We used gadolinium-enhanced fat-suppressed MRI to investigate 67 patients with persistent pain after lumbar discectomy. Twenty-five patients had reoperations for lesions diagnosed in this way. Eleven were for recurrent disc prolapse at the same level and sciatica was relieved by all but one. Five operations were for prolapse at an adjacent level and all were successful. The
A total of 138 revision hip arthroplasties in 134 patients, all operated upon by one surgeon, were followed for an average of 7.4 years. The overall results were reasonable, with good to excellent Mayo hip scores in 62% and little or no pain in 86%. These results were independent of body weight, age, primary
Inter-observer agreement and reproducibility of opinion were assessed for the radiographic
Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the
We have reviewed 61 children treated for septic arthritis from 1972 to 1981. The
The clinical presentation and treatment of 18 cases of osteoid osteoma or osteoblastoma of the spine are described, with an average follow-up of 4.2 years (range three months to 11.5 years). The average delay between the onset of symptoms and definitive
Carpal tunnel syndrome is a common condition and clinical
Ischaemia is a rare complication of injury to a limb but must be excluded in every case. Two distinct types occur: Type I, where a proximal arterial injury gives rise to ischaemia distally; and Type II, where a direct injury gives rise to ischaemia at the site of the injury. Whatever the nature of the insult, an ischaemic contracture only develops as a result of swelling of the soft tissues where these soft tissues are contained in un unyielding osteofascial compartment. This secondary ischaemia can only be relieved by a timely fasciotomy. The
Old calcified fibrin coagula are frequently found in simple bone cysts. They provide a scaffold on which new bone is laid down, in a process analogous to endochondral ossification. It is suggested that these coagula are derived in substantial part from the plasma-like contents of the cyst, after the release of plasma-clotting factors as the result of injury. Major haemorrhage is not involved and in many cases there is no antecedent fracture. The phenomenon is not seen in other common cystic conditions of bone and its recognition is thus helpful in the histological
The "osteopetrosis" section of the Fairbank Collection in the Radiology Museum of the Royal National Orthopaedic Hospital contains radiographs and case notes of twenty-two patients. This material has been reviewed in terms of modern concepts in an attempt to obtain a long-term follow-up and a firm
1. Thirteen cases of fracture of the lateral process of the talus seen over a period of thirteen months are reported. 2. The mechanism of the injury would appear to be inversion strain of the foot with dorsiflexion of the ankle. 3. The
1. Twenty-eight patients with pyogenic infection of the spine are reported. 2.
1. Nine cases of disturbance of the relationship between the scaphoid and the radius and between the scaphoid and the lunate bones are described. 2. Persistent dislocation of the scaphoid bone may follow reduction of perilunar dislocations or of other dislocations of the proximal row of the carpus. It may be obvious, as in waist-deep dislocation, or may be solely a rotational dislocation which may be difficult to diagnose. 3. Uncorrected rotational dislocation of the scaphoid bone caused significant disability in six of seven cases. 4. Aids to the
We have tested the hypothesis that the meniscofemoral ligaments make a significant contribution to resisting anteroposterior and rotatory laxity of the posterior-cruciate-ligament-deficient knee. Eight cadaver human knees were tested for anteroposterior and rotatory laxity in a materials-testing machine. The posterior cruciate ligament (PCL) was then divided, followed by division of the meniscofemoral ligaments (MFLs). Laxity results were obtained for intact, PCL-deficient, and PCL-MFL-deficient knees. Division of the MFLs in the PCL-deficient knee increased posterior laxity between 15° and 90° of flexion. Force-displacement measurements showed that the MFLs contributed 28% to the total force resisting posterior drawer at 90° of flexion in the intact knee, and 70.1% in the PCL-deficient knee. There was no effect on rotatory laxity. This is the first study which shows a function for the MFLs as secondary restraints to posterior tibial translation. The integrity of these structures should be assessed during both imaging and arthroscopic studies of PCL-injured knees since this may affect the
We made a prospective study of 58 patients with suspected internal derangement of the knee. They were examined by magnetic resonance imaging using 3-D gradient echo intermediate-weighted studies before having an arthroscopy. The preoperative clinical assessment was found to have a diagnostic sensitivity of 77% and a specificity of 43%, compared with 100% and 63% respectively for magnetic resonance imaging. Comparison of magnetic resonance imaging and arthroscopy confirmed the accuracy of magnetic resonance imaging in the
We reviewed 275 cases and calculated the prevalence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 resident in Greater Glasgow during 1970 to 1990. In the 20-year period there was a fall of over 50%, mainly involving cases of long-bone infection, and those due to Staphylococcus aureus. There was a reduced incidence of complications. The proportion of cases involving long bones decreased from 84% to 57%, and those of Staphylococcus aureus infection from 55% to 31%. These changes, in what is becoming a rare disease, need to be known to ensure early
We diagnosed 50 patients (58 shoulders) with a mean age at presentation of 17.3 years, as having involuntary positional instability of the shoulder. They were managed by a programme consisting of a careful explanation, analysis of abnormal muscle couples and then muscle retraining carried out by a specialist physiotherapist. The mean follow-up was two years. Six shoulders had a poor result, but 52 were graded as good to excellent. Nine patients (12 shoulders) relapsed and required further episodes of retraining. In our experience, involuntary positional instability of the shoulder causes symptoms which interfere with normal activities; these can be controlled by a treatment plan of retraining of the muscle pattern with functional benefit. Only 19 of the patients were referred with a
We reviewed a series of 91 patients with deep infection of a cemented total hip arthroplasty caused by coagulase-negative staphylococci (C-NS). Of these, 72 were treated by one-stage exchange arthroplasty with a failure rate of 13% due to recurrence of infection. The other 19 patients have started or completed treatment by a two-stage exchange without failure to date. In 27 of the 91 patients multiple strains of C-NS were discovered, many being resistant to previously used antibiotics. The use of gentamicin-containing cement in the primary arthroplasty was significantly associated with the emergence of gentamicin-resistant C-NS in subsequent deep infection. Bacteriological
In a retrospective review of 302 clinically suspected cases of congenital syphilis, bone changes were found in 197. The skeletal manifestations were periostitis (102 cases), osteitis (20), and metaphyseal changes (71). Combinations of more than one lesion were found in 61. Pseudoparalysis was a presenting sign in 34 infants; 12 of these were found to have had pathological fractures and four had dactylitis. Complete radiological healing without residual changes was seen in all 59 cases that were recalled for review. The orthopaedic surgeon should consider the