Femoral head intramedullary stemmed implant. A historical prospective.

A historical review reveals that McBride may have been the first to use a femoral head intramedullary stemmed hip implant. It had a threaded stem and limited use. Eicher may have been the first to develop and use the smooth intramedullary stemmed femoral implant with a calcar collar, which was the forerunner of implants used today. Moore subsequently developed the self-locking intramedullary stemmed femoral implant with a calcar collar. Shortly thereafter, Thompson introduced a similar prosthesis. These four surgeons pioneered the development of the intramedullary stemmed femoral head prosthesis, which has been a key contribution to modern hip reconstruction.

Bateman bipolar hip arthroplasty for femoral neck fractures. A five- to ten-year follow-up study.

Displaced femoral neck fractures in 128 patients were treated with cemented Bateman universal proximal femoral bipolar hemiarthroplasties. The follow-up period ranged from five to ten years. In the surviving 49 cases, the average follow-up period was seven years and five months. Seventy-nine percent of surviving patients had no or slight pain after their primary procedure. None of these patients developed acetabular protrusio. Ten percent of the survivors required late revision; 88% of the unrevised hips had no or slight pain. When compared with studies of noncemented Moore and Thompson fixed-head prostheses, the cemented Bateman bipolar prosthesis had decreased protrusio and less pain.

The management of paralytic spasticity.

The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity.

Bateman bipolar hip arthroplasty. A review of 44 cases.

A consecutive series of 71 Bateman hemiarthroplasties were performed in a single hospital over a 20-month period. Forty-four hips or 62% were available for review with an average follow up of 22 months. Of the 44 cases, the Bateman Universal Proximal Femur, original design was used in 40 acute, displaced femoral neck fractures, two failed Austin Moore prostheses, and two cases of femoral head osteonecrosis unassociated with fracture. The mean Harris hip score was 84.7%. Of the patients 93.2% had minimal or no pain. The range of motion was excellent and the dislocation rate was 1.8%. Morbidity was not increased compared to more conventional unipolar implant procedures. The Bateman Universal Proximal Femur (UPF) is felt to offer improved surgical results compared to Austin Moore and Thompson prostheses, and this may be due to the low friction inner bearing motion that occurs with this bipolar implant.

Forces in the metacarpophalangeal joint due to elevated fluid pressure--analysis, measurements and relevance to ulnar drift.

The mechanics of the metacarpophalangeal joint are analyzed, with a view to understanding why the finger moves in the direction of ulnar drift when the intra-articular pressure in the joint is increased. The first step is the in situ measurement of stiffness of the various tissues surrounding the joint, and the data show that (a) the two collateral ligaments are the major component and (b) the ulnar ligament is the stiffer. This latter result, combined with finding the centre of pressure at the base of the phalanx, reveals how increased intra-articular pressure produces ulnar deviation. Flexion, the other component of ulnar drift, is produced because of the volar side attachment of the ligaments. The mechanics are evaluated quantitatively by the measurement of forces at the finger tip for various pressures; the data agree reasonably well with predictions using the measured joint properties in a simplified mechanical model of the joint.

Ganglion migrans of the proximal tibiofibular joint causing lesions in the subcutaneous tissue, muscle, bone, or peroneal nerve: report of three cases and review of the literature.

Three cases illustrate the variety of ways a ganglion may arise from the tibiofibular joint. In one case, the diagnosis was initially obscure because the swelling occurred under the muscles of the lateral compartment of the lower leg; the lesion was also intraosseous and extended into a tendon. In the second case, the ganglion had invaded the peroneal nerve, and in the third, the ganglion was a palpable subcutaneous tumor.

Intra-articular pressure as a factor in initiating ulnar drift.

To determine the possible relevance of intra-articular pressure in the production of ulnar drift, metacarpophalangeal joints of fresh cadaver specimens were injected with water to increase the intra-articular pressure. Of the thirty-two joints tested, ulnar deviation was produced in twenty-three, flexion in twenty-four, and simultaneous ulnar deviation and flexion (ulnar drift) in nineteen. In two or three instances, the displacement was in extension or radial deviation. These results suggest that elevated intra-articular pressure may be a factor in the initiation of ulnar drift in patients with rheumatoid arthritis.