Compartment syndrome following ankle sprain.

Injury to the perforating branch of the peroneal artery has not been reported previously as a cause of acute compartment syndrome following soft-tissue injury to the ankle. We describe the case of a 23-year-old male who sustained such an injury resulting in an acute compartment syndrome. In a review of the literature, we could find only five previous cases, all of which gave rise to a false aneurysm which was detected after the acute event.

Diagnosis of lumbar disc protrusion. A comparison between magnetic resonance imaging and radiculography.

Forty-two consecutive patients with suspected lumbar disc protrusions were studied prospectively to compare the diagnostic accuracy of low-field strength MRI with that of radiculography. Thirty patients subsequently underwent surgical exploration at 33 levels and the operative findings were compared to both methods of diagnostic imaging. All patients had MRI studies, whilst 29 patients also had radiculography. Both studies were evaluated without prior knowledge of the clinical signs, operative findings or the results of other imaging techniques. MRI predicted the correct diagnosis in 29 of the 33 levels explored, an accuracy of 88%. All discs proven to be abnormal demonstrated a reduced signal from the nucleus pulposus. There were two false positive results and two doubtful cases but no false negatives. Radiculography predicted the correct diagnosis in 24 of 32 levels explored, an accuracy of 75%. There were two false positive results, five doubtfuls and one false negative. The overall accuracy when both tests were considered rose to 94%. Of the remaining 12 patients all except one showed good correlation between the MRI and radiculographic findings. These results indicate that low field strength MRI is slightly better than radiculography in diagnosing lumbar disc protrusions.

Unilateral lumbar facet joint hypertrophy causing nerve root irritation.

We present four cases of massive unilateral lumbar facet joint hypertrophy in an otherwise morphologically normal spine. All presented with a combination of low back pain and symptoms of entrapment of a single lumbar nerve root. The abnormality is best visualised by CT scanning and the results of surgical decompression by partial undercutting facetectomy are favourable.

The use of acrylic bone cement for cervical fusion in patients with rheumatoid arthritis.

We report on 14 patients with instability of the cervical spine secondary to rheumatoid arthritis treated by fusion using a combination of traditional bone grafting techniques and methylmethacrylate bone cement. Successful fusion was achieved in all cases with few complications. The high infection rate reported by other authors was avoided by reducing the bulk of the cement mass and the use of antibiotic impregnated cement. We recommend this method of fusion to all orthopaedic surgeons involved in the treatment of patients with rheumatoid arthritis.

Epidural buprenorphine for pain relief after spinal decompression.

We report a prospective double-blind trial of the efficacy of a single epidural dose of buprenorphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain chart and by the additional requirement for analgesia. The patients receiving buprenorphine were significantly more comfortable (p less than 0.005) and required less analgesia in the first 12 hours after operation (p less than 0.05) than the control group. This simple procedure is recommended as an effective and safe method of reducing pain.

Circumferential periosteal release in the treatment of children with leg-length inequality.

We present the results of 38 children with leg inequality treated by circumferential periosteal release. Leg-length discrepancy was expressed as a percentage of the longer limb. All patients showed a decrease in percentage difference at one year after operation, the mean difference dropping from 7.24% to 5.45%. The size of the response was directly related to the age of the patient at operation, being more pronounced in the younger patients. The response was not related to sex, diagnosis, or rate of growth of the patient immediately preceding operation.

Breast reconstruction by tissue expansion.

The techniques of tissue expansion for use in breast reconstruction is described, together with the results of its use in 33 patients. The advantages and disadvantages of tissue expansion in relation to other currently favoured techniques are discussed. It is concluded that tissue expansion represents a major advance in the field of breast reconstruction.