Aims

Surgeons and most engineers believe that bone compaction improves implant primary stability without causing undue damage to the bone itself. In this study, we developed a murine distal femoral implant model and tested this dogma.

The foregoing suggestions may be summarised in the following recommendations for the treatment of osteogenic sarcoma. 1. Deep x-ray therapy in high dosage, followed by local resection, should be given serious trial especially: 1) in the upper limb; 2) in the group with atypical clinical or radiographic signs, or histology resembling that of inflammatory lesions; 3) with Grade I histology; and 4) in the young. 2. Deep x-ray therapy followed at once by amputation should be used for osteogenic sarcoma if : 1) local resection would leave a lower limb more unstable than an artificial leg ; or 2) if response to x-rays is poor. 3. Deep x-ray therapy alone should be used: 1) if the patient is unsuitable for, or refuses, any operation ; and 2) palliatively, if metastases are present or the tumour is too advanced, or the patient is not fit for radical treatment. 4. Amputation alone should be used palliatively, for pain or fungation, when x-ray therapy has failed to relieve, or is not readily obtainable. 5. Biopsy and histological grading must be performed in every case. A histological diagnosis is most important. Coley (1949) and MacDonald and Budd (1943) support this view. 6. The records of every possible case should be sent to and discussed by a group with special experience of these tumours

We followed 138 patients (145 hips) who had had uncemented total hip arthroplasty using the Taperloc femoral component for a mean of ten years (8 to 12.5). No patient was lost to follow-up; 31 (31 hips) died before the minimum time of eight years for inclusion in the study, and 30 of these still had their femoral component in place. One well-fixed prosthesis had been exchanged at the time of acetabular revision. Of the remaining 114 hips, one femoral component required revision for aseptic loosening and one for sepsis. Three other well-fixed femoral components were removed during acetabular revision. Complete clinical and radiological follow-up was obtained in the 109 hips which had not had revision. Clinically, 94 (87%) were rated good or excellent, eight (7%) fair and seven (6%) poor. The average Harris hip score increased from 48 before operation to 88 at the time of the last follow-up. Radiologically, 103 hips (94%) had fixation by bone ingrowth, three (3%) showed stable fibrous ingrowth and three (3%) were unstable. Osteolysis of the femoral cortex was seen in seven hips (6%), with major lysis in only one. At a mean follow-up of ten years, the results of the Taperloc femoral component are comparable with those of modern techniques of cementing in primary total hip arthroplasty

In an unselected series of 55 cases of slipped capital femoral epiphysis (SCFE) we observed an incidence of 25% of epiphyseal reduction, mostly unintentional. Reduction indicated physeal instability and was associated with an effusion, detected by sonography on admission, and inability to bear weight. The true prevalence of instability may be higher since an effusion was noted in 33 cases (60%) on the initial sonographic assessment. Serial radiographs showed reduction in 12 (22%), with an average change of 15.1 degrees in the head-neck angle. Serial sonography showed reduction in 7 out of 20 cases (35%), with an average change of 3.7 mm in displacement. In two cases reduction was seen on sonography but not on radiography. Of the hips which showed subsequent reduction, 12 had had a bone scan on admission; three showed initial epiphyseal avascularity but only one progressed to symptomatic avascular necrosis. All stable hips had normal epiphyseal vascularity on the initial bone scan. This indicates the importance of injury from the initial displacement in causing avascular necrosis, rather than effusion, vascular compromise or iatrogenic injury from gentle repositioning. Physeal instability in SCFE is common and should be assessed clinically on admission. It is indicated by joint effusion or inability to bear weight. A slip is very unlikely to be unstable in a child able to bear weight and with no sonographic effusion

1. Three hundred and twenty cases of tuberculosis of the hip joint have been analysed and the late results assessed three or more years after discharge from hospital. 2. The primary bone focus involved the acetabulum alone in 39·3 per cent; the acetabulum and femoral head in 34·1 per cent; the head of femur alone in 19·2 per cent, and the femoral neck alone in 7·4 per cent. In 101 cases widespread destruction of the joint had taken place by the time the patient first came under observation. 3. Premature epiphysial fusion round the knee joint of the affected side occurred in 23 per cent of all patients under the age of fifteen years. 4. When hip disease was complicated by multiple foci of active tuberculosis or by secondarily infected abscesses and sinuses, the prognosis was seriously worsened. 5. Significant late deformity occurred in 38·3 per cent of patients discharged with "sound" fibrous ankylosis, and in 60·5 per cent of those with an unstable fibrous ankylosis. 6. Of 187 patients observed for more than three years after discharge from hospital 174 returned to full activity, seven were partly incapacitated and six were totally incapacitated. 7. Analysis of the late results suggests that the prognosis is best when an adequate period of conservative treatment is followed by some form of arthrodesis operation

Between May 1992 and April 1997, there were 20 452 births in the Blackburn District. In the same period 1107 infants with hip ‘at-risk’ factors were screened prospectively by ultrasound. We recorded the presence of dislocation and dysplasia detected under the age of six months using Graf’s alpha angle. Early dislocation was present in 36 hips (34 dislocatable and 2 irreducible). Of the 36 unstable hips, 30 (83%) were referred as being Ortolani-positive or unstable; 25 (69%) of these had at least one of the risk factors. Only 11 (31%) were identified from the ‘at-risk’ screening programme alone (0.54 per 1000 live births). Eight cases of ‘late’ dislocation presented after the age of six months (0.39 per 1000 live births). The overall rate of dislocation was 2.2 per 1000 live births. Only 31% of the dislocated hips belonged to a major ‘at-risk’ group. Statistical analysis confirmed that the risk factors had a relatively poor predictive value if used as a screening test for dislocation. In infants referred for doubtful clinical instability, one dislocation was detected for every 11 infants screened (95% confidence interval (CI) 8 to 17) whereas in infants referred because of the presence of any of the major ‘at-risk’ factors the rate was one in 75 (95% CI 42 to 149). Routine ultrasound screening of the ‘at-risk’ groups on their own is of little value in significantly reducing the rate of ‘late’ dislocation in DDH, but screening clinically unstable hips alone or associated with ‘at-risk’ factors has a high rate of detection

Aims

The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check.

The wrist is a complex joint involving many small bones and complicated kinematics. It has, therefore, been traditionally difficult to image and ascertain information about kinematics when making a diagnosis. Although MRI and fluoroscopy have been used, they both have limitations. Recently, there has been interest in the use of 4D-CT in imaging the wrist. This review examines the literature regarding the use of 4D-CT in imaging the wrist to assess kinematics and its ability to diagnose pathology. Some questions remain about the description of normal ranges, the most appropriate method of measuring intercarpal stability, the accuracy compared with established standards, and the place of 4D-CT in postoperative assessment.

Cite this article: Bone Joint J 2019;101-B:1325–1330.

Aims

Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair.

We describe the results of treatment of open tibial fractures in 92 children; 22 fractures were Gustilo type I, 51 type II and 19 type III. All children received tetanus prophylaxis, systemic antibiotics for 48 hours and thorough debridement and irrigation of the wound. Fifty-one wounds with minimal soft-tissue injury were closed primarily. The other 41 were initially left open; of these, 18 small wounds were allowed to heal secondarily and 23 larger wounds required split skin grafts or soft-tissue local or microvascular free flaps. Stable fractures were reduced and immobilised in an above-knee plaster cast (71%) and external fixation (28%) was used for unstable fractures, extensive soft-tissue injury and multiple injuries. Short-term complications included compartment syndrome (4%), superficial infection (8%), deep infection (3%), delayed union (16%), nonunion (7.5%) and malunion (6.5%): these incidences are similar to those reported in adults. Selective primary closure of wounds did not increase the incidence of infection. External fixation was associated with a greater occurrence of delayed and nonunion than plaster immobilisation, but this technique was used most often for the more severe injuries. Late review, at 1.5 to 9.8 years, showed a high incidence of continuing morbidity including pain at the healed fracture site (50%), restriction of sporting activity (23%), joint stiffness (23%), cosmetic defects (23%) and minor leg-length discrepancies (64%). Open tibial fractures in children are associated with a high incidence of early and late complications, which are more frequent in children with Gustilo type III injuries. The Gustilo classification was a useful guide for predicting the outcome and planning treatment

Aims

The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires.

Aims

The aim of this study was to report the mid-term clinical outcome of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties when used in patients with rheumatoid arthritis (RA).