Hip-spine syndrome.

Thirty-five patients were reviewed with what is called hip-spine syndrome. Concurrent disease at both the hip and spine is not infrequent in the older population. In most cases, the finding and diagnosis were straight forward, and were classified as a simple hip-spine syndrome. Cases in which the spine symptoms are aggravated by deformity of the hip were called a secondary hip-spine syndrome. Symptomatic disease at both the hip and spine can present as a complex hip-spine syndrome. Symptoms from both sites gives a confusing clinical picture and may require ancillary investigations to diagnose the major source of disability. Failure to recognize concurrent disease at both the hip and spine may lead to misdiagnosis and possibly erroneous treatment.

The response of articular cartilage to the in vivo replacement of synovial fluid with saline.

Experiments on rabbits were performed to determine whether continuous irrigation of a synovial joint produced irreversible degenerative changes in the articular cartilage. Continuous irrigation of a synovial joint permits observations of the effect on articular cartilage of altering the intra-articular environment. The right knee joints were irrigated with normal saline for varying periods, up to 14 days, and the left knees served as nonirrigated controls. One group of animals (short-term) was killed immediately following irrigation, while another group (long-term) was assessed after six months of cage activity following the irrigation period. Within each group, half were skeletally immature and half were mature. No differences in cell density, nuclei-to-lacunae ratio, or the ratio of calcified layer to total cartilage thickness were found in any group. Irrigation did produce a significant reduction in matrix staining with safranin-O. This was first detectable following three days of irrigation and was severe by seven to 14 days. Staining properties returned to normal after six months of cage activity. No obvious difference was found between immature and mature animals.

Late revision of fibular malunion in ankle fractures.

Eleven patients with fibular malunion after ankle fracture healed with stiff, painful joints and radiographic evidence of fibular malunion, diastasis of the ankle mortice, and talar tilt. Reconstruction was performed by mobilizing the fibula (by osteotomy or through the old fracture site), lengthening the fibula, and restoring the ankle mortice anatomically. The operation was done three months to three years after the initial fracture in patients ranging in age from 26 to 52 years. The average follow-up period was 3.3 years. Radiographically, seven patients had the ankle joint restored anatomically. Four patients had residual talar tilt. On clinical assessment, eight patients were rated as good, two fair and improving, and one poor resulting in fusion. Good functional results were maintained at long-term follow-up examination. The factors that determined the success of the revision were the duration of the malunion, the quality of the reduction achieved, and the condition of the articular cartilage at the time of revision. Late correction of the malunited fibula with diastasis of the ankle mortice is an effective means of salvaging function in a joint otherwise destined to be stiff and painful.

Traumatic dislocation of the hip in children.

Thirty-three children with traumatic dislocation of the hip who had been treated at the Hospital for Sick Children between 1960 and 1977 were reviewed. The amount of trauma causing dislocation of the hip in younger children was less than that for older children. The most frequent complication was soft-tissue interposition which usually required a posterior arthrotomy to clear the interposed tissue. Less frequent complications included avascular necrosis, redislocation of the hip and an irreducible hip. Nineteen children were reviewed with an average follow-up time of 10 years. Clinical examination indicated that 84 per cent of these hips were normal but the radiographs showed that 47 per cent of the dislocated hips had a coxa magna of two millimetres or more. There was no correlation between the development of coxa magna and the clinical result.