Nontraumatic dislocation of the hip following screw/plate fixation for a femoral neck fracture.

An unusual case of nontraumatic hip dislocation following screw/plate fixation of a basicervical fracture of the neck of the femur, which is unassociated with sepsis, is reported.

Weakness of foot dorsiflexion and changes in compartment pressures after tibial osteotomy.

Weakness of dorsiflexion of the foot is a common complication of proximal tibial osteotomy and it has been suggested that this may be caused by an anterior tibial compartment syndrome. A prospective study of 20 patients undergoing tibial osteotomy was undertaken, in which compartment pressures were recorded and related to clinical signs. In 10 of the patients, the operation site was drained, and in 10 no drainage was employed. The undrained group showed significant elevation (greater than 45 mmHg) of the anterior compartment pressure in seven patients, and five of these had transient clinical signs. Only one patient had any permanent deficit, a minor asymptomatic weakness of extensor hallucis longus. In the drained group the pressures remained below 30 mmHg in all except two patients, who both had only a minor pressure rise and no significant early clinical signs. However, two patients from this group later developed weakness of dorsiflexion, probably due to common peroneal nerve injury, the cause of which is not clear.

Diagnostic failures in the multiple injured.

A retrospective survey of the records of 327 patients with multiple injuries ws carried out in order to establish the incidence of missed injuries and the reasons for diagnostic failures. Twelve per cent of the patients had an injury not diagnosed at the first examination. The most vulnerable group were motorcyclists in whom the incidence was 23%. Missed injuries tended to be grouped about the major joints. Factors which predisposed to an inadequate initial assessment were poor clinical routine, failure to interpret correctly certain physical signs, poor utilization of X-ray services and, above all, admission of these patients to nonorthopaedic wards.

High tibial osteotomy for rheumatoid arthritis of the knee. A one to six year follow-up study.

Although high tibial osteotomy for osteoarthrosis of the knee joint is well recognized, its place in the management of rheumatoid arthritis of the knee is much less well established. Thirty-six rheumatoid knees were reviewed 1 to 6 years following tibial osteotomy. The results were 42 per cent good, 19 per cent satisfactory and 39 per cent poor. No patient remained free of pain for more than 3 years, and recurrence of pain was not always associated with recurrence of deformity. Varus knees did considerably better than valgus knees despite some technical errors. Maintenance of a normal femoro-tibial angle range of 164 degrees to 177 degrees at follow-up was important but not as vital as in osteoarthrosis of the knee. The beneficial effect of tibial osteotomy in rheumatoid arthritis of the knee seldom lasted more than 3 years after which time an increasing number of bad results were seen. It was concluded that high tibial osteotomy was a satisfactory procedure for rheumatoid arthritis of the knee but its efficacy was not comparable to that seen in osteoarthrosis nor was its effect long-lasting.

Thompson prosthesis for fractured neck of femur. A comparison of surgical approaches.

The records of 243 patients with Thompson prostheses for displaced femoral neck fractures have been studied. One hundred and seven prostheses were inserted through an anterior approach and 136 by a posterior approach. The short-term results and complications in these otherwise comparable groups are discussed. The infection rate of 18.5 percent in the group operated upon by the posterior approach was thrice that after operations by the anterior route (6.5 per cent infected). Drained wounds had significantly less infection (6.3 per cent) compared with the undrained group (28 per cent infected). Other factors influencing the infection rate are discussed. The anterior approach offered greater stability. Of the twenty dislocations in the series, nineteen followed operations by the posterior approach. The mortality rate six weeks after operation was 6.5 per cent after the anterior approach and 20.6 per cent after the posterior approach. Statistical analysis significantly favours the anterior approach.

Subclavian artery rupture (an unusual seat-belt injury).

A case of blunt injury to the subclavian artery in the absence of bony injury or dislocation sustained while wearing a seat belt is described. Its rarity and diagnostic pitfalls are discussed. The mechanism of the injury is analysed. The value of angiography is emphazided. It is suggested that, even in the presence of collateral circulation, exploration and repair should be undertaken.

Tibial osteotomy for osteoarthrosis of the knee.

Forty-five knees with tibial osteotomy for osteoarthrosis were studied at 5 to 10 years following surgery. Twenty-seven were graded excellent, eight good and ten poor. The best results were found in knees which maintained a Femoro-Tibial angle of 163 degrees--180 degrees whereas the poor results were associated with either under-correction at operation or late recurrence of deformity. The latter was closely related to pain. Provided that the initial deformity is adequately corrected and maintained, tibial osteotomy for osteoarthrosis of the knee gives good results which can last up to 10 years.