The posterior triangle and the painful shoulder: spinal accessory nerve injury.

Forty-three cases of accessory nerve injury referred to the Peripheral Nerve Injury Unit have been reviewed. Accessory nerve injury results in a characteristic group of symptoms and signs. Referral for treatment is usually delayed, the average time being 11.3 months. Surgical treatment resulted in improvement of symptoms in almost all cases.

Thoracoscapular fusion in facioscapulohumeral dystrophy: clinical review of a new surgical method.

A new method of scapulothoracic fusion is described for patients with facioscapulohumeral dystrophy. To improve upper limb function by abolishing scapula winging, bilateral procedures were performed in six patients with an average age of 30 years (range 17 to 44 years). The average follow-up was 49 months (range 1 to 7 years). A good functional and cosmetic result was obtained in all patients. An average postoperative increase in shoulder abduction of 28 degrees and flexion of 40 degrees was seen. Only a small diminution in respiratory function occurred (mean decrease in forced expiratory volume in 1 second of 14% and forced vital capacity of 21%).

Meningitis complicating spinal surgery.

STUDY DESIGN: A retrospective review of all cases of bacterial meningitis after spinal surgery. OBJECTIVES: To identify the usual clinical and laboratory features, and to determine the frequency of this complication. SUMMARY OF BACKGROUND DATA: Meningitis has been recognized as a rare complication of spinal surgery, but no series of cases has been reported previously, and there are no published estimates of its frequency. METHODS: A retrospective review of the medical records of all cases of bacterial meningitis after spinal surgery in Auckland over a 3-year period was done. RESULTS: Four cases were identified after 2180 operations, an incidence of 0.18%. All four patients survived. CONCLUSIONS: This is a rare complication from which a good outcome is possible with early diagnosis and prompt management.

The doorstop procedure. A technique for treating unstable fracture dislocations of the proximal interphalangeal joint.

The unstable fracture dislocation of the proximal interphalangeal joint remains a difficult injury to manage despite the availability of a wide variety of treatment options. We describe a simple alternative method of treatment called the doorstop procedure.

Hazard of ionizing radiation to trauma surgeons: reducing the risk.

A study aimed to establish the level of radiation exposure to orthopaedic surgeons involved in the care of injured patients; parts of the body most at risk, and to establishing whether surgeon control of X-ray image intensification reduced the risk. This was conducted on five orthopaedic surgeons regularly involved in musculoskeletal care. Radiation dosage (in millisieverts (mSv) to the body, neck, eyes and hands, was measured by means of dosimeters applied to these areas, before and after surgeon-controlled use of X-ray image intensification. Although all doses measured were within current safety guidelines (1.25 mSv total body dose/month, 3.75 mSv eye dose/month and 12.5 mSv extremity dose/month), the hands were most at risk (maximum recorded dosage 3.95 mSv/month). Control by the surgeons of X-ray image intensification significantly reduced exposure of the hands (P < 0.05).

Osteochondritis dissecans of the knee. A long-term study.

Twenty-two knees with osteochondritis dissecans diagnosed before skeletal maturity were followed prospectively into middle age: 32% had radiographic evidence of moderate or severe osteoarthritis at an average follow-up of 33.6 years; only half had a good or excellent functional result. We found that osteoarthritis was more likely to occur if the defect was large or affected the lateral femoral condyle.

Congenital hypoplasia of the medial meniscus: a report of two cases.

Congenital abnormalities of the medial meniscus are extremely rare. We present two cases of hypoplasia and demonstrate the arthroscopic and radiological features.