High rates of psychosocial complications after road traffic injuries.

A total of 134 people, aged between 25 and 60, were randomly selected from the Traffic Injury Register in Göteborg and interviewed 2 years after the accident. They were asked by telephone about their lives before and after the accident. There was a high rate of complications, even after some minor injuries. Half of the respondents still reported travel anxiety. Pain, fear and fatigue were also common. Sixteen per cent of those employed could not return to their ordinary jobs. Nearly one-third reported a reduction in leisure-time activities. Cervical spine 'distortion' was the only diagnosis associated with a high rate of complications. Married/cohabiting individuals developed complications more often than single people (p = 0.01). A risk factor for women--but not for men--was if they had children (p = 0.004). With respect to dealing with insurance, inadequate medical information and poor psychosocial support were other risk factors. Intervention programmes offering psychological and social support should be included in the care of traffic accident victims.

Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries.

In many cases of whiplash injury symptoms persist and do not respond to treatment. There is uncontrolled evidence to suggest that intracutaneous injections of sterile water might help. Since that route may be unacceptable to patients the subcutaneous route is used in the randomised trial reported here. 40 patients with whiplash syndrome, mean age 46 years (24-73) were given subcutaneous injections of 0.3-0.5 ml sterile water or saline over tender and trigger points in the neck and shoulder. A maximum of three treatments were given during the first two months of the study and the patients were followed up for 8 months. The accidents had occurred 4-6 years previously. X-ray examinations revealed no traumatic spinal lesions. Neck mobility and pain levels were evaluated by a physiotherapist immediately before and after the first treatment and after 1, 3, and 8 months. After 3 months, the mean total mobility of the cervical spine had increased by 39 degrees in the sterile water group and 6 degrees in the saline group (p < 0.05). Minimum and maximum levels of pain in the weeks just before treatment were evaluated by a visual analogue scale from 0 to 10. After 3 months the minimum pain level had fallen from 2.2 to 1.4 in the sterile water group but was not reduced in the saline group (p < 0.02); the maximum had fallen from 8.1 to 3.8 in the sterile water group and from 8.3 to 7.5 in the saline group (p < 0.001). After 3 months, 19 of 20 patients in the sterile water group assessed their condition as generally improved but only 6 in the saline group felt that they had got better. After 8 months there were still significant differences for minimum pain score and for mobility but not for maximum pain or for self-assessment of improvement.

Lowering of the patella secondary to anterior advancement of the tibial tubercle for the patellofemoral pain syndrome.

From a series of 72 patients treated with anterior advancement of the tibial tubercle for patellofemoral pain syndrome, secondary lowering of the patella was noted in eight. In all eight patients the results were poor following surgery, with severe disabling retro- and peripatellar pain and atrophy of the quadriceps muscle. We describe this complication and illustrate and discuss the biomechanical consequences. The shortening of the patellar ligament and lever arm of the ligament were determined from radiographs of the knee joints before and after surgery. A theoretical analysis was made of the compressive force in the patellofemoral joint in one of these patients. The Insall-Salvati index decreased from 0.88-1.25 (mean 1.07) preoperatively to 0.54-0.78 (mean 0.70) at follow-up, 1.0-2.5 years post-operatively. The lowering of the patella was correlated to a reduction of the lever arm of the patellar ligament in seven patients. The mechanism behind the lowering of the patella is obscure, but the reduced lever arm of the patellar ligament will increase the compressive force in the patellofemoral joint, and this might be one explanation of the poor results. Impaired congruity of the patellofemoral joint, increased tension in the patellar ligament, and increased pressure against the quadriceps tendon are other possible explanations.

Resurfacing arthroplasty of the hip. Biomechanical, morphological, and clinical aspects based on the results of a preliminary clinical study.

As an alternative in total hip replacement the so called resurfacing arthroplasty of the hip is gaining wider acceptance. The procedure can be said to be a modernisation of the original Smith-Pedersen operation and is suggested in young people with degenerative hip disease, congenital hip dysplasia or Perthes' disease. The advantages are that the femoral head and neck are retained and thus no femoral stem prosthesis is necessary. The greatest disadvantage is that in case of socket loosening a secondary operation might not remain as successful as could the initial operation with a socket which is not as large as those recommended for the resurfacing procedure. In this presentation a preliminary report of a one-year material is presented together with a presentation of advantages, disadvantages, and the biomechanical appraisal of resurfacing of the hip. Fifteen patients with 17 hips have been operated and followed-up and by using the Merle d'Aubigné evaluation there was an improvement of some 3--4 points in pain, walking, and total motion. Patient opinion indicated 80% satisfaction. The management of two serious complications is also described.