Insufficiency fractures, an often unrecognized diagnosis.

Diagnosis of sacral insufficiency fractures is difficult since the onset is mild, and usually discomfort is attributed to degeneration of the lumbar spine. Computed tomography and radionuclide bone scans are helpful in making the diagnosis, as regular X-ray and magnetic resonance imaging usually fail to demonstrate the fracture.

Anterior cruciate ligament reconstruction with alternative tibial tunnel: early results after accelerated weight-bearing.

In this study an autologous graft of 50%-60% of the patellar tendon (mid portion) was used for anterior cruciate ligament (ACL) reconstruction in 50 patients (19 women, 31 men; mean age 26 years). The distal part of the graft was fixed in a tunnel running from the centre of the anatomical tibial attachment of the ACL to the place where the bone block of the graft was removed from the tibial tubercle. A rehabilitation programme with accelerated weight-bearing postoperatively without external protection was followed. Evaluation consisting of function and stability tests, activity level and Lysholm's subjective function score took place an average of 26 months postoperatively; 35 of 50 patients had an additional evaluation monthly for 1 year and 6 monthly after 1 year. The stability tested manually after an average of 26 months postoperatively was good in 45 patients; 5 of them had a positive Pivot shift test (one 1+, two 2+, two 3+). Only 2 of these patients complained of giving way of the knee. All patients regained good knee function. The average postoperative Lysholm score was 85 (SD 14.5) and the subjective stability of the knee was described as 'good' in 41 patients, and 'poor' in 9. The objective stability was good in 7 of these 9 patients. The mean Tegner score was 6.5 (SD 1.9). The mean time to resuming activities was 5.4 weeks for full weight-bearing, 10 weeks for running, 13.5 weeks for going back to work and 6 months for returning to previous sports. In the group of 35 patients who underwent an additional evaluation, no change in manual stability was found during observation except for 3 of them. No patellar ruptures were seen. The operation technique used in this study appears to allow accelerated knee rehabilitation after ACL reconstruction.

Natural history of ultrasound hip abnormalities in clinically normal newborns.

One hundred one clinically normal newborn hips showed varying degrees of sonographic hip dysplasia according to the classification of Graf. None were treated, and after +/- 6 months, radiographs showed that only four had definite dysplasia. Of these, three had had risk factors such as breech delivery or familial predisposition. Forty-three other clinically normal newborn hips showed ultrasonic instability, which spontaneously corrected. The severity of ultrasound dysplasia at birth was not related to ultimate development of the hip. Our results indicate that ultrasound should not be performed as a general screening procedure in clinically normal newborns.

Tibial fracture after transposition of the tibial tubercle.

Eight weeks after transposition of the tibial tubercle for recurrent subluxation of the patella, the patient sustained a tibial fracture during rope jumping. In spite of consolidation of the osteotomy in the frontal plane, there remained a small gap in the anterior cortex in the transverse plane through which the tibia failed during bending stress.

Investing to maximize after-tax dollars.

There are many tax-saving options still available to the practicing physician. The material contained in this article is a brief introduction to some of these options. To fully utilize any tax-saving provision, a full understanding of that provision is essential. Therefore, it is important that doctors seek professional advice before implementing a tax-reduction plan, including those discussed in this article.

[Echography of the hip in children]. / Echografie van de kinderheup.

Ultrasonography has emerged in recent literature as a reliable technique to visualise the infant hip. Its advantages are that non-osseous structures can be seen as well as bone, that a dynamic investigation can be performed, and that it lacks ionising radiation. This article describes the results of a screening study in 307 newborns. 13.4% of all clinically normal (stable) hips showed ultrasound abnormalities. 96.3% of these normalised spontaneously, however. Apparently the natural history of ultrasound abnormalities at birth is relatively mild. Furthermore, in a group of older children, Graf's alpha angle was related to the acetabular index on the radiograph. There was no linear relationship, but a tendency was noted to find higher (better) alpha angles together with lower (better) acetabular indices. Possibly ultrasound is superior to standard radiography in depicting subtle disturbances in ossification of the lateral edge of the acetabulum.

Ultrasound screening for congenital dysplasia of the hip in newborns: its value.

Three hundred seven newborns were examined clinically and by ultrasound for congenital dysplasia of the hip (CDH). The purpose of the study was to determine the prevalence of sonographic abnormalities and to discover if sonography could be helpful in detecting cases of CDH that would be missed by clinical diagnosis alone. Eighty-two hips (13.4%) had ultrasound abnormalities despite a normal clinical examination. Of these, three developed definite hip dysplasia. The remaining 79 hips became clinically and sonographically normal within 12 weeks. Ultrasound visualized and recorded the dislocation-reposition maneuver of three other hips that were clinically dislocatable at birth. Dislocation occurred in a craniodorsal direction.

Aneurysmal bone cyst in association with fibrous dysplasia. A case report.

A patient with polyostotic fibrous dysplasia had several fractures of the right lower limb. An above-knee amputation was eventually performed, followed by arthrodesis of the hip. Five years later the stump became painful and swelled with dramatic rapidity. Biopsy showed that this was not due to malignant change, but that an aneurysmal bone cyst had developed in association with the fibrous dysplasia.

Lumbar hernia in an iliac bone graft defect. A case report.

A hernia developed in the region of the inferior lumbar triangle of Petit 1.5 years after a full thickness bone graft had been taken from the part of the iliac crest that forms the base of the triangle.

Fat embolism after static and dynamic load. An experimental investigation.

Rabbit femora were fractured with different strain rates (static and dynamic) with measurements of the bone marrow pressure during the actual moment of fracturing. The results show that the amount of fat emboli is dependent on the strain rate, and occurs at the moment of fracture, when elastic strain energy is released in the form of pulse waves. A further group of rabbit femora were subjected to standardized pulse-waves on the bone marrow. The number of fat emboli produced was proportional to the strength and number of these waves.