Lumbar facet joint injection in treating low back pain: Radiofrequency denervation versus SHAM procedure. Systematic review.

The lumbar facet joints have been implicated as one of the causes of low-back pain syndromes. About 15-40% of patients who presented with chronic low-back pain was attributed to lumbar facet joint pain. The purpose of this study was to analyse whether radiofrequency denervation is better than SHAM procedure in treating chronic low-back pain caused by lumbar zygapophysial joints pathology. From the four identified randomised control trials, there is conflicting evidence at an intermediate 3-6-month stage, however; one study demonstrates statistical significance of radiofrequency denervation at 3 months. Longer-term follow-up is needed to prove the efficacy of radiofrequency denervation technique.

Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem.

INTRODUCTION: Measurement of early subsidence of uncemented femoral stems can be used to evaluate the likelihood of long term stem component loosening and therefore clinical failure. Our aim was to evaluate the factors associated with subsidence in collared and uncollared versions of the Corail femoral stem. METHODS: 121 hips in 113 consecutive patients were studied, operated on by two surgeons in our hospital differing in their choice of Corail stem. This gave two groups of patients with 66 hips having collared stems and 55 hips having uncollared. We recorded patients' age, sex, ASA grade and BMI. Radiographs post-operatively at day 1, 6 weeks and 1 year were evaluated measuring subsidence, angulation, signs of stability and fixation, and canal fill ratio at the metaphysis and diaphysisafter correcting for magnification errors by calibration using femoral head size. RESULTS: Clinically significant subsidence (>3 mm) occurred in 7.6% of collared and 10.9% of uncollared stems, all within 6-8 weeks, but did not reach statistical significance (p = 0.345). Revision for symptomatic loosening was required in 1 patient in each group (1.5% collared versus 1.8% uncollared). DISCUSSION: Early subsidence of Corail femoral stem should alert surgeons to closer patient follow-up as the rate of early revision is 18% in stems with >3 mm of subsidence. However, the presence of a collar does not seem to be protective.

Missed adolescent acetabular apophyseal avulsion with late hip dislocation.

BACKGROUND: Chronic hip dislocation associated with acetabular apophyseal avulsion in adolescence is rare. Whilst superior acetabular rim fractures have a documented theoretical risk of hip instability, we have not found a case of chronic dislocation resulting from this. METHODS: We report a case of a 12-year-old healthy boy who initially sustained a missed right acetabular apophyseal avulsion after falling from a quad bike. This was missed on the initial radiograph and a subsequent radiograph following weight bearing a few days later showed a hip dislocation that was also missed. Upon diagnosis at 6 weeks, he underwent open reduction but also required acetabuloplasty to stabilise the hip. RESULTS: At 2 years follow-up, he was enjoying pain free swimming, cycling and walking. His Harris hip score was 87. CONCLUSION: This case reinforces the need for recognition that in the patient presenting with knee or thigh pain, exclusion of hip pathology is required. It also explores the pitfalls of diagnosis associated with rare patterns of injury and the need for adequate investigations such as examination under anaesthetic, arthrography and MRI. The use of acetabuloplasty is shown to be a useful strategy for the unstable hip resulting from irreparable acetabular rim fracture.

Giant solitary synovial osteochondromatosis of the elbow causing ulnar nerve neuropathy: a case report and review of literature.

INTRODUCTION: Giant or solitary osteochondroma is part of a rare disorder known as synovial osteochondromatosis. It forms part of a spectrum of disease characterized by metaplastic changes within the joint synovium that are eventually extruded as loose bodies. It has been suggested that solitary synovial osteochondroma forms as progression of synovial osteochondromatosis through a process of either coalescence of multiple smaller bodies or the growth of a dominant synovial osteochondroma. Previous studies have shown that it occurs as a late phase of the disease. We report a rare case of giant synovial osteochondromatosis at the elbow causing ulnar nerve neuropathy and mechanical symptoms which has not been previously reported in the literature. CASE REPORT: We report a case of a 56 year old Western European gentleman who presented with ulnar nerve neuropathy and swelling behind the elbow. The patient underwent MR imaging and subsequent biopsy that demonstrated synovial osteochondromatosis. Initially the patient declined surgery and opted for a watch and wait approach. Five years later he returned with worsening symptoms and underwent successful surgical resection of a giant solitary synovial osteochondroma. CONCLUSION: The unique outcome in our patient despite the long interval between presentation and surgical treatment resulted in early full resolution of symptoms within a short period. It may suggest an improved prognosis as compared to multiple synovial osteochondromatosis in terms of mechanical and neurological outcomes.