A more stable posterior approach for hemiarthroplasty of the hip.

The dislocation rate following the insertion of a hemiarthroplasty of the hip via the posterior approach is variously quoted as between 8 per cent and 15 per cent. We set out to determine if this could be reduced by preserving the labrum and capsular structures at the time of surgery. We used a modification of the posterior approach, in which the labrum and capsule are preserved which appears not to have been widely reported. This increases the stability of the joint by adding to the depth of the acetabulum. We look prospectively at a series of 150 patients who were treated with an Austin Moore hemiarthroplasty using this technique. There were only two dislocations within 1 year of surgery in the series (one of these being in a patient with a dysplastic acetabulum) making our dislocation rate 1.3 per cent. We conclude that preserving the labrum significantly increases the stability of a hemiarthroplasty when it is inserted via a posterior approach.

KY nailing of impending and pathological fractures of the proximal femur.

Eight two patients underwent 86 Küntscher Y nailing for impending and pathological fractures of the proximal femur. All but five mobilised post-operatively, thus improving their quality of life. Eighteen patients died in hospital. Prophylactic nailing improved survival. Fifteen out of 86 nailings were followed by complications.

Observations on the current and future surgical management of hydatid disease affecting the vertebrae.

Five cases of hydatid disease affecting the vertebrae are described. Clinical features, radiologic appearance, and poor prognosis are emphasized. Four patients had some degree of neurologic deficit at the time of presentation and in three cases there was an increasing kyphosis. In two patients, spinal instrumentation with Harrington apparatus supplemented removal of hydatid material, and its use improved the previous neurologic deficit with stabilization of kyphosis. The antihelmintic drug mebendazole was used in two cases.

Osteoid osteoma of the pisiform.

Osteoid osteoma of the pisiform seems not to have been previously reported. In both the cases reported in this paper there was diagnostic difficulty and delay. Complete surgical removal of the nidus was curative.

Entrapment of the superficial peroneal nerve. Three case reports.

Entrapment of the superficial peroneal nerve is an unusual cause of pain in the ankle and foot. In such cases decompression of the nerve at the point of exit from the deep fascia will produce a good result. Three cases are described.

Effects of vascular occlusion on the femoral head in growing rabbits.

Temporary vascular occlusion of the femoral head in 6-week-old rabbits was produced by a closed means in a hip spica; the hips were maintained for 24 h in the position of flexion, abduction and internal rotation. All animals developed necrosis of the capital femoral epiphysis, best seen histologically at 2 weeks, and this subsequently recovered. Despite marked histological changes only one hip developed radiographic changes.

An anomalous flexor digitorum superficialis indicis muscle in association with a fibroma presenting as a stiff painful finger.

A description is given of a fibroma associated with an anomalous muscle arising from the flexor digitorum superficialis indicis tendon distal to the transverse carpal ligament, which presented as a stiff painful finger.

An unusual "giant" lipofibroma in the palm.

A case is described of an unusually large lipofibromatous hamartoma arising from the tendon sheath of flexor pollicis longus.

Dolorous calcification of the lateral sesamoid bursa of the great toe.

A case of painful calcification within a sesamoid bursa of the great toe is presented. This may be the first description of painful calcification of this site.

'Locking knee' due to osteochondroma.

An unusual cause of locking of the knee is reported, due to an osteochondroma at or around the inner part of the upper tibia. It usually presents in young teenagers who frequently have difficulty extending the knee from a fully flexed position. The cause is interference with the free excursion of the pes anserinus. Excision of a symptomatic osteochondroma has been known to relieve the complaint.

An anomalous flexor digitorum superficialis indicis muscle presenting as carpal tunnel syndrome.

The description is given of an anomalous muscle arising from the flexor digitorum superficialis indicis tendon distal to the transverse carpal ligament which presented as carpal tunnel syndrome.