1. Clinical, radiological and pathological findings in seven cases of rheumatoid arthritis with giant bone cysts are presented. 2. In three cases the large cysts represented massive involvement of subchondral bone by rheumatoid granulation tissue; in two cases the cysts were due to rheumatoid nodules, and in two other cases the
1. Of 456 patients with features of herniated intervertebral disc eight were under twenty years of age. 2. Differences in the pattern of clinical presentation of the herniated disc syndrome in adults and in adolescents are discussed. 3. Whereas in the adult conservative treatment is usually successful, this is not so in the adolescent, in whom the symptoms and signs tend to persist for many months. 4. It is suggested that in the adolescent conservative treatment should not be prolonged despite the absence of neurological deficit; operation should be undertaken early after confirmation of the
1. Four cases of myositis ossificans circumscripta are presented. 2. It remains an obscure condition but there are characteristic clinical, radiological and microscopical features. 3. While the majority of cases arise as a direct result of injury, these four cases suggest that this is not always so ; the
1. The syndrome of spinal stenosis is due to compression of the cauda equina from structural narrowing of the lumbar spinal canal. 2. Patients with this syndrome present symptoms of cauda equina claudication or of unremitting bizarre back pain and sciatica. 3. The compression of the cauda equina is always posterior and postero-lateral and is caused by narrowing of the lateral recesses and of the dorso-ventral diameter of the spinal canal. 4. The
1. Haemorrhage into the fascial compartment which contains the iliacus muscle and the femoral nerve is a common complication of haemophilia. 2. The iliacus haematoma syndrome is described and illustrated from the authors' study of thirty episodes occurring in twenty-four patients. 3. The anatomy of the iliopsoas fascia is described and the mechanism of femoral nerve compression explained. 4. Differential
1. Nineteen patients with congenital shortening of the femur without associated coxa vara have been examined and discussed. 2. The
1. The literature on acute osteomyelitis of the maxilla in infants is reviewed and the improvement in the prognosis since the introduction of chemotherapy is noted. 2. The clinical features,
The aim of this study was to examine the results of the acetabular
distraction technique in achieving implantation of a stable construct,
obtaining biological fixation, and producing healing of chronic
pelvic discontinuity at revision total hip arthroplasty. We identified 32 patients treated between 2006 and 2013 who underwent
acetabular revision for a chronic pelvic discontinuity using acetabular
distraction, and who were radiographically evaluated at a mean of
62 months (25 to 160). Of these patients, 28 (87.5%) were female.
The mean age at the time of revision was 67 years (44 to 86). The patients
represented a continuous series drawn from two institutions that
adhered to an identical operative technique.Aims
Patients and Methods
It has been suggested that mobile-bearing total knee arthroplasty
(TKA) might lead to better outcomes by accommodating some femorotibial
rotational mismatch, thereby reducing contact stresses and polyethylene
wear. The aim of this study was to determine whether there is a
difference between fixed- and mobile-bearing versions of a contemporary
TKA with respect to durability, range of movement (ROM) and function,
ten years postoperatively. A total of 240 patients who were enrolled in this randomized
controlled trial (RCT) underwent a primary cemented TKA with one
of three tibial components (all-polyethylene fixed-bearing, modular
metal-backed fixed-bearing and mobile-bearing). Patients were reviewed
at a median follow-up of ten years (IQR 9.2 to 10.4).Aims
Patients and Methods
This new blood test for infection is based on the phenomenon of leukergy in which white cells agglomerate in the peripheral blood of patients with inflammatory diseases. It was used in 26 patients with proven bone or joint infection and was positive in 25. The leukergy test was more accurate than the ESR, white cell count or blood culture. The percentage of cells agglomerated correlated with the clinical severity of the infection and the test detected reactivation of the septic process better than the other haematological tests. It is a rapid and inexpensive method which is useful in the
We studied 100 fresh human shoulders in cadavers (mean age 76 years), and the range of passive abduction (RPA) in 100 volunteers with normal shoulders and in 90 patients with instability of the joint, over a period of six years. The anatomical and clinical findings showed that passive abduction occurs within the glenohumeral joint only, is controlled by the inferior glenohumeral ligament and has a constant value in 95% of both shoulders in normal subjects. In patients with instability, 85% showed an RPA of over 105° with 90° in the contralateral shoulder. In the remaining patients a strongly positive apprehension test suggested a
Dedifferentiated chondrosarcoma is a rare, highly malignant variant of chondrosarcoma in which a high-grade spindle-cell sarcoma coexists with a lower-grade chondroid tumour. We have reviewed our experience with this neoplasm in 22 patients, all of whom were treated using modern oncological principles of planned resection and chemotherapy. Despite this the median survival was under nine months and only 18% were alive at five years. Those patients who received chemotherapy, and in whom wide margins of excision were achieved at operation, did best. It is essential to have an accurate preoperative
We performed an independent survivorship analysis on 208 Kinematic Condylar knee replacements with a minimum follow-up of ten years and a mean of 12 years. Seven patients had been lost to follow-up. At ten years the estimated survival was 92% (95% confidence limits 95% and 87%) and when stratified for
We reviewed the magnetic resonance (MR) images of eight adults with acute hyperextension-dislocation of the cervical spine. The images were obtained to evaluate damage to the spinal cord. All eight patients had disruption of the anterior longitudinal ligament and of the annulus of the intervertebral disc, and separation of the posterior longitudinal ligament from the subjacent vertebra. Some, but not all, showed widening of the disc space, posterior bulging or herniation of the nucleus pulposus, and disruption of the ligamentum flavum. The MR demonstration of these ligament injuries, taken with the clinical and radiographic findings, establishes the mechanism of hyperextension-dislocation, confirms the
We studied arthroscopically the meniscal pathology in 100 patients with functional instability of the knee from isolated rupture of the anterior cruciate ligament at an average time of three years after injury. Meniscal tears were observed in 86 patients and multiple lesions of both menisci were common. An incomplete longitudinal cleavage, visible on both surfaces of the posterior horn, was seen in more than half the knees and seemed to indicate progressive meniscal deterioration. Clinical examination was unreliable and we suggest that arthroscopic assessment is necessary for accurate
We report 13 patients with missed bilateral facet dislocation of the lower cervical spine who subsequently developed severe spinal-cord involvement. There were more women and the patients were older than in most groups with spinal injury. The commonest cause was a fall, and paralysis appeared from six to 48 hours after injury in most patients. Ten patients made some recovery after late reduction but three remained totally paralysed. We discuss the pathogenesis of the late cord lesion and the reasons for delay in
We describe a technique for arthroscopy of the wrist which is carried out without traction and with the arm lying horizontally on the operating table. The wrist is not immobilised, which makes it possible to assess the extent of instability after a ligamentous tear. In a prospective study of 30 patients we compared this technique with conventional wrist arthroscopy, performing the new method first followed by conventional arthroscopy. The advantages are that the horizontal position of the arm allows the surgeon to proceed directly from arthroscopic
There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12 447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the
We used high-resolution ultrasonography to image the ulnar collateral ligament in 39 patients who had sustained recent injuries of the metacarpophalangeal joint of the thumb. All the patients were subsequently operated on and the lesions of the ligament were recorded. In 36 patients the preoperative ultrasonographic
The majority of patients with chronic infantile and juvenile forms of spinal muscular atrophy survive to adult life. Forty-four patients have been reviewed at an average of 17 years after