Proximal femoral replacement for pathological fracture.

Nine patients presented to our unit with extensive metastatic destruction of the proximal femur. The extent of bone loss precluded the use of standard methods of fixation. We undertook proximal femoral replacement as a palliative treatment to restore mobility and relieve pain. Six patients mobilized satisfactorily postoperatively. Three patients did not regain independent mobility and died within 4 weeks of surgery. The major complication was dislocation, which occurred in two patients. The mean postoperative survival was 8 months. We believe proximal femoral replacement is a useful palliative procedure in selected cases of metastatic disease of the femur.

Brodie's abscess. A long-term review.

In 20 patients with 21 Brodie's abscesses, a long-term review revealed that 13 occurred in the second decade of life. All had local symptoms for six weeks or more. The tibia was involved in 11 cases and seven of these were in the proximal metaphysis. The erythrocyte sedimentation rate (ESR) was elevated in only six cases. When the ESR was more than 40 mm per hour, recurrence was more likely. Staphylococcus aureus was cultured from 11 abscesses. Curettage and antibiotics for six weeks were adequate for treatment in most cases. However, lesions larger than 3 cm in diameter should be grafted, and patients with an elevated ESR require more aggressive decompression and prolonged antibiotic therapy. Lesions within the neck of the femur pose particular anatomic problems and should not be approached laterally. All cases were followed to full bone maturity. No significant leg length inequality was clinically or roentgenologically apparent. If an abscess was juxtaphyseal, deformity of the epiphysis could develop.

Legg-Calvé-Perthes disease in a family: genetic or environmental.

This is a case report of a family in which Legg-Calvé-Perthes disease (LCPD) occurred in four members. All the patients were male and between the ages of three and eight years. This unusually high incidence in one family raises questions about the genetic versus the environmental factors in the etiology of LCPD.

Acute haematogenous osteomyelitis.

Seventy-seven children admitted with a provisional diagnosis of acute osteomyelitis over a three year period have been reviewed. Acute haematogenous osteomyelitis was confirmed in 45 of these patients whose ages varied from three days to 14 years with a mean of 6.2 years. All patients were treated with intravenous fusidic acid and cloxacillin with splintage for three weeks followed by oral antibiotics for a further period of six weeks. Only seven patients required operation. One patient had recurrence of infection; all other patients were cured with no evidence of chronic osteomyelitis. It is suggested that surgical drainage of acute haematogenous osteomyelitis is seldom needed and that high intravenous doses of antibiotics in combination with splintage are adequate treatment in most cases.

Dextran prophylaxis in total hip replacement: A scintigraphic evaluation of the incidence of deep vein thrombosis and pulmonary embolus.

The results of a prospective randomised study in a series of 106 patients undergoing Charnley total hip arthroplasty are discussed. All were consecutive and no one was excluded on the grounds of previous medical history. Fifty-five received prophylactic Dextran while 51 acted as controls. A total of 867 separate studies were performed on these patients. Radionuclide venography was employed to detect deep vein thrombosis and perfusion lung scanning for pulmonary emboli. Eighteen per cent of the control patients and 27% of the Dextran patients developed deep vein thrombosis. Pulmonary emboli occurred in 16% of the patients in each group. The overall incidence of thromboembolic disease was 27% in the control and 36% in the Dextran group. A prophylactic effect of Dextran was not demonstrated.