Fractures of the navicular can occur in isolation but, owing
to the intimate anatomical and biomechanical relationships, are
often associated with other injuries to the neighbouring bones and
joints in the foot. As a result, they can lead to long-term morbidity
and poor function. Our aim in this study was to identify patterns
of injury in a new classification system of traumatic fractures
of the navicular, with consideration being given to the commonly associated
injuries to the midfoot. We undertook a retrospective review of 285 consecutive patients
presenting over an eight- year period with a fracture of the navicular.
Five common patterns of injury were identified and classified according
to the radiological features. Type 1 fractures are dorsal avulsion
injuries related to the capsule of the talonavicular joint. Type
2 fractures are isolated avulsion injuries to the tuberosity of
the navicular. Type 3 fractures are a variant of tarsometatarsal
fracture/dislocations creating instability of the medial ray. Type
4 fractures involve the body of the navicular with no associated
injury to the lateral column and type 5 fractures occur in conjunction
with disruption of the midtarsal joint with crushing of the medial
or lateral, or both, columns of the foot.Aims
Patients and Methods
Over a nine-year period, 20 feet with persistently symptomatic talocalcaneal coalition were treated by resection of the bar. The 17 patients were all under 16 years of age. Excellent or good long-term results were achieved in the ten feet in which preoperative coronal CT had shown that the area of coalition measured 50% or less of the area of the posterior facet of the calcaneum. In these feet heel valgus was less than 16 degrees and there were no
We performed total hip replacement on 25 congenitally dislocated hips using corticocancellous bone from the femoral neck as a bone graft to reconstruct the deficient acetabulum. Two patients (two hips) died less than five years after surgery and three hips developed deep infection. We reviewed the remaining 20 hips at an average interval of 8.4 years (5.2 to 12.9). Their functional scores (modified Merle d'Aubigne and Postel) averaged 5.7 for pain, 5.1 for walking ability, and 4.2 for range of motion.
We report the results of anterior soft-tissue release of the hip for fixed flexion deformity in 17 patients (31 hips) with juvenile chronic arthritis. The mean age at operation was 8 years 6 months. All the patients were reviewed at one and three years and 11 (21 hips) were available for review at five years. The results were good as regards early pain relief and improved mobility. At one year, the average fixed flexion deformity was reduced from 35 degrees to 9.5 degrees, and at three years it was 18 degrees. This degree of improvement was maintained in the hips followed for five years. At 5 to 12 years' follow-up (mean 6.7) seven patients (14 hips) have required no further surgery and have maintained an acceptable range of motion. We discuss the influence of surgery on
We describe the
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
The aims of this study were to compare the mid-term outcomes
of patients with late-stage arthritis of the wrist treated with
proximal row carpectomy (PRC) and dorsal capsular interposition
(DCI) arthroplasty with a matched cohort treated with routine PRC
alone. A total of 25 arthritic wrists (24 patients) with pre-existing
degenerative changes of the proximal capitate and/or the lunate
fossa of the radius were treated with PRC + DCI over a ten-year
period. This group of patients were matched 1:2 with a group of
50 wrists (48 patients) without degenerative changes in the capitate
or lunate fossa that were treated with a routine PRC alone during
the same period. The mean age of the patients at the time of surgery
was 56.8 years (25 to 81), and the demographics and baseline range
of movement of the wrist, grip strength, Quick Disabilities of the
Arm, Shoulder, and Hand (QuickDASH) score, and Patient-Rated Wrist
Evaluation (PRWE) score were similar in both groups. Aims
Patients and Methods
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
Hydroxyapatite (HA) granules of 100 to 300 μm, 0.9 to 1.2 mm and 3.0 to 5.0 mm were mixed in a ratio of 10:45:45 and packed into massive bone deficiencies in revision operations for total hip arthroplasty. We did not use additional graft or cup support for deficiencies of the lateral and medial wall. The procedure was carried out in 40 hips between 1986 and 1992. 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