Aims

Outcome measures quantifying aspects of health in a precise, efficient, and user-friendly manner are in demand. Computer adaptive tests (CATs) may overcome the limitations of established fixed scales and be more adept at measuring outcomes in trauma. The primary objective of this review was to gain a comprehensive understanding of the psychometric properties of CATs compared with fixed-length scales in the assessment of outcome in patients who have suffered trauma of the upper limb. Study designs, outcome measures and methodological quality are defined, along with trends in investigation.

Objectives

Osteoporosis is a chronic disease. The aim of this study was to identify key genes in osteoporosis.

1. During a fifteen-year period a clinical, radiological and in some cases a surgical study has been made of 319 patients suffering from spondylolisthesis–that is, forward slipping of one lumbar vertebra on another or forward sagging of the whole lumbar spine in relation to the sacrum. 2. The five etiological factors are described, and the cases are assigned to five groups according to the factor responsible for the slip. In every case slipping is permitted by a lesion of the apparatus which normally resists the forward thrust of the lower lumbar spine–that is, the hook of the neural arch composed of the pedicle, the pars interarticularis and the inferior articular facet engaging caudally over the superior articular facet of the vertebra below. 3. In Group I (congenital spondylolisthesis–sixty-six cases) the lesion is a congenital defect of the facets. In Group II (spondylolytic spondylolisthesis–164 cases) the lesion occurs in the region of the pars interarticularis and is either an elongation of the bone or a break in continuity. There are reasons for thinking that the lesion is caused by stress over a long period rather than by acute injury or by a congenital anomaly of ossification. In Group IV (degenerative spondylolisthesis–eighty cases) the lesion of the facets is degenerative. There are no good grounds for thinking that an abnormality of the angle between the facets and the pedicles is the primary lesion behind the degenerative change. 4. Group III and V comprise few cases. In the former (traumatic spondylolisthesis–three cases) the lesion–a fracture of the neural arch–is caused by a single severe injury. In Group V (pathological spondylolisthesis–six cases) the slipping is caused by weakness of bone from various causes. 5. A full description is given of the etiological and biomechanical features of each group. A special investigation has been made into the etiological factors in degenerative spondylolisthesis. 6. The incidence of involvement of nerve tissues is highest in degenerative spondylolisthesis; the most severe degrees of slip are found in congenital spondylolisthesis

Aims

The pelvis rotates in the sagittal plane during daily activities. These rotations have a direct effect on the functional orientation of the acetabulum. The aim of this study was to quantify changes in pelvic tilt between different functional positions.

Aims

In the United Kingdom, lower incidences of intraspinal abnormalities in patients with early onset idiopathic scoliosis have been observed than in studies in other countries. We aimed to determine the rates of these abnormalities in United Kingdom patients diagnosed with idiopathic scoliosis before the age of 11 years.

Objectives

The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.

Objectives

The aim of this study was to identify key pathological genes in osteoarthritis (OA).

Objectives

In order to address acetabular defects, porous metal revision acetabular components and augments have been developed, which require fixation to each other. The fixation technique that results in the smallest relative movement between the components, as well as its influence on the primary stability with the host bone, have not previously been determined.

Bilateral interlocking of the articular facets of the cervical spinal column results from excessive flexion. Unilateral interlocking (hemiluxation) results from simultaneous excessive flexion and rotation. Patients with hemiluxation of the cervical spine often have only mild complaints and the clinical signs may be slight. The diagnosis is made radiologically, but it is often overlooked. Various forms of treatment may give good results. In recent hemiluxation, reduction is advisable to promote recovery of radicular symptoms. The effect of reduction on spinal cord symptoms is uncertain. Manual reduction under general anaesthesia is usually successful, with the possible exception of some cases of interlocking at C.6-C.7, or C.7-T.1. Skull traction with weights of 5 to 10 kilograms even when prolonged is hardly ever successful; with weights of 10 kilograms or more there is a chance of success. Surgical reduction is not always necessary. A hemiluxation of more than two weeks' standing may still be reduced but non-operative methods offer little chance of success. In this series there has been no aggravation of the neurological deficit after reduction. Although hemiluxation shows a tendency to spontaneous stabilisation it is wise in our opinion to apply some form of fixation. The selection of the method of fixation depends on the neurological picture and on the estimated degree of instability. The latter depends on the presence or absence of additional damage to the interlocked and adjacent vertebrae. Manual reduction by means of traction in the longitudinal axis of the cervical spine under general anaesthesia with muscle relaxation, followed by immobilisation in a plaster jacket (Minerva type) for three months is successful in many cases. If surgical stabilisation is considered necessary an attempt at manual reduction should be made before operation so that when the patient is placed on the table the cervical spinal canal has regained its normal shape. In general, sufficient stability will have been achieved after approximately three months, so that for hemiluxations of more than three months duration surgical treatment will only rarely be necessary. Figure 11 shows the methods of treatment that we advise

1. A review of the literature on the normal variations in bone mass in a given population in relation to age, sex, nutritional and genetic background shows several lacunae in our knowledge. Consequently, the separation of milder degrees of osteoporosis is difficult and the definition of osteoporosis itself is uncertain. 2. This paper presents a necropsy study to determine variations in the bone mass that occur with age and sex in a normal Indian population in the Delhi area. Two hundred persons between nine months and seventy-six years of age who died by accident and with no evidence of chronic disease were studied. 3. The parameters of bone mass employed were : apparent bone density, ash per millilitre of bone, cortical thickness and visual grading of porosity of bone in macerated specimens. The first lumbar vertebra, the iliac crest, the fourth rib and the femoral shaft were the bones evaluated. 4. After an initial rise up to the third decade, the apparent bone density and ash per millilitre showed a progressive and significant decline with age in all the three trabecular bones: vertebra, iliac crest and rib. Although these values were in general lower in the females than in males at all ages, and the rate of decrease with age was faster in them than in males, it was only in the rib that a statistically significant difference between the sexes could be established with respect to decrease with age. 5. Decreases in apparent bone density and ash per millilitre of the vertebral bone with age were associated with an increase with age in the porosity as assessed by visual grading. 6. In the case of the femur no significant change was demonstrable with age in any of the parameters used in the present study. 7. From a comparison of the values for apparent density and ash per millilitre with grading of macerates and histological preparations, it is suggested that osteoporosis may be said to be present in this population if the apparent bone density is less than 020 and 046 in the vertebra and the iliac crest respectively or ifthe ash per millilitre is less than 0l2 in the vertebra. 8. The study has revealed that 44 per cent of persons studied in this sample over the age of fifty exhibit significant osteoporosis. It is considered possible that nutritional factors such as protein-calorie malnutrition may be responsible for this relatively high incidence

1. Compression forces are mainly absorbed by the vertebral body. The nucleus pulposus, being liquid, is incompressible. The tense annulus bulges very little. On compression the vertebral end-plate bulges and blood is forced out of the cancellous bone of the vertebral body into the perivertebral sinuses. This appears to be the normal energy-dissipating mechanism on compression. 2. The normal disc is very resistant to compression. The nucleus pulposus does not alter in shape or position on compression or flexion. It plays no active part in producing a disc prolapse. On compression the vertebral body always breaks before the normal disc gives way. The vertebral end-plate bulges and then breaks, leading to a vertical fracture. If the nucleus pulposus has lost its turgor there is abnormal mobility between the vertebral bodies. On very gentle compression or flexion movement the annulus protrudes on the concave aspect–not on the convex side as has been supposed. 3. Disc prolapse consists primarily of annulus; it occurs only if the nucleus pulposus has lost its turgor. It then occurs very easily as the annulus now bulges like a flat tyre. 4. I have never succeeded in producing rupture of normal spinal ligaments by hyperextension or hyperflexion. Before rupture occurs the bone sustains a compression fracture. On the other hand horizontal shear, and particularly rotation forces, can easily cause ligamentous rupture and dislocation. 5. A combination of rotation and compression can produce almost every variety of spinal injury. In the cervical region subluxation with spontaneous reduction can be easily produced by rotation. If disc turgor is impaired this may occur with an intact anterior longitudinal ligament and explains those cases of tetraplegia without radiological changes or a torn anterior longitudinal ligament. The anterior longitudinal ligament can easily be ruptured by a rotation force and in my experience the so-called hyperextension and hyperflexion injuries are really rotation injuries. 6. Hyperflexion of the cervical spine or upper thoracic spine is an anatomical impossibility. In all spinal dislocations a body fracture may or may not occur with the dislocation, depending upon the degree of associated compression. In general, rotation forces produce dislocations, whereas compression forces produce fractures

Aims

We report the clinical results of glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia.

Aims

After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction.

Aims

This study aims to assess first, whether mutations in the epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (kRAS) genes are associated with overall survival (OS) in patients who present with symptomatic bone metastases from non-small cell lung cancer (NSCLC) and secondly, whether mutation status should be incorporated into prognostic models that are used when deciding on the appropriate palliative treatment for symptomatic bone metastases.

Aims

The aim of this study was to examine the real time in vivo kinematics of the hip in patients with cam-type femoroacetabular impingement (FAI).