Medial epicondylitis of the elbow.

Ninety-five cases of medial epicondylitis are reported in 83 patients; 90% were related to work and only 10% to sport or leisure activities. Most recovered with conservative treatment. Operation was needed in 12%, which compared with under 4% of patients with lateral epicondylitis over the same period. The results of open release of the common flexor origin were good, with only one exception.

Intramedullary nailing technique and its effect on union rates of tibial shaft fractures.

Seventy tibial shaft fractures treated by intramedullary nailing using two different techniques were compared. The first group (35 cases) was treated with a Herzog intramedullary nail following hand reaming and minimal traction. The second group (35 cases) had a Grosse and Kempf or AO nail inserted following power reaming and skeletal traction. Fracture patterns were similar in both groups. In the hand-reamed group, the mean time to union was 15.2 weeks with two delayed unions and no non-unions. In the power-reamed group, the mean time to union was 19.9 weeks with 10 delayed unions and two non-unions. These differences were statistically significant. Complications in the hand-reamed group included a Sudecks atrophy and one mal-union. In the power-reamed group, there were three transient foot drops, two compartment syndromes and one pulmonary embolus. This difference was not statistically significant. Our findings suggest that surgical technique has an important effect on the healing rates of nailed tibial shaft fractures. When intramedullary nailing is performed, minimal reaming is required and skeletal traction should be avoided if possible.

Scaphoid exostosis causing rupture of the flexor pollicis longus.

A case of attrition rupture of the flexor pollicis longus (FPL) tendon caused by a scaphoid osteophyte in a patient with rheumatoid arthritis is reported. This lesion was found only after a thorough search of the floor of the carpal tunnel was performed.

Tibial shaft fractures with an intact fibula.

The effect of several factors on the healing rates of tibial shaft fractures with an intact fibula were examined. Those found to adversely affect healing rates included: 1. Open fractures; 2. Oblique or comminuted fractures; 3. High-velocity injuries; 4. Angulation in the sagittal plane; 5. Displacement. No other factors examined were associated with delayed union. The predictive values for delayed union are estimated for each of these factors in isolation and in combination.

Tibial plateau fractures: the arthroscopic option.

Tibial plateau fractures remain one of the most difficult fractures to treat. A multitude of classifications exist and several treatment options have been advocated. In the last few years arthroscopy has been used in the treatment of these fractures. We report our experience of treating over 30 cases by this method and review the literature.

The Exeter bipolar prosthesis in the active elderly patient: the results at 7 years.

Seventy one Exeter bipolar hemiarthroplasties were reviewed after a mean follow up of 3.2 years (range 1-7 years). Patients with displaced subcapital fractures were selected for operation on the basis of good mobility before the fracture. The operation was well tolerated and the mortality at 1 month and 6 months was 3.7% and 6.5% respectively. Using a newly devised hip scoring system 89% had a good or excellent result and 94% had no or only occasional pain. There was no radiological evidence of acetabular erosion.

Arthroscopic management of tibial plateau fractures.

Ten tibial plateau fractures treated arthroscopically are reported. In eight cases, closed internal fixation was performed under arthroscopic control while in another two patients, arthroscopic washout alone was undertaken. Only one case required external splintage (a cast brace), the remainder being mobilized non-weight-bearing without plaster immediately after the operation. The results were good. We suggest that the arthroscope is a useful tool in the treatment of these fractures and provides information not otherwise available. There is a low morbidity, inpatient stay is short and early joint movement can be encouraged.

The intact fibula.

The notes and radiographs of 281 adult tibial shaft fractures were reviewed. In 17 per cent there was an intact fibula. Delayed union rates were lower when the fibula remained intact, thus confirming that this is a good prognostic indicator. This fracture is caused by less severe trauma than fractures where both bones are broken. It is rare over the age of 30 years.

Corrective tibial osteotomy for genu recurvatum by callus distraction using an external fixator.

Genu recurvatum due to an osseous abnormality is a condition that rarely requires surgical intervention. When necessary, the operative solution usually considered is an opening wedge osteotomy using bone graft and plate fixation. The donor site (usually the iliac crest) has a well reported morbidity with a further procedure being required to remove the plate. We report two cases treated by a hemicorticotomy and callus distraction (hemicallotasis) of the tibia using an external fixator. Correction was performed under supervision as an out-patient. Hospital stay was short, the morbidity of the donor site was eliminated, further procedures for removal of the plate were unnecessary and mobility of both the patient and his joints was maintained throughout the period of treatment. Satisfactory correction of the deformity was obtained in both cases.

Proximal tibio-fibular synostosis. A rare congenital anomaly.

A case of proximal tibiofibular synostosis is presented along with a review of the literature. The variety of presenting complaints is discussed and the syndrome is compared with that of radio-ulnar synostosis. Possible modes of treatment are explained.

The plica syndrome.

A retrospective study of 89 patients undergoing 98 arthroscopies of the knee in which a medial synovial plica was noted was undertaken. In 86 cases, the plica was deemed to be pathological and was resected arthroscopically. The symptoms and signs of these patients were noted preoperatively and the results of their operation noted in the outpatient department and subsequently by questionnaire. Our findings agree with other authors in this field and we propose that arthroscopic resection of a pathological plica is a worthwhile procedure.

The association between lowest palpable pulse and wound healing in below knee amputations.

A retrospective study of 191 patients undergoing 203 Burgess type below knee amputations for end-stage peripheral vascular disease showed that the only clinical feature which associated significantly with wound healing was the lowest palpable pulse. The pulse level was noted preoperatively and was compared with the healing rates in the amputation stumps. When the femoral pulse was absent, 79% of below knee amputations failed. When the femoral pulse was palpable, only 29% wound breakdown occurred. When the popliteal or more distal pulses were palpable, only 10% failure was recorded.