Search

We report a consecutive series of 131 total hip arthroplasties using a prosthesis of Brunswik type and a posterior approach to the hip. Special attention is paid to technical details, postoperative course and early complications. The results are compared with those in published studies in which the lateral transtrochanteric approach has been used. Total hip replacement was performed by a team of four persons. This led to a marked decrease in the average operating time (60 minutes). The amount of blood transfused during and after the operation averaged 761 g. The postoperative course was complicated by one wound infection (0.8%). The immediate results regarding pain and walking capacity were good in 83% of the cases. The use of the posterior approach and a highly trained operating team reduced the time required for the operation, the blood loss and the frequency of postoperative complications, and caused less morbidity in the arthritic patients.

Experimental osteotomies were made in 35 rabbit tibiofibular bones and fixed with rigid stainless steel osteosynthesis plates (DCP/ASIF). The radiographic and histopathologic appearances in the healing osteotomies and adjacent bone were analysed at intervals from 3 up to 24 weeks postoperatively. Radiologically the osteotomy had closed at 9 weeks and microscopically this could be confirmed as longitudinal orientation of the cutter heads across the osteotomy gap with longitudinal orientation of the bone structure. The healing of the osteotomy was accompanied by gross structural changes in the adjacent cortical bone with loss of intracortical and subendosteal osteons, cementing lines and intermediate tissue between the osteons. This was characterized by decreasing attenuation of the cortical bone after healing of the osteotomy and should clinically be regarded as an indication for removal of the implant.

Results after the operative treatment of 39 total (Type III) acromioclavicular (AC) dislocations are reported. The operation consisted of suture of the acromioclavicular and coracoclavicular ligaments and transfixion of the AC joint with an AO/ASIF malleolar screw passed through the acromion into the lateral end of the clavicle. The screw was removed at an average of six weeks after the operation. In 36 patients re-examined after a mean of 4 years, the overall results were good in 92 per cent of cases. The range of flexion and abduction was excellent (over 170 degrees) in 90 per cent. Stress radiographs revealed persisting subluxation of the AC joint in 6 patients and persisting dislocation in 1. Signs of osteoarthrosis were seen in 4 patients and signs of osteolysis in 12. Radiological signs of osteolysis correlated well with incongruity of the AC joint but not with the clinical function. Radiological signs of osteoarthrosis in the AC joint, however, correlated with a poor clinical result: all patients with a fair or poor clinical result had signs of osteoarthrosis in the AC joint. Except for one, all patients returned to their preoperative occupations within an average of two months.

The presence of the connective tissue components fibronectin and collagen types I and III have been demonstrated by immunohistological methods after reconstruction of the anterior cruciate ligament of pigs with carbon fibre. The carbon fibre ligament prosthesis was covered with pediculated fascia lata. During the initial 16-week period, fibronectin was seen both in the surrounding fascial layer and between the carbon fibres of the substitute. Type III collagen was also found, especially in the fascial layer, but collagen was absent from the carbon fibre prosthesis and was seen only in the fascial layer. Results indicate that the tissue in the 'neoligament' after carbon fibre reconstruction consists mostly of granulation tissue with a high amount of fibronectin, and type III collagen from mesenchymal cells without sufficient amount of type I collagen with tensile strength to withstand subsequent mobilization and rehabilitation.

Transverse osteotomies of the midshaft of the tibia in 75 rabbits were stabilized with intramedullary nails which prevented rotational instability. In a further 36 animals intramedullary nailing was performed without preceding osteotomy. The animals were able to move freely immediately after the operation without any supporting case or splint. The structural changes in the bones were analysed radiographically 3 to 24 weeks after the operation. Fracture repair was accompanied by moderate periosteal callus formation and remodelling of the callus was seen from 9 weeks on. A sleeve of new endosteal bone surrounding the nail was found after 12 weeks. Porotic transformation of the diaphyseal cortical bone was seen in both osteotomized and non-osteotomized bones from 12 weeks onwards. It is concluded that intramedullary nailing provides favourable conditions for fracture repair and enables accurate radiographic assessment of the healing. Attention is focused on the causes and features of secondary porotic transformation of the cortical bone after intramedullary nailing.

The purpose of this study was to analyze arthrographic imaging of the structures of the shoulder joint when using either sodium meglumine metrizoate or iopamidol as a contrast medium. Two hundred and ten patients underwent single-contrast shoulder arthrography. In patients with a full-thickness tear of the rotator cuff, both contrast agents reliably revealed this lesion. However, in patients with a full-thickness rotator cuff tear, the biceps tendon could be demonstrated more readily with iopamidol, which is a non-ionic contrast medium.

The injuries seen in 200 Afghan war wounded in the International Committee of the Red Cross (ICRC) hospital in Quetta are reported. Evacuation took several days and no proper initial first aid was available. Therefore few of those reaching us had serious multiple injuries. The anatomic distribution of wounds was remarkably similar to that seen in other conflicts: 38% of the injuries were caused by bullets, 50% by fragmentation weapons, and 10% by mines. Two thirds of the patients had limb injuries. Of all wounded, patients with fractures of long bones needed the greatest number of repeated operations and the longest hospitalization time. Twenty-five patients had abdominal or perineal wounds and 12 needed laparotomy. Of 25 with head injuries 14 had penetrating brain trauma. Thoracic, vascular, and burn injuries were rare. The eight patients with spinal cord injury could fortunately be referred to the ICRC rehabilitation center in Peshawar within a week. Wound sepsis was the major problem due to the extraordinarly long delay in the initiation of treatment. In spite of the often grossly infected wounds, radical debridement usually led to good recovery for most patients, with a hospital mortality rate of only 2.5%.

The purpose of the present study was to compare ultrasonographic signs with macroscopic and histological findings in lesions of the rotator cuff and the biceps tendon. Twenty-six shoulder joints from 10 male and 3 female cadavers, ranging in age from 40 to 89 years (mean 65.9), were examined with a linear array real-time ultrasonographic scanner provided with a 7.5 MHz transducer. Arthrotomy and histological preparations were made after ultrasonography. Thinning and discontinuity of echogenic homogenicity of the tendons of the rotator cuff were the most reliable ultrasonographic signs of a total tear of the tendon, but focal hyper- and hypo-echogenic changes of the tendons of the rotator cuff were unreliable criteria. Partial tears of the rotator cuff were difficult to determine with static ultrasonograms. Ultrasonography readily revealed discontinuity of echogenic homogenicity of the biceps tendon as a sign of a rupture of the tendon, which was commonly associated with rotator cuff tears.

Lesions of the biceps tendon have been studied with plain radiographs and arthrograms of the intertubercular groove. Sometimes, however, especially when the rotator cuff has a full-thickness tear anteriorly, the sheath of the biceps tendon fails to fill with contrast medium, thus preventing diagnosis of dislocation of the tendon. To solve this problem the authors have tried sonography of the biceps tendon. The suitability of sonography for examining the intertubercular groove and the biceps tendon was assessed in ten volunteers. Thirty patients with chronic shoulder pain were subsequently studied by radiography, arthrography, and sonography. The observations made with these examinations were compared, and in 21 of the patients who were treated by operation with the surgical observations as well. Sonography seemed to provide accurate information about the configuration of the intertubercular groove and the position of the biceps tendon. The technique could be used to show dislocation of the tendon in cases in which the tendon sheath is not visualized in arthrography. Tenderness and the site of this in relation to the anterior upper end of the humerus could also be verified with sonography.

Thirty-eight patients had a Neer II replacement for rheumatoid arthritis of the shoulder. The average age at operation varied from 23 to 68 years. The average follow-up was 20.9 months. Forty shoulders were free of pain and function was reasonable in 21. Overall evaluation showed an excellent or satisfactory result in 15, 16, were acceptable and 10 poor. The most frequent radiological finding was upward subluxation which was present in 20 shoulders. An incomplete radiolucent zone was found around the glenoid component in 32% and around the humeral in 5%; there was no gross loosening.

During a follow-up period of 16 weeks in 18 pigs, macroscopical and histological studies revealed invasion of fibroblasts and mesenchymal cells around the carbon fiber prosthesis inserted to replace the ACL but scarce tissue ingrowth into the prosthesis proper. There was no adherence of the carbon ligament onto the bony channels. The peak tensile strength of the reconstructed ligament was about one third of the paired normal ACL ligament during the 16 week experiment.

The initial treatment of complicated fractures several days old when first seen in Afghan war wounded is reported for 52 limbs in 47 patients. External fixation was the method of choice for stabilizing fractures in adults. In children, traction and plaster-of-Paris were preferred. In 30 cases (58 per cent) tissue damage was classified as moderate. With radical wound toilet and delayed closure, infection could be controlled in most of these limbs. In 15 fractures (29 per cent) there was severe laceration and exposure of bone. After operation, deep infection persisted in three-quarters of these cases and the fate of these limbs often seemed doubtful. The patients usually refused amputation. However, of seven limbs (13 per cent) in which the fracture was associated with an arterial injury, only one could be saved. The brief period of observation of only 11 weeks does not permit assessment of time to healing, frequency of late osteitis or definitive amputation rate. It seems, however, that in spite of the lack of any proper first aid for these severe injuries, a functional limb could be salvaged in over two-thirds of the cases, even with our modest resources.