This paper presents the first report of a prospective study to assess the outcome of using coregistration localisation and selective arthrodesis in chronic midfoot degenerative arthritis. In a previous report from Cambridge ( Nineteen consecutive patients over a three-year period (1996–9) with severe midfoot joint pain and disability of over six months’ duration underwent coregistration imaging followed by selective arthrodesis. The procedures involved 17 patients with one-level single or multiple fusions of the metatarsocuneiform, metatarsocuboid or naviculocuneiform joints, and two patients with two-level multiple fusions. Pain and functional assessments were recorded pre-operatively and at one and at two to four years postoperatively using the American Orthopaedic Foot and Ankle Society Midfoot Scoring System. Bone union was determined clinically and with X-rays. Results showed fusions in all 19 patients between 10 and 15 weeks. Three K-wires and one screw required removal for later prominence and there was one delayed wound healing. Pian and functional scores showed significant differences between the pre- and post-operative and one year measurements, and less between the one year and two to four year scores. This preliminary study concludes that there is a high correlation between the coregistration localisation of the midfoot degenerative arthropathies and the successful results of selective fusion of these joints for the one to four year follow-up period.
We report the results of treatment with the dynamic condylar screw of 21 cases of supracondylar and intercondylar fractures of the femur in patients aged 22 to 91 years. There were two nonunions and no deaths. We found the device easy to use and the good fixation allowed early patient mobilisation.
The uncommon injury of mallet thumb is described, with four case reports. In diagnosis the condition must be distinguished from dropped thumb. Operative treatment is advised which, in this small series, gave excellent results.
A comparative study of methods for treating fractures of the distal half of the femur was carried out prospectively in the five-year period January 1973 to December 1977. The three methods compared were conservative treatment on a Thomas' splint, application of a knee-hinged cast-brace at five to seven weeks, and intramedullary nailing. The time in bed, in hospital and to union were compared as was the rate of functional recovery of the knee. It is concluded that the cast-brace provides a safe reliable method of treatment, combining the advantages of non-operative management with the early mobilisation possible with intramedullary fixation but without the disadvantages of surgical treatment.
A study was made of the mechanics of blood-bearing in a series of patients treated with a cast-brace for fracture of the distal femur. Knee hinges incorporating strain-gauges, a simple force-plate on the floor and a standardised weight-bearing test were used to record axial loads through the cast-brace itself and through the fracture during the phases of healing. The cast-brace carried loads of only 10 to 20 per cent of body weight and functioned mainly as an antibuckling hinged tube. Patterns of weight-bearing recovery showed that the fracture itself limited loads to safe levels. A measure of the recovery of strength at the fracture was determined and termed the "fracture load index". Graphs obtained in this way demonstrated four biomechanical phases of bony union which correlated well with the stages of clinical healing. The clinical application of these results have led to improvements in the design of braces and the use of a cylinder cast-brace for fractures of the distal half of the femoral shaft and of a new type of brace with a hinge at the hip attached to the thigh cast for fractures of the proximal shaft. A simple clinical test is described by which it is possible to monitor the healing of fractures in cast-braces.
In 65 mature Wistar rats a Kirschner wire was introduced into the medullary cavity of each femur. A closed transverse mid-shaft fracture of one femur was produced by a three-point bending technique. Subsequently the mechanical characteristics of the healing fracture, including the torque and angle of twist required to take the callus to its yield point and to ultimate failure, were compared with those for the opposite femur of each rat. Controls were killed in groups at two, three, four, five and seven weeks. Test animals were given bovine growth hormone in a daily dose of five milligrams before being killed in groups at two, three and four weeks. A significant increase in torque index was found in the two-week group of test animals but not in subsequent groups. No evidence was found that growth hormone given alone could produce an overall shortening of the healing time in fresh fractures.
