Secure fixation of lumbar osteotomy. Surgical experience with 50 patients.

Despite intensive conservative treatment, severe kyphotic spinal deformities may develop in patients with ankylosing spondylitis. Lumbar osteotomy can restore a horizontal visual field in these patients. Of 50 patients undergoing corrective lumbar osteotomy, there were 44 men and 6 women. A transpedicular screw and cable system was used in 37 patients. Mean correction of deformity was 38.7 degrees. Mean loss of correction was 4.8 degrees, but was 15 degrees in those cases in which transpedicular fixation was not used. All patients were able to see straight ahead after the operation. There were 2 deaths and 1 permanent sacral root lesion. Fixation failure was seen in 2 of 37 patients in whom transpedicular implants were used and in 3 of 13 in whom alternative methods of internal fixation were used.

Influence of magnetic resonance imaging on a knee arthroscopy waiting list.

Magnetic resonance imaging (MRI) scans were performed on 155 patients who had been placed on a diagnostic knee arthroscopy waiting list 4 to 18 months previously. In all, 32 per cent were removed from the waiting list following this investigation. A total of 24 patients on the waiting list improved spontaneously, including 13 per cent of those with MRI-demonstrable meniscal tears. MRI had an accuracy of 93 per cent, a sensitivity of 100 per cent and a specificity of 67 per cent using arthroscopy as a standard; the false-positive rate was 7 per cent and the false-negative rate 1 per cent. It is concluded that the use of MRI can reduce the requirements for diagnostic arthroscopy, but that the ideal time for MRI is not clear.

Late positional correction of uniting femoral fractures using the Wagner external fixator.

The use of the Wagner leg lengthening external fixator is described in six patients with extensive segmental fractures of the femoral shaft. Good fixation of the fracture is combined with the facility for distraction and lengthening of the early reparative callus up to 10 weeks after injury. The method is recommended for those patients in whom shortening and malalignment of the fracture persist as union proceeds.

Internal fixation for stress fractures of the ankylosed spine.

Three cases of stress fractures affecting the rigid spine of ankylosing spondylitis are reported. Even without the typical destructive features of the Romanus lesion, symptoms may be very prolonged and disabling and the diagnosis difficult. Internal fixation produces immediate pain relief and rapid fracture union.

Use of Ender's nails in unstable trochanteric femoral fractures.

Eighty consecutive patients with unstable trochanteric femoral fractures treated by the Ender technique have been studied. Early fixation failure was seen in 18% of patients. Leg shortening and external rotation deformities due to uncontrolled fragmentary collapse were found in almost 80% of the 57 surviving patients at 3 months, and caused severe disability. The continued use of the Ender technique in unstable fractures is questioned.

Experiences with abdominal aortic aneurysms in a district general hospital.

Fifty-four patients who presented with an abdominal aortic aneurysm at a district general hospital are reviewed. Survival was 100% in the 15 patients who underwent elective surgery and 41% in the 29 who presented as emergencies and were operable. In the latter group a coagulation disorder developed in 9 patients, of whom only 1 survived, and the importance of this complication is stressed. Screening of patients over 50 and early referral of all patients with asymptomatic aneurysms is urged if overall survival is to be increased.

Balloon catheter contol of a ruptured abdominal aortic aneurysm in a patient with Cullen's sign.

A patient with Cullen's sign due to a ruptured abdominal aortic aneurysm is reported. At operation a balloon catheter was used to stop severe retroperitoneal bleeding and the aneurysm was replaced with a graft.