The natural history of the silent hip in bilateral atraumatic osteonecrosis.

The natural history of presymptomatic ischemic necrosis of the femoral head was studied in the contralateral hip of 15 patients undergoing total hip arthroplasty for avascular necrosis between 1979 and 1984. These 15 hips were retrieved from among 416 patients undergoing total arthroplasty during this time period. Presymptomatic avascular necrosis was defined according to three strict criteria that allowed the hips to be studied from an index entry point (no evidence of avascular necrosis). Follow-up examinations of each of these 15 hips from this entry point revealed that all hips eventually collapsed at a mean of 23 months after index entry point (range, 3-66 months). These data indicate that the "silent hip" is at significant risk of developing avascular necrosis and, if it becomes involved, it progresses to collapse in a high percentage of patients in a relatively short time. There was no correlation between underlying etiology and the time to collapse.

Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa.

Ten displaced intra-articular fractures of the glenoid fossa were treated with open reduction and internal fixation between 1980 and 1987. Nine patients were available for evaluation at an average of four years (range, two to ten years) after the operation. Eight patients had mild or no symptoms and little or no restriction of the motion of the shoulder. There were no infections or malunions. The only complication was heterotopic ossification in one patient. Radiographic evaluation showed no evidence of traumatic osteoarthrosis in any patient. Open reduction and internal fixation is a useful and safe technique for the treatment of selected, displaced fractures of the glenoid fossa, and it can restore excellent function of the shoulder.

Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius.

The results in sixteen patients who had a displaced, comminuted intra-articular fracture of the distal end of the radius and who were treated by open reduction and internal fixation were retrospectively reviewed. At a mean follow-up of 4.8 years, 81 per cent of the patients had a rating of good or excellent by the scoring system of Gartland and Werley, but only 56 per cent had such a rating when the modified scoring system of Green and O'Brien was used. All of the fractures healed at an average of nine weeks. A step-off of two millimeters or more in the distal radial articular surface at the time of healing was important, because the four patients in whom the fracture healed with this amount of incongruity all had post-traumatic arthritis at follow-up, compared with only three of twelve in whom the incongruity was less than two millimeters.

Blount disease: a review of the English literature.

A review of the English literature on Blount disease (osteochondrosis deformans tibiae; tibia vara) revealed that two forms of the disease, infantile and adolescent, are recognized. The cause of Blount disease is probably multifactorial. Most recent evidence on the pathogenesis implicates mechanical factors. The diagnosis can be difficult in very young children and must be based on history, physical examination, and radiographic findings. A proximal tibial metaphyseal-diaphyseal angle of greater than 11 degrees should be observed carefully for the development of Blount disease. Both nonoperative and operative treatment has been used successfully.