Fractured neck of femur in black patients: a prospective study.

We explored the role of iron overload, deficiency of vitamin C and alcohol abuse in the aetiology of cervical and intertrochanteric fractures of the neck of the femur as a result of minor trauma. We studied prospectively 72 patients (45 men, 27 women). Levels of serum iron markers, vitamin C and alcohol markers were measured. Consumption of alcohol was estimated using questionnaires. The findings were compared with those of an age- and gender-matched control group. The mean age of the men was 59.5 years and of the women 66.9 years, with a male predominance. In the men, iron overload, as shown by high levels of serum ferritin (p < 0.001) and deficiency of vitamin C (p < 0.03), as well as abuse of both Western and the traditional type of alcohol, appear to be important aetiological factors. In women, alcohol abuse was also common, but iron markers and levels of vitamin C did not differ significantly from the control group.

Serum keratan sulfate levels in marathon runners.

The effect of strenuous joint loading on the metabolism of articular cartilage in man is not known. The development of a non-invasive immunoassay for the assessment of the catabolism of cartilage aggrecan has enabled us to quantify keratan sulfate (KS), a component of aggrecan, in the serum of fifteen male marathon runners. Serum KS was measured by an ELISA before and immediately after a marathon (42 km), as well as 48 hours after the completion of the race. The mean level at rest was similar to those previously reported for another population of age-matched males. There was no statistically significant difference in the serum level of KS at the three different readings. Further, there was no correlation between age, height, weight and performance time, and the serum level of KS at any of the three different times. We conclude that marathon running by carefully trained runners causes neither a transient nor a sustained increase in proteoglycan catabolism in articular cartilage.

External fixation for intra-articular fractures of the distal radius.

In a prospective study of 132 patients with an average age of 35 years, unstable intra-articular fractures of the distal radius were treated by external fixator. Only 15 cases required limited open reduction. Follow-up was for a mean of 42 months. There were few complications and 83% of patients had good or excellent results. There was a statistically significant correlation between the severity of the fracture and the clinical outcome, irrespective of radiological restoration. Articular and soft-tissue damage following violent compressive forces may lead to a degree of functional impairment.

Circulating keratan sulfate: a marker of cartilage proteoglycan catabolism in osteoarthritis.

The serum level of a highly sulfated epitope present on long keratan sulfate chains provides a direct measure of the rate of catabolism of cartilage proteoglycans. Levels of the keratan sulfate epitope are elevated in patients with generalized osteoarthritis (OA), indicating these individuals have elevated rates of cartilage proteoglycan catabolism. In the Pond-Nuki model of canine OA, the serum level of the keratan sulfate epitope rises rapidly after the transection of the anterior cruciate ligament, long before OA lesions can be detected, and remains high for at least 13 weeks.

Serum keratan sulphate levels during prolonged rest.

Serum levels of keratan sulphate (KS) were measured by an enzyme-linked immunosorbent-inhibition assay on admission to hospital in 26 previously healthy young patients who had sustained fractures of the pelvis without involvement of the hips. The serum KS level was found to decrease during the period in hospital (5-6 weeks), but rose after return to ambulatory life (6-12 months). The results suggest that serum KS levels are related to rest.

Isolated traumatic posterior dislocation of the radial head.

Only 4 cases of isolated posterior dislocation of the radial head in adults have been reported in the English-language literature. We describe 2 cases with a clear mechanism of injury and present a concise review of the literature.

Long-term results of revision total hip arthroplasty.

A total of 138 revision hip arthroplasties in 134 patients, all operated upon by one surgeon, were followed for an average of 7.4 years. The overall results were reasonable, with good to excellent Mayo hip scores in 62% and little or no pain in 86%. These results were independent of body weight, age, primary diagnosis and type of arthroplasty used. The incidence of radiological loosening was alarming, though comparable to that found in other series. Our findings indicate that it may be wise to replace both components even when, after careful assessment before and during operation, one of them seems to be securely fixed.

Radiological signs of loosening of the femoral stem in cementless total hip arthroplasty.

The radiological evaluation of cementless stem hip arthroplasty has received scant attention in medical publications. A retrospective analysis of 34 patients who underwent RM iso-elastic hip arthroplasty indicated the existence of a reproducible series of radiological features visible on plain radiography, which correlated both with clinical failure and with arthrographic evidence of loosening in 10 cases. In addition, there was correlation with scintinographic results and findings at revision surgery. The radiological signs were as follows: radio-opaque lines within radiolucent zones, the 'pedestal' sign, stem shift, localised cortical hypertrophy, and proximal bony overgrowth.

Isolated avulsion fracture of the anterior tubercle of the atlas.

Avulsion fracture of the tubercle of the atlas is a rare injury which is probably frequently overlooked. The fracture results from hyperextension of the neck against contraction of the long flexors. We describe two different fracture patterns and discuss the anatomical implications thereof.

Acute-on-chronic bilateral reversed slipped capital femoral epiphysis managed by Imhauser-Weber osteotomy.

In a rare case of progressive bilateral valgus-slipped capital femoral epiphysis, modified Imhauser-Weber osteotomies were carried out. The osteotomies allowed for significant varus correction and thus included shortening of the neck and distal transfer of the greater trochanter. The planning technique of the complex osteotomy is discussed. At 5-year follow-up the patient had a gratifying result.

Transverse fracture through the body of the axis.

We report a case of transverse fracture through the body of the axis. This fracture was unstable, had been produced by extension forces and was managed conservatively. The classification of such fractures is discussed.

Serum keratan sulfate levels in osteoarthritis patients.

Serum levels of keratan sulfate (KS), measured by an enzyme-linked immunosorbent-inhibition assay, were found to be significantly higher in 31 patients with hypertrophic osteoarthritis (OA) than those in 41 adults without joint disease. Seventy-seven percent of patients with OA, but only 12% of control subjects, had serum levels which were more than 1 SD above the mean of the control group. Following replacement of a single osteoarthritic hip joint, serum KS levels decreased, at first, in all patients. Subsequently, the concentration of serum KS progressively increased; 6 months following surgery, KS levels were similar or close to the preoperative levels in virtually all patients. The results suggest that patients with hypertrophic OA may have a generalized imbalance of cartilage proteoglycan metabolism. Measurements of serum KS are likely to prove most useful in studying this particular subset of patients with generalized OA.

Histomorphometric analysis of osteopenia associated with endemic osteoarthritis (Mseleni joint disease).

Mseleni Joint Disease (MJD), a polyarticular osteoarthritis of uncertain etiology is endemic among the Tonga-Zulu tribe. The traditional diet is deficient in calcium, and palm wine (2-4% alcohol) is drunk widely. Patients with MJD are reported to be more osteopenic than those without. Iliac bone biopsies of 19 arthritic patients were examined by routine histomorphometry and revealed decreased trabecular bone volume (p less than 0.0005), increased resorption surfaces (p less than 0.01), decreased bone formation rate at the BMU (p less than 0.01) level and increased mineralization lag time (p less than 0.01). Six of the 19 patients (31.6%) had features of osteomalacia and six (31.6%) signs of osteoblast failure. The most likely cause of the bone disorder is calcium deficiency, but inanition, inactivity and alcohol abuse may have contributed. Although the joint disorder may have contributed to the bone disorder, the converse is unlikely the case.

A 5-9-year follow-up study of the Sheehan total knee arthroplasty.

Of 83 Sheehan total knee arthroplasties evaluated 5-9 years after surgery, 14 had been revised for mechanical failure and 9 for late sepsis, leaving 60 cases for clinical and radiologic evaluation. Fifty-seven percent of the patients achieved satisfactory pain relief, but only 15% were satisfied with their knees. There was loss of alignment in 48% of cases. Most patients exhibited some degree of varus/valgus instability. These complications are attributed to polyethylene wear, a major problem in this series. Sixty percent of the patients had anterior knee pain and 48% had radiologic evidence of patellar dysfunction. The overall poor results and the high rate of revision have persuaded the authors to abandon this procedure.

Serum biochemical and haematological markers of alcohol abuse in patients with femoral neck and intertrochanteric fractures.

Excessive alcohol intake causes bone loss. Alcohol abuse is a commonly associated disorder in femoral neck fractures in men, but little attention is given to such an association in women. Using serum biochemical and haematological markers (mean red cell volume MCV, gamma-glutamyl transpeptidase GGT, aspartate transaminase AST, uric acid UA and triglyceride TG) alcohol abuse was assessed in 14 men and 93 women with non-violent fractures of the hip. Abnormal elevations in one or more of the five test pairs known to correlate with increasing alcohol consumption (GGT/MCV, GGT/AST, AST/MCV, MCV/UA) were found in 7.1% of men, and 11.8% of women. When abnormal results in other test pairs were included the prevalence rose to 14.3% in men and 20.4% in women. These figures are higher than those reported for the general population of elderly people.

RM isoelastic total hip arthroplasty. A review of 34 cases.

Thirty-four cases of RM isoelastic total hip arthroplasty were followed for an average period of 42 months after surgery. Eleven (32%) were revised because of purely mechanical loosening of the femoral stem. Of the remaining cases, 16 (69%) had poor Mayo hip scores and only 2 (9%) had good results. Radiologic evidence of loosening of the uncemented femoral stem, as exemplified by radiopaque lines within radiolucent zones, the so-called "pedestal sign" of increased density at the stem tip, and proximal bony overgrowth around the collar were present in all 11 cases that were revised. Marked stem shift and localized cortical hypertrophy were noted in nine revised cases. Radiopaque lines were observed in 11 nonrevised cases, all with poor Mayo hip scores.