Nonorganic pain drawings are associated with low psychological scores on the preoperative SF-36 questionnaire in patients with chronic low back pain.

The Short Form 36 questionnaire (SF-36) measures general health and well-being. Within the last 5 years it has been used increasingly to characterise patients in the medical literature. Relatively few studies have used the SF-36 on patients with chronic low back pain undergoing preoperative evaluation, but results suggest that it may be predictive of surgical outcome. Pain drawings are a routine part of evaluation prior to spinal surgery in several centres, since their classification of organic or nonorganic has been shown in some studies to correlate well with psychological characteristics predicting poor outcome. The purpose of the present study was to assess possible correlations between nonorganic pain drawings and the psychological scales in the SF-36. We included 128 patients in the study, all of them referred from other hospitals. Previous spinal surgery had been undergone by 25%, and 59% required daily medication because of low back pain. All patients completed pain drawings using predefined symbols These pain drawings were scored dichotomously as organic or nonorganic based on a brief description of a typical nonorganic characteristics. Patients also completed the Danish version of the SF-36 questionnaire. Statistical analysis was performed using logistic regression analysis. The pain drawing classification was used as the dependent variable and scores on the eight scales of the SF-36 as independent variables. P values of <0.05 were considered significant. The mean scores of the patient population on all eight scales were significantly lower than Danish norms. The only scales that correlated with the presence of nonorganic pain drawings were emotional role (RE) and mental health (MH), both measuring psychological health. The odds ratio (OR) of receiving a nonorganic pain drawing was 22 (95% confidence interval, or CI, 7-65) if the scores on RE and MH were more than 2 standard deviations (SD) below the Danish norm. This is the first study providing evidence that pain drawing ratings are influenced by the psychological scales of the SF-36. The clinical relevance of this observation regarding prediction of outcome after spinal surgery should be assessed in future studies.

[Percutaneous fixation of sacral fractures. Primary experiences with a new technique]. / Perkutan fiksering af sacrumfrakturer. Primaere erfaringer med en ny teknik.

A number of techniques have been introduced to obtain reduction and fixation of rotational and vertical unstable sacral fractures and sacro-iliac (SI) joint disruptions. The purpose of this study is to report our primary experience with percutaneous cannulated screw fixation across the joint or fracture line. Fifteen consecutive patients, seven males and eight females, were operated. Six patients had isolated sacral fractures or SI joint disruption. All patients had a type C pelvic fracture according to Tile's classification. Percutaneous fixation of sacral fractures and sacro-iliac joint disruptions allows a short operating time, minimal bleeding and soft tissue damage, and immediate non-weight bearing mobilisation. No non-unions were seen and there were no cases of infection. In two patients the material had to be removed. The method gives adequate fixation of unstable posterior pelvic-ring fractures, but is technically difficult as malposition of the screws might cause serious perioperative complications.

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system.

Several biomechanical studies have evaluated the quality of fusion obtained with a rigid versus a semi-rigid pedicle screw implant. Some studies indicate that increased rigidity of the implant system results in an increased strength of the fusion mass. Other reports have underlined the risk of stress shielding due to rigid implant systems. Based on these findings some authors have recommended the use of a semi-rigid system. There are, however, few studies focusing on any possible difference in clinical outcome between the two different types of implant systems. Questionnaires were sent to 89 patients who had undergone primary spinal fusion with either a rigid or a semi-rigid pedicle-screw-based implant system. In every case the diagnosis was spondylolisthesis or degenerative lumbar disease. The questionnaires were analysed using forward stepwise logistic regression analysis. Eighty (90%) of the questionnaires were returned. There was a mean follow-up of 4 years (range 2-8 years). It was not possible to demonstrate any difference in clinical outcome between patients undergoing lumbar fusion with a rigid implant system and those given a semi-rigid system. The overall patient satisfaction rate was 69%, with no difference between the two types of implant. No difference in clinical outcome between the two types of implant was found. Considering the fact that the primary goal of spinal fusion procedure is to obtain a solid fusion mass, biomechanical tests favour the used of a rigid pedicle screw system. This fact combined with the fact that early mobilisation is possible with rigid implants justifies the use of rigid implant systems, although no difference in clinical outcome could be demonstrated in this study.

Subtrochanteric fractures following osteosynthesis of femoral neck fractures with the VLC-femoral system.

Twenty-two patients with femoral neck fracture were treated with the VLC (Variable Length Cannulated)-femoral screw system. In four patients, the osteosynthesis had complications with ipsilateral subtrochanteric femoral fractures in relation to the screw holes in the lateral cortex. The problem seemed to be excessive stress on the lateral cortex during insertion of the screws. The method has been abandoned in our department.

Pressure-position relations in the glenohumeral joint.

The intra-articular pressures in the glenohumeral joint in different positions were measured in 12 cadaveric shoulders. The lowest pressure was found in abduction combined with traction. A significant rise in pressure was seen in positions combining flexion or abduction with rotation. The injected volume to produce a certain pressure as well as the maximum pressure attained in each shoulder showed great variation. These factors are important considerations for immobilization of the shoulder and manipulation during arthroscopy.

Effect of functional bracing, quadriceps and hamstrings on anterior tibial translation in anterior cruciate ligament insufficiency: a preliminary study.

Anterior tibial translation was measured in six patients with anterior cruciate ligament insufficiency. The tests were done in 15, 45, and 90 degrees of knee flexion, partly with activated quadriceps or hamstrings, and partly with subjects wearing a 4-point functional DonJoy brace. The translation was evaluated with a computerized electrogoniometer (Acufex KSS). The anterior tibial translation was significantly reduced by use of the hamstrings in all three degrees of knee flexion. The effect of the 4-point brace was only significant in 15 and 45 degrees of flexion. The quadriceps did not reduce the anterior tibial translation.

Pes anserinus and iliotibial band transfer for anterior cruciate insufficiency.

Twenty-one patients with chronic anterior cruciate ligament insufficiency were treated with a combined iliotibial band (Ellison) and pes anserinus (Slocum-Larson) transfer procedure. Preoperatively, the most prominent instabilities were drawer laxity in 16 patients and anteromedial rotation in 5 patients. After a median of 34 months of followup, 15 patients were absolutely satisfied with the result, 2 were fairly satisfied, and 4 were not satisfied at all, including 2 patients who had been reoperated. All of the patients with unsatifactory results had a pivot shift and a positive Slocum test. Intraarticular derangements had no influence on the results. At followup, 14 patients demonstrated an anteromedial rotatory instability, indicating that the lateral stabilization procedure acted better than the medial one. Only a few patients returned to their preinjury levels of sports activity. Compared with other extraarticular procedures in the literature, the results were quite similar. The operative procedures used in this study cannot be recommended in cases with combined instabilities of the knee.

The influence of skeletal traction on intraarticular pressure of the hip.

Patients with a femoral neck fracture often undergo skeletal traction until surgery. These patients may develop hip joint tamponade that can lead to necrosis of the femoral head. We have measured the pressure variations in 20 cadaveric hips using a semiflexion frame and various loads of skeletal traction. We found a significant decrease in pressure with loads of 5 kg or more of skeletal traction. Skeletal traction does not increase the risk of femoral head necrosis.

Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982-84.

In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.

Subcapital fracture of the femoral neck following internal fixation with a dynamic hip screw.

A case of subcapital femoral neck fracture following osteosynthesis of a trochanteric fracture is described. The implant used was the dynamic hip screw. This kind of fracture is very rare, and has to our knowledge never been described with the use of the dynamic hip screw.

Ultrasonographic detection of foreign bodies in soft tissue. A human cadaver study.

The usefulness of ultrasound in the detection of foreign bodies was examined in a blind study in human cadavers using glass, plastic and wood as foreign bodies. Of 65 foreign bodies placed in 102 cicatrices, 58 were found using a 5 MHz transducer. The sensitivity was 89% and the specificity 93% making ultrasound a useful clinical tool for this purpose.

Snapping knee from biceps femoris tendon. A case report.

Painful snapping of the knee was caused by the long tendon of the biceps femoris muscle sliding over the fibular head to an abnormal insertion on the tibia. Removal of the fibular head gave immediate relief.

Rupture of the knee capsule from articular hyperpressure. Experiments in cadaver knees.

We used 10 cadaver knees to estimate the safe pressure during arthroscopy by measuring the volumes and pressures of irrigation fluid at different flexion angles. Maximum volumes could be contained at 35 degrees of flexion. Pressures of 200 to 450 mmHg were measured, and all the knees ruptured by extension or flexion after they were filled to 100 mmHg at 35 degrees of flexion. Fifty milliliters of irrigation fluid had to be removed if the pressure remained constant when extending from 35 degrees and 70 ml when flexing to 90 degrees. Totally, 100 ml irrigation fluid had to be removed when flexing from 35 degrees to 120 degrees. Our investigation indicates that a pressure of 150 mmHg can be tolerated by all knees. Both flexion and extension from the 35 degrees position must be done gently and slowly using a large bore, wide-open inflow and outflow tubes allowing egress of irrigation fluid to prevent capsular rupture, extravasation of irrigation fluid, vascular compromise, or compartment syndrome.