Correction of Madelung's deformity by the Ilizarov technique.

We present our experience with correction of Madelung's deformity by the Ilizarov technique. Seven patients (eight deformities) were treated by osteotomy of the radius with subsequent lengthening and angular correction. They were reviewed at a mean of 30 months (1.5 to 5.5 years). At the time of operation their mean age was 19 years (9 to 44). At follow-up all were free from pain and supination had improved by a mean of 34 degrees and pronation by 9 degrees. Flexion had increased in most cases with a median increase of 15 degrees, but only one patient gained further extension. Radial and ulnar deviation were increased by a mean of 6 degrees and 9 degrees, respectively. Radiographic measurements showed that the mean volar angulation had been reduced from 25 degrees to 11 degrees, ulnar inclination from 45 degrees to 30 degrees and carpal malalignment (volar translation) from 7 to 2 mm. The mean lengthening of the radius was 12 mm (6 to 25). All the patients were satisfied with the functional and cosmetic results.

Chronic flexion contracture of proximal interphalangeal joint treated with the compass hinge external fixator. A consecutive series of 27 cases.

Twenty-seven chronic flexion contractures of the proximal interphalangeal joint were treated with the Compass((R)) hinge external fixator without open surgery. The fixator was removed after a mean of 33 (range, 14-68) days. The mean time from injury to operation was 4 (range, 1-19) years and all patients were reviewed at a mean follow-up of 21 (range, 12-50) months. The mean extension gain was 38 degrees (range, 0-70 degrees), and the mean flexion-extension arc improved by 42 degrees (range, 0-80 degrees). Complications included superficial pin-track infection in 11 cases and pin loosening in four cases.

Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases.

In a 4 year period (1996-1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19-72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienböck's disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann's contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6-50) months. The Buck-Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.

Synovectomy and radial head excision in rheumatoid arthritis. 11 patients followed for 14 years.

A radial head excision and partial synovectomy of the elbow through a lateral approach was performed in 24 patients suffering from rheumatoid arthritis. At follow-up examination of 11 patients (12 elbows) 14 years postoperatively, 10 patients were still satisfied with pain reduction and improved elbow motion. 2 elbows had been reoperated on. Radiographic destruction, assessed by the Larsen index, was, on average, 2.9 preoperatively and 3.8 at follow-up.

Burns: epidemiology and the effect of a prevention programme.

Epidemiological data concerning 1391 patients hospitalized at the Burns Unit, Odense University Hospital during a 17-year period are presented. The annual incidence showed a steady downward trend of 3 per cent per year. Scald and fire were the most important causes of burn injuries. Among children a significant reduction in burns due to scalds and electrical or corrosive injuries was noted. The rate of injury among adults and the elderly was constant. These results might reflect an intensive information campaign in the media, revisions of laws and regulations and improvements in the safety of household products, especially directed towards thermal injuries among smaller children.

Fractures of the shaft of the tibia treated with Hoffmann external fixation.

Ninety-six compound or unstable fractures of the tibial shaft were treated with external fixation of different mountings. The median healing time was 10 months without a statistically significant difference between the healing time after treatment with unilateral frames and quadrilateral frames. The rate of pin-track infection was 36%, which is comparable to those of other published series. Seven cases of chronic osteitis and four pseudarthroses required further surgical management. We had no primary or secondary amputations in this series.

Recurrent dislocation of the shoulder. The Alvik modification of the Eden-Hybinette operation.

We re-examined 31 patients treated with Alvik's modification of the Eden-Hybbinette operation for recurrent anterior dislocation of the shoulder joint after 5 (2-14) years. Two patients had been re-operated because of instability. Muscular strength and joint motion were only insignificantly affected. Only one patient did not rate the results as good. The rate of recurrences was comparable to other methods, but the frequency of reoperations was low, as no complications occurred from fixation of the bone block.

Familial aggressive fibromatosis of the lower extremities. A report of two cases.

Aggressive fibromatosis occurred in a father and his son. Both are alive without signs of recurrence 3 and 10 years after below-knee amputation and exarticulation of the hip joint, respectively. When possible, this tumour should be excised radically.

Experimental analysis of Hoffmann external fixation in various mountings.

The mechanical properties of four different configurations of the Hoffmann external fixation system were tested in an experimental setup using 4-mm stainless steel pins. Furthermore, stainless-steel pins and titanium pins 5 mm in diameter were applied in one of the fixators. The evaluation of the results was based on a paired t-test, with P less than 0.05 as the significance level. The quadrilateral transfixing Hoffmann-Vidal frame (HVF) proved to be the most rigid fixator under all loading conditions. The unilateral frame type supplied with two connecting bars and four ball joints was significantly more rigid than the unilateral single-bar device. By increasing the pin diameter from 4 to 5 mm a further increase of stiffness could be achieved, thus reaching about two-thirds of the rigidity of the HVF. The difference between titanium and stainless steel pins was not significant. Common for all the frame mountings was a fivefold greater rigidity in the lateral direction (in the plane of the pins) than in the anteroposterior direction (perpendicular to the pins).

External compression arthrodesis of the shoulder joint.

Compression arthrodesis of the shoulder was carried out in 16 patients. One case of postoperative infection healed by conservative treatment, and all but one had primary fusion. With a median of 12 years follow-up, 12 patients were examined clinically and radiologically; one patient was lost to follow-up and three patients were dead. The result was rated as good by 10 patients and as improved by two patients. External compression arthrodesis was found to be a safe and easy way to achieve solid fusion of the shoulder joint. Arthroplasty and arthrodesis of the shoulder joint are complementary operations, applicable in different clinical situations.