Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases.

We present a series of 247 undisplaced femoral neck fractures, of which 122 were primarily treated non-operatively, and 125 with primary operative stabilization. The background parameters did not differ significantly in the two groups. The length of hospitalization was 1 week shorter in the operatively treated group. They started to walk bearing full weight at an average of 11 days earlier. Two-thirds of the operatively treated but only one-quarter of the non-operatively treated patients were able to walk alone when they left hospital. General complications were recorded in 19 of the non-operatively and in four of the operatively treated patients during their hospitalization. Early displacement (within 6 weeks) was noted in 20 per cent of the non-operatively treated patients who required late operation. However, there was no early displacement in the operatively treated group. We therefore recommend primary operative stabilization of undisplaced femoral neck fractures.

Silicone-induced synovial and osseal granuloma following metacarpophalangeal and carpal arthroplasty.

Intraarticular particulate silicone rubber created by abrasion of silicone arthroplasty of the hand may be responsible for the development of an iatrogenic granulomatous synovitis and ostitis. Histological and ultrastructural appearances of the involved tissues are presented, together with a discussion of the possible mechanism and methods of pathological diagnosis.

[Synovitis and bone changes induced by silicone prosthesis]. / Szilikon-protézis okozta synovitis- és csontelváltozások.

Authors report on the clinico-pathological analysis of cases of silicon granuloma, developed 5-15 years after the insertion of the prosthesis. It is thought on the basis of histological and electron microscopic examinations that the process of granulation already started, is augmented by the granules, newly arising from the attrition. The silicon granuloma causes not only the damage of the synovia but the destruction of the surrounding soft parts and bones too.

[Diagnostic procedures in cases of wrist pain following distortion of the wrist]. / Diagnosztikus lépések "distorsio carpi" után fellépö csuklófájdalom esetén.

Behind the diagnosis of "distorsio carpi" frequently ligamental injuries with severe functional damage of the carpal joint are hidden. To clear these is, in a significant part of the cases, also in the outpatient department possible if both the clinical (physical) and radiological examinations are carried out with adequate accuracy. Author deals with the "algorithm", summarizing the sequence of these examinations. If, in major complaints, it was not possible to make a diagnosis, an arthroscopy of the carpal joint is suggested.

[The role of Gardner's classification in the detection of dislocation in femoral neck fractures]. / A Garden-beosztás jelentösége a combnyaktörés dislocatiójának meghatározásában.

As the literary data are contradictory, authors examined in 489 operated femoral neck fractures the significance of Garden's classification. Based on their material it was found that this classification gives help in the judgement of the single fractures and in the choice of the adequate treatment. For a more exact assessment however they think the consideration of the lateral Roentgenograms also necessary.

Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur.

The value of internal fixation of fractures of the neck of the femur within 6 h was assessed in a review of a 3-year series. Three groups were compared, in which the operation was performed within 6 h, between 6 and 24 h and after 24 h respectively. The time and quality of union and the incidence of collapse of the head of the femur were significantly better in the first group. The difference in the results between the other two groups was not significant. In view of these data the authors recommend the internal fixation of fractures of the neck of the femur within 6 h.

Conversion of hip fusion to Charnley low-friction arthroplasty.

Spontaneous fusion of the hip following infection or surgical procedures can result in deformity that causes degenerative change in the associated joints. Loss of function can cause pain in adjacent joints. Conversion of hips fused in a deformed position to low-friction arthroplasty reduces shearing strain and improves walking function. Conversion of the fused hips constitutes a technically difficult procedure; adequate exposure with trochanteric osteotomy with the patient in the supine position is strongly advocated.

Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation.

Clinical, experimental and post-mortem studies suggest that avascular necrosis of the femoral head following fractures of the neck of the femur, is due to compression, torsion, stretching or rupture of the blood vessels by displacement of the fragments. If this is true then urgent reduction and internal fixation are important in the prevention of this complication. This study shows that those cases which were submitted to early reduction and internal fixation had a reduced incidence in severity of avascular necrosis compared with those in whom operation was delayed. Therefore it is proposed that fractures of the femoral neck should be treated by early reduction and internal fixation.

The role of intraosseous phlebography in the prognosis of injuries of the talus.

Fracture-dislocations of the talus are often followed by avascular necrosis. In these cases weight bearing must be forbidden in order to prevent collapse of the talus. Experience with intraosseous phlebography in 31 cases and a 2- to 6-year follow-up in 25 of them showed that this is a useful diagnostic procedure in the assessment of the talar blood supply, and an important aid in deciding the necessary period of relief from weight bearing as well as giving a prognosis.

The stress-tenogram in the diagnosis of ruptures of the lateral ligament of the ankle.

The stress-tenogram is a radiological technique for the investigation of injuries to the lateral ligament of the ankle, and combines the information previously provided by inversion and anterior stress radiographs, and the peroneal tenogram. It is designed to differentiate between stable and unstable ankles, and between isolated ruptures of the anterior talofibular ligament and combined tears of the anterior talofibular and calcaneofibular ligaments. A high degree of diagnostic accuracy has been confirmed at operative repair in a group of thirty-two patients.

[Microlesions of articular cartilage as a possible cause for post-traumatic osteoarthritis]. / Mikroläsionen des Gelenkknorpels als mögliche Ursache der posttraumatischen Arthrose

During operative treatment for intraarticular fractures osteochondral fragments were retrieved in 12 cases and sent for histological evaluation. The histology showed microlesions of the articular cartilage and subchondral bone. An etiological connection between these histological changes and posttraumatic osteoarthritis is being discussed.