Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores.Aims
Methods
Between 2002 and 2011, 81 patients with a traumatic total brachial
plexus injury underwent reconstruction by double free muscle transfer
(DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve
transfers (NT, 18 cases). They were evaluated for functional outcome and quality of life
(QoL) using the Disability of Arm, Shoulder and Hand questionnaire,
both pre- and post-operatively. The three groups were compared and
followed-up for at least 24 months.Aims
Methods
The two distinct surgical techniques for total knee arthroplasty (TKA) are gap-balancing technique (GB) and measured resection technique (MR). The aim of this study was to compare coronal stability of the knee after TKA with GB or MR. A total of 80 TKA cases with at least 6 months follow up (average 34.4 months) were evaluated. The MR group comprised of 33 patients with an average age of 73.1 years, while the GB group comprised of 47 patients with an average age of 74.4 years. Zimmer NexGen LPS Flex was used for all cases. Coronal stability of the knee was examined by varus-valgus stress X-ray at full extension and in the 90 degree flexed position as reported by Kanekashu et al (CORR 2005). X-ray measurement was performed using the FUJI diagnostic imaging system FS-V673. The varus-valgus stress X-ray test at full extension showed a laxity of 4.7 + 2.1 degrees in the MR group and 3.9 + 1.9 degrees in the GB group. No significant difference was detected between the two groups. On the other hand, the varus-valgus stress X-ray in the 90 degree flexed position revealed a laxity of 8.7+4.1 degrees in the MR group and 5.3 + 2.7 degrees in the GB group (p<0.01, Student's t-test). Of the 11 knees that showed laxity of >11 degrees in the 90 degree flexed position, 10 were from the MR group and only one from the GB group (p<0.01, Fisher's exact probability test). Furthermore, the postoperative clinical score assessed by Japanese Orthopaedic Association criteria was significantly better in knees with a coronal laxity of <10 degrees in the 90 degree flexed position compared to those with >10 degrees (82.7 + 6.8 and 77.3 + 8.5 in the GB and MR groups, respectively). In conclusion, GB may contribute to improved functional performance after TKA by providing better coronal stability of the knee in the 90 degree flexed position.
The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.
One pattern of injury to the brachial plexus shows recovery of the fifth and sixth cervical nerves but little else. These patients have useful shoulders and functional elbow flexion, but elbow and wrist extension is weak or absent. Their hand function is negligible. We restored hand function in three such patients using free functioning muscle transfer for finger flexion and transfer of the sensory rami of the intercostal nerve to the ulnar nerve for sensation. Supplementary operations to restore elbow and wrist extension were necessary in one patient.
Five vascularised allografts of the knee joint were performed in dogs immunosuppressed with cyclosporin A and azathioprine. Three survived with normal function for 3 to 4 months after operation. One of the unsuccessful grafts had a failed vascular anastomosis, the other an inadequate blood level of cyclosporin A. All three successful grafts healed well. In two, bone scans, radiographs and biopsies were indistinguishable from successful autografts; in the third the blood supply to the graft failed despite patent anastomoses but the graft healed well with good function. All three grafts were rejected within 2 to 3 weeks of withdrawal of cyclosporin A and azathioprine. In non-immunosuppressed dogs, allografts of the knee, both vascularised and non-vascularised, were rejected within a few days of operation. In two non-vascularised allografts, administration of cyclosporin and azathioprine had no apparent effect on the rate of rejection of the graft.
