Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial.

We compared the chevron and the Wilson metatarsal osteotomy for hallux valgus in a prospective randomised trial on 87 feet in 51 patients, reviewed at averages of 5.5 and 38 months after operation. The patients in the chevron group returned to work earlier and mobilised faster, but, at the later review, those in the Wilson group had better functional results and were more satisfied with the appearance of the foot. Correction of the hallux valgus angle was better maintained in patients in the Wilson group and they had a better range of motion at the metatarsophalangeal joint; fewer complained of metatarsalgia.

Mobility after amputation for failed knee replacement.

Management of the failed total knee replacement is a formidable problem. In a 13-year period, 24 patients with above knee amputation following unsuccessful knee replacement were referred for prosthetic limb fitting. Adequate data was available for 23 patients. At review (or at the time of death), an average of 48.6 months after amputation, only seven of the 23 patients were regular daily walkers, although 10 patients had managed to walk for more than two years; 20 of the 23 used a wheelchair for some part of the day and 12 were confined to a wheelchair.

Bipolar fixation of fractures of the distal end of the radius: a comparative study.

This paper reports a prospective study of the treatment of Colles' fractures, either by bipolar fixation or a forearm cast. Bipolar fixation reduced the degree of secondary displacement and no patient required a repeat manipulation. The functional results at 6 months, as assessed by the Scheck system, showed a strong trend in favour of bipolar fixation, but did not reach 95 per cent confidence limits. The technique of bipolar fixation proved to be safe and suitable for use in a busy district general hospital, without the necessity of elaborate equipment.

Scaphoid osteosynthesis: early experience with the Herbert bone screw.

The results of our first fourteen patients with fractured scaphoids treated with the Herbert bone screw have been disappointing. Six have failed to unite. The operation is technically demanding and there is a high incidence of malpositioning of the screw which correlates with failure to achieve union. This is predictable from initial radiographs and peroperative radiology is advised. The osteosynthesis should be protected until union has occurred radiologically, especially in manual workers.

Closed rupture of extensor digitorum communis tendon following excision of distal ulna.

Two cases of closed rupture of the extensor communis tendons are presented following excision of the distal ulna after fracture of radius and ulna. This complication has not been previously reported. A mechanism of injury is described.

Bipolar fixation of fractures of the distal radius: preliminary results.

Twenty-eight unstable distal fractures of the radius have been treated with pins incorporated into a forearm plaster. The wrist is maintained in a neutral position permitting early use of the hand. Secondary displacement has been decreased. It is a safe and effective method of treating unstable distal fractures of the radius suitable for regular use in a busy district general hospital without the need of expensive specialized equipment.

Autologous granulocyte scanning of painful prosthetic joints.

To detect sepsis in the painful joint, autologous granulocytes labelled with indium-111 were used to scan 60 patients with 74 prosthetic joints. All 18 patients with confirmed sepsis had positive scans, that is, migration of granulocytes into the region of the prosthesis. Of the 22 sterile arthroplasties 20 had negative scans. In 34 cases there was good correlation between the clinical impression and the result of the scan. We suggest that indium granulocyte scintigraphy is a reliable method of detecting an infected prosthesis.

Indium-granulocyte scanning in the painful prosthetic joint.

The value of indium-111-labeled granulocyte scanning to determine the presence of infection was assessed in 50 prosthetic joints (41 of which were painful) in 40 patients. Granulocytes were obtained from the patients' blood and labeled in plasma with indium 111 tropolonate. Abnormal accumulation of indium 111 in the region of the prosthesis was noted. Proven infection occurred in 11 prostheses, and all of the infections were detected by indium-111-labeled granulocyte scanning. Nineteen were not infected (including nine asymptomatic controls) and only two produced false-positive scans. This represents a specificity of 89.5%, sensitivity of 100%, and overall accuracy of 93.2%. These results compare favorably with plain radiography. There was no radiologic evidence of infection in three of the infected prostheses, and 10 of the noninfected prostheses had some radiologic features that suggested sepsis. We conclude that indium-granulocyte scanning can reliably detect or exclude infection in painful prosthetic joints and should prove useful in clinical management.

The mechanical properties of human flexor tendons in relation to artificial tendons.

The continuation of an unacceptable failure rate with tendon repair or grafting procedures, largely due to adhesions, suggested that an artificial flexor tendon could be an attractive alternative. A literature search found no published data of the mechanical properties of fresh human finger flexor tendons, so a study of the strength and extensibility of 153 tendons was carried out. The bone insertion strength of twenty middle finger tendons was also examined. The results showed that an artificial tendon should have a strength of approximately 1500N, and that it should extend 13% at that load, an elongation of 26mm for a tendon 200mm long. The insertion strength was less than a half of the tendon strength. This data will allow an artificial flexor tendon to be designed with sufficient strength and the correct elastic properties to allow its function to integrate reliably with natural tendons in adjacent fingers.

Radiolucent plastic in gunshot wounds.

We present two patients who suffered a total of three close-range gunshot wounds. In each injury plastic shot-retaining wadding had been carried deep into the tissues but this was not apparent on the initial radiographs. The presence of such plastic wadding must be considered in all such wounds.

"Dorsal incision" the treatment of complicated forefoot plantar ulcers in the anaesthetic foot.

The in-patient treatment of 107 complicated forefoot plantar ulcers occurring in the anaesthetic foot by the operation of dorsal incision is presented. The operative technique of dorsal incision and subsequent wound dressing is described. 69 ulcers healed prior to discharge and all but 3 ulcers healed in an average of 27.2 days. In-patient stay averaged 31.4 days. The complications of the procedure are presented. Emphasis is placed on health education of the patient regarding care of the anaesthetic foot. Further follow up is suggested to see if dorsal incision reduces the recurrence of plantar ulceration.