Showing papers in "Journal of Bone and Joint Surgery, American Volume in 1975"

Colles' fractures. Functional bracing in supination.

Abstract: The classic position of immobilization of Colles' fractures with the elbow in flexion, the forearm in pronation, and the wrist in volar flexion and ulnar deviation is probably the main reason for the common and rapid recurrence of the original deformity. Such a position places the brachioradialis muscle, a strong flexor of the elbow and the only muscle attached to the distal fracture fragment, in an ideal physiological position to exert a deforming force on the fracture fragments. Based on this assumption, further supported by electromyographic studies, a method of treatment was developed which calls for the initial immobilization of the arm in an above-the-elbow cast with the elbow in flexion, the forearm in supination, and the wrist inmoderate ulnar and volar flexion. This cast is changed a few days after application for an Orthoplast brace that permits motion of the elbow and volar flexion of the wrist while preventing pronation and supination of the forearm and dorsiflexion of the wrist. The proposed method did not prevent collapse of the fragments in all instances. However, the degree of collapse was minimum. The position of supination of the forearm and the freedom of motion of all joints seemed to reduce the swelling, stiffness, and incapacitation frequently found during active treatment of these fractures.

The mechanical properties of bone tissue in children.

Abstract: Specimens of femoral cortical bone from eighteen subjects between two and forty-eight years old were loaded in bending. Compared with the bone of adults, that of children had a lower modulus of elasticity, a lower bending strength, and a lower ash content. However, the children's bone deflected more and absorbed more energy before breaking. It also tended to absorb more energy after fracture had started. The typical greenstick fracture surface of many specimens of children's bone requires more energy for its production than the relatively smooth surface of adult specimens.

Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society.

Abstract: A survey conducted by the Scoliosis Research Society found eighty-seven patients with acute neurological complications resulting from the treatment of scoliosis. The incidence of these complications was determined to be 0.72 per cent. Seventy-four major complications involving the spinal cord were reported, half of them complete paraplegia and half partial paraplegia. Thirty-six per cent recovered completely, 32 per cent had partial recovery, and 32 per cent had no return of function. Thirteen minor complications involving cranial and peripheral nerves were reported. Major complications occurred in forty-two cases of posterior spine fusion with Harrington instrumentation and in twenty cases of posterior spine fusion without instrumentation. Six patients became paraplegic following skeletal traction alone.

Fatigue fracture: the basic lesion is inthmic spondylolisthesis.

Abstract: The defect in the pars interarticularis in spondylolysis and spondylolisthesis is most often the result of repeated trauma, stress, and factors other than acute fracture. These fatigue fractures develop early in life, may have a strong hereditary basis, and most often represent incidental roentgenographic findings. Attention should be given to the youngster or adolescent with low-back pain and paraspinal muscle spasm. If these patients are followed closely, the incidence of pars interarticularis defect is higher than appreciated. The lesion in some of these individuals may progress to significant vertebral slipping. If the developing defect is recognized early, treatment can be quite satisfactory.

Contribution of collagen and mineral to the elastic-plastic properties of bone.

Abstract: Tension testing of wet bovine haversian cortical bone demonstrated marked plastic behavior Progressive surface decalcification of this bone with dilute hydrochloric acid resulted in progressive decreases in the tension yield point and the ultimate stress with no change in the yield strain or ultimate strain unless decalcification was complete The slope of the plastic region remained identical throughout decalcification These findings are consistent with an elastic-perfectly plastic model for the mineral phase of bone tissue in which the mineral contributes the major portion of the tension yield strength The slope or stiffness of the plastic region of the stress-strain curve is a function only of the properties of collagen, which itself plays a minor role in the tension yield strength of bone

Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function.

Abstract: Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function G Lundborg; The Journal of Bone & Joint Surgery

Compression-plate fixation in acute diaphyseal fractures of the radius and ulna

Abstract: At the Campbell Clinic and City of Memphis Hospital from 1960 to 1970, 244 patients (216 with closed and twenty-eight with open fractures) had 330 acute diaphyseal fractures of the radius and ulna which were treated with ASIF compression plates and followed for from four months to nine years. One hundred and twelve patients had fractures of both bones of the forearm; fifty, single fractures of the ulna; and eighty-two, single fractures of the radius. In all, 193 fractures of the radius and 137 fractures of the ulna were treated by compression plating. Sixty-three patients (25.9 per cent) with severely comminuted fractures also had iliac-bone grafts. The over-all rate of union for the radius was 97.9 per cent and for the ulna, 96.3 per cent. ASIF compression plates, therefore, provided a successful method for obtaining union and restoring optimum function after acute diaphyseal fractures of the forearm.

The development of the tibiofemoral angle in children.

Abstract: VOL. 57-A, NO. 2, MARCH 1975 ing the acromion by replacing it after osteotomy is desirable because of the ease and rapidity of closure, the good cosmetic result, and the biomechanical advantage of preserving the acromion as the origin of the deltoid muscle 2#{149}This method also allows excellent exposure of the entire rotator cuff area. In the presence of an inadequate repair of the rotator cuff, the method is predicated on the idea that the biceps can be utilized functionally as a substitute for the rotator cuff. One can readily visualize the effect of the transplanted tendon to depress the humeral head. Inferomedial pressure will tuck the proximal end of the humerus into the glenoid socket. The results in this small series of fourteen patients were satisfactory 78 per cent of the patients had good or excellent results. It should be emphasized that the fourteen patients had very severe damage to the shoulder capsule, and the results therefore are to be rated with this selectivity in mind.

Normal postural stability and steadiness: quantitative assessment

Abstract: A force platform was utilized to provide a new and sensitive means to measure postural steadiness and stability. Normal standards are presented for the center of pressure of the vertical supportive force during standing and sustained weight-shifting of normal men in three age groups. Two distinguishing characteristics were seen for normal upright posture: (1) a large area of stability over which weight can be safely shifted and maintained, and (2) steadiness such that the center of pressure fluctuates incessantly, traversing large total excursions, while remaining remarkably close to the mean point. The youngest age group showed the greatest steadiness and stability and the oldest group showed the least.

Analysis of knee-joint forces during flexed-knee stance.

Abstract: Using an instrumented cadaver lower extremity, the forces in the quadriceps, patella, and tibia during flexed-knee stance were measured and the calculated and experimental data were found to correlate with an average discrepancy of 6 per cent. The quadriceps force required to stabilize the knee was 75 per cent of the load on the femoral head at 15 degrees of knee flexion, 210 per cent at 30 degrees, and 410 per cent at 60 degrees. Stresses at the tibiofemoral and patellofemoral joint surfaces increased in similar fashion. The quadriceps force was equivalent to 20 per cent of average maximum quadriceps strength at 15 degrees and to 50 per cent at 30 degrees, as determined from torque tests on five normal subjects.

Giant-cell tumor of bone. A demographic, clinical, and histopathological study of all cases recorded in the Swedish Cancer Registry for the years 1958 through 1968.

Abstract: All seventy-five cases recorded as giant-cell tumor of bone in the Swedish Cancer Registry for the years 1958 through 1968 were analyzed. At reexamination, fifty-three cases constituted genuine giant-cell tumor of bone and twenty cases were so-called "giant-cell variants". The genuine giant-cell tumors showed a significantly higher incidence in the urban than in the rural population. The recurrence rate was 42 per cent. Patients under the age of twenty-five rarely had recurrences. A high recurrence rate was found among patients with tumors located in the distal end of the femur and the proximal end of the tibia. Tumors penetrating through the bone cortex were more aggressive than those located entirely within bone, regardless of tumor size and presence or absence of spontaneous fracture. A malignant course was found in 11.3 per cent of cases, predominantly in patients with tumors in the femur. Histopathological grading was of no prognostic value. Primary en bloc resection with or without prosthetic replacement is recommended in patients over the age of twenty-five.

Physical and biological aspects of repair in dog cortical-bone transplants.

Abstract: The amount of repair and the time required to accomplish repair of four-centimeter segmental fibular transplants in twenty-one male adult dogs were determined at from two to forty-eight weeks after transplantation by torsional stress testing, microradiography, and tetracycline labeling. The transplanted cortical bone was greatly weakened at from six weeks to six months but was nearly normal at one year. The strength of the transplant appeared to be related to the amount of porosity of the matrix rather than to the quality or completeness of biological repair. Spatially, the repair was ordered rather than random. The initial resorption caused increased porosity which was slowly offset by apposition of new bone, a process which was dependent on general skeletal metabolic activity. Although physical strength was near normal at forty-eight weeks, only 60 per cent of the transplants had been remodeled.

Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Principles and preliminary experience.

Abstract: A classification of quadriplegic patients based on available sensory receptors (ocular only or both ocular and hand sensibility) and motor function in each upper extremity greatly facilitates the planning and evaluation of surgical treatment. In forty hands of thirty-three patients with post-traumatic quadriplegia and cord lesions higher than those usually thought to be benefited by reconstructive surgery, three or more procedures were performed at one or more sittings to create an active wrist extensor and a thumb flexor grip, a function easier to provide and much more useful to these patients than tripod pinch. In these forty hands no function was lost and in all but two function was improved significantly if not greatly. A useful level of active elbow extension was restored in fifteen of sixteen extremities in quadriplegics by transfer of the posterior half of the deltoid to the triceps aponeurosis, lengthening the deltoid with free grafts from the toe extensors. Each upper extremity of quadriplegic patients of the type under consideration is a highly individualized problem. Successful treatment requires strict attention to every detail of preoperative evaluation, surgical treatment, and postoperative care.

Fractures and anatomical variations of the proximal portion of the fifth metatarsal.

Abstract: Fractures of the tuberosity of the fifth metatarsal are frequent and with conservative treatment uniformly heal well. In contrast, fractures of the metatarsal shaft distal to the tuberosity heal slowly. Of 100 fractures of the tuberosity, almost all were clinically united within three weeks and roentgenographically united within two months. Of twenty fractures in the proximal part of the shaft, five required bone grafts and the time elapsed before roentgenographic and clinical evidence of union was variable and often prolonged.

Degenerative spondylolisthesis. Predisposing factors.

Abstract: Study of twenty skeletons and two hundred patients with degenerative spondylolisthesis established that it occurred four times more frequently in females, six to nine times more frequently at the interspace between the fourth and fifth lumbar vertebrae than at adjoining levels, three times more frequently in blacks than in whites, and four times more frequently the fifth lumbar vertebra was sacralized. It did not occur before the fifth decade or in conjunction with spina bifida or isthmic spondylolisthesis. The slipping occurs as a result of degenerative disease of the articular processes, but it never exceeds 30 per cent. When symptoms are severe and unrelieved by conservative treatment (10 per cent of our patients), decompression laminectomy and excision of the medial portion of the articular processes affords relief of pain. The predisposing factor is a straight, stable lumbosacral joint which puts abnormal stress on the intervertebral joint between the fourth and fifth lumbar vertebrae, leading to decompensation of disc and ligaments, hypermobility, and degeneration of the articular processes allowing forward slipping.

Ulnar variance in Kienböck's disease.

Abstract: The distal extent of the radius and ulna (ulnar variance) was compared on roentgenograms of normal wrists in randomly selected black and white patients and of fifteen affected wrists in patients with Kienbock's disease. The results establish a statistically significant association between negative ulnar variance and Kienbock's disease. Blacks have more positive ulnar variance and the disease is less likely to develop in them than in whites.

A characterization of polymethylmethacrylate bone cement.

Abstract: Polymethylmethacrylate cement is characterized in terms of chemical composition, handling characteristics, and physical properties; the dough time, setting time, handling time, and temperature rise were found to be most affected by environmental temperature and kneading of the dough mass. As the set material ages, the residual monomer content gradually decreases and the strength increases. A volume shrinkage of up to 5 per cent was observed. The porosity, which is increased by rapid mixing, may reach 10 per cent. The mechanical properties of the cement approximate those of polymethylmethacrylate denture base material. Some variability encountered in the handling qualities of the cement could be attributed only to the variability of different batches.

Traumatic dislocation of the knee joint.

Abstract: The results in thirty-three of fifty-three traumatic dislocations of the knee followed for more than one year confirmed our conclusion, made in 1971, that early repair of all torn ligaments gives the best results, and that the vascular status following this injury must be observed carefully since vascular repair or thrombectomy within eight hours of injury gives the best chance of preventing gangrene of the leg. The twenty associated fractures in these thirty-three patients were treated successfully with conventional methods, except for three displaced fractures of the medial tibial plateau in which closed reduction failed and internal fixation was required.

Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome.

Abstract: Pre-injection psychological test scores, surgeon ratings, and patient biographical data were evaluated as predictors of success of chymopapain injection therapy in 130 patients who would otherwise have been treated by laminectomy. Three psychological tests were administered to each patient: the Minnesota Multiphasic Personality Inventory, the Cornell Medical Index, and the Quick Test (a measure of mental ability). In addition, the surgeons rated their patients on a five-point scale immediately after injection relative to their suitability for injection therapy and at one year relative to the objective and symptomatic results. The MMPI hysteria and hypochondriasis scales and the surgeon's rating of the psychogenic component of the patient's pain were predictive of the result of chemonucleolysis. The patient's biographical data which consisted of age, sex, marital status, occupation, and education were not related to postoperative outcome.

Scoliosis: A prospective epidemiological study.

Abstract: A two and a half-year prospective study was carried out to determine incidence rates and distributions of various parameters associated with idiopathic scoliosis. Data were also collected on the progression curves detected at the initial screening. The results showed: (1) that the incidence rate was 13.6 per cent with a female-to-male ratio of 1.2:1, (2) that the most common type of curve was thoracolumbar, and (3) that spontaneous improvement occurred in approximately 22 per cent of those patients followed for an average of one year.

Plantar fasciitis. The painful heel syndrome.

Abstract: Of 116 patients with pain in the plantar portion of the heel, nineteen proved on follow-up to have systemic disease as the etiology. Of these treated with phenylbutazone, 71 per cent showed good results and a similar percentage benefited equally from injections of cortisone derivatives. Only two patients required surgical procedures, and these were successful in both.

Water content and binding in normal and osteoarthritic human cartilage.

Abstract: Water binding in normal and osteoarthritic cartilage slices from human femoral heads was studied using tritiated water to measure the water binding after short exposure, total water content, and avidity with which water is held. In osteoarthritic cartilage, compared with normal cartilage, there was no increase in water binding but water content increased by 9 per cent and the avidity with which the newly bound water was held also increased. These findings were almost exactly duplicated by partial extraction of the proteoglycan from normal tissues with 4 molar guanidinium hydrochloride.

Benign osteoblastoma: range of manifestations.

Abstract: A study of twenty-five new cases of osteoblastoma and a review of 172 previously reported cases demonstrated the wide spectrum of manifestations of the lesion. The ratio of males to females was 2:1, with 80 per cent of the patients being under thirty years of age. The duration of complaints prior to diagnosis averaged seventeen months. The majority of the lesions were found in the spine or major long bones of the lower extremity. When complete excision of the tumor was done a cure always was the result, but incomplete curettage also affected a cure in some cases. Three cases presented in detail emphasize the wide variation in biological behavior which this lesion may exhibit. Histological characteristics of aneurysmal bone cyst may frequently appear in the tumor tissue. Radiotherapy does not alter the course of the disease and appears to be contraindicated.

Pins and plaster treatment of comminuted fractures of the distal end of the radius

Abstract: The technique used in the treatment of seventy-five patients with severely comminuted, often intra-articular fractures near the wrist was as follows- Pins were inserted through the metacarpals and proximal part of the ulna, reduction was done, and the pins were incorporated in a cast from elbow to knuckles. This allowed movement of the fingers and the elbow. The main complications - loss of radial length and pintract infection - are avoided by attention to technical details. Of the patients with adequate follow-up, 86 per cent had good or excellent results.

Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap.

Abstract: A method is described that achieves end-to-end anastomosis of ruptures of the Achilles tendon. A sliding tendinous flap is developed over the proximal portion of the tendon by making an inverted V incision which is then repaired in a Y fashion. The procedure is recommended for patients with neglected ruptures of the Achilles tendon in which end-to-end anastomosis is otherwise impossible.

The immunogenicity of fresh and frozen allogeneic bone.

Abstract: Both fresh and frozen allogeneic bone elicit both acellular and humoral immune response. This response includes the development of enhancing factors which block detectable immunity and probably protect the graft from rejection. There seems to be no evidence of an alteration in immunogenicity by freezing of the graft. The importance of these observations lies in the potential technique of employing fresh viable allografts; prior freezing and tissue matching for HL-A transplantation antigens should not be necessary.

Femoral fractures in conjunction with total hip replacement.

Abstract: We reviewed thirty-eight cases, in thirty-six patients, of fracture of the femur distal to the base of the neck incurred in conjunction with total hip replacement. There were thirteen preoperative, eighteen intraoperative, and seven postoperative fractures. The cases were contributed by thirteen surgeons. We found that the preoperative fractures with pre-existing disease in the hip joint were effectively treated by primary total hip replacement using custom-made femoral components with long necks or long stems, or both. The intraoperative femoral fractures usually occurred while the surgeon was reaming the canal, seating the femoral component, or manipulating the femur in patients who were predisposed to fracture. Theoretically these lesions can be treated like preoperative fractures, but this demands immediate access to custom-made femoral components with long necks or long stems, or both, along with an appreciation of the extent and significance of the fracture. Inadequate fixation was found to lead to painful non-union or late loosening of the femoral component in four of eighteen patients. Postoperative fractures occurred too rarely for us to draw any definite conclusions about management, except to say that surgical treatment can be hazardous and traction has been successful in this series and in other reports. Prophylactic measures, however, may help to prevent postoperative femoral fractures. Most of these fractures occur through a cortical defect near the tip of the femoral component. A long-stem femoral component may help to prevent postoperative fractures whenever a proximal cortical defect of the femur is present preoperatively or is created at surgery.

Ewing's sarcoma. A clinicopathological and statistical analysis of patients surviving five years or longer.

Abstract: Of 229 patients with primary Ewing's sarcoma of bone, thirty-seven survived five years or longer. When the patients who survived five years or longer were compared with the 192 who did not, two factors associated with longer survival were identified in this retrospective study: location of the primary tumor within an extremity and inclusion of surgery as part of the initial treatment. The probability of five-year survival for all 229 patients with primary Ewing's sarcoma was 16 per cent. For those seen since 1950, this probability was 18 per cent, and for patients without metastasis, it was 22 per cent.

Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle.

Abstract: The Insall-Salvati method of assessing the position of the patella was applied to four groups of patients:normal patients, and those with dislocation of the patella, chondromalacia of the patella, and apophysitis of the tibial tubercle. The ratio of patellar length to tendon length was 1.0 in the normal patients, 0.8 in the patients with dislocations, 0.86 in those with chondromalacia, and 1.2 in those with apophysitis of the tibial tubercle. Patella alta may be an important cause of dislocating patella and of chondromalacia patellae. The significance of the patella infera found in the Osgood-Schlatter lesion may be one of either cause or effect.

Osteoid-osteoma: diagnostic problems.

Abstract: The clinical records and roentgenograms of fifty-four patients had the typical features of osteoid-osteoma, but no histological evidence of a nidus was found at initial surgery. The symptoms of thirty-one patients were relieved by initial operation and those of twenty-three were not. In two cases, Brodie's abscess was identified in the surgical specimen. A second operation in eighteen patients brought relief in thirteen, and a nidus was found histologically in seven of these patients. A parosteal osteogenic sarcoma was found in one of the patients who had no relief of symptoms. Three patients underwent a third operation and were relieved of symptoms, a nidus being found in two. Thus, symptoms were relieved in thirty-six of forty-two patients in whom no nidus or other pathological entity was found, indicating the significance of this symptomatic sclerotic osseous lesion.