Steroid injection for carpal tunnel syndrome.

We studied the medium- to long-term results of steroid injection into the carpal tunnel of women with the carpal tunnel syndrome (CTS). Of 45 hands, only 11 had lasting relief of symptoms and 22 had no relief whatsoever. There was no correlation of the typical signs and symptoms of CTS with outcome. Other series have offered various predictive factors for the outcome of injection but we found little or no correlation between these factors and outcome.

Isolated flexor pollicis longus palsy in twin sisters treated by brachioradialis transfer.

Isolated paralysis of flexor pollicis longus is an uncommon variation of the anterior inter-osseous nerve compression syndrome. Two cases occurring in twin sisters were treated by brachioradialis tendon transfer when no recovery was evident after six months, with good results. Brachioradialis transfer is technically easy to perform, but complete mobilization of the tendon and muscle is necessary to achieve the desired excursion of the muscle-tendon unit.

Lower limb fractures in the chronic spinal cord injured patient.

Experience in managing 33 lower limb fractures in 25 chronic spinal injured patients is described. An increased awareness among patients and medical staff is required to avoid misdiagnosis. Effort should be made to ensure bone union in satisfactory position, recognising the different requirements of ambulant and non-ambulant patients. 'Soft pillow splints' were found to give the best results in all fractures other than those of the femoral neck. Operative treatment with antibiotic prophylaxis is only indicated to correct important deformity.

Bilateral hip and knee replacement in rheumatoid arthritis.

A series of 20 patients who had bilateral hip and knee replacement are reviewed and analyzed. Early surgical opinion should be sought before all four joints are irreparably destroyed and the patient is nonambulant so that the joints can be replaced one at a time, as necessary to maintain mobility. This considerably reduces stress to the patient, the surgeon, the nursing staff, and the rehabilitation team. The follow-up period ranged from 2 to 13 years. The early postoperative complications were few and the reoperation rate for aseptic loosening in this study was 3.75%.

Bilateral simultaneous traumatic avulsion of the quadriceps tendon.

Bilateral simultaneous traumatic avulsion of the quadriceps tendon has not been reported previously. One such case is reported in this paper. A method of reattachment of the quadriceps tendons to the patellae is described and the relevant literature is reviewed.

Diagnostic arthroscopy of the knee in children.

Seventy-two symptomatic knees were studied in 68 patients between 2 and 17 years of age. A firm clinical diagnosis was made in all knees before arthroscopy. The clinical diagnosis and the arthroscopic findings were compared to establish the accuracy of the clinical diagnosis. This was 42% in children under 13 years old (Group 1) and 55% in children between 14 and 17 (Group 2). Possible unnecessary arthrotomy was avoided in 58% of the knees in Group 1, and 31% of the knees in Group 2. The most common "incorrect" clinical diagnosis in Group 1 was that of a discoid lateral meniscus followed by a torn medial or torn lateral meniscus in that order. The most common "incorrect" diagnosis in Group 2 was a torn medial meniscus followed by a discoid lateral meniscus. It is considered that children presenting with knee symptoms should be managed by orthopaedic surgeons who are experienced in arthroscopic diagnosis.

Unstable fractures of the distal end of the radius (transfixion pins and a cast).

Forty-five unstable fractures of the distal end of the radius were treated with transfixion pins and plaster cast. Thirty-seven patients were personally reviewed and an analysis of the results are presented in this paper. Scheck's point system was used to grade functional results; 81.1 per cent were classified as satisfactory (excellent and good) and 18.9 per cent unsatisfactory (poor) group.

Functional bracing in lower limb fractures.

This paper reports the experience of treating 198 fractures of the femoral shaft and 154 fractures of the tibial shaft in a cast brace. Cast bracing allows early weight bearing on a fractured limb, rapid bone healing, avoids post-operative infection and minimises the incidence of joint stiffness - the so-called "fracture disease". The advantages of early ambulation and freedom of joint movement is much appreciated by patients. Satisfactory functional results were achieved in 96% of the femoral shaft fractures treated in a cast brace. This method has been used in ipsilateral femoral shaft and femoral neck fractures, and ipsilateral femoral and tibial shaft fractures with satisfactory results. Functional bracing has been equally successful in treating fractures of the tibial shaft. The incidence of delayed union in tibial shaft fractures was 1.94%, significantly lower than reported in the literature.

Treatment of fractures of the femoral shaft with early cast bracing.

This study describes experience in the treatment of fractures of he femoral shaft by early weight bearing in a cast brace, at Glasgow Royal Infirmary. During 1977-79, 117 fractures of the femoral shaft were treated. The average time for fracture had overall satisfactory results.

Orthoplast brace for the treatment of tibial shaft fractures.

This is a preliminary report of a prospective study in treating 82 tibial shaft fractures using Orthoplast brace during 1979-80 at Glasgow Royal Infirmary. The brace was applied at 3-4 1/2 weeks to tibial shaft fractures managed conservatively. This method is found to be extremely satisfactory and free of major complications e.g. non-union and infection. The average time for fracture healing was 13.50 weeks for closed and 16.75 weeks for open fractures.

Prosthetic replacement of the femoral head for fractures of the neck of the femur: a comparative study.

In this study the results of the use of Austin Moore's and Monk's protheses in displaced subcapital femoral neck fractures have been compared. Patients treated with Monk's prosthesis did better. The relief of pain and sense of security in the early postoperative days were noteworthy findings in patients with Monk's prosthesis. No cases of fat embolism or cardiac arrest were reported with the use of cemented Monk's prosthesis.

The management of tibial shaft fractures by early weight bearing in a patella tendon bearing cast: a comparative study.

The purpose of this paper is to describe the author's personal experiences in using the Patella Tendon Bearing Cast (P.T.B.) as described by Sarmiento (6), in the management of tibial shaft fractures. In all patients weight-bearing was instituted in a P.T.B. cast 4 weeks from the date of the fracture. The results obtained were compared with those of conventional methods used in the treatment of tibial shaft fractures. Analysis revealed that when the P.T.B. cast was used for treatment of tibial shaft fractures, the time taken for fracture healing was significantly reduced and the functional results were superior to those of conventional methods.