The erythrocyte sedimentation rate in orthopaedic patients.

The ESR, a sensitive measure of the inflammatory response, is elevated in 90% of patients who have serious orthopedic infections, e.g., discitis, septic arthritis, and hematogenous osteomyelitis. In most cases, it is sufficient to distinguish these entities from the less serious disease states, i.e., transient synovitis. After major surgical operations or extensive trauma, the ESR often increases to high levels and, if sepsis does not supervene, it returns to normal within six months. Outpatient determination of the ESR, although useless in the early detection of malignancy, is valuable in detecting inflammatory arthridities and major sepsis.

Transient impotence from positioning on the fracture table.

A case of transient impotence caused by pressure from the perineal post of the fracture table is reported. The anatomic position of the pudendal and cavernous nerves appears to account for the impotence. The use of a foam-rubber fitting for the perineal post is recommended.

Pseduarthrosis of a tibial plateau fracture: report of a case.

In an elderly woman a tibial condylar pseudarthrosis was angulated with disabling pain, significant deformity, and progressive articular deterioration. The treatment of this non-union consisted of arthrotomy, mobilization of the ununited medial condyle, slight over-elevation of the tibial plateau, iliac bone grafting to reconstitute loci of bone loss, and rigid interfragmentary and buttress plate fixation. Postoperative management consisted of early knee motion and delayed weight-bearing to facilitate functional restoration of the extremity. Within 3 months, union occurred in anatomic position.

A theoretical analysis of cast wedging with practical applications.

Cast wedging using vector and geometrical analysis demonstrated that the open wedge produces distraction of the fracture, the closing wedge shortening, and that the opening--closing wedge can perfectly correct skeletal deformity. The level of wedging should lie at the axis intersection, i.e., at the intersection of the long axes of the 2 major fracture fragments. An open wedge at the axis intersection is recommended for tibial shaft fractures immobilized with long leg casts; an opening--closing wedge at the axis intersection, for fractures immobilized with "pins and plaster".

Fractures of tibial plateaus. A review of the literature.

Tibial plateau fractures, common injuries in the middle-aged, often result from falls or vehicular accidents. The wide spectrum of fracture patterns can be theoretically related to the sequential application of bending (valgus/varus) and compression forces. End-results of 599 fractures in 13 different studies were compared by fracture pattern using a clear-cut fracture classification. Minimally displaced (less than 5-10 mm displacement) fractures average 85-90 per cent acceptable end-results. Associated soft tissue lesions include frequent meniscal (50% of cases) and ligamentous (10-30%) injuries. Vascular and nerve injuries are most unusual: non-union is not reported. A diagnostic and therapeutic approach is outlined. The assessment of bony and/or ligamentous instability is stressed. Reduction is required in most displaced fractures: open reduction and rigid internal fixation with ample bone grafting is suggested in displaced local depression fractures and other unstable fracture types refractory to closed reduction. Operative repair of ruptured ligaments seems indicated. Early knee motion is important in all fractures. In unstable fractures angular alignment must be maintained (rigid internal fixation, skeletal traction, or bracing) during early motion. Quadriceps rehabilitation must be vigorous. Weight-bearing should be deferred for at least three months. The cast brace is useful in unicondylar fractures.