Accessory bands of the hamstring tendons: A clinical anatomical study.

Gracilis and semitendinosus tendons are commonly used as grafts in ligamentous reconstruction. Awareness of accessory bands of these tendons is essential in preventing inadvertent diversion of the tendon harvester into the main tendon resulting in premature tendon amputation and inadequate tendon graft. The aim of this study was to describe the characteristics of these accessory bands. Twenty five patients undergoing arthroscopic anterior cruciate ligament reconstruction using hamstring tendons were included. The number of accessory bands and distance of the most proximal band from the distal periosteal insertion point on the tibial crest was recorded for both gracilis and semitendinosus. In most cases gracilis had two accessory bands; the average distance of the most proximal band from the tibial crest insertion being 5.1 cm. Semitendinosus had three bands in most cases, the average distance of the most proximal band from the tibial crest insertion being 8.1 cm. Five (20%) semitendinosus but no gracilis tendons had an accessory band originating greater than 10 cm from the tibial crest insertion. Semitendinosus had more accessory bands compared to gracilis. A significant proportion (20%) of semitendinosus and none of the gracilis tendons had bands originating greater than 10 cm proximal to the tibial crest insertion. This knowledge about the accessory bands of the hamstrings can guide toward safe harvesting of these tendons.

Hemiarthroplasty for trapeziometacarpal arthritis - a useful alternative?

We performed hemiarthroplasty using the Swanson titanium implant for treatment of isolated and advanced trapeziometacarpal joint osteoarthritis Nineteen implants were placed in 18 patients (mean age: 57 years) between 1995 and 1999. One joint required revision and conversion to trapeziectomy. Eighteen joints in 17 patients were evaluated with a mean follow-up period of 34 (range, 14-60) months. Good pain relief was noted in 13 hands. All patients had good hand function as scored using validated questionnaires. Radiographic loosening occurred with five implants and trapezial wear in ten joints. Though radiographic loosening or trapezial wear did not correlate with less satisfactory clinical results, failure of the implant is a concern in the long term. Preliminary results indicate that hemiarthroplasty can be a useful treatment alternative in selected, relatively young patients with isolated trapeziometacarpal osteoarthritis and good bone stock. Good motion and stability can be preserved Failures can be effectively salvaged by trapeziectomy.

Poland's syndrome and military personnel.

We describe three cases of undiagnosed Poland's syndrome in Army personnel and discuss their fitness according to the PULHHEEMS system. This syndrome has variable clinical features that include unilateral chest wall and upper limb abnormalities. The syndrome is not hereditary and is of unknown origin. If the syndrome was diagnosed prior to enlistment the potential recruit would normally be graded P8, and unfit to enlist. However, these individuals had managed to pass routine medical examination as well as successfully complete basic training. The suitability of continuation in the army of personnel with Poland's syndrome is discussed.

Locked lateral patellar dislocation with impaction fracture of patella.

Irreducible lateral patellar dislocation is rare. It has previously been described with rotation around a vertical axis. We describe a case of irreducible lateral patellar dislocation in a 66-year-old lady with an impaction fracture of medial facet of patella locked on the lateral femoral condyle. Closed reduction was unsuccessful and the patient was treated by total knee replacement. Such a case has not been described previously in the literature.

Fracture-dislocation at the thoracolumbar junction in an infant with locked vertebrae. A case report.

STUDY DESIGN: A retrospective, single-patient case report. OBJECTIVES: To report on a 9-month-old infant with fracture-dislocation at the thoracolumbar junction with locking of vertebral bodies, probably with incomplete neurologic injury and partial postoperative recovery. SUMMARY OF BACKGROUND DATA: Fracture-dislocation at the thoracolumbar junction is rare in infants, the upper cervical spine being the level usually affected. Incomplete neurologic injury is uncommon after such a severe shear injury. METHODS: The patient was followed through personal examination and chart review from initial presentation to 6 months after the injury. RESULTS: Open reduction with posterior spinal fusion was followed by partial neurologic recovery and a stable spine over 6-month follow-up. CONCLUSIONS: Fracture-dislocation at the thoracolumbar junction is rare in infancy. This is probably due to unique anatomic and biomechanical features of the spine in infancy.

Is McMurray's osteotomy obsolete?

A review of the method of performing, advantages, disadvantages of McMurray's displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray's osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the 'Armchair effect'.