Subject(s)
Bacterial Infections/prevention & control , Cyanoacrylates/therapeutic use , Surgical Wound Infection/prevention & control , Aged , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Bacterial Infections/mortality , Hospitalization , Humans , Morbidity , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiology , Surgical Wound Infection/mortalityABSTRACT
We present an unusual cause of anterior tibial pain in a 24-year-old professional international football player who was found to have a synostosis of the middle-third of the diaphysis of the tibia and fibula. This is a rarely described phenomenon. Conservative treatment is the recommended treatment of choice, but this failed in our patient. Resection produced resolution of symptoms; he remained symptom-free three years later.
Subject(s)
Fibula/diagnostic imaging , Occupational Diseases/diagnostic imaging , Soccer , Synostosis/diagnostic imaging , Tibia/diagnostic imaging , Adult , Fibula/surgery , Humans , Male , Occupational Diseases/etiology , Occupational Diseases/surgery , Radiography , Stress, Mechanical , Synostosis/etiology , Synostosis/surgery , Tibia/surgeryABSTRACT
A radiological and histological analysis of five knee joints after a minimum of 15 years following the implanting of carbon fibre, which had been used as a treatment for knee instability, was undertaken. All patients underwent total knee replacement for secondary osteoarthritis. Histological analysis demonstrated a variable amount of macroscopically visible carbon particles in the synovium, hyaline cartilage and menisci. At microscopy these particles were found in association with fibrous tissue adjacent to bone with no acute inflammatory changes. No intact carbon fibre ligament was noted within the joint, small portions of the old ligament were covered with a thin fibrous layer but there was no evidence of any structure resembling neo-ligament. Extra articularly the carbon fibre was covered with a thick fibrous sheath with no active inflammation changes inflammation. In the bone tunnels, the carbon fibre-bone interface showed an apposition of the bone to the carbon fibre without any interposing fibrous sheath. Carbon fibre bonds directly with the bone without fibrous interposition.
Subject(s)
Carbon , Joint Instability/surgery , Joint Prosthesis , Knee Joint/surgery , Prostheses and Implants , Anterior Cruciate Ligament/surgery , Arthrography , Arthroplasty, Replacement, Knee , Carbon Fiber , Female , Humans , Knee Joint/diagnostic imaging , Knee Joint/pathology , Longitudinal Studies , Male , Middle Aged , Osteoarthritis/surgeryABSTRACT
The concept than an intact anterior cruciate is needed for normal knee function and that its absence is associated with meniscal damage and hyaline cartilage has become widely accepted. This evidence for this assumption and the suggested effects of surgical reconstruction is presented.
Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries/complications , Anterior Cruciate Ligament/surgery , Disease Progression , Humans , Knee Injuries/surgery , Time Factors , Treatment OutcomeABSTRACT
As part of a waiting list initiative, magnetic resonance imaging (MRI) scans were arranged for 69 patients waiting for knee arthroscopy. All patients had a clinical diagnosis of a meniscal tear. With 11 non-attenders, 58 scans were performed. Of the patients scanned, 35 had demonstrable meniscal tears, and five patients had other pathology on their scans. All patients were reviewed clinically after their scans, and 24 patients were removed from the waiting list. After a further 9 months, only one of the 24 patients removed had been re-listed for therapeutic arthroscopy. This initiative proved a cost-effective method of reducing waiting times for knee arthroscopy.
Subject(s)
Arthroscopy , Knee Joint , Magnetic Resonance Imaging , Tibial Meniscus Injuries , Waiting Lists , Diagnosis, Differential , Humans , Knee Injuries/diagnosis , Male , Menisci, Tibial/pathology , Middle Aged , WalesABSTRACT
OBJECTIVE: To measure the levels of epitope on the chondroitin sulfate (CS) and keratan sulfate (KS) chains of proteoglycan fragments in synovial fluids from injured and contralateral uninjured knees of patients with traumatic cruciate ligament and/or meniscus damage. METHODS: Enzyme-linked immunosorbent assays were used to determine the levels of monoclonal antibody epitopes 3-B-3 and 7-D-4 (CS), and 5-D-4 (KS), in paired joint fluids from the injured and uninjured knees of trauma patients. RESULTS: Levels of the CS epitopes were increased in the trauma joint fluids from most patients, with higher levels of 3-B-3 epitope in 12 of the 16 patients, but the difference did not achieve significance; however, 7-D-4 levels were higher in 15 patients, and the difference was highly significant (P = 0.0005). In contrast, the KS epitope detected by 5-D-4 was decreased in 13 of 15 patients, and the difference was significant (P = 0.0074). CONCLUSION: The increased level of 7-D-4 epitope on proteoglycans in joint fluid from injured knees may reflect the response of the articular cartilage to acute trauma resulting in altered expression of specific CS epitopes on cartilage proteoglycans. The fall in KS epitope levels may reflect the synthesis of proteoglycans that have lower KS content.
Subject(s)
Epitopes/analysis , Glycosaminoglycans/analysis , Knee Injuries/immunology , Synovial Fluid/chemistry , Antibodies, Monoclonal/analysis , Antibodies, Monoclonal/immunology , Cartilage, Articular/chemistry , Cartilage, Articular/metabolism , Cartilage, Articular/pathology , Chondroitin Sulfates/analysis , Chondroitin Sulfates/immunology , Chondroitin Sulfates/metabolism , Enzyme-Linked Immunosorbent Assay , Epitopes/immunology , Epitopes/metabolism , Glycosaminoglycans/immunology , Glycosaminoglycans/metabolism , Humans , Keratan Sulfate/analysis , Keratan Sulfate/immunology , Keratan Sulfate/metabolism , Knee Injuries/pathology , Knee Joint/chemistry , Knee Joint/metabolism , Knee Joint/pathology , Synovial Fluid/metabolismABSTRACT
In order to compare the adequacy of exsanguination produced by Esmarch bandages with that produced by simple elevation for 2 min, a blind randomized prospective trial was undertaken in 50 patients undergoing total knee replacement surgery and 50 patients undergoing knee arthroscopy surgery. The mean blood loss during total knee replacement was significantly greater in the group exsanguinated by elevation (P < 0.01). The haematocrit of samples of the arthroscopy drainage fluid was consistently less than 1%, irrespective of the method of exsanguination used. None of the operating surgeons reported that they considered that either knee replacement surgery or arthroscopic knee surgery had been made any more difficult by the use of elevation as a means of exsanguination. In view of the established risks of using Esmarch bandages, we would suggest that the use of this method of exsanguination in these fields of orthopaedic surgery is not justified.
Subject(s)
Arthroscopy , Bandages , Blood Loss, Surgical/prevention & control , Knee Prosthesis/methods , Manipulation, Orthopedic/instrumentation , Tourniquets , Combined Modality Therapy , Humans , Preoperative Care , Prospective Studies , Single-Blind Method , Treatment OutcomeABSTRACT
We performed arthrodesis of the ankle in eight patients by arthroscopic joint excision and fixation with crossed tibiotalar compression screws. Two patients had rheumatoid arthritis and six had post-traumatic osteoarthritis. None had a serious deformity of the ankle. Clinical ankylosis was achieved in all cases and there was radiological evidence of bone fusion in four.
Subject(s)
Ankle Joint/surgery , Arthritis, Rheumatoid/surgery , Arthrodesis/methods , Osteoarthritis/surgery , Adult , Aged , Arthritis, Rheumatoid/complications , Arthroscopy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis/complications , Pain/etiologyABSTRACT
To define the anatomical relationships of the nerves to the common arthroscopy portals at the elbow an arthroscope was introduced into 20 cadaver elbows and the positions of the nerves were then determined by dissection. In all cases the posterior interosseous nerve lay close to the radiohumeral joint and to the anterolateral portal. Pronation of the forearm displaced the nerve away from the arthroscope. The median nerve passed consistently within 14 mm of the arthroscope when it was introduced through the anteromedial portal. The branches supplying the superficial forearm flexor muscles were at risk.
Subject(s)
Arthroscopy/methods , Elbow Joint , Peripheral Nerve Injuries , Arthroscopy/adverse effects , Elbow Joint/innervation , Humans , Median Nerve/injuries , Radial Nerve/injuriesABSTRACT
A survey of 113 hospitals in the UK was performed to assess current practices regarding skin preparation for surgery. The findings of the survey are presented and where relevant compared with a similar survey conducted in 1983. It was found that, despite scientific evidence supporting change, traditional practices still dominate. This evidence is discussed and, based on this, some changes in practice are suggested.
Subject(s)
Dermatologic Surgical Procedures , Preoperative Care/methods , Humans , Preoperative Care/statistics & numerical data , Surveys and QuestionnairesABSTRACT
A prospective study was undertaken to compare the accuracy of the Lachman test, anterior drawer test and jerk test with the KT1000 knee arthrometer in patients with proven anterior cruciate ligament deficiency. The Lachman and anterior drawer tests were found to be the most accurate indicators of anterior cruciate ligament deficiency. The KT1000 knee arthrometer was found to be totally inaccurate, which precludes its use as an objective measure of anteroposterior laxity of the knee.
Subject(s)
Anterior Cruciate Ligament Injuries , Arthroscopes , Joint Instability/diagnosis , Knee Injuries/diagnosis , Chronic Disease , Humans , Prospective Studies , Range of Motion, ArticularABSTRACT
A prospective study was undertaken to compare the incidence of arthroscope eyepiece misting in two groups of patients. In one group the irrigation fluid was at room temperature and in the other group the fluid was warmed to body temperature. Arthroscope eyepiece misting was eliminated when irrigation fluid at body temperature was used.
Subject(s)
Arthroscopes , Therapeutic Irrigation , Hot Temperature , Humans , LensesABSTRACT
An early radiological sign of anterior cruciate ligament deficiency is described. A retrospective study of the radiographs of 38 patients with chronic anterior cruciate ligament deficiency was performed. In 36 patients from this group an osteophyte was present on the medial femoral condyle adjacent to the medial tibial spine. This was best seen on a 30 degree notch view and was the earliest radiographic sign of chronic anterior cruciate ligament deficiency.
Subject(s)
Anterior Cruciate Ligament Injuries , Joint Instability/diagnostic imaging , Knee Joint/diagnostic imaging , Anterior Cruciate Ligament/diagnostic imaging , Humans , Joint Instability/etiology , Ossification, Heterotopic/diagnostic imaging , Radiography , Retrospective StudiesABSTRACT
A series of 66 patients who have undergone arthroscopy of the knee using three local anesthetic techniques is presented. Over a similar period of time 70 patients had knee arthroscopy performed under general anaesthesia. In the local anaesthetic group the technique was successful in 50 cases, partially successful in 12 cases and totally unsatisfactory in 4 cases. In the general anaesthetic group all the procedures were successful. Local anaesthetic techniques were found to be satisfactory for diagnostic arthroscopy but general anaesthesia was better for operative procedures and was more acceptable to the surgeon and patient.
Subject(s)
Ambulatory Surgical Procedures , Anesthesia, General , Anesthesia, Local , Arthroscopy , Anesthesia, Local/adverse effects , Femoral Nerve , Humans , Knee/surgery , Nerve Block/adverse effects , TourniquetsABSTRACT
A series of cases is described in which sciatic nerve block (by the lateral approach of Guiardini et al., 1985), with or without femoral nerve blockade, proved useful in the manipulation of tibial and ankle fractures without recourse to general anaesthesia. A case is presented in which this approach was the method of choice.
Subject(s)
Ankle Joint/surgery , Nerve Block/methods , Sciatic Nerve , Tibial Fractures/surgery , Adolescent , Adult , Aged , Ankle Injuries , Femoral Nerve , Humans , Lidocaine , Male , Middle AgedABSTRACT
In a retrospective study of patients presenting with symptoms of knee instability, 16 patients were discovered who had developed severe chondromalacia or osteoarthritis of the femoral condyles. All of the patients gave a history of a previous severe knee injury occurring in their teenage years and all had continued to play competitive sport. Ten of the group had subsequent meniscal injuries requiring surgery. In nine of the group previous arthroscopic or open joint procedures had demonstrated normal femoral joint cartilage. There was no difference in the degree of degeneration in those who had had a meniscectomy as compared with those who had not had meniscal damage. It is concluded that severe anterolateral instability is a cause of early degenerative joint disease in young athletes even in the absence of meniscal damage and that they should be strongly advised against participating in active sport until the joint has been stabilized.
Subject(s)
Athletic Injuries/complications , Joint Instability/complications , Knee Joint , Osteoarthritis/etiology , Adult , Humans , Male , Retrospective Studies , Time FactorsABSTRACT
All patients returning from skiing holidays who had sustained injuries of the knee ligaments were assessed. Thirteen patients had radiologically evident flake fractures around the knee. Of these, all had marked laxity when examined under anaesthetic. In ten cases the accident had occurred at low speed. It is concluded that all knee injuries following a skiing fall must be examined to exclude ligament laxity. The relevance of the bony flakes is discussed.
Subject(s)
Athletic Injuries/diagnostic imaging , Knee Injuries/diagnostic imaging , Ligaments, Articular/injuries , Skiing , Fractures, Bone/diagnostic imaging , Fractures, Bone/etiology , Humans , Joint Instability/diagnostic imaging , Joint Instability/etiology , Knee Injuries/etiology , RadiographyABSTRACT
Patients with myelomeningocele who had had surgery to stabilise the hip were reviewed; the results of the 106 operations in 88 patients were assessed. In the earlier part of the series there were 55 children who had 64 iliopsoas transfers; later in the series 33 children had 42 varus-rotation osteotomies combined with adductor tenotomy, anterior obturator neurectomy and psoas division. The technical results of both operations were satisfactory: following iliopsoas transfer only 19% of the hips were either dislocated or subluxated; the corresponding figure for the osteotomy was 12%. Thus varus-rotation osteotomy with psoas division, adductor tenotomy and anterior obturator neurectomy was at least as effective in stabilising the hip as iliopsoas transfer. Nevertheless 80% of the latter and 61% of the osteotomy patients relied on wheelchairs for mobility.