Magnetic resonance evaluation of idiopathic scoliosis: a prospective study.

The objective of the present study was to determine the incidence of unsuspected intraspinal pathology and to assess the value of atypical clinical features as predictors of these intraspinal pathologies, in patients with idiopathic scoliosis. Twenty-five consecutive patients (13 boys, 12 girls) with idiopathic scoliosis were prospectively evaluated with MRI. Magnetic resonance imaging detected intraspinal pathology in seven patients (28%), which included syringohydromyelia with Chiari I malformation (n = 5), and syringomyelia and dumb-bell neurofibromas in one patient each, respectively. Dural ectasia was also present in five patients. Atypical features, described in the literature as pointers to intraspinal pathologies such as the age < 11 years at presentation, presence of pain, hyperkyphosis, severe curves and the presence of the left thoracic or thoracolumbar curves, were seen to be equally distributed between the two groups (those with and without intraspinal pathologies), thus raising doubts about the importance of these features.

Interplay of matrices in cartilage synovial fluid combine under moderate & high loadings.

Interplay of the constituents of the articular cartilage synovial fluid combine and its role was examined through the biochemical and rheological studies on bovine joints. The results showed an inverse relationship between the changes in the hyaluronic acid of synovial fluid and the proteoglycans content in articular cartilage together with alterations in the rheological properties of synovial fluid. The study indicated that the inter-movement of fluid solutes across the cartilage and synovial fluid may have an important role in the pathophysiology of osteoarthritis.

Classification and treatment of volar Barton fractures.

Results of treatment in 78 patients with volar Barton's fractures have been analysed. On radiological assessment these fractures were divided into three distinct categories and this classification is related to the results of closed manipulation. Results are best when this fracture is treated with open reduction and internal fixation. In non-operatively treated cases results are much better if the articular step is less than 2 mm.

Primary pyogenic abscess of the psoas muscle.

Nine children who were less than nine years old and had a primary pyogenic abscess of the psoas muscle were treated in a five-year period. This rare lesion often simulated septic arthritis of the hip. Ultrasonography was found to be the most reliable and easily performed diagnostic study. Because of the rarity of the lesion, the diagnosis requires a high index of suspicion. The best treatment is early operative drainage and administration of systemic antibiotics.

High valgus tibial osteotomy for osteoarthritis of the knee.

We report a statistical analysis of the results of 65 tibial osteotomies for primary osteoarthritis of the knee followed up at 3 and 5 years. Preoperative walking ability and the severity of pain are the factors with which the long term prognosis can best be correlated. The preoperative range of motion and mild subluxation become important at 5 years, but these factors were not important at 3 years. Mild instability did not have any influence. The severity of the osteoarthritis in radiographs and the postoperative femoro-tibial angle did not have any important association with the result. The results are therefore best predicted by preoperative pain and activity. The degree of correction did not affect the result.

Temporomandibular joint ankylosis: an Indian experience.

Seventy-five condylectomy and coronoidectomy specimens of temporomandibular joint ankylosis in 61 patients were studied. Fourteen patients had bilateral ankylosis, six of whom had fibrous ankylosis on one side. There were two types of ankyloses: intra-articular and juxta-articular. Intra-articular ankylosis was seen only in reankylosis or in postinfective cases. Sixty-six cases were posttraumatic juxta-articular ankylosis. A rudimentary temporomandibular joint with an atrophic condylar articular surface was found in all juxta-articular ankyloses. The size of new bone in the specimens varied from 0.5 to 3 cm. Fusion of the extra-articular bone mass with tympanic plate was also observed. Contracture of temporalis muscle was noted in all the cases, which made excision of the coronoid processes mandatory in all the arthroplasties. Arthroplasty early in childhood did not hamper growth; instead, facial remodeling was enhanced.

Value of osteomedullography in the early diagnosis of non-union in tibial diaphyseal fractures.

Osteomedullography was performed in 17 diaphyseal fractures of the tibia at ten to 12 weeks from injury to assess the reliability and sensitivity of the procedure in predicting non-union. It was found to be accurate in more than 80% of cases in predicting the ultimate outcome early in the course of fracture healing.

Open reduction and internal fixation of displaced supracondylar fractures of the humerus.

The results of open reduction and internal fixation were analysed in 200 displaced supracondylar fractures of the humerus in children. Overall, excellent results were obtained in 65% of cases, good in 15% and unsatisfactory in 20%. Delay in surgery was found to lead to unsatisfactory results. The operation was performed within 48 hours of injury in 140 cases and gave an excellent result in 120 cases, whereas delayed surgery, in 60 cases, gave an excellent result in only 10 cases. Open reduction provides an accurate, stable reduction, is easy to perform and has been found to give consistently good results.

Effect of high tibial osteotomy on upper tibial venous drainage: study by intraosseous phlebography in primary osteoarthritis of knee joint.

The effect of high tibial osteotomy on the upper tibial venous pattern in primary painful osteoarthritis of the knee joint was studied by preoperative and three to six months postoperative intraosseous phlebograms. The normal phlebographic pattern was established by phlebograms in five patients with normal knees. The preoperative engorgement, tortuosity of the medullary sinusoids, and slow dye clearance showed a remarkable conversion to a near normal appearance after the operation. Rest pain disappeared in all patients after the osteotomy, suggesting that venous congestion is the cause of 'rest pain'.

Aneurysmal bone cyst in the metacarpal of a child: a case report.

An unusual case of aneurysmal bone cyst in the metacarpal of a five-year-old girl is described. The lesion was initially diagnosed and treated as a simple bone cyst. Subsequently the affected metacarpal was excised and replaced by an autogenous fibular graft, with good results. A discussion of the pathogenesis of the lesion is given, with a review of the literature.

Circulating levels of sialic acid and glycosaminoglycans: a diagnostic test for ankylosing spondylitis.

The circulating levels of sialic acid (N-acetylneuraminic acid) and glycosaminoglycans (GAGs) were measured in 69 patients with spinal disorders of orthopaedic interest (ankylosing spondylitis 17, osteofluorosis 6, idiopathic backache 10, osteoarthrosis 16, osteoporosis 20). The serum GAG levels showed no statistically significant change from control values in the five disorders investigated in the present study. Although osteoporosis and osteoarthrosis showed a decrease in serum sialic acid (SA) levels, the mean ratio (SA/GAG) demonstrated no change from control values. Idiopathic backache showed no difference in any of the parameters studied when compared with control values. Ankylosing spondylitis and osteofluorosis had a remarkable similarity in their clinical and radiological features, but a divergent mean value of ratio was noted. The mean ratio of both the conditions also showed a statistically significant difference from the control value. This suggests that the SA/GAG ratio can be used as a diagnostic test in ankylosing spondylitis.

Comparative study of knee function after patellectomy and osteosynthesis with a tension band wire following patellar fractures.

In order to assess the relative merits of patellectomy and osteosynthesis with tension band wires in patellar fractures, 66 patients given patellectomy and 30 given tension band wiring for almost identical fractures of the patella have been analysed. Following patellectomy only about half the patients achieved excellent results while after osteosynthesis excellent results were in 80%. We, therefore, recommend that whenever possible patellar fractures should be treated by accurate reduction and tension band wiring. When needed patellectomy should be performed without hesitation as the operation produces a negligible number of poor results, although excellent results will be achieved in only about half the cases.