Neglected posterior dislocation of the elbow. A reconstruction operation.

A new technique for repair of neglected posterior dislocation of the elbow is described, consisting of open reduction with tendon graft stabilisation to create a medial collateral and an intra-articular "cruciate" ligament. This allows flexion-extension exercises to start six days after operation. Eleven cases are reported in which the average range of movement improved from 38 degrees before operation to 105 degrees after a minimum follow-up of two years, with a mean valgus-varus instability of only 13 degrees. One patient had a postoperative infection but all the others were satisfied with the functional result.

A new technique of fusion for tuberculous arthritis of the elbow.

Of eleven patients with tuberculosis of the elbow who were operated on using a new technique, six were followed for two years or more. This technique (which includes debridement and total synovectomy, excision of the radial head, insertion of the triangularly shaped olecranon into a correspondingly shaped hole in the distal end of the humerus, fixation of the humerus and ulna with a single screw, medial and lateral epicondylectomy, and anterior transposition of the ulnar nerve) provides superior bone contact and firm internal fixation without the need for bone grafts. Solid fusion resulted in the six patients who were followed for two years or more. The only complications observed in all eleven patients were transient ulnar-nerve hypoesthesia in one patient and a tourniquet paralysis in an other, both of which resolved. The advantages of the procedure are that the fixation is stable; bone-grafting is not required; adequate joint débridement, including anterior synovectomy, is possible after the radial head is excised; and to date no pseudarthrosis has occurred.

Joint replacement in non-ambulatory patients.

We treated eighteen non-ambulatory patients by multiple operations consisting of total replacement of the hip or the knee, or both. Thirteen patients had rheumatoid arthritis, four had degenerative arthritis, and one had had bilateral resection of the femoral head and neck. The patients were followed for an average of forty months. We devised a classification based on the number of joints involved and a rating scale for function. Good to excellent results were achieved in the patients who had two or three joints operated on (with one exception). Fifteen patients became ambulatory and seven could climb stairs. Seven patients were pain-free. The factors responsible for poor results were significant neural problems and loss of motivation. The presence of severe upper-extremity involvement was not an obstacle preventing walking.

Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis.

In 9 patients with symptomatic calcific deposits in the rotator cuff, followed for an average of 9 years, good to excellent results were obtained by barbotage (needle irrigation and aspiration). The deposit was localized with a needle using an image intensifier. Postbarbotage X-rays show residual deposits, but films taken on follow-up show complete disappearance of the lesion except in one instance where a small density was seen. One patient had early recurrence of symptoms out of the 3 who had postbarbotage cortisone injection. Barbotage is simple, effective, with virtually no complications. Failures of the method were apparently due to difficulty in locating the deposit with the needle. Barbotage is most indicated in the acute phase of the disease but may be used in cases with chronic symptoms to remove dry granular deposits. It is not essential, however, to completely remove the deposits because the resorption process continues. Local cortisone injection either as a primary procedure of after barbotage is not recommended because it aborts the natural course of the disease and promotes recurrences.