Suprascapular nerve palsy.

Isolated traumatic suprascapular nerve palsy without associated fracture is a rare occurrence. Localized segmental muscle atrophy limited to the supraspinatus and infraspinatus muscles associated with weakness in initiating abduction and in external rotation of the shoulder should suggest the diagnosis. Electromyography will confirm the diagnosis by excluding nerve root and brachial plexus involvement with denervation potentials limited to the supraspinatus and infraspinatus muscles.

Assessment of bone grafts used for acetabular augmentation in total hip arthroplasty. A study using roentgenograms and bone scintigraphy.

Total hip arthroplasty was performed in 13 hips with acetabular bone grafts for secure component fixation. The incorporation and healing of acetabular bone grafts were investigated with the aid of roentgenograms, planar bone scans, and a newer scintigraphic technique, three-dimensional single photon emission computed tomography (SPECT). Conventional roentgenograms proved unreliable in evaluating bone graft reconstitution because of overlapping trabecular bone patterns of the graft and iliac wing. There was no evidence of graft failure or acetabular loosening. Bone grafts in the late follow-up group (four to seven years postoperation) exhibited normal radionuclide activity, whereas grafts less than one year postsurgery demonstrated patterns of increased activity. SPECT was helpful in producing an anatomic reconstruction of the acetabulum. The observation that bone grafts exhibited normal biological viability is crucial for ensuring secure acetabular component fixation on a long-term basis.

Septic arthritis of the wrist.

Twenty-eight patients (two of them children) with septic arthritis of twenty-nine wrists were treated with early surgical drainage, parenteral antibiotics, and early motion after surgical decompression. The etiology was trauma in seventeen patients, and Staphylococcus aureus was the organism that was most commonly recovered on culture. In twenty-two patients (twenty-three wrists) who were followed for six months to nine years there were no recurrences. The results were evaluated in terms of range of motion, grip strength, and subjective complaints of discomfort and disability. Of the ten wrists with a good or excellent result, all had had the arthrotomy within ten hours after diagnosis, and of the thirteen with a fair or poor result, surgery had been delayed for sixteen hours or longer. The long-term results deteriorated in direct proportion to increasing time until treatment and the number of procedures performed.