We prospectively studied 26 consecutive patients with clinically documented sensory or motor deficiency of a peripheral nerve due to trauma or entrapment using ultrasound, and in 19 cases surgical exploration of the nerves was undertaken. The ultrasonographic diagnoses were correlated with neurological examination and the surgical findings. Reliable visualisation of injured nerves on ultrasonography was achieved in all patients. Axonal swelling and hypoechogenity of the nerve was diagnosed in 15 cases, loss of continuity of a nerve bundle in 17, the formation of a neuroma of a stump in six, and partial laceration of a nerve with loss of the normal fascicular pattern in five. The ultrasonographic findings were confirmed at operation in those who had surgery. Ultrasound may be used for the evaluation of peripheral nerve injuries in the upper limb. High-resolution ultrasound can show the exact location, extent and type of lesion, yielding important information that might not be obtainable by other diagnostic aids

We describe injuries to the posterior root of the medial meniscus in patients with spontaneous osteonecrosis of the medial compartment of the knee. We identified 30 consecutive patients with spontaneous osteonecrosis of the medial femoral condyle. The radiographs and MR imaging were reviewed. We found tears of the posterior root of the medial meniscus in 24 patients (80%). Of these, 15 were complete and nine were partial. Complete tears were associated with > 3 mm of meniscal extrusion. Neither the presence of a root tear nor the volume of the osteonecrotic lesion were associated with age, body mass index (BMI), gender, side affected, or knee alignment. The grade of osteoarthritis was associated with BMI. Although tears of the posterior root of the medial meniscus were frequently present in patients with spontaneous osteonecrosis of the knee, this does not prove cause and effect. Further study is warranted

Three unusual injuries of the cervical spine in wearers of safety belts are reported. In each case, the presence of diagonal bruising and abrasions in the line of the sash strap indicated its involvement in the mechanism of the injury

1. Three cases of cement injection into the tissues of the thumb and index finger are recorded. 2. This is probably the first description of this type of injection injury. 3. Recommendations are made for the prevention of the injury

Eighty patients who sustained a fracture of the floor of the acetabulum are reviewed, and the mechanism of the injury was investigated by clinical and experimental studies. The results of the injury in fifty patients are presented, with an account of the three clinical types of acetabular fracture

Two cases of an unusual injury to the proximal end of the radius in children are reported illustrating a pitfall of closed manipulation. A review of the literature suggests that this injury is comparatively rare and is likely to be followed by permanent restriction of rotation of the forearm

Stable fractures of the ankle can be successfully treated non-operatively by a below-knee plaster cast. In some centres, patients with this injury are routinely administered low-molecular-weight heparin, to reduce the risk of deep-vein thrombosis (DVT). We have assessed the incidence of DVT in 100 patients in the absence of any thromboprophylaxis. A colour Doppler duplex ultrasound scan was done at the time of the removal of the cast. Five patients did develop DVT, though none had clinical signs suggestive of it. One case involved the femoral and another the popliteal vein. No patient developed pulmonary embolism. As the incidence of DVT after ankle fractures is low, we do not recommend routine thromboprophylaxis

1. A low oblique fracture of the libula is described associated with diastasis of the inferior tibio-fibular joint. 2. Seven cases are presented in which this injury was seen. 3. A method of internal fixation is described. 4. The importance of recognising this injury is stressed

We identified a group of patients from the Swedish Arthroplasty Register who reported no relief of pain or worse pain one year after a total knee replacement (TKR). A total of two different patient-reported pain scores were used during this process. We then evaluated how the instruments used to measure pain affected the number of patients who reported no relief of pain or worse pain, and the relative effect of potential risk factors. . Between 2008 and 2010, 2883 TKRs were performed for osteoarthritis in two Swedish arthroplasty units. After applying exclusion criteria, 2123 primary TKRs (2123 patients) were included in the study. The Knee injury and Osteoarthritis Outcome Score (KOOS) and a Visual Analogue Scale (VAS) for knee pain were used to assess patients pre-operatively and one year post-operatively. . Only 50 of the 220 patients (23%) who reported no pain relief on either the KOOS pain subscale or the VAS for knee pain did so with both of these instruments. Patients who reported no pain relief on either measure tended to have less pain pre-operatively but a higher degree of anxiety. Charnley category C was a predictor for not gaining pain relief as measured on a VAS for knee pain. . The number of patients who are not relieved of pain after a TKR differs considerably depending on the instrument used to measure pain. . Cite this article: Bone Joint J 2014;96-B:1222–6

1. The mechanism of production of injury to the lateral condyle epiphysis is discussed. 2. A technique of closed reduction of rotational displacements of the epiphysis is described. Nine cases in which the method was successful are noted. 3. It is suggested that the injury should be classified with dislocation of the elbow

1. A case of flake fracture of the talus progressing to osteochondritis dissecans is reported. 2. The relationship between direct injury and the onset of the lesion is noted. 3. The sequence of events was observed radiographically and clinically for two years from the date of the original injury

Anatomical atlases document safe corridors for placement of wires when using fine-wire circular external fixation. The furthest posterolateral corridor described in the distal tibia is through the fibula. This limits the crossing angle and stability of the frame. In this paper we describe a new, safe Retro-Fibular Wire corridor, which provides greater crossing angles and increased stability. In a cadaver study, 20 formalin-treated legs were divided into two groups. Wires were inserted into the distal quarter of the tibia using two possible corridors and standard techniques of dissection identified the distance of the wires from neurovascular structures. In both groups the posterior tibial neurovascular bundle was avoided. In group A the peroneal artery was at risk. In group B this injury was avoided. Comparison of the groups showed a significant difference (p < 0.001). We recommend the Retro-Fibular wire technique whereby wires are inserted into the tibia mid-way between the posteromedial border of the fibula and the tendo Achillis, at 30° to 45° to the sagittal plane, and introduced from a posterolateral to an anteromedial position. Subsequently, when using this technique in 30 patients, we have had no neurovascular complications or problems relating to tethering of the peroneal tendons

The retrospective analysis of 131 patients suffering from a fracture of the ring of the axis is reported. The injury was classified into three types according to radiological displacement and stability. Associated injuries and neurological deficit are discussed and a theory of pathogenesis presented. Guidelines for the management of each type of fracture are proposed

The mammalian growth plate is a complex structure which is essential for the elongation of long bones. However, an understanding of how the growth plate functions at the cellular level is lacking. This review, summarises the factors involved in growth-plate regulation, its failure and the consequence of injury. We also describe some of the cellular mechanisms which underpin the increase in volume of the growth-plate chondrocyte which is the major determinant of the rate and extent of bone lengthening. We show how living in situ chondrocytes can be imaged using 2-photon laser scanning microscopy to provide a quantitative analysis of their volume. This approach should give better understanding of the cellular control of bone growth in both healthy and failed growth plates

Objectives

The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.

1. A motor-cyclist's temporary loss of ten inches (25 centimetres) of femoral shaft and its replacement are recorded. 2. The mechanism of injury is considered. 3. The management of extensive bone loss is discussed. 4. Attention is drawn to the importance of retained periosteum and its contribution to healing in such injuries