The Oswestry Low Back Pain Disability Questionnaire. a two-year follow-up of spine surgery patients.

BACKGROUND AND AIMS: So far there is no golden standard for the measurement of functional disability in spinal problems. The Oswestry index can be used to monitor the response to treatment and rehabilitation. It is based on a patient's subjective impression of his or her own state of disability. The purpose of this prospective study is to give a graphic presentation of the behaviour of the Oswestry index in different spine surgery groups. MATERIAL AND METHODS: The material includes 193 discectomy and decompressive operations. 37 of these patients had been operated earlier. The patients were observed for two years after the index operation through the mail with the Oswestry questionnaire. RESULTS: Before an operation the average Oswestry index corresponded to severe disability on average. After successful treatment the Oswestry index dropped by 20-40 points on average. The more complex the problem the higher the postoperative lines remained. CONCLUSIONS: The results compared well with those of earlier studies. The graphs presented in this study may help the treating clinician to make conclusions on how his or her patients are doing on average after surgery.

Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study.

In a prospective, randomized study, 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications, or range of motion. Although there was more soaked dressing requiring reinforcements in the groups without drainage, as a result of this study, we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis.

Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting.

We did a prospective study to compare the results of treatment of subcapital fractures of the fifth metacarpal bone by closed reduction and splinting or by functional treatment. Twenty-nine consecutive patients were randomly divided into the two treatment groups (functional n = 14, and reposition and splinting n = 15). The results of treatment were satisfactory in both groups. Functionally treated patients recovered their grip force and range of movement of the affected hand a little sooner. All fractures in both groups had united within three months. There were no complications. We conclude that subcapital fractures of the fifth metacarpal bone can successfully be treated without closed reduction and splinting.

Serum C-reactive protein levels after total hip and knee arthroplasty.

Any operation induces an elevation in the level of serum C-reactive protein (CRP). After hip and knee arthroplasty the maximal values are seen on the second and third postoperative days, after which the CRP decreases rapidly. There is no difference between patients with cemented or uncemented prostheses. Major postoperative complications may cause a further increase in CRP levels at one and two weeks.

Simple ligation vs stump inversion in appendicectomy.

Although modern gastrointestinal surgery has abandoned the invagination of stapler closures, the traditional technique for appendicectomy with appendix stump invagination is still in common use. In a prospective study altogether 200 patients operated on for acute appendicitis were treated either by simple ligation or ligation and inversion of the appendix stump. The complication rates between the two groups were equal. Thus, we recommend the simple ligation technique for conventional as well as for laparoscopic appendicectomy because it is simpler and faster, and it preserves the intact anatomy of the caecal wall.

Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release.

In a follow-up study of 67 patients with an arthroscopically diagnosed patellar chondromalacia, we compared the results of plain conservative treatment with those after an open lateral retinacular release. The mean follow-up was 35 months. In Grade I chondromalacia the lateral release did not affect the result, which was in all cases good or excellent. In Grade II to IV chondromalacia the lateral release appeared beneficial, although the difference did not reach statistical significance. We also examined the validity of three clinical signs in arthroscopically verified patellar chondromalacia. Patellar inhibition and tracking tests were clearly more sensitive than the lateral apprehension test, which often gave a false negative result. If the patellar inhibition test is positive and a Grade II to IV chondromalacia of the patella is found at arthroscopy, lateral release should be considered among other procedures, like patellar shaving or patellar resurfacing.

Arthrodesis of the first metatarsophalangeal joint in rheumatoid arthritis. Biodegradable rods and Kirschner-wires in 39 cases.

The first metatarsophalangeal joint was arthrodesed in 39 patients with rheumatoid arthritis. Fixation material was either biodegradable self-reinforced poly-L-lactide rods or Kirschner-wires. There were 3 clinical nonunions in the biodegradable group, and none in the K-wire group, and radiographic nonunion in 5 and 2 cases, respectively. The fixator had to be removed in 3 cases in the K-wire group. The biodegradable rods did not seem to be any better than K-wires.

Alvik's glenoplasty for humeroscapular dislocation. 6-year follow-up of 52 shoulders.

In Alvik's modification of the Eden-Hybbinette operation, an iliac crest bone graft is inserted in a groove in the glenoid rim of the scapula. In this retrospective study, 52 shoulders in 46 patients operated on using the modified Alvik's method were reviewed. The mean age of the patients at the time of the operation was 32 years, and the average follow-up time was 6 years. There were no operative complications, and two thirds of the patients were satisfied with the operation. Spontaneous redislocation occurred postoperatively in only one shoulder. In addition, there were 10 traumatic redislocations. Postoperative arthrosis was found in nine shoulders; the arthrosis had more correlation with the patient's age at the time of the operation than with the follow-up time. In 41 shoulders, there was bony healing of the transplant.

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries--a report of two cases.

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries offers an alternative in conservative splenic surgery. We report on two patients who were successfully treated with polyglycolic acid mesh for Grade III splenic injuries and discuss the difficulties in surgical techniques when trying to avoid splenectomy in splenic injuries.