Delayed sciatic nerve compression following hamstring injury.

A 47-year-old man presented three months post-hamstring injury with posterior thigh and buttock pain, paraesthesia over the lateral part of the leg and dorsum of the foot and a foot drop. MRI identified a hamstring muscle injury with a lesion surrounding 20 cm of the proximal sciatic nerve consistent with an extensive haematoma. Surgical debridement and release was planned; however, his signs spontaneously resolved with rest, physiotherapy and splintage prior to surgery. There have been no other reports of a sciatic nerve lesion with neurological signs resolving without surgical exploration.

A review of atypical subtrochanteric femoral fractures in Northern Ireland between 2010 and 2014.

The term atypical femoral fractures most commonly occur in the subtrochanteric area. Concerns exist regarding the role of bisphosphonate treatment in their aetiology. Which surgical intervention provides the best outcome remains contentious. We reviewed all atypical subtrochanteric femoral fractures treated in Northern Ireland over 5 years, specifically investigating incidence, prodromal symptoms, association with bisphosphonates and optimal fixation methods. All subtrochanteric fractures treated in the region were identified and reviewed for atypical features. Case notes and imaging were then reviewed for each patient. A total of 364 subtrochanteric femoral fractures were identified during the 5-year study period. Twenty-six of these met the criteria for an atypical fracture (7%). Thirteen patients (50%) had presented with prodromal symptoms prior to complete fracture, six of which had radiological evidence of an incomplete fracture of the lateral cortex. Thirteen patients had a history of bisphosphonate treatment. All were treated operatively, with twenty-five cephalomedullary nails and one dynamic hip screw. Twenty-one patients had follow-up for greater than 2 months, nine of which (42.9%) achieved radiological union with a mean time to union of 297 days. Dynamically locked nails had a higher union rate than statically locked (80% versus 33.3%). Four patients required major revision surgery (15.4%). The quality of reduction was statistically significant in predicting need for revision. Atypical fractures often present with prodromal symptoms. Complete fractures are difficult to successfully manage with longer than expected times to union. Treatment with a dynamically locked, cephalomedullary with a good reduction provided the best results.

The changing face of fractures of the hip in Northern Ireland: a 15-year review.

AIMS: We reviewed all patients who sustained a fracture of the hip and were treated in Northern Ireland over a period of 15 years to identify trends in incidence, the demographics of the patients, the rates of mortality, the configuration of the fracture and the choice of implant. PATIENTS AND METHODS: Since 01 January 2001 data about every fracture of the hip sustained in an adult have been collected centrally in Northern Ireland. All adults with such a fracture between 2000 and 2015 were included in the study. Temporal changes in their demographics, the mode of treatment, and outcomes including mortality were analysed. RESULTS: The incidence of fractures of the hip, in Northern Ireland, rose from 54 in 100 000 in 2000 to 86 in 100 000 in 2015. If these trends continue, we predict this rising to 128 in 100 000 in 2030. We found that these patients are becoming older and increasingly frail, as assessed by the American Association of Anesthesiology grade. Complex extracapsular fractures have become more common since 2009, which may explain the increased use of cephalomedullary nails. Despite increasing frailty, the 30-day and 12-month rates of mortality fell significantly (p = 0.002 and 0.001, respectively). CONCLUSION: Fractures of the hip are becoming more common and more complex in an aging, increasingly frail population. We expect these trends to continue. This will place an increasing economic and clinical strain on healthcare systems. Forward planning is essential to put systems in place that can deal with the increasing demand. Cite this article: Bone Joint J 2017;99-B:1223-31.

Baumann's confusing legacy.

Dr Ernst Baumann has been credited with describing an angle that can be measured from radiographs taken of children's elbows. This article presents three variations in the definition of this angle that we found in the orthopaedic literature. Variation I is the angle between the long axis of the humerus and a line through the physis of the lateral condyle of the distal humerus. Variation II is the angle between the perpendicular to the long axis of the humerus and a line through the physis of the lateral condyle. Variation III is the angle between the line through the physis of the lateral condyle and a line connecting a point on the edge of the trochlea to a point at the lateral limit of the physis of the lateral condyle. By reading translations of two of Baumann's own articles, we have realised that he used variation I when assessing the radiographs. He did, however, believe that the reciprocal angle, variation II equalled the carrying angle of the elbow and this can be demonstrated by Fig. 1, which has been taken from an article that was published in 1929. The relationship between this angle and the carrying angle has since been proven to be more complex than Baumann believed. We recommend that a descriptive term such as the 'shaft-physeal' angle would cause less confusion and variation in the definition of this angle.

Phenotype of CF and the effects of possible modifier genes.

Cystic fibrosis is an inherited multi-system disease, characterised by progressive lung disease and pancreatic insufficiency that is classically attributed to the dysfunction of a single gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). The widely diverse phenotypic expression of CF is likely influenced by other genetic traits separate from the CFTR locus or modifier genes. Many of the genes currently under study as potential modifiers of CF, particularly those which influence the severity of lung disease, are involved in the control of infection, immunity and inflammation. Some of these include HLA class II antigens, mannose-binding lectin, alpha(1)-antitrypsin and alpha(1)-antichymotrypsin, glutathione-S-transferase, nitric oxide synthase type I, TNF-alpha, TGF-beta, IL-1beta and IL-1Ra.

Production of interferon by alveolar macrophages.

Acton, Jean D. (Bowman Gray School of Medicine, Winston-Salem, N.C.), and Quentin N. Myrvik. Production of interferon by alveolar macrophages. J. Bacteriol. 91:2300-2304. 1966.-Rabbit alveolar macrophages inoculated with parainfluenza-3 virus in vitro produce a viral inhibitor which possesses the properties of interferon. The interferon is nondialyzable, is stable at pH 4, is not sedimented at 100,000 x g, exhibits species specificity, and can passively protect other alveolar macrophages from infection with virulent rabbitpox virus. The possible significance of alveolar macrophage-produced interferon is discussed.

Effect of interferon on polymerization of single-stranded and double-stranded mengovirus ribonucleic acid.

Gordon, Irving (University of Southern California, Los Angeles), Sara S. Chenault, Douglas Stevenson, and Jean D. Acton. Effect of interferon on polymerization of single-stranded and double-stranded mengovirus ribonucleic acid. J. Bacteriol. 91:1230-1238. 1966.-The effect of interferon on actinomycin-resistant mengovirus ribonucleic acid (RNA) replication in L cells was investigated to determine whether defective or partially polymerized RNA products were made and whether synthesis of any specific class of virus RNA was prevented. RNA labeled with uridine-C(14) was extracted in hot and cold phenol and analyzed by zonal sucrose density centrifugation. Both single- and double-stranded infectious RNA peaks were identified. Interferon treatment caused almost complete depression of uridine-C(14) incorporation throughout linear sucrose gradients except in the 4S region, and no infectivity was detectable in any fraction. These inhibitory effects are attributable to the action of interferon, because they were reversed when cultures were treated with actinomycin D simultaneously with interferon. The results, with those of other investigators, indicate that the step at which interferon interrupts virus multiplication is between the events immediately after uncoating and the formation of template "minus" strands; under the conditions of our experiments, no partially polymerized virus RNA products were made.