Early results of the Acclaim total elbow replacement in patients with primary osteoarthritis.

This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged > or = 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4). Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved. This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged > or = 65 years with primary osteoarthritis of the elbow.

Correction of simple and complex pediatric deformities using the Taylor-Spatial Frame.

INTRODUCTION: Correcting multiplanar lower-limb pediatric deformities requires complex and, in many cases, staged procedures. The Taylor-Spatial Frame (TSF) is a sophisticated external fixator system that can be used to treat simple to complex multiplanar and multiapical skeletal deformities. We describe its use in 53 children during the last 7 years in a variety of pathologies and demonstrate its ease of use and versatility. METHODS: A review of medical and physiotherapy records, radiographs, and computed tomographic scans of all patients treated with a TSF between June 1999 and December 2005 at the Booth Hall Children's Hospital was conducted. Data recorded were etiology of deformity, sex, age, number of previous operations, preoperative deformity parameters, operative records and frame constructs, treatment regime, frame duration, follow-up protocol, posttreatment deformity, complications, and clinical and radiological outcome. RESULTS: Fifty-three patients between the ages of 12 months and 16 years (mean, 10.7 years) underwent correction programs for 55 limbs (44 tibia and 11 femurs). The etiology of deformity was congenital in 39 cases and acquired in 14. We were able to achieve an acceptable correction of deformity (leg length discrepancy <15 mm, angulation <5 degrees) in 52 limbs. A number of complications were encountered, which are discussed. DISCUSSION AND CONCLUSION: We demonstrate its ease of use for both surgeon and patient and its versatility in a variety of pathologies. The advantages of the TSF system are many. It is a simple frame construct, and application is easy. The plan and execution are structured with precise end points; it is a single-stage correction and thus avoids frame modifications. Any residual deformity can be further corrected by use of the same frame. We conclude that the TSF is an effective and efficient way to correct a wide variety of simple and complex often obstinate pediatric limb deformities.

Underestimation of severity of previous whiplash injuries.

INTRODUCTION: We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS: We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS: From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66-84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS: We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect.

Relationship between occupation, social class and time taken off work following a whiplash injury.

INTRODUCTION: Little has been published about occupational and social factors in relation to time off work following a whiplash injury. PATIENTS AND METHODS: We analysed 800 medicolegal case sheets from a consultant orthopaedic surgeon's practice. RESULTS: Of those injured, 596 were working and 204 were unemployed or retired. The working group was further analysed. Severity of injury was estimated by analysing velocity of injury combined with vehicular damage. Mean time off work for a minor injury was 10.6 days, moderate 12.1 days, severe 13.8, and very severe 24.9 (P < 0.05). Looking at work categories as previously described in the literature, 20.5 days were taken off by heavy manual workers, light manual 15.7, driving 13.9, secretarial 9.2 and sedentary 12.8 (P < 0.05). Analysing as per social class showed that professionals required 7.0 days, intermediate 14.7 days, skilled non-manual 16.1 days, skilled manual 34.2 days, semi-skilled manual 33.2 days, and unskilled manual 11.5 days (P < 0.05). Nearly a third (31.2%) required no time off work, after 4 days off, 52.1% had returned to work and 90.1% were back at work after 30 days. Time off lasting more than 12 weeks occurred in 29 cases (4.9%). CONCLUSIONS: Job style, severity of injury and social class have a bearing on time taken off work after road traffic accidents causing whiplash injury.

Minimal surgical approach for recurrent hip dislocation using the posterior lip augmentation device for the Charnley hip arthroplasty.

We present the management of recurrent posterior dislocations in cemented Charnley total hip arthroplasties treated with acetabular augmentation. Certain patients are elderly with comorbid conditions and diminished reserves. We have used a minimal surgical approach to implant 21 posterior lip augmentation devices in elderly patients. Ninety percent of the hips are stable with follow-up of 1 to 3 years (mean, 1.9 years). Eighty-four percent of the patients were satisfied with the outcome. Two cases, which redislocated, were further stabilized by changing the position of the posterior lip augmentation device and are stable. Because of a minimal surgical approach, the time duration of surgery, blood loss, transfusion requirement, inpatient stay, and morbidity are reduced. Posterior lip augmentation device surgery with a minimal approach is a safe and effective procedure for elderly patients who do not have any obvious cause for dislocation.

A biomechanical comparison of the Mitek RapidLoc, Mitek Meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures.

The aim of this in vitro study was to measure and compare the biomechanical properties and mode of failure of the five different methods of meniscal repair. Reproducible tears were created in 50 bovine medial menisci and repaired in a standardized fashion with one of the following devices: the RapidLoc meniscal repair device (Mitek Products, Westwood, MA), an 8 mm Mitek meniscal repair system (Mitek Products, Westwood, MA), Clearfix screw (Innovasive Devices, Marlborough, MA), a single vertical mattress suture of 2-0 Ti-Cron (Ethicon, Massachusetts) and a vertical mattress suture of No. 1 PDS II (Johnson and Johnson Int.). The repairs were tested by single cycle load to failure in a materials testing machine. The mean loads to failure for each of the repair groups were as follows: Mitek RapidLoc 44.9 N, Mitek meniscal repair system 20.3 N, Clearfix screw 37.4 N, vertical Ti-Cron 66.1 N and vertical PDS suture 103.0 N. The mean load to failure was significantly greater with PDS vertical sutures than with other techniques (P<0.05). The Mitek RapidLoc had the least extension at failure (14.8 mm) (P<0.05). This study confirms meniscal repair with vertical PDS sutures confers the highest biomechanical stability and that the new Mitek RapidLoc device offers improved load to failure than the previous generations.

A model for the conservative management of mallet finger.

This prospective study assessed the results of a custom-made thermoplastic splint for treatment of mallet finger deformity. From April 1999 to April 2000, 42 patients with mallet finger deformity were recruited. All patients were seen within 1 week and treated with a thermoplastic splint custom-made by the hand therapy department. The splint was simple to make, easy to fit and suitable for all finger shapes and sizes. It improved the deformity in 30 out of 34 cases, and caused no skin irritation.

The noradrenergic system influences the fate of Cajal-Retzius cells in the developing cerebral cortex.

Cajal-Retzius cells are neurons prominently located in layer I of the developing cerebral cortex. They are the first neurons to be born in the cortex reaching maturity long before any other cortical neuronal cell type; later in development they degenerate and/or change phenotype. The noradrenergic system, which originates in the locus coeruleus in the brain stem, is one of the earliest axonal systems to enter the cortex forming contacts with Cajal-Retzius cells in layer I. Here we followed the course of development of the Cajal-Retzius cells in postnatal life in animals depleted of noradrenaline in the cortex. We found that removal of this system after birth resulted in significantly more Cajal-Retzius cells during the first 2 weeks of life. This may be due to the observed decline in the number of dying cells in layer I of these animals during the same period. We speculate that the noradrenergic system regulates the development of Cajal-Retzius cells which have been implicated in neuronal migration and laminar formation in the cerebral cortex.