An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures.

We use a braided polyester suture in place of cerclage wire in tension band fixations. The objective of this study was to test the biomechanical properties of this technique. Sixteen cadaveric patellae were fractured and repaired by modified tension band fixation. Eight were fixed using eighteen gauge stainless steel wire as a tension band and eight using braided polyester. All specimens were subjected to tensile testing. Polyester was 75.0% as strong as wire. For dynamic testing, the patellae of seven cadaveric knees were fractured and then fixed with polyester tension bands. These were mounted in a device capable of extending the knees from 90 degrees to neutral against an applied force. None of the fixations failed. Three of the specimens fixed using 18 gauge stainless steel wire were compared with three fixed using polyester over 2000 cycles of knee flexion and extension. Polyester performed as well as wire. We conclude that polyester is an acceptable alternative to wire in tension band fixation.

Damage to the superior gluteal nerve after the Hardinge approach to the hip.

We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified Trendelenburg test. Power was measured using a force plate. We performed assessment at two weeks, and at three and nine months after operation. At two weeks we found that 19 patients (23%) showed evidence of damage to the superior gluteal nerve. By three months, five of these had recovered. The nine patients with complete denervation at three months showed no signs of recovery when reassessed at nine months. Persistent damage to the nerve was associated with a positive Trendelenburg test.

Proprioception in the cruciate deficient knee.

Proprioception was measured in the knees of 20 subjects with instability of the anterior cruciate ligament and compared with 17 age-matched control subjects. There was diminished position sense and threshold for movement detection in the injured patients compared with the control group. The proprioceptive deficit recorded from the injured knee showed a significant correlation with the hamstring/quadriceps power ratio recorded from the injured leg.

Percutaneous screw fixation of tibial plateau fractures.

A series of 13 patients with displaced fractures of the tibial plateau treated by closed reduction and percutaneous pinning have been reviewed 17 months after surgery. All the operations were performed using image intensification to aid reduction of the fracture by ligamentotaxis and to guide screw placement. In two cases, arthroscopy was used in addition to facilitate elevation of the articular surface using a probe inserted through a cortical window in the proximal tibial metaphysis. The postoperative rehabilitation programme consisted of early mobilization and non-weight bearing for at least 2 months. Of the patients, 11 had a satisfactory result, one patient had a fair result with persistent pain and the other had a poor result when the fixation failed in a comminuted bicondylar fracture in porotic bone. This technique is minimally invasive and avoids many of the complications of both conservative and operative treatment and will have an expanding role to play in the management of these fractures.

Vertebral osteomyelitis caused by fusobacterium nucleatum: a case report.

A 58-year-old man with a history of chronic alcohol abuse presented with vertebral osteomyelitis caused by Fusobacterium nucleatum. This case demonstrated the foul smelling abscess characteristic of anaerobic infection. Deep anaerobic infections are well known to be resistant to closed treatment, and the computerized tomographic scan confirmed the diagnosis of a paravertebral abscess in this case. An increased awareness among clinicians that anaerobic bacilli can cause oteomyelitis, together with more sophisticated culture techniques, will greatly aid the management of this virulent form of osteomyelitis.

Sarcoidosis presenting as a wrist tumour.

A forty-year-old male with a painless, indurated mass on the volar surface of the wrist, was proved to have Boeck's Sarcoid. The surgery and pathology of the mass is described and the literature reviewed.

Hemihypertrophy of lower extremity associated with multifocal intraosseous hemangioma.

This is a case report of a child with hemangioma of the bones of the lower extremities. The evolution of the disease in several bones, during the period between infancy and maturity, and serial growth studies of the extremities and differences in length of bones reveals that in some cases the involved bone grew longer than its fellow, whereas in others it grew shorter. Histological examination of an epiphyseal plate demonstrates that hemangioma grew on either side of the plate.

Blood glucose variations and clinical experience with glibenclamide in diabetes mellitus.

Thirty patients were treated with glibenclamide for periods up to 16 months. The drug is a potent hypoglycaemic agent, and taken in a single daily dose controls blood glucose levels over a 24-hour period in maturity onset diabetes. A definite dose-effect relationship exists, and the drug may be used in doses of 5 to 20 mg. daily. There were no appreciable side-effects or toxic effects during the period of study.