Showing papers in "Journal of Bone and Joint Surgery, American Volume in 1972"

Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report.

Abstract: Impingement on the tendinous portion of the rotator cuff by the coraco-acromial ligament and the anterior third of the acromion is responsible for a characteristic syndrome of disability of the shoulder A characteristic proliferative spur and ridge has been noted on the anterior lip and undersurfac

Traumatic instability of the wrist: diagnosis, classification, and pathomechanics.

Abstract: The scaphoid is a mechanical link that stabilizes the intercarpal joint during motions of the wrist. Without this stability the proximal carpal row acts as an unsupported intercalated link in a three-link system and zigzag collapse occurs with axial loading. A deformity with dorsiflexion of the lunate within the linkage (dorsiflexion instability) occurs commonly after scaphoid fracture and scapholunate dissociation. When dissociation occurs the scaphoid assumes a vertical position, that is, the angle formed by the longitudinal axes of the scaphoid and the lunate approaches a right angle. Rupture of the distal attachments of the palmar radiocarpal ligament and of the scapholunate ligament appears to induce dissociation. It is therefore concluded that ligamentous injury along with scaphoid fracture is probably necessary if dorsiflexion instability is to develop. Palmar flexion instability characterized by palmar flexion of the lunate within the wrist linkage appears to be associated with ulnar displacement of the carpus as is seen in rheumatoid arthritis or after loss of the distal end of the ulna. This position may be normal in a small percentage of patients. The direction of the intercarpal collapse is related to the location of the pressure of the head of the capitate against the concave surface of the lunate, that is, whether this pressure is dorsal or palmar to the plane of the radiolunate fulcrum on the proximal convex surface of the lunate. The direction of the collapse is also related to the normal oblique path of motion (rotation and sliding) of the capitate during ulnar and radial deviation and is intimately controlled by the geometric configuration of the bones and the resultant of forces on the carpus. These forces are determined by the strength, direction, and leverage of the musculotendinous units, which cross the joints of the wrist complex.

Treatment of acromioclavicular injuries, especially complete acromioclavicular separation.

Abstract: A schema of treatment of the three types of acromioclavicular injuries, based [See table in the PDF file] on pathological change in each, is presented. Type-I injuries are those with direct trauma to the acromioclavicular joint without significant ligamentous tears or intability. Type-II injuries are those with acromioclavicular ligamentous injury and instability but without disruption of the coracoclavicular ligaments. Type-III injuries are those with complete clavicular instability and disruption of both sets of ligaments. Type-I injuries are treated expectantly when seen early, and when seen late, with acromioclavicular arthritis, they are treated by resection arthroplasty. Expectant treatment is advocated for early Type-II injuries while late symptomatic Type-II separations are treated by resection arthroplasty of the acromioclavicular joint. Those patients with acute and chronic Type-III injuries are treated surgically by a new operation which combines resection arthroplasty of the acromioclavicular joint with fixation of the clavicle in an anatomical position by suture of the acromial end of the shortened coraco-acromial ligaments into the medullary canal of the clavicle. The results in both acute and chronic cases, fifteen in number, have been quite good.

The Interfascicular Nerve-grafting of the Median and Ulnar Nerves

Abstract: A technique of nerve-grafting based on experimental studies is described. Complete absence of tension at the suture site is regarded as the most important factor for a successful nerve repair. Nerve regeneration after grafting without tension is much better than after direct end-to-end suture under moderate tension even though the regenerating axons must cross two suture lines when grafts are used. The technique involves use of a dissecting microscope to perform an intraneural dissection of both nerve stumps to isolate the major fasciculi individually and the minor ones in groups. The scarred ends of the fasciculi are then resected, the mobilized fasciculi in each nerve stump are matched, and grafts, usually from the sural nerve, are inserted loosely with no tension to bridge the gaps between the matched fasciculi or groups of fasciculi—five or six grafts in the median nerve and usually four in the ulnar nerve. Only one very fine suture is used to fix each end of a graft and the coaption between the ends of the graft and the corresponding fasciculi is carefully adjusted using the dissecting microscope. The results using this technique in thirty-three median and thirty-two ulnar nerve lesions of different types are presented in detail.

Temperatures Measured in Human Cortical Bone when Drilling

Abstract: Temperature measurements have been made in cortical bone while drilling under controlled laboratory conditions. Cortical temperatures greater than 100 degrees centigrade were frequently recorded when drilling if no specific provisions for cooling were made. The force applied to the drill was found to be much more important than drilling speed as a factor in both the magnitude and duration of cortical temperature elevations. Increases in the force applied to the drill were associated with decreases in the maximum temperatures and the durations of temperature elevation. Worn drills caused much greater temperature changes than new drills. All forms of irrigation that allowed the stream of irrigating fluid to be directed to the point of penetration of the cortex were effective in limiting the increases in cortical temperature. Tapping did not appear to cause significant temperature elevations.

Flexible Implant Arthroplasty for Arthritic Finger Joints: Rationale, Technique, And Results Of Treatment

Abstract: The development, basic concepts, and technique of flexible implant arthroplasty of the metacarpophalangeal and proximal interphalangeal joints are described and the need for treatment of all the interrelated deformities in the fingers is considered. The results after follow-ups ranging from six months to five years are analyzed both in the patients treated by me in Grand Rapids and in patients treated by the surgeons in 211 clinics who participated in a Field Clinic study. The Grand Rapids series included 358 metacarpophalangeal joints, all with rheumatoid arthritis, and 148 proximal interphalangeal joints, eighty-five with rheumatoid arthritis, thirty with osteoarthritis and thirty-three with post-traumatic arthritis. The over-all average range of motion achieved was from 2 to 64 degrees of flexion in the metacarpophalangeal joints and from 6 to 65.5 degrees of flexion in the proximal interphalangeal joints. The Field Clinic Study series included 3,409 metacarpophalangeal joints, all in hands with rheumatoid arthritis. The average range of motion in the 2,544 fingers for which data were available in this series was from 4 to 57 degrees of flexion. In both series, the deformity was corrected in 97 per cent or more of the fingers. The complications in the combined series included fracture of the implant which occurred in less than 2 per cent of cases, and dislocation of the implant and infection both of which occurred in less than 1 per cent of the fingers. Five implants in the two series combined had to be removed because of postoperative infection.

The intra-articular effects of immobilization on the human knee.

Abstract: The Intra-Articular Effects of Immobilization on the Human Knee W. ENNEKING;MARSHALL HOROWITZ; The Journal of Bone & Joint Surgery

Anterior interbody lumbar spine fusion. Analysis of Mayo Clinic series.

Abstract: A consecutive series of eighty-three patients treated with anterior interbody disc excision and bone-grafting has been presented. A good clinical result was achieved by only 36 per cent of the patients and roentgenographic evidence of fusion at all levels grafted occurred in only 56 per cent. A one-level grafting procedure gave a better chance of fusion (68 per cent) and the lumbosacral interspace became solid slightly more frequently than more cephalad interspaces. Postoperative cast immobilization significantly improved the fusion rate. We concluded that the reported differences in success with this technique are attributable chiefly to the interpretation of clinical and roentgenographic factors by different authors and to the type of patients selected for this procedure. We believe that this technique should be utilized as a salvage procedure only in those infrequent cases in which posterolateral grafting is inadvisable because of infection or unusally extensive scarring.

Glomus tumors of the hand: review of the literature and report on twenty-eight cases.

Abstract: Twenty-eight cases of glomus tumor of the hand have been studied from various aspects including a review of the pertinent literature, clinical manifestations, treatment, and the incidence of this lesion in relation to other hand tumors and to glomus tumors occurring extramanually. These interesting and unusual lesions often are not palpable, frequently not visible, and usually not detectable on roentgen examination. Nonetheless, the diagnosis can be readily made if there is awareness of the characteristic triad of symptoms: pain, tenderness, and cold sensitivity. Meticulous complete excision, the only recommended treatment, should result in complete cure.

Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty.

Abstract: Arthritic involvement of the joints at the base of the thumb can seriously interfere with normal function of the hand. This disability may result from osteoarthritis, traumatic arthritis, or rheumatoid arthritis. The severity of the symptoms and deformity depend on the severity of the destructive changes which occur at the basal thumb joints and the resulting imbalance of forces on the distal thumb joints. The swan-neck deformity seen in rheumatoid thumbs and in severe osteoarthritic thumbs is caused by arthritic changes of the basal joints. [See figure in the PDF file]. A study of the roentgenograms of the patients selected for reconstructive surgery of the thumb demonstrated that the arthritic changes most frequently occur at the trapeziometacarpal joint, but that the trapezioscaphoid, trapeziotrapezoid, and the trapezio-second metacarpal joints are also involved in a significant number of cases. The trapezium was at the center of the arthritic process in all cases of osteoarthritis and of traumatic arthritis. Rheumatoid patients may have a similar localized involvement of the basal thumb joints. They also may have severe absorptive changes of the trapezium and base of the metacarpal which produces a result not unlike a resection arthroplasty. If the joint is reasonably stable, mobile and pain-free, no surgery is indicated. A new method of trapezium resection and implant arthroplasty for the treatment of disabilities at the base of the thumb is described. Total resection of the affected trapezium and replacement with a heat-molded, intramedullary-stemmed silicone rubber implant has been used successfully in my clinic for the last five and one-half years. It has restored a stable, mobile, pain-free and powerful thumb. With a mobile joint at the base of the thumb, a severe collapse deformity can be treated by fusion of the distal joints, if need be, without producing a rigid thumb. The indications and surgical techniques are discussed as well as the treatment of the associated collapse deformities of the thumb and the technical pitfalls that must be avoided. The results obtained in forty-six thumbs operated on during the past five and one-half years are presented. The trapezium resection implant arthroplasty is a reliable method of treatment for disabling arthritis at the base of the thumb if certain simple points of technique are followed.

Tibiofemoral contact area--determination and implications.

Abstract: We have presented a roentgenographic method of determining the area of contact of the femur on the medial and lateral tibial plateaus. The area of contact on both tibial plateaus decreases throughout the first 35 degrees of flexion. The average area of contact on the medial plateau was 1.6 times greater than the area on the lateral plateau. This relationship remained constant through the first 35 degrees of flexion. The ratio of the medial and lateral contact areas is applicable to the study of clinical problems.

Deformation of the thoracolumbar intervertebral joints in response to external loads: a biomechanical study using autopsy material.

Abstract: Static loading tests on fresh human spinal segments obtained at autopsy were performed to measure the deformation of thoracic and lumbar intervertebral joints in response to lateral bending moment, flexion moment, extension moment, torsional moment, anteroposterior and mediolateral shear force, axia

Oxygen Tension of Healing Fractures in the Rabbit

Abstract: True appreciation of the structure and function of the knee joint meniscus is a relatively recent occurrence. Even decades after studies were published documenting the detrimental effects of meniscectomoy such as osteoarthritis, many physicians continued to advocate total meniscectomy for even minor meniscal pathology. Fortunately, the clinical approach to these problems has undergone dramatic change over the past 20 years. A review of the anatomy and ultrastructure of the meniscus, and its relationship to normal function in terms of load transmission, shock absorption, joint stability, lubrication, and nutrition will enable a better understanding of the rationale for meniscus preservation techniques, including meniscal repair and meniscal transplant.

Total Hip Replacement with Fixation by Acrylic Cement: A PRELIMINARY STUDY OF 100 CONSECUTIVE MCKEE-FARRAR PROSTHETIC REPLACEMENTS

Abstract: Total hip replacement utilizing the McKee-Farrar prosthesis and acrylic cement relieved pain in seventy-nine of 100 diseased hips and improved the stance, walking function, and mobility of these same hips for periods of follow-up ranging from two to four years. The results have been so-satisfactory

Non-surgical treatment of tendo achillis rupture.

Abstract: We have analyzed the results in sixty-six cases of Achilles tendon injury which were treated by a simple non-surgical method. A gravity equinus walking boot cast was applied for eight weeks. The patient then used a 2.5 centimeter heel elevation for four weeks. Resistance exercises were used to build up the triceps surae. The frequent complications in other series of operative repair were discussed. The virtues of this method are that the hazards of anesthesia and open surgery are avoided. The complications of infection, skin slough, and scar formation do not occur, and the patient is spared the expense of hospitalization. Early return to work is a distinct economic advantage. The functional results are as entirely satisfactory as those from operative repair; the cosmetic appearance is much better.

Dislocation and subluxation of the hip in cerebral palsy. Pathogenesis, natural history and management.

Abstract: 1. Of 1013 hospitalized patients with cerebral palsy, 274 patients with dislocated or subluxated hips have been studied, a prevalence of 28 per cent. This figure is high because severely involved, neurologically and developmentally immature quadriplegic patients constituted a large fraction of the hospital population. 2. The mean age at which dislocation occurred in 139 of these patients was seven years. 3. It is proposed that retained neonatal reflexes, muscle imbalance and contracture, coxa valga, femoral anteversion, and acetabular index are responsible for the dislocations. 4. The results and complications of the 518 combined operations are summarized. 5. Correction of coxa valga and of femoral anteversion are the most important surgical considerations in the prevention and treatment of dislocation of the hip in cerebral palsy.

Avascular Necrosis of the Capital Femoral Epiphysis as a Complication of Closed Reduction of Congenital Dislocation of the Hip: A Critical Review Of Twenty Years' Experience At Gillette Children's Hospital

Abstract: In a retrospective study of 154 congenital dislocations of the hip treated by closed reduction with and without preliminary traction at Gillette Hospital during the period January 1, 1948, through December 31, 1967, the incidence of avascular necrosis was analyzed after follow-ups ranging from two to more than nineteen years. There were twenty-seven hips with complete necrosis and twenty-four with partial necrosis. Eight of the normal hips had shown Type-I changes previously described by Salter, Kostuik, and Dallas. An attempt was made to identify the factors responsible for avascular necrosis of the capital femoral epiphysis, either complete or partial. As a result of this study the following conclusions were reached: 1. The older the child is, the more frequent the complication of avascular necrosis, all other factors being equal. 2. There is a direct correlation between inadequate traction and the incidence of avascular necrosis of the femoral head. 3. There is a direct correlation between the Lorenz position and the incidence of avascular necrosis of the femoral head. 4. Avascular necrosis usually results in permanent deformity of the femoral head, but there is a spectrum of deformities which in all likelihood depend on the severity of the vascular insult. 5. A program of adequate traction, gentle reduction, and avoidance of the extreme Lorenz position reduced the incidence of total avascular necrosis from 34.8 per cent during the first five years of the study period to 4.5 per cent in the last five years. The incidence of partial necrosis, on the other hand, remained essentially the same.

Bone strength. The effect of screw holes.

Abstract: 1. In dogs, redrilling a screw hole after removal of the screw did not improve final repair as judged by both histological examination and biomechanical testing.2. The screw holes, despite the radiolucency apparent on roentgenograms were rapidly filled with dense woven bone, and then were slowly rem

Posterolateral lumbar-spine fusion. Analysis of Mayo Clinic series.

Abstract: A series of 177 patients who had posterolateral lumbar-spine bone-grafting has been presented. The clinical result was based on reliefof pain, the need for analgesic medication, the restriction of physical activities, and the return to employment. Sixty per cent achieved good results, and 81 per cent satisfactory results (good and fair). A solid fusion based on roentgenographic evaluation was achieved in 80 per cent. There was high correlation between the clinical result and the presence or absence of a solid fusion in all diagnostic categories except spondylolisthesis. For spondylolisthesis, a one-level posterolateral grafting procedure seemed to be more reliable than a two-level procedure. Compensation considerations and a diagnosed psychoneurosis were factors that were identified as predisposing to a poor clinical result. Postoperative immobilization with a plaster body cast did not improve the fusion rate. Our experience indicates that posterolateral lumbar-spine bone-grafting resulted in a better fusion rate and a greater percentage of good clinical results than those reported for either anterior interbody or strictly posterior bone-grafting techniques.

Management of fracture-dislocation of the proximal interphalangeal joints by extension-block splinting.

Abstract: A closed method is recommended for the treatment of a common injury of the proximal interphalangeal joint, a fracture of the articular surface of the middle phalanx with dorsal dislocation or subluxation. The method uses extension-block splinting (a forearm gauntlet with a dorsal extension along the finger) which allows early active flexion of the proximal interphalangeal joint but prevents extension beyond a predetermined point at which the joint subluxates on dislocates. The method is described and the results in seventeen patients are presented.

Pelvic Instability: A CONSEQUENCE OF REMOVING ILIAC BONE FOR GRAFTING

Abstract: Instability of the pelvis after removal of iliac bone for grafting was demonstrated roentgenographically in six patients. The anatomy of the pelvic ring is such that stresses placed on it by abnormal motion at any one of three points—the two sacroiliac joints and the symphysis—may cause instability.

Lumbar intervertebral disc degeneration: the influence of geometrical features on the pattern of disc degeneration--a post mortem study.

Abstract: From a roentgenognaphic and anatomical study of 182 lumbar spines obtained at autopsy, the following conclusions were reached: The distribution of degenerative changes in the lumbar intervertebral joints varies with the lumbar londosis, and the amount of lordosis is not related to sex and age. An increased inclination of the lunibosacral joint seems to protect it against anular damage. Five basic patterns of radial tears or fissures in the anulus can be identified: posterolateral, posterior bilateral, posterocentral, lateral, and anterior. The pattern of the tear appears to be related to at least two geometric features of the joint: (1) shape of the disc and (2) symmetry of the articular processes. In discs with a flattened posterior anular surface posterolateral fissures develop while in discs with rounded posterior surfaces, posterior mid-line ruptures are found. Asymmetrical anticular processes lead to asymmetrical degeneration, while symmetrical processes lead to symmetrical degeneration.

Bone Sarcomas Arising in Fibrous Dysplasia

Abstract: Twelve patients with histologically proved sarcoma arising in fibrous dysplasia of bone (six monostotic, six polyostotic) are described. In five (Group I) the existence of the dysplasia was known years before the sarcoma arose, and in seven (Group II) the discovery of both lesions was concurrent. The average age of patients in Group I [See figure in the PDF file] was fifteen years when compared with thirty-five years in Group II. In only one instance could the history of previous radiotherapy be elicited. The histological examination of the primary bone sarcomas revealed eight osteosarcomas, two chondrosarcomas, and two spindle-cell sarcomas.

Industrial injuries of the back and extremities. Comprehensive evaluation--an aid in prognosis and management: a study of one hundred and eighty patients.

Abstract: Comprehensive evaluation and follow-up of a group of 180 industrially injured patients and a group of non-injured workers were carried out to ascertain the extent to which psychological, vocational, physical and other factors influenced the return to work of the injured patients. Significant differences were demonstrated in the psychological posture of back-injured, extremity-injured, and non-injured industrial workers. This study indicated that physical and psychological disability play an important role in the return to work of both extremity-injured and back-injured patients. Although a significant number of patients returned to work two or more years after injury, there was a general relationship between the duration of non-employment and the probability of return to work. In predicting return to work of the back-injured patient, psychological ratings by psychologists were superior to those made by physicians. These studies document the importance of psychological evaluation for optimum rehabilitation effort and suggest that the whole man concept is a useful, and perhaps necessary, consideration in the rehabilitation of the industrially injured workman. We believe that psychological evaluation is of value for patients who have failed to respond to usual therapy and in those being considered for spine fusion. Such evaluation is also useful in predicting the need for vocational retraining. Although the population represented in this study is a distinctive group, it is not unique. There are a large number of patients who exhibit similar characteristics. It seems unlikely that the concepts illustrated in this study are confined to the industrially-injured worker on compensation. They undoubtedly apply to other patients as well. Additional studies of the various factors influencing return to work following injury are needed.

Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting.

Abstract: The results in the first 100 consecutive children, eighteen months to ten years old, who had debridement and anterior spine fusion for Pott's disease at the Ruttonjee Sanatorium, Hong Kong, between December 1955 and June 1959 were reviewed retrospectively after follow-ups ranging from one to fifteen years. The duration of symptoms prior to admission ranged from two months to five years. Forty-three of the 100 children had paraplegia and were first seen one month to thirty-six months after the onset of their neural symptoms. The clinical roentgenographic and operative findings, the methods of treatment, and the results at follow-up are described. In the forty-three patients with paraplegia, the causes of neural compression were: bone sequestrum, caseous material, pus, a sequestrated disc, a protruding ridge of bone produced by the kyphoscoliosis, pachymeningitis, and frank pus within the dura. All forty-three patients survived; thirty-seven made a complete recovery and six, a partial recovery. Twelve patients had penetration of a lung by the paravertebral abscess. All did well after debridement, insufflation of streptomycin, closure of the visceral pleura, and the insertion of strut grafts in the spinal defect. In seventy-four patients, solid fusion and healing of the tuberculous lesion occurred. In sixteen there was a stable non-union and apparent healing of the disease. The remaining ten were classified as having unstable non-unions requiring further treatment. Fifteen patients had an apparent decrease in their kyphos as determined roentgenographically, ten had no increase, and seventy-five had increases ranging from 2 to 106 degrees, or an average increase of 22.2 degrees. The causes of increasing kyphosis were slippage of the grafts, protrusion of the grafts into osteoporotic vertebral bodies, fracture or shortening of the grafts (in two instances combined with suspected reactivation of the disease process), and overgrowth of the posterior part of the fusion mass. Assessment of these children's working capacity at follow-up revealed that in ninety-four it was complete and in six, partial. The postoperative complications were: four superficial infections and one deep wound infection, all of which responded to appropriate therapy; pneumothorax in two patients: persistent pleural effusion in one; fracture of the graft in ten; slippage of the graft in five; a Horner's syndrome in two; convulsions in two; postoperative ileus in one; and bed sores in two. The findings and results in these 100 children are compared with those reported in the literature. The following conclusions are offered: 1. In the surgical treatment of Pott's disease in children, the anterior approach gives direct, wide access to the diseased area, which is always more extensive than the preoperative roentgenograms lead one to suppose. Through this approach, it is possible to remove all pathological foci and to make an accurate diagnosis. 2. In children, particularly those with a thoracic lesion, we believe that early decompression of the abscess is essential to avoid further destruction which may result in severe kyphosis, paraplegia, and impairment of cardiopulmonary function. 3. When there is penetration of a lung, the anterior approach to the spine is the only method of dealing with the spinal and the pulmonary lesion in one procedure. 4. Only surgical exposure permits a definite and accurate diagnosis of the cause of paraplegia. 5. The prognosis for recovery from a pure pressure type of paraplegia is remarkably good if the cause of the pressure is removed soon after the onset of symptoms. 6. Based on experiences with the treatment of both adults and children with Pott's paraplegia, it is our impression that the prognosis for recovery is far better in children than in adults. 7. An anterior interbody fusion between more than two vertebral segments can be made more stable, if need be, by a posterior fusion of the same segments. 8. In the treatment of tuberculosis of the spine in children, evacuation of the contents of the abscess, combined with removal of all avascular bone and anterior fusion using strut grafts has given results superior to those obtained by other methods.

A comparison of the physical behavior of normal articular cartilage and the arthroplasty surface.

Abstract: A study of the rabbit metatarsophalangeal joints with arthroplasty surface and normal articular cartilage was done by using compression testing to compare the elastic and viscoelastic behaviors of these two surfaces. Consistent differences were observed. Articular cartilage exhibited less instantaneous deformation than the arthroplasty surface, that is, the cartilage was stiffer. Both the rate and magnitude of time-dependent deformation under constant load (creep) of the articular cartilage were less than that of the arthroplasty surface. These differences increased significantly as a function of load. However, within the range of three to twelve-month-old anthroplasties, the viscoelastic behavior remained approximately constant. Mechanical analogues were constructed in an attempt to characterize the physical behaviors of these tissues, and mathematical relations of the experimental data to the analogues were developed. The loading range used in this study was not felt to exceed physiological limits as no plastic or permanent deformation was observed. Our findings show that cartilage is superior to the anthroplasty surface for resistance to and for recovery from the repetitive and rapid deformations which might be experienced in normal joint function Clinical experience supports this finding. The difference in elastic and viscoelastic behaviors was related to histological and biochemical differences of the two surfaces.

Postradiation Sarcoma of Bone

Abstract: Thirty-four additional cases of sarcoma developing in previously irradiated bone are documented, bringing the total Mayo Clinic experience in sarcoma appearing after radiation therapy to fifty-five instances. The sarcomas arose in normal bone within the radiation treatment field in eleven patients, while they arose in pre-existing bone lesions in sixteen patients. Osteogenic sarcoma and fibrosarcoma were most commonly diagnosed. The outlook in tumors of this nature is poor, the average survival being 1.14 years, with only two long-term survivors. Although a relationship has been established in experimental animals, a direct relationship between exposure to external radiation and the development of sarcoma is not established in man. There is no absolute proof that ionizing radiation caused any of these sarcomas. However, this and other significantly large series add to the mounting circumstantial evidence that the association between ionizing radiation and sarcoma is a real one. It must also be emphasized that this is a rare complication clinically.

Recurrent Posterior Dislocation of the Shoulder

Abstract: The preliminary results of an operative procedure for recurrent posterior dislocation of the shoulder are reported. A posterior capsulorrhaphy is combined with a tendon transfer of the long head of the biceps which is routed around the posterior aspect of the neck of the humerus and reinserted on th