Dissociation and implantation of Exeter femoral instrumentation during total hip arthroplasty.

Proprietary femoral plug introducers are routinely used to insert intramedullary plugs during total hip arthroplasty. The cement restrictor pin from an Exeter intramedullary plug introducer may become detached during insertion of the cement restrictor plug, or during sponge packing of the femur. We suggest some precautions that should be taken to prevent this from occurring and advise that the patient is unlikely to experience any long-term adverse reactions to the presence of the restrictor pin in the intramedullary canal.;

Perceived efficacy and risks of infection following intra-articular injections: a survey of orthopaedic surgeons.

BACKGROUND: Efficacy of intra-articular injections is controversial and published studies on efficacy and risks are few. AIMS: We sought the opinion of practicing orthopaedic consultants in order to establish the perceived benefits and risks of infection following intra-articular steroids. METHODS: A questionnaire was sent to all the orthopaedic consultants in the UK and Ireland on the use of intra-articular steroids. RESULTS: A total of 853 completed questionnaires (response rate 57.4%) were analysed. The perceived risk of infection was 1:1000 in almost half of the surgeons polled and 1:10,000 in one third. The 759 consultants who administer intra-articular steroids recalled sixty-eight cases of infection; 85.2 % of the surgeons rated efficacy 5 or above on a visual analog score of 1-10. CONCLUSIONS: Correct patient selection, proper indications for use, and a limited number of appropriately spaced injections were all perceived to be important to achieve maximum benefit without serious side-effects.

Intracapsular fractures of the femoral neck in younger patients.

BACKGROUND: Most femoral neck fractures in younger patients have a different mechanism, treatment, and prognosis from those in elderly patients. AIMS: To evaluate the results of internal fixation of femoral neck fractures in patients aged between 20 and 60 years, and to determine reasons for failure. PATIENTS AND METHODS: Thirty three patients aged between 20 and 60 years who sustained a femoral neck fracture between 1995 and 2000 were reviewed. This represents 5.6% of the total femoral neck fractures admitted to the unit during this period. RESULTS: In 26 patients (78.8%) the fracture resulted from higher energy trauma. Of 23 patients with displaced fractures four patients (17.4%) developed avascular necrosis and one patient (4.3%) developed non-union. Factors influencing outcome were mechanism of injury, pre-operative fracture displacement, adequacy of fracture reduction and delay in surgery. CONCLUSION: Our study emphasises the importance of timely surgery and adequate reduction of displaced femoral neck fractures in younger patients.

Short-term benefit of arthroscopic washout in degenerative arthritis of the knee.

Over a 4-year period, 55 consecutive knee arthroscopies were performed on 54 patients with symptomatic mild to moderate osteoarthritis. There were 30 female patients and the average patient age was 60.9 years. The average follow-up period was 29.6 months. All patients underwent diagnostic arthroscopy and washout. Further procedures including removal of loose bodies and partial meniscal resection were necessary in 19 patients. There were no significant postoperative complications. Thirty-seven patients had subjective improvement in symptoms. The average duration of benefit was 25.5 months. Arthroscopy and appropriate debridement of the degenerative knee results in significant subjective improvement. This relatively minor procedure can delay or indeed obviate the need for reconstructive surgery.

Recurrent congenital haemangiopericytoma in a child.

A five-day-old boy was referred with a soft-tissue mass in his right upper arm. Plain radiographs and ultrasound demonstrated a lesion extending from the axilla to the elbow on the posterolateral aspect of the humerus. Open biopsy confirmed the diagnosis of congenital haemangiopericytoma. After MRI and selective angiography, excision biopsy was carried out, but no adjuvant therapy was administered. At further examination, four years and ten months later, he was noted to have three small nodules at the site of the original tumour. Excision biopsy confirmed this to be a local recurrence, although the lesion was less cellular with no appreciable mitotic activity. Congenital haemangiopericytoma is a rare cause of a soft-tissue mass in children. Most tumours are benign, and recurrence is uncommon. The treatment is controversial, but most centres recommend the use of adjuvant chemotherapy, combined with complete excision. We recommend treatment with doxorubicin. Orthopaedic surgeons should be familiar with this tumour since 30% to 50% of cases occur in the limbs.

Tibial hemimelia of a different class.

A variant of tibial hemimelia, previously undescribed in the literature and not classifiable by either of the established classification systems, is described. The features of this condition include a short, deformed tibia; proximal subluxation of the fibula at the knee; a normal knee joint and an ankle joint that may look abnormal but falls short of true diastasis of the joint. Treatment of two cases by differential lengthening of the tibia and fibula using the Ilizarov device is described. This form of tibial hemimelia should be recognised as a separate variant as preservation of the foot and ankle with expected excellent function should be possible, unlike the more severe forms of this condition.

Management of the collapsing spine for patients with Duchenne muscular dystrophy.

Instrumented fusion of the collapsing spine has gained widespread acceptance for patients with Duchenne Muscular Dystrophy but controversy still exists on the issue of extending the surgical fusion to sacrum in these patients. This retrospective study reviews the long-term outcome of a group of patients with spinal deformity associated with Duchenne Muscular Dystrophy who were managed with long spinal fusion to L5 and ongoing wheelchair seating attention. The clinical notes and radiographs of 19 consecutive patients were reviewed. Fifteen patients attended for clinical and radiological assessment at a mean of 28 months post operatively. The surgery for these patients involved a mean anaesthetic time of 3.5 h and a mean transfusion requirement of 5 units of red cell concentrate. At long-term follow-up 15 patients continued to sit in a well-balanced position. Surgical fusion of the spine to L5 combined with ongoing attention to seating is associated with good long-term functional results in these patients.

Patellofemoral contact forces and pressures during intramedullary tibial nailing.

Patellofemoral joint forces and pressures were measured in a cadaver model during intramedullary nailing of the tibia. A significant increase in contact pressures was found at the lateral facet of the patellofemoral articulation using the medial paratendinous approach (P = 0.01) and at the medial facet when using the trans-patellar tendon approach (P = 0.001) to the proximal tibia. Increased contact pressures at the patello-femoral joint may result in chondral injury, which in turn may cause anterior knee pain, a common complication of tibial nailing.

Duplication of the medial column presenting as a fixed equinus deformity: a case report.

A case of accessory talus is described in which a large ossicle on the medial aspect of the talus had formed an articulation with the distal tibial epiphysis and had produced a fixed equinus deformity of the ankle. We propose that this ossicle, in association with a previously excised accessory toe at the level of the base of the first metatarsal, represents a partial duplication of the medial column of the foot.

Gangrenous cystitis: case report and review of the literature.

A case of gangrenous cystitis in a 67-year-old woman is reported. Associated etiological factors include invasive recurrent carcinoma of the cervix, radiotherapy and atherosclerosis. Primary infection was not a feature. The patient was treated with antibiotics, bladder drainage and total cystectomy with complete recovery. The etiology and management of this unusual condition are discussed.