On burn injuries related to airbag deployment.

Airbags have been shown as a vital, supplemental restraining device that save lives and reduce morbidity associated with motor vehicles crashes. However, as with any developing technology, airbags have also been identified in some instances, as the source of injuries which, have been well described in the literature. To a significantly lesser degree, burns due to airbag deployment (about 7-8% of these injuries) have been reported. These injuries will be seen more frequently as more vehicles are equipped with airbags and should be suspected in drivers and passengers involved in accidents in which airbags have been activated. This article, reviews the various types of burns and their pathogenesis, found in crashes involving airbag deployments.

Late follow-up of femoral head avascular necrosis managed by intertrochanteric osteotomy & bone grafting.

A prospective study was carried out on fifty hips in forty-eight patients with Ficat stage III (Steinberg stage IV) avascular necrosis (head deformity evident on plain x-ray) involving the supero-ventral segment. Mean age was 33 +/- 8 years (mean and standard deviation). There were thirty-six male and twelve female patients. Followup was 3-14 years (mean 8 years). This study precluded patients who were more than 45 years old, had an underlying condition requiring continued chemotherapy or cortisone, who had extensive dorsal (posterior) head segment involvement or those who were poorly motivated. Avascular necrosis was associated with alcohol in 35% of hips, trauma in 26% and 39% were idiopathic. One pregnancy related case was included in the latter subgroup. Curettage of the avascular segment and impaction of the bone graft was performed via subcapital fenestration of the anterior femoral neck. Pain was the presenting symptom in all cases. The mean pre-operative Harris hip score was 36 points and the mean score at last assessment was 87 points. Seven hips (14%) failed, failure implied conversion to a hip replacement or a Harris hip score of less than 70 points. Failures were seen within the first 3 years after osteotomy. Kaplan Meyer Survivorship analysis demonstrated an overall survivorship probability of 86% at 14 years. One patient died 10 years post surgery, the head was retrieved for histological study. Statistical study (Mann-Whitney U test) was carried out to determine factors related to failure. Of significance were age of the patient at time of osteotomy, contralateral hip involvement and size of the lesion. X ray studies of the femoral head included measurement of the necrotic angle, evaluation of restoration and maintenance of head contour and graft incorporation or stabilisation. Subsequent CAT scan studies enabled accurate quantification and siting of the avascular segment. Secondary x ray degenerative changes of the joint tended to manifest with time but these changes had little bearing on the clinical outcome. Osteotomy does have a measure of unpredictability, but in the appropriate case a high incidence of satisfactory results would be anticipated.

Retroperitoneal abscess after normal delivery. A report of two cases.

BACKGROUND: Retroperitoneal abscess is a rare complication of normal labor and delivery, and no apparent etiology is evident. CASES: We report on two patient who presented with back and leg pain soon after normal deliveries. While the condition was initially clinically misdiagnosed, ultrasonography and computed tomography demonstrated retroperitoneal collections and aided in guided percutaneous drainage. After a protracted course of antibiotic treatment and daily irrigation, the collections resolved. CONCLUSION: Ultrasonography and computed tomography were invaluable in the diagnosis and guided drainage of rare psoas abscesses complicating delivery.

Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head.

A prospective study was done of forty-five hips in forty-three patients who had Ficat stage-III avascular necrosis of the anterosuperior part of the femoral head. The patients had been followed for an average of sixty-five months (range, thirty-six to 126 months) after an operation that included a valgus-flexion intertrochanteric osteotomy, curettage of necrotic bone, and grafting of autogenous bone to the avascular segment. The patients were 32 +/- 8 years old (mean and standard deviation). Patients who were more than forty-five years old, had an underlying systemic disease, had been treated with steroids, had more extensive involvement of the femoral head, or were poorly motivated were excluded from the study. The mean preoperative Harris hip score was 34 +/- 10 points, and the mean score at the most recent assessment was 90 +/- 7 points. Six hips (13 per cent) failed; failure was defined as a Harris hip score of less than 70 points or the performance of a subsequent replacement arthroplasty. Survivorship analysis demonstrated cumulative survival without such failure to be 87 per cent at five years; the ten-year cumulative survival was essentially unchanged. The results of this study suggest that the role of intertrochanteric osteotomy and bone-grafting of the femoral head should be considered anew for the treatment of avascular necrosis of the hip in younger patients who have not received steroids. The results of this procedure should be compared again with those of arthroplasty in the treatment of this condition.

Serum keratan sulfate levels in marathon runners.

The effect of strenuous joint loading on the metabolism of articular cartilage in man is not known. The development of a non-invasive immunoassay for the assessment of the catabolism of cartilage aggrecan has enabled us to quantify keratan sulfate (KS), a component of aggrecan, in the serum of fifteen male marathon runners. Serum KS was measured by an ELISA before and immediately after a marathon (42 km), as well as 48 hours after the completion of the race. The mean level at rest was similar to those previously reported for another population of age-matched males. There was no statistically significant difference in the serum level of KS at the three different readings. Further, there was no correlation between age, height, weight and performance time, and the serum level of KS at any of the three different times. We conclude that marathon running by carefully trained runners causes neither a transient nor a sustained increase in proteoglycan catabolism in articular cartilage.

Combined intertrochanteric and Chiari pelvic osteotomies for hip dysplasia.

Thirty-two dysplastic hips with secondary osteoarthritis, in 28 patients aged 18 to 42 years, were treated by combined intertrochanteric and Chiari osteotomy. They were followed up for 2.5 to 10 years. Pain was the main presenting symptom in all the patients. The indication for surgery was based on the severity of disease with respect to congruency, secondary degenerative change and degree of dysplasia. The average pre-operative Harris hip score was 47.7 and the majority had severe dysplasia with degenerative changes. On final review the average score was 88. The radiographic appearances of degenerative arthritis regressed in 72% of hips and dysplasia was improved in all cases. The results of this conservative form of surgery are better in hips with less severe dysplasia and mild secondary degenerative change.

External fixation for intra-articular fractures of the distal radius.

In a prospective study of 132 patients with an average age of 35 years, unstable intra-articular fractures of the distal radius were treated by external fixator. Only 15 cases required limited open reduction. Follow-up was for a mean of 42 months. There were few complications and 83% of patients had good or excellent results. There was a statistically significant correlation between the severity of the fracture and the clinical outcome, irrespective of radiological restoration. Articular and soft-tissue damage following violent compressive forces may lead to a degree of functional impairment.

Serum keratan sulphate levels during prolonged rest.

Serum levels of keratan sulphate (KS) were measured by an enzyme-linked immunosorbent-inhibition assay on admission to hospital in 26 previously healthy young patients who had sustained fractures of the pelvis without involvement of the hips. The serum KS level was found to decrease during the period in hospital (5-6 weeks), but rose after return to ambulatory life (6-12 months). The results suggest that serum KS levels are related to rest.

Isolated traumatic posterior dislocation of the radial head.

Only 4 cases of isolated posterior dislocation of the radial head in adults have been reported in the English-language literature. We describe 2 cases with a clear mechanism of injury and present a concise review of the literature.

Trochanter re-attachment in revision hip arthroplasty.

We present a new method of trochanter stabilisation designed for use in difficult revision hip arthroplasties. A fixator is secured to the metaphysis of the femur, and its two malleable prongs encompass the trochanter fragment and stabilise it using the tension band principle. The fixator is versatile, simple to apply and has better mechanical properties than any technique using wires. We reviewed 49 revisions after a mean follow-up of 40 months. Patients had been mobilised early, but there were no detachments or displacements from the initial postoperative position. Although 31% of patients were osteoporotic and 16% had poor trochanter fragments, there was bony union in 46 of the 49 hips, the remaining three developing stable fibrous union.

Long-term results of revision total hip arthroplasty.

A total of 138 revision hip arthroplasties in 134 patients, all operated upon by one surgeon, were followed for an average of 7.4 years. The overall results were reasonable, with good to excellent Mayo hip scores in 62% and little or no pain in 86%. These results were independent of body weight, age, primary diagnosis and type of arthroplasty used. The incidence of radiological loosening was alarming, though comparable to that found in other series. Our findings indicate that it may be wise to replace both components even when, after careful assessment before and during operation, one of them seems to be securely fixed.

Radiological signs of loosening of the femoral stem in cementless total hip arthroplasty.

The radiological evaluation of cementless stem hip arthroplasty has received scant attention in medical publications. A retrospective analysis of 34 patients who underwent RM iso-elastic hip arthroplasty indicated the existence of a reproducible series of radiological features visible on plain radiography, which correlated both with clinical failure and with arthrographic evidence of loosening in 10 cases. In addition, there was correlation with scintinographic results and findings at revision surgery. The radiological signs were as follows: radio-opaque lines within radiolucent zones, the 'pedestal' sign, stem shift, localised cortical hypertrophy, and proximal bony overgrowth.

Isolated avulsion fracture of the anterior tubercle of the atlas.

Avulsion fracture of the tubercle of the atlas is a rare injury which is probably frequently overlooked. The fracture results from hyperextension of the neck against contraction of the long flexors. We describe two different fracture patterns and discuss the anatomical implications thereof.

Acute-on-chronic bilateral reversed slipped capital femoral epiphysis managed by Imhauser-Weber osteotomy.

In a rare case of progressive bilateral valgus-slipped capital femoral epiphysis, modified Imhauser-Weber osteotomies were carried out. The osteotomies allowed for significant varus correction and thus included shortening of the neck and distal transfer of the greater trochanter. The planning technique of the complex osteotomy is discussed. At 5-year follow-up the patient had a gratifying result.

Transverse fracture through the body of the axis.

We report a case of transverse fracture through the body of the axis. This fracture was unstable, had been produced by extension forces and was managed conservatively. The classification of such fractures is discussed.

Serum keratan sulfate levels in osteoarthritis patients.

Serum levels of keratan sulfate (KS), measured by an enzyme-linked immunosorbent-inhibition assay, were found to be significantly higher in 31 patients with hypertrophic osteoarthritis (OA) than those in 41 adults without joint disease. Seventy-seven percent of patients with OA, but only 12% of control subjects, had serum levels which were more than 1 SD above the mean of the control group. Following replacement of a single osteoarthritic hip joint, serum KS levels decreased, at first, in all patients. Subsequently, the concentration of serum KS progressively increased; 6 months following surgery, KS levels were similar or close to the preoperative levels in virtually all patients. The results suggest that patients with hypertrophic OA may have a generalized imbalance of cartilage proteoglycan metabolism. Measurements of serum KS are likely to prove most useful in studying this particular subset of patients with generalized OA.