the heel in inversion, although the forefoot was plantigrade. 5. The posture of patients with laterally rotated hip joints is related to the fixed inverted heel. 6. Clinical assessment correlated with
1. Fifty-eight adult patients who had been treated for radial head fractures by excision of the head of the radius have been reviewed at periods varying between two and nineteen years after operation. 2. Symptoms referable to the inferior radio-ulnar joint were present in half of the patients and the mechanisms of the disorder in these patients are discussed in the light of a
1. Thirty-five children suffering from a mild illness with narrowing of an intervertebral disc have been studied. 2. Backache was the presenting symptom in only a small proportion of children, vague aching in the legs being almost as common at the onset. 3. Stiffness of the affected part of the spine is often present, but there may be no abnormal signs in the back. 4.
1. One hundred and forty-nine cases of leontiasis ossea reported in the literature have been reviewed. 2. The clinical,