Showing papers in "International Orthopaedics in 1994"
TL;DR: A technique for total en bloc spondylectomy through a posterior approach is developed and the experience of 20 patients with a solitary or localised metastasis in the thoracic or lumbar vertebrae is reported.
Abstract: We have developed a technique for total en bloc spondylectomy through a posterior approach and now report our experience of 20 patients with a solitary or localised metastasis in the thoracic or lumbar vertebrae. There are two steps: an en bloc laminectomy, followed by en bloc resection of the vertebral body with an oncological wide margin and the insertion of a vertebral prosthesis. Pain was relieved in the 17 patients who could be assessed; 11 of the 15 patients with a neurological deficit were much improved, impending paralysis being prevented in 5 patients. There have been no local recurrences. Nine patients are at present alive with a mean follow up of 17.4 months.
325 citations
TL;DR: Anatomical investigations and nerve conduction studies of the Radial Tunnel Syndrome supported the hypothesis that the Lateral Cubital Force Transmission System is involved in the pathogenesis of tennis elbow.
Abstract: Five studies of tennis elbow are presented. Epidemiological studies showed an incidence of tennis elbow between 1 and 2%. The prevalence of tennis elbow in women between 40 and 50 years of age was 10%. Half of the patients with tennis elbow seek medical attention. Local corticosteroid injections were superior to the physiotherapy regime of Cyriax. Release of the common forearm extensor origin resulted in 70% excellent or good results one year after operation and 89% at five years. Anatomical investigations and nerve conduction studies of the Radial Tunnel Syndrome supported the hypothesis that the Lateral Cubital Force Transmission System is involved in the pathogenesis of tennis elbow.
256 citations
TL;DR: In this paper, the authors compared screw fixation with hooks and hooks only and with screws only and found that the screws provided immediate stability with rigid fixation, together with better correction of frontal, sagittal and rotational deformity.
Abstract: Eighty-two patients with idiopathic scoliosis were treated by Cotrel-Dubousset instrumentation between 1987 and 1991. Twenty were treated with hooks only, 47 with screws and hooks, and 15 with screws only. The methods were compared and the findings showed that screw fixation can be used in the thoracic spine without neurological complications. The screws provided immediate stability with rigid fixation, together with better correction of frontal, sagittal and rotational deformity. There is less loss of correction, a shorter fusion and less risk of neurological complications because of the placement outside the spinal canal and the rigid fixation in derotation. The technique was simpler and the operating time shorter than with the other methods.
219 citations
TL;DR: A retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture was carried out.
Abstract: We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.
113 citations
TL;DR: In this paper, the authors developed reasonably strong but bioabsorbable osteosynthetic screws, pins and nails made of ultra high strength poly-L-lactide (PLLA) and evaluated their use in 143 patients.
Abstract: We have developed reasonably strong but bioabsorbable osteosynthetic screws, pins and nails made of ultra high strength poly-L-lactide (PLLA) and evaluated their use in 143 patients. The PLLA implants have the highest strength among those reported to date. They lose about 10% of their initial strength within 8 weeks, about 40% within 4 weeks and nearly 100% within 20 weeks in vivo. The patients were aged from 9 to 78 years, and the follow up was from 2 to 6 years. The implants were used for fixation of bone grafts in 84 patients, peri- and intra-articular fractures in 49, after osteotomy in 8, and in 2 others. Bony union was not achieved in only one case. In the early stages of the study, breakage of screws occurred in 12 cases (8%), mostly because of an inappropriate size of tap; these problems have not occurred after improvement of the tapping system. There were no cases with abnormal blood tests, infection or foreign body reaction.
85 citations
TL;DR: In this article, a prospective 5-year study was carried out of 143 patients with trochanteric fractures treated by Ender nailing, and a detailed proforma was used for multifactorial analysis in order to identify the prognostic indicators of social function and quality of life of the patients.
Abstract: A prospective 5-year study was carried out of 143 patients with trochanteric fractures treated by Ender nailing. A detailed proforma was used for multifactorial analysis in order to identify the prognostic indicators of social function and quality of life of the patients. Their mean age was 81 years and the female: male ratio 7:1. The mortality rate 6 months after injury was 23%, and at the end of 5 years 45.5%. The patients surviving the first 6 months had the same life expectancy as the general population. Dementia, associated disease, medical complications, total dependency and age were the most significant predictors of mortality. These factors, with pressure sores and poor rehabilitation, were also significant in determining the prognosis of social function. Deterioration of health status was seen in 36% during the first 6 months after injury and 40% showed deterioration of their social condition within this period. Later, most survivors recovered and were restored to their previous state. Postoperative geriatric care is essential to achieve this aim.
81 citations
TL;DR: A survey of the 2075 cases in the Leeds Bone Tumour Registry showed that 54 cases of Primary Lymphoma of Bone that had been registered since data collection began in 1958 were retrouvé, with a significant reversal of the sex ratio with females being more commonly affected in the older group.
Abstract: A survey of the 2075 cases in the Leeds Bone Tumour Registry showed that 54 cases of Primary Lymphoma of Bone that had been registered since data collection began in 1958 (2.6% of primary bone tumours). The overall sex ratio was 1.5 males: 1 female, largely due to the preponderance of males in the under 40 age group. The age distribution was bimodal, the second peak of incidence demonstrating a significant reversal of the sex ratio with females being more commonly affected in the older group. The clinical features and radiological findings were non-specific, diagnosis relying principally on tissue histology. The overall survival at five years was 46% and was not affected by the interval from the onset of symptoms until the final diagnosis.
76 citations
TL;DR: One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast as discussed by the authors, and the mean age of the patients was 55 years, and the severity of the initial radial shortening was the most reliable indication of instability.
Abstract: One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast. The mean age of the patients was 55 years. Radiographs were taken after 1,2 and 5 weeks to evaluate the frequency of early and late displacement. Dorsal angulation occurred in 71 patients, shortening of the radius in 47 and flattening of the radial angle in 32. Late displacement was more frequent than early. Statistical analysis showed a greater incidence of secondary shortening in Older's types III and IV fractures. The severity of the initial radial shortening was the most reliable indication of instability.
63 citations
TL;DR: Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical, and the aetiology of the length discrepancy has an important role in the complications which occur in each segment.
Abstract: Bone lengthening is a surgical method which requires meticulous technique, continuous attention, and satisfactory cooperation on the part of the patient. The absence of common criteria makes it difficult both to classify the complications which arise, and to compare them with those of other authors. We report the complications in a group of 61 patients who were studied prospectively. Disorders of the lengthening callus accounted for 45% of all complications, and a further 33% arose in the joints. The remainder occurred in the bone, the apparatus and the soft tissues, of which the most common were stiffness of the joints, axial deviations and loosening of the pins, while articular subluxation, fractures with angulation and delayed consolidation occurred less frequently. In our study, the overall number of complications per lengthening process was 2.1. In bilateral lengthening, the rate was 1 per segment, while in unilateral cases the mean was 2.7. Problems which we defined as severe, requiring that the lengthening had to be halted, occurred in 1.8% of the total complications. The aetiology of the length discrepancy has an important role in the complications which occur in each segment. Over twice as many problems occur in asymmetrical lengthening procedures as in patients where lengthening is symmetrical.
62 citations
TL;DR: In this article, a human immuno-deficiency virus (HIV) infected bone allograft model has been created using HTLV-IIIB virus in a concentration simulating a massively HIV infected bone donor.
Abstract: A human immuno-deficiency virus (HIV) infected bone allograft model has been created using HTLV-IIIB virus in a concentration simulating a massively HIV infected bone allograft donor [HTLV-III is the denomination initially given to the human immuno-deficiency by the american team of Prof. Gallo. It represent the virus HIV 1 of the present international nomenclature]. 5×104 tissue culture infective doses per ml. of virus were placed within the medullary cavity of bovine femora and tibiae with a radiation dosimeter, and the ends sealed with lead. The bone/virus model was maintained at −70° C while being irradiated with 1 to 4 megarads of gamma irradiation in increments of 0.5 megarads. The study showed that the HTLV-IIIB virus is a relatively radio-resistant organism, a property common to most viruses. The results suggest that HTLV-IIIB can be inactivated in bone infected with a clinically significant viral load, as may be found in donors who are initially negative when screened for HIV. It is recommended that bone allografts which are secondarily sterilized by gamma irradiation receive at least 2.5 megarads. The amount of radiation absorbed by the bone cortex was minimal.
60 citations
TL;DR: There is currently little place for shockwave treatment in clinical orthopaedics, and the effect of shockwaves on mature cortical and healing bone is demonstrated.
Abstract: It has been proposed that high energy shockwaves could be used to create microfractures in cortical bone. This quality might be exploited clinically to perform closed osteotomies and promote healing in nonunion (15). However, no study has previously documented the effect of shockwaves on cortical bone “in vivo”. We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.
TL;DR: Healing of an experimental bony defect in the rat's tibia was studied with an immunofluorescent technique to clarify when and where substance P (SP) and calcitonin gene-related peptide (CGRP) would develop.
Abstract: Healing of an experimental bony defect in the rat's tibia was studied with an immunofluorescent technique to clarify when and where substance P (SP) and calcitonin gene-related peptide (CGRP) would develop. The normal tibia showed a few SP- and CGRP-immunofluorescent nerve fibres. In the experimental tibia, the number of these fibres increased on the 6th day after operation, reached a peak of proliferation on the 15th day and reverted to normal after the 24th day. The changes were associated with the development and decay of callus tissue suggesting that harmful stimuli from the injured site in a bone could be mediated by sensory nerves throughout the repair period. Most of the SP- and CGRP-immunofluorescence was seen near the vessels, frequently in the same nerve fibres. The SP- and CGRP-immunofluorescent nerves seemed to take part jointly in callus formation through the enhancement of local blood flow.
TL;DR: The KMFTR is easy to use and has provided good medium to long term results in the authors' cases, and a new method of radiological assessment has been used for the acetabular component of bipolar hip endoprosthesis.
Abstract: Seven patients underwent total resection of the femur with replacement by the Kotz modular femur and tibia reconstruction system (KMFTR); three of these operations were for primary malignant tumours and four were salvage procedures after failed limb-sparing surgery. Clinical and radiological results were excellent or good at final follow up at an average of 23 months. A new method of radiological assessment has been used for the acetabular component of bipolar hip endoprosthesis. The polythylene bush of the hinged knee component may wear. Reattachment of the abductors to the endoprostheses often fails and we now suture the abductors to the fascia lata. The rectus femoris muscle should be saved, if possible, after resection. When total excision of the quadriceps is indicated, the knee should be arthrodesed. The KMFTR is easy to use and has provided good medium to long term results in our cases.
TL;DR: A massive retroperitoneal haemorrhage due to perforation of the external iliac vein by a drill tip passing through the antero-superior quadrant of the acetabulum during cementless total hip arthroplasty is encountered.
Abstract: We encountered a massive retroperitoneal haemorrhage due to perforation of the external iliac vein by a drill tip passing through the antero-superior quadrant of the acetabulum during cementless total hip arthroplasty. An anatomical study of the acetabulum was undertaken to determine the safe zones for transacetabular screw fixation. Five cadavera were studied to find the proper locations for screws using acetabular quadrants. The postero-superior and postero-in-ferior acetabular quadrants have good bone stock and are safe for the transacetabular replacement of screws. The antero-superior and inferior quadrants should be avoided. Screws placed in these quadrants may damage the external iliac artery and vein or the obturator vessels.
TL;DR: A 36 year old woman with a history of chronic renal failure secondary to acute glomerulonephritis sustained an injury to the tendon of the triceps brachii in her right arm, which showed an incomplete rupture of the tendon.
Abstract: A 36 year old woman with a history of chronic renal failure secondary to acute glomerulonephritis sustained an injury to the tendon of the triceps brachii in her right arm. Magnetic resonance imaging showed an incomplete rupture of the tendon. The injury was successfully treated conservatively.
TL;DR: An intraspinal epidermoid tumour developed six years after a lumbar puncture in a woman aged 30 years, possibly arose from implanted cutaneous tissue.
Abstract: An intraspinal epidermoid tumour developed six years after a lumbar puncture in a woman aged 30 years. This rare complication possibly arose from implanted cutaneous tissue.
TL;DR: The most significant benefit from employment of the special team was in reducing the incidence of wound sepsis and of failure of fixation following the operative management of displaced intracapsular and extracapsular fractures.
Abstract: The incidence of the major complications of operation have been studied prospectively in 1,722 patients with a proximal femoral fracture treated by either insertion of a hemiarthroplasty, internal fixation with a Dynamic Hip Screw (DHS) or multiple parallel screws. Major complications occurred in 8.0%. A special surgical “Hip Fracture Team” reduced the incidence of major complications from 12.5% to 5.0%. The most significant benefit from employment of the special team was in reducing the incidence of wound sepsis and of failure of fixation following the operative management of displaced intracapsular and extracapsular fractures. Assigning hip fracture surgery to designated personel will result in a significant reduction in morbidity.
TL;DR: Implantation of periosteum with or without reconstructed peripheral tissues resulted in the formation of a bony bridge which led to a 32% inhibition of longitudinal growth and a 12° varus deformity in the absence of peripheral connective tissues.
Abstract: This experimental study reports the results of implantation of cartilaginous and periosteal tissues into growth plate defects in the tibiae of sheep. When no material was used, the defect rapidly filled with marrow-like tissue. When cartilage from the margin of the secondary centre of ossification was implanted, endochondral ossification continued and no shortening or deformity resulted. Implantation of periosteum with or without reconstructed peripheral tissues resulted in the formation of a bony bridge which led to a 32% inhibition of longitudinal growth and a 12° varus deformity in the absence of peripheral connective tissues. After reconstruction with these tissues, the inhibition of longitudinal growth was 47% with a 28° varus deformity. The chondroprogenitor cells in the implanted tissues cannot change phenotypic expression. Periosteum has a strong potential for bone formation after it has been implanted.
TL;DR: The sagittal splitting procedure is recommended in routine laminoplasty in order to avoid complications at the site of osteotomy, and to allow simultaneous posterior fusion to be easily performed.
Abstract: We have reviewed 83 patients who had undergone canal-expansive laminoplasty for the treatment of cervical myelopathy between 1982 and 1991. The procedures used for laminoplasty were a Z-plasty in 35 patients, unilateral laminoplasty in 19, and sagittal splitting of the spinous processes in 29. At an average follow-up of more than two years and five months, there were no significant differences in clinical results among the three operations, and excellent or good results were obtained in more than 70% of the patients. However, Z-plasty was the least preferable because this procedure had the longest operating time and the greatest intraoperative blood loss. The sagittal splitting procedure is recommended in routine laminoplasty in order to avoid complications at the site of osteotomy, and to allow simultaneous posterior fusion to be easily performed.
TL;DR: Spondylectomy of at most two vertebrae, with fusion, is recommended for ossification of the posterior longitudinal ligament and if there is more extensive involvement laminoplasty may be indicated.
Abstract: The authors reviewed 85 patients who had undergone anterior decompression and cervical fusion for myeloradiculopathy due to ossification of the posterior longitudinal ligament. There were 72 males and 13 females; the average follow up was for 8.3 years. Sixteen patients (group I) underwent one vertebra subtotal spondylectomy with fusion, 58 (group II) two vertebra subtotal spondylectomy, and 11 (group III) three vertebra subtotal spondylectomy. Neurological recovery was assessed on the grading system of the Japanese Orthopaedic Association. The patients in group I had an average improvement of 75%, in group II 72% and in group III 23%. The severity of compromise of the spinal cord did not affect the postoperative improvement. Duration of disease, previous injury and advanced neurological symptoms all affected neurological recovery. Spondylectomy of at most two vertebrae, with fusion, is recommended for ossification of the posterior longitudinal ligament. If there is more extensive involvement laminoplasty may be indicated.
TL;DR: A modification of Jahss's classification is suggested and findings in amputation specimens of dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction are confirmed.
Abstract: A case of dorsal dislocation of the first metatarso-phalangeal joint is reported because it is a very unusual injury, and the literature is reviewed.
TL;DR: In this article, the authors quantified the rate and severity of osteoarthritis after the Eden-Hybbinette-Lange procedure and found that the rate of late OA was higher than other operations with an equally low rate of redislocation.
Abstract: We have quantified the rate and severity of osteoarthritis after the Eden-Hybbinette-Lange procedure. With a mean follow up of 15 years, 44/56 (79%) of operated shoulders showed osteoarthritis changes on radiographic review. Of the contralateral non-operated shoulders the rate of osteoarthritis was 8/60 (8%). Only shoulders in the operated group demonstrated severe osteoarthritis. In our hands the rate of osteoarthritis for the Eden-Hybbinette-Lange procedure is higher than for the Eden-Hybbinette procedure or for rival operations for recurrent dislocation. We recommend careful evaluation of the Eden-Hybbinette-Lange procedure. The high rate of late osteoarthritis indicates that other operations with an equally low rate of redislocation may be of greater long term benefit to the patient.
TL;DR: A patient with an osteochondral defect of the talus and a mirror image lesion of the adjacent tibial plafond is described and modification of the existing classification of osteochondrals may be necessary to describe such lesions.
Abstract: We describe a patient with an osteochondral defect of the talus and a mirror image lesion of the adjacent tibial plafond. Modification of the existing classification of osteochondral fractures of the talus may be necessary to describe such lesions.
TL;DR: This type of plug avoids the complications which have necessitated the removal of metal devices and is a promising new method of fixing the transferred coracoid bone block.
Abstract: In a prospective study, 33 patients with recurrent anterior dislocation of the shoulder were treated by a modified Bristow-Latarjet operation using a biodegradable poly-L-lactide expansion plug to fix the transferred coracoid bone block. The mean follow up was 12 months. No redislocations occurred. To assess incorporation of the bone block, serial CT scans were obtained in 18 randomly selected patients and 15 showed solid fusion. The shape of the implant was not affected by degradation during the first 18 months and there were no signs of inflammatory foreign body reaction. This type of plug avoids the complications which have necessitated the removal of metal devices and is a promising new method of fixing the transferred coracoid.
TL;DR: 5 patients with vertebral haemangiomas treated by radiotherapy of 30–40 Gy, 2–3 Gy/day are described and the management of vertebrae vertébraux is discussed.
Abstract: We describe 5 patients with vertebral haemangiomas treated by radiotherapy of 30–40 Gy, 2–3 Gy/day. The management of vertebral haemangiomas is discussed.
TL;DR: The 164 consecutive reconstructions which the authors carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects and the allografts were used as intercalary or composite graft-prosthesis reconstructions.
Abstract: Massive bone allografts sterilised by radiation have been used in our hospital since 1985. The 164 consecutive reconstructions which we carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects. The allografts were used as intercalary or composite graft-prosthesis reconstructions. Fourteen (8.5%) skin sloughs or infections occurred, all but one after operations for malignant tumours. The grafts never appeared to be responsible. Infection after malignant tumour resection most commonly occurred at the knee when preoperative radiation had been used. Twenty-five reconstructions were performed in the presence of infection, which only recurred in one case. Twelve infections were treated, but 2 other patients died for other reasons within a year. One patient had to have an amputation and one had persistent infection. In the other cases, the infection healed. Only two debridements alone were successful. Removal of the graft and replacement with antibiotic-loaded cement was the most effective treatment.
TL;DR: The authors present their experience with 35 cases of radial tunnel syndrome, which is caused by compression of the posterior interosseus nerve in the proximal dorsal forearm related to exertion, and surgical decompression of the nerves in the region of the supinator will give relief in most cases.
Abstract: The authors present their experience with 35 cases of radial tunnel syndrome, which is caused by compression of the posterior interosseus nerve in the proximal dorsal forearm related to exertion. Chronic aching muscle pain is the problem. Real paralysis is very rare, and is usually considered as a separate entity. The syndrome is often confused with tennis elbow, although the patient may have both problems. The diagnosis remains clinical, and surgical decompression of the nerve in the region of the supinator will give relief in most cases.
TL;DR: In this paper, the authors describe a simple bone cyst in a patient who had an osteoblastic lesion which had been discovered 1 1/2 years earlier, and suggest that increased regional blood flow, in association with bone formation, produces a hydrodynamic disorder followed by venous obstruction leading to the formation of a bone.
Abstract: We describe a simple bone cyst in a patient who had an osteoblastic lesion which had been discovered 1 1/2 years earlier. Curettage and drilling proved effective treatment. We suggest that increased regional blood flow, in association with bone formation, produces a hydrodynamic disorder followed by venous obstruction leading to the formation of a bone cyst.
TL;DR: A case of bilateral total knee arthroplasty where three months after the second replacement, and without significant injury, the patient suffered a femoral neck fracture in the limb which had received the first new knee joint.
Abstract: Although total knee arthroplasty is a valuable surgical technique, complications and problems do occur. Associated stress fracture of the femoral neck is relatively rare and we have only found eleven relevant reports. In this paper we present a case of bilateral total knee arthroplasty where three months after the second replacement, and without significant injury, the patient suffered a femoral neck fracture in the limb which had received the first new knee joint.
TL;DR: Both operations appeared to slow, but did not halt, the radiographic deterioration of the joints, and Synovectomy by both methods significantly reduced bleeding episodes.
Abstract: Twenty seven patients with haemophilia who had repeated haemarthroses affecting the knee joint, despite appropriate substitution therapy, were treated by surgical synovectomy. Open operations were carried out on 18 and 9 had an arthroscopic procedure. The average age at the time of synovectomy was 13 years for both the open and arthroscopic groups. The open group was followed up for an average of 15.2 years and the closed for 5.4 years. Operation took 70 minutes on average in the arthroscopic group and 50 minutes in the open. Patients who had an arthroscopy were in hospital for an average of 5 days and those with an open operation for 10. Synovectomy by both methods significantly reduced bleeding episodes. The results were assessed according to the classification recommended by the Orthopaedic Advisory Committee of the World Federation of Haemophilia. In the open group 2 patients had a good result, 10 were fair and 6 poor; in the arthroscopic group 3 had a good result, 5 were fair and 1 poor. Both operations appeared to slow, but did not halt, the radiographic deterioration of the joints.