Biodegradable fixation of ankle fractures. Complications in a prospective study of 25 cases.

In a prospective study, 25 displaced ankle fractures were treated with one or two biodegradable rods (Biofix), sizes 3.2 or 4.5 mm. In 2 cases the medial malleolus fractured during drilling. At the 1-year follow-up of 22 cases, the following complications had occurred: sinus formation in 1 case and osteolysis corresponding to the fracture line and/or drill channels in 9 cases, 2 of whom had symptoms. 2 patients had been reoperated on, one for pseudarthrosis and another for secondary fracture displacement. Because of the high complication rate and the unknown importance of osteolysis formation, we cannot recommend biodegradable fixation with rods of 3.2 or 4.5 mm length as a supplement to the treatment of displaced ankle fractures, particularly of medial fractures.

Retroversion of the humeral prosthesis in shoulder arthroplasty. Measurements of angle from standard radiographs.

A method for assessing the retroversion angle of the humeral prosthesis in total shoulder arthroplasty is presented. The method is accurate and simple, requiring only an anteroposterior radiograph and a conversion table.

Chondromalacia induced by patellar subluxation in the rabbit.

A unilateral patellar malalignment was induced in 20 young and 20 mature rabbits by lateral displacement of the tibial tuberosity, the other knee serving as osteotomized in situ control. At 6 weeks, all the knees appeared macroscopically normal, but histologically definite cartilage degeneration was found on the experimental side. At 3 months, macroscopic changes occurred in 5 of 10 mature rabbits, and histologic cartilage degeneration was found in all the experimental knees, most pronounced in mature animals, and particularly in joint facets submitted to high pressure. This experimental model produces changes resembling chondromalacia patellae and early arthrotic changes suggesting the importance of malalignment in the development of patellofemoral cartilage degeneration.

Chronic recurrent multifocal osteomyelitis: a follow-up study.

Thirteen children/adolescents and two young adults with unifocal or multifocal nonpyogenic inflammatory bony lesions with a prolonged, fluctuating course are reported. The lesions were most often located at the metaphyseal region of tubular bones and the clavicle, but also at the spine, ischiopubic bone, and the sacroiliac joint. Progressive sclerosis and hyperostosis occurred mostly in the clavicle and occasionally in the tibia, femur, metatarsal, and ischiopubic bone, linking the changes to those described under the name Garré osteomyelitis. Seven patients had pustulosis palmoplantaris, and the skeletal disorder may be regarded a form of pustulotic arthroosteitis.

Shoulder arthroplasty with the Neer Mark-II prosthesis.

Total shoulder joint replacement was used as primary intervention in 50 shoulders--35 with rheumatoid arthritis, eight with osteoarthritis, and seven with traumatic arthritis. Follow-up time was 27 (12-42) months. The primary indication for the operation was chronic severe pain; improvements in motion and function were secondary objectives. Relief of pain was obtained in 46 of 50 shoulders. The best results regarding pain, motion, and function were obtained in the osteoarthritic group. The majority of patients with rheumatoid arthritis obtained pain relief and the largest increase in range of motion occurred in this group, although full range of motion was never regained. The results in patients with traumatic arthritis seemed unpredictable. Two shoulders were complicated by glenoid loosening, one by humeral subluxation, and one by musculocutaneous nerve palsy.

Chronic sclerosing osteomyelitis of the clavicle. A manifestation of chronic recurrent multifocal osteomyelitis.

The cases of five children/adolescents and two young adults with unilateral chronic osteomyelitis of the clavicle are reported. The clinical course was prolonged and characterized by intermittent periods of exacerbation followed by improvement. Extensive investigations revealed no causative organisms and the disease seemed resistant to antibiotic therapy. The only laboratory abnormality was elevated ESR, present in five cases. Osteomyelitis of other bones was detected in four cases and pustulosis palmoplantaris in two, suggesting that the disease is a manifestation of chronic recurrent multifocal osteomyelitis.

The quadriceps function in patellofemoral disorders. A radiographic and electromyographic study.

The influence of quadriceps contraction on patellar alignment was investigated in tangential views of 31 patients with patellofemoral complaints and compared with 25 controls. The congruence angle decreased significantly following quadriceps contraction in patients with patellar subluxation in contrast to those with chondromalacia and normals. Electromyography (EMG) of the vastus lateralis (VL) and vastus medialis obliquus (VMO) during maximal quadriceps contraction was obtained prior to and after 3 months of isometric quadriceps exercises in 15 knees with patellar subluxation and in 11 with idiopathic chondromalacia of the patella. The EMG after 3 months revealed an increase in the activity of both VL and VMO only in patients with patellar subluxation, but the muscular balance of the patella remained unchanged. Only seven patients were improved after 3 months. A more selective training of the VMO is proposed.

Patellofemoral incongruence in chondromalacia and instability of the patella.

We measured the patellofemoral congruence in tangential radiographic projections according to Merchant in 64 patients with unilateral patellar pain. The congruence angle was usually within normal limits. However, compared with the asymptomatic side, the angle was increased in chondromalacia and instability of the patella. A comparison of congruence angles of the two knees seems more valuable than a comparison with normal values.

Isometric contractions in the patellofemoral pain syndrome. An electromyographic study.

The role played by the vastus lateralis and vastus medialis obliquus in their alignment of the patella during maximal isometric quadriceps contractions was studied by electromyography in 28 patients with unilateral symptoms of the patellofemoral pain syndrome. Eleven knees were classified as subluxation of the patella and 17 as idiopathic chondromalacia patellae. The muscular activity pattern was the same in the two groups but decreased as compared with the contralateral nonsymptomatic knees. However, none of the groups revealed differences in the activity of vastus lateralis and vastus medialis obliquus suggesting muscular imbalance.

Inflammatory hyperostosis and sclerosis of the clavicle.

Six cases with chronic inflammatory hyperostotic and sclerotic changes of the clavicle are reported. No causative organisms could be detected. Four patients had involvement of other bones including the thoracic spine, the femur, the tibia and the sternal end of the other clavicle. These may be classified as having "chronic recurrent multifocal osteomyelitis" (CRMO). The remaining two patients with similar clavicular changes might have an, as yet, unifocal CRMO.

Sclerosis and hyperostosis of the manubrium sterni.

Seven females and one male with almost identical sclerotic and hyperostotic changes of the manubrium sterni are reported. The clinical course was prolonged and characterized by intermittent periods of exacerbation followed by improvement. Malignancies, bacterial inflammatory processes, and Paget disease, which were first suspected, could be excluded. Pustulosis-palmoplantaris was present in four patients and one had psoriasis vulgaris. None of the patients had sacroiliitis or peripheral joint changes, but the three youngest patients had sclerotic changes of other bones, including the lumbar spine, the pubic bone, and the clavicle. This may indicate that this is an adult disease analogous to "chronic recurrent multifocal osteomyelitis", a disease mainly present in children and adolescents.

Dynamic knee brace in the treatment of patellofemoral disorders.

The efficiency of a knee brace with a 0 degree-30 degrees range of motion was studied in 17 patients with anterior knee pain. Eighteen patients with identical symptoms served as controls. The brace was worn for 6 weeks. Follow-up was performed after 6 weeks and 3 and 12 months. After 6 weeks, 82% of the patients treated with the brace were classified as improved, compared with 44% without it, according to a strict evaluation system. However, after 12 months only 35% of the patients treated with the knee brace could be rated as improved. Despite this marked deterioration, the brace should be considered an alternative to immobilization, because it minimizes the load on the patellofemoral joint and prevents atrophy of the quadriceps muscle.

Gas-producing infections after lower-limb amputation because of ischemia.

During the period 1972-1982, 22 patients with gas-producing infections after lower-limb amputation because of ischemia were reviewed. In 16 cases bacteria of the genus Clostridium could be cultured. Treatment consisted of hyperbaric oxygen, surgical debridement, and antibiotics. The incubation period was 1-11 days after the primary amputation, and the duration of the infection 2-31 days, significantly lower among 14 patients with diabetes mellitus. There was no difference in the course of clostridial and nonclostridial infections. No deaths were attributable to gas-forming infection.

Patellar height and patellofemoral congruence.

The patellar tendon/patella ratio and the patellofemoral congruence was estimated in 118 knees. There was a statistically significant positive correlation between the two measurements, high-riding patella occurring with patellofemoral incongruence.

Alcohol involvement in violence. A study from a Danish community.

All cases of assaults with violence (n = 1639) from a well defined area were registered for 1 year. A positive alcolmeter test (% greater than 0.2) was registered in 488 cases (29%). A further 216 patients (13%) were found under the influence of alcohol according to a simple clinical judgement. In nine of ten manslaughter and murder cases alcohol was involved. Young men, 19-29 years of age, comprised the majority of victims. Of the episodes of violence 66% took place during the weekend. In 250 cases the alcohol concentration surpassed 1.5%. Almost 50% of the violence episoded took place in or around restaurants. Blunt violence was concerned in 73% of the episodes. Gunshot was registered in five cases, stabbings in two cases.

Antibiotic prophylaxis in lower limb amputation.

We have prospectively studied the effect of 1-day prophylactic antibiotic therapy in lower-limb amputation for ischaemia. Twenty-seven patients were treated with Meticillin 1 g X 4 intravenously on the day of operation; 23 control patients did not receive any antibiotics. Eight patients in the control group had postoperative wound infections compared to none in the Meticillin group. Seven patients were re-amputated because of infection. Preoperatively, Staphylococcus aureus was isolated in 5/8 of the patients in the Meticillin and 6/8 in the control group. In the postoperatively infected stumps, S. aureus occurred in 6/8 of the patients in the control group, and one patient developed gas gangrene.

Interpersonal violence: patterns in a Danish community.

We studied all cases of assault with violence (1,639) in a Danish population of 275,000 over a one-year period. Most victims were young men. The incidence rose during evenings, nights and weekends, and assaults were often seen in or around bars and restaurants. Women accounted for 64 per cent of all victims of assault in the home. Influence of alcohol was identified in 43 per cent of all cases. The fist was the most frequent agent of assault; use of firearms was a very rare act of violence but was associated with death in three out of five cases. There were 10 deaths in all.

Wound infection after lower extremity amputation because of ischemia.

The importance of postoperative wound infection in major amputations was elucidated by recording the organisms isolated in preoperatively infected gangrene and in postoperatively infected wounds of patients undergoing lower-limb amputations for ischemia. Sixty-four amputations were performed on 61 patients. The frequency of coexisting diabetes mellitus was 34%. Postoperative infections occurred in nearly two-thirds of the 19 cases of infected gangrene, as compared with less than one-third of cases of noninfected gangrene. The presence of diabetes mellitus did not significantly influence the infection rate. Preoperatively as well as postoperatively, the most frequently isolated bacterium was Staphylococcus aureus. Clostridium perfringens was cultured in four cases. Postoperative wound infection following lower-limb amputation for ischemia is the main reason for reamputation, especially in patients with infected gangrene.