Deformity of the forearm is common in patients with hereditary multiple exostoses, producing cosmetic and functional impairment in which shortening of the ulna is a significant factor. The results of ulnar lengthening in 10 forearms of eight patients are reported. Lengthening was performed by osteotomy of the shaft followed immediately by a bone graft and internal fixation, or by gradual distraction with an external fixator. In all patients the appearance was improved and the range of radial deviation at the wrist was increased. In most patients forearm movement and radial head stability were improved. Partial recurrence of the deformity was seen during the follow-up of skeletally immature patients, but in
Ulceration of the lower leg is considered to be a ‘hard’ clinical endpoint of venous thrombosis. Total knee replacement (TKR) is a significant risk factor for venous thrombosis of the leg and therefore potentially for ulceration. We sent a postal questionnaire to 244 patients at a minimum of five years after TKR enquiring about the development of ulceration since their TKR. The overall incidence of ulceration, both active and healed, was 8.67% which is similar to that in the age-matched
1. A review of fifty-eight posterior dislocations or fracture-dislocations of the hip is presented. 2. With few exceptions, patients were treated by immediate reduction of the dislocation under
Although an osteosarcoma appears to be a solitary lesion clinically, as in this instance, only routine radiographic skeletal survey in such cases will detect multiple osseous involvement. Ross (1964) reported that in ninety-eight cases of osteosarcoma arising in apparently normal bone, fifteen showed metastases to other bones, a much higher incidence than previously recorded. It is also possible that multicentric osteosarcomata, although undoubtedly rare, may be discovered more often if a radiological survey is done. In many large series of osteosarcomata no mention of a skeletal survey has been made, and, while this is routine in some centres, it is not yet
HIV predisposes patients to opportunistic infections. However, with the establishment of Highly Active Anti-Retroviral Therapy (HAART), patients’ CD4 counts are maintained, as is a near normal life expectancy. This study aimed to establish the impact of HIV on the bacteriology of spondylodiscitis in a region in which tuberculosis (TB) is endemic, and to identify factors that might distinguish between them. Between January 2014 and December 2015, 63 consecutive cases of spontaneous spondylodiscitis were identified from a single-centre, prospectively maintained database. Demographics, presenting symptoms, blood results, HIV status, bacteriology, imaging, and procedure undertaken were reviewed and comparisons made of TB, non-TB, and HIV groups. There were 63 patients (22 male, 41 female) with a mean age of 42.0 years (11 to 78; Aims
Patients and Methods
All elderly patients with extracapsular hip fractures seen in hospitals in Newcastle upon Tyne over a 12-month period were studied and followed up for six months. At one of the hospitals, patients were randomised to treatment by AO dynamic hip-screw or by traction. Complications specific to the two treatments were low, and
We have reviewed 50 patients at a mean period of 2.7 years after operations to restore elbow flexion lost as a result of traction injuries of the brachial plexus. A variety of operations were used and, in
The right sciatic nerve of 50 one-month-old male rats was cut under
We report the outcome of 135 knees with anteromedial osteoarthritis in which the Oxford meniscal-bearing unicompartmental arthroplasty was inserted in a district
1. Decalcified lyophilised rat bone matrix prepared by Urist's method acts as an inductor of cartilage and bone when implanted into animals of other species, namely mice, rabbits and gerbils. Induction in rabbits and gerbils was very much weaker than in the mouse. 2. The site of implantation affected the outcome; intramuscular implants induced cartilage and bone more strongly and regularly than subcutaneous or intraperitoneal implants. 3. Rabbit transitional epithelium, growing in cortisone-treated gerbils, caused bone induction, but in
1.
Twenty-one post-irradiation fractures of the femoral neck are reported in seventeen patients who had been treated by radiotherapy for carcinoma of the uterus. The clinical and radiological appearances are described and the diagnosis, prognosis and treatment of this type of fracture are discussed. Histological material has been studied in three cases. It is concluded:. 1. That there is a characteristic clinical picture in which premonitory pain is of paramount significance. 2. That when the diagnosis is considered, the likelihood of irradiation damage should take precedence over the remote possibility of metastatic invasion. 3. That the disability varies, but in
The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA). The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively.Aims
Patients and Methods
Carpal tunnel syndrome is a common condition and clinical diagnosis is often easily made. A system of direct referral for day-case carpal tunnel surgery was introduced.
The aim of this study was to quantify the risk of developing cancer from the exposure to radiation associated with surgery to correct limb deformities in children. A total of 35 children were studied. There were 19 girls and 16 boys. Their mean age was 11.9 years (2 to 18) at the time of surgery. Details of the radiological examinations were recorded during gradual correction using a Taylor Spatial Frame. The dose area product for each radiograph was obtained from the Computerised Radiology Information System database. The effective dose in millisieverts (mSv) was calculated using conversion coefficients for the anatomical area. The lifetime risk of developing cancer was calculated using government-approved Health Protection Agency reports, accounting for the age and gender of the child.Aims
Patients and Methods
We reviewed the cases of 38 children with 45 congenitally dislocated hips who presented for primary treatment after the age of three years. Of these, 34 hips were managed by the 'direct approach' of Somerville and Scott (1957); 14 of these required secondary operations for subluxation, often with a poor outcome. Eleven hips were treated by combined pelvic and femoral osteotomy which, in
Heterotopic ossification which may develop around the elbow in patients with burns may lead to severe functional impairment. We describe the outcome of early excision of such heterotopic ossification in 28 patients (35 elbows), undertaken as soon as the patient’s
1. Seven cases of infection following medullary nailing of the femur have been studied. 2. Points in the diagnosis of nail track infection are emphasised, especially periosteal reaction. 3. It is felt that a sinograph is an essential part of the investigation and can be useful to assess progress. 4. The principles of treatment of established nail track infection are: adequate drainage of the fracture site; dependent drainage of the whole track by draining the pocket at the lower end; the use of instillation tubes to irrigate the nail track with antibiotics. Once the fracture is stable and the nail track adequately treated by local and
1. Four cases of polyostotic fibrous dysplasia are presented. 2. All are males, all show cutaneous pigmentation, and in two there has been precocious puberty. 3. The literature has been reviewed, and present conceptions of the pathology and etiology of the disease have been discussed. 4. The dysplasia if often confused with parathyroid osteodystrophy and sometimes the parathyroid glands are needlessly explored. This confusion should not arise if it is remembered that no