Unreamed nailing of tibial fractures--a prospective study of the routine use of the unreamed tibial nail.

We prospectively studied 44 patients treated with the AO Unreamed Tibial Nail (UTN) at two orthopaedic trauma units. There were 15 open fractures: eight type I, four type II, one type IIIA, and two IIIB (Gustilo). The mean follow-up time was 13 months (range 6-24 months). There were 14 type A, 26 type B and four type C fractures (AO classification, Muller). All patients with the open fractures had surgery within eight hours of injury. Closed fractures were treated on the next available trauma list. The mean time to fracture union was 15.3 weeks (range 10-26). In the closed fracture group (n = 29), the mean time to union was 14.9 weeks compared to 18.6 weeks for the open fracture group. There were no non-unions and no infections. One patient had a malunion and breakage of locking bolts occurred in two cases. Our results indicate that the UTN provides excellent results in the treatment of both closed and open fractures of the tibial shaft, with union times comparable to reamed techniques.

Aspiration arthrography of the hip joint. Its uses and limitations in revision hip surgery.

Seventy-one patients undergoing revision hip surgery over a 5-year period from 1988 to 1993 had aspiration arthrography of the hip as a preoperative investigation. Sixteen hips were found to be infected at operation. Preoperative aspiration yielded positive cultures in 11 of these 16 hips. There was identical correlation between the organisms isolated on aspiration and during surgery. There were 5 false positive cultures from the aspirates of the remaining 55 noninfected hips. All of the hips from which a true positive culture was obtained had either clinical or radiologic evidence suggestive of infection. Aspiration arthrography does not have a major role to play as a routine investigation prior to all revision hip surgery. It is recommended that its use be reserved for those hips in which there is either clinical, hematologic, or radiologic evidence of infection.

Early mobilization of acute whiplash injuries.

Acute whiplash injuries are a common cause of soft tissue trauma for which the standard treatment is rest and initial immobilisation with a soft cervical collar. Because the efficacy of this treatment is unknown a randomised study in 61 patients was carried out comparing the standard treatment with an alternative regimen of early active mobilisation. Results showed that eight weeks after the accident the degree of improvement seen in the actively treated group compared with the group given standard treatment was significantly greater for both cervical movement (p less than 0.05) and intensity of pain (p less than 0.0125).

The total femoral prosthesis. A preliminary report.

The use of a total femoral prosthesis can offer a realistic alternative to amputation or disarticulation. The limited indications for such a prosthesis in the surgical management of primary bone tumours and pathological fractures still exist. In this specialised clinic there is an increased need to replace the entire femur where repeated procedures have failed, from loss of bone stock with infection or because of non-union in the presence of a prosthesis. Over the past eight years, four basic models have been developed. The most recent designs allow for the preservation of non-involved bone or for stable support where there is complete acetabular destruction.

Disarticulation of the hip as a result of failed arthroplasty. A series of 11 cases.

Eleven patients underwent disarticulation for infected arthroplasty of the hip. Exchange total hip arthroplasty or conversion to a Girdlestone excision arthroplasty had been undertaken previously an average of 2.9 times. The indications for disarticulation were as a life-saving measure, or as a result of severe infection of soft tissue and bone, loss of bone stock, or vascular injury. While the indications for this drastic operation were highly individual, there were instances where disarticulation could have been avoided if repeated exchange operations had been eschewed in deference to a Girdlestone procedure.