We reviewed 26 patients who had had internal fixation of an open intra-articular supracondylar fracture of the humerus. All operations were performed using a posterior approach, 13 with a triceps split and 13 with an olecranon osteotomy. The outcome was assessed by means of the Mayo Elbow score, the Disability of the Arm, Shoulder and Hand (DASH) score and the SF-36 Physical Function score. Patients with an olecranon osteotomy had less good results

Adults with deformities of the lower limb due to spasticity may be considerably improved by operation, but thorough pre-operative assessment as an inpatient is essential in order to pinpoint the disability. The commonest deformity is equinovarus which often responds to simple operative procedures. The results of seventy-seven operative procedures in fifty patients are recorded. Correction once achieved is stable and the deformity does not recur

Displaced fractures of the os calcis involving the subtalar joint frequently cause chronic disability due to subsequent osteoarthritis. Early posterior subtalar fusion may prevent this outcome. We have reviewed forty-seven fractures in forty-three patients at an average of seven years after operation. Over 90 per cent of patients had an excellent, good or satisfactory result

1. Three cases of osteomyelitis of a metatarsal sesamoid bone are described. 2. The diagnosis should be considered in patients with acute pain under the first metatarsophalangeal joint, particularly if the temperature is elevated. 3. Failure ofdiagnosis may lead to persistent disability until sinus formation and sequestration dictate operative intervention. 4. Early antibiotic therapy may lead to resolution of the infection

We have assessed whether an epidural steroid injection is effective in the treatment of symptoms due to compression of a nerve root in the lumbar spine by carrying out a prospective, randomised, controlled trial in which patients received either an epidural steroid injection or an intramuscular injection of local anaesthetic and steroid. We assessed a total of 93 patients according to the Oxford pain chart and the Oswestry disability index and followed up for a minimum of two years. All the patients had been categorised as potential candidates for surgery. There was a significant reduction in pain early on in those having an epidural steroid injection but no difference in the long term between the two groups. The rate of subsequent operation in the groups was similar

Aims

Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort.

Aims

Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees.

Aims

Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort.

We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal avulsion treated by early reduction and internal fixation with restoration of full function

1. Experimental evidence is advanced to suggest that the effect of the McMurray displacement osteotomy in osteoarthritis of the hip is to diminish the load carried by the head of the femur, firstly by correction of deformity, and secondly by a "pelvic support" action. 2. A review of seventy-five cases has revealed certain important details in selection and operative management. The end-results indicate that the operation, when correctly performed, is successful in relieving pain and diminishing disability

We have assessed the results of 34 simple excisions of the trapezium, with no additional soft-tissue procedures, in 30 patients. At a median follow-up of five years (2 to 22), 16 thumbs (47%) were completely painfree and a further 10 (29%) were slightly painful after use. Nineteen thumbs (56%) had no functional disability, but thumb-pinch strength was reduced by about 20%. No patient had painful degeneration at the scaphotrapezial pseudarthrosis

A case is reported four years after successful total replacement of the left humerus for chronic osteomyelitis of six years' duration, with an axillary sinus that had persisted despite repeated operations and more distally a pathological fracture that had failed to united after bone grafting. The disability was such that the patient had requested amputation, but he returned to his previous work as a driver six months after the total replacement and there has been no recurrence of infection

A retrospective survey has been made of forty children with spinal tumours. Difficulties in establishing the correct diagnosis are mentioned and the value of radiological and cerebrospinal fluid investigations discussed. The major orthopaedic disabilities are spinal deformity or instability, and paraplegia. The main factor in the development of the former is the site of laminectomy: the higher the level the greater is the likelihood of deformity or instability developing. Measures to prevent this distressing complication are discussed. The role of the orthopaedic surgeon in the management of these children is emphasised

Injury of the neck may result when a motor vehicle is run into from behind; such injury is frequently the cause of prolonged disability and litigation. We report a series of 61 patients with these injuries. A classification, based upon the presenting symptoms and physical signs has been evolved. This classification is shown to be a reliable basis for formulating a prognosis. Factors which adversely affect prognosis include the presence of objective neurological signs, stiffness of the neck, muscle spasm, and pre-existing degenerative spondylosis

The best treatment for a fractured neck of femur in an old person is considered by many to be replacement hemiarthroplasty which allows the patient to walk immediately on a stable, painless hip. The late results can be marred by acetabular erosion in which the metal head of the prosthesis erodes upwards into the acetabulum to give pain and disability. Here the trial of a new bipolar prosthesis with a dynamic self-aligning outer head is described in 161 fractured necks of femur. No acetabular erosion has been seen with its use over four years

Aims

Distal radial fractures are the most common fracture sustained by the adult population. Most can be treated using cast immobilization without the need for surgery. The aim of this study was to assess the feasibility of a definitive trial comparing the commonly used fibreglass cast immobilization with an alternative product called Woodcast. Woodcast is a biodegradable casting material with theoretical benefits in terms of patient comfort as well as benefits to the environment.

A prospective study of 480 patients who underwent enzymatic dissolution of the nucleus pulposus with chymopapain is reported. Seventy per cent of patients with the clincial criteria for a disc herniation had a favourable response to chemonucleolysis. The commonest cause of failure was persistent back pain. In patients with sequestered discs or lateral recess stenosis surgical intervention was not made more difficult by chemonucleolysis. Those with a previous operation, spinal stenosis or psychogenic components to the disability had very poor results. Complications were few and easily managed

The combination of an irreparable tear of the rotator cuff and destructive arthritis of the shoulder joint may cause severe pain, disability and loss of independence in the aged. Standard anatomical shoulder replacements depend on a functioning rotator cuff, and hence may fail in the presence of tears in the cuff. Many designs of non-anatomical constrained or semi-constrained prostheses have been developed for cuff tear arthropathy, but have proved unsatisfactory and were abandoned. The DePuy Delta III reverse prosthesis, designed by Grammont, medialises and stabilises the centre of rotation of the shoulder joint and has shown early promise. This study evaluated the mid-term clinical and radiological results of this arthroplasty in a consecutive series of 50 shoulders in 43 patients with a painful pseudoparalysis due to an irreparable cuff tear and destructive arthritis, performed over a period of seven years by a single surgeon. A follow-up of 98% was achieved, with a mean duration of 39 months (8 to 81). The mean age of the patients at the time of surgery was 81 years (59 to 95). The female to male ratio was 5:1. During the seven years, six patients died of natural causes. The clinical outcome was assessed using the American Shoulder and Elbow score, the Oxford Shoulder Score and the Short-form 36 score. A radiological review was performed using the Sirveaux score for scapular notching. The mean American Shoulder and Elbow score was 19 (95% confidence interval (CI) 14 to 23) pre-operatively, and 65 (95% CI 48 to 82) (paired t-test, p < 0.001) at final follow-up. The mean Oxford score was 44 (95% CI 40 to 51) pre-operatively and 23 (95% CI 18 to 28) (paired t-test, p < 0.001) at final follow-up. The mean maximum elevation improved from 55° pre-operatively to 105° at final follow-up. There were seven complications during the whole series, although only four patients required further surgery

The results of Charnley stabilisation of the hip in forty-three patients observed for one to four and a half years are reported. The operation readily produced a bony fusion in young patients and also in some of the older ones. Fibrous ankylosis, with or without some movement in the joint, gave an excellent result. Even when a pseudarthrosis or a stress fracture occurred, the clinical result often showed a definite improvement. Only three patients did not benefit from the operation, though none of these showed any significant increase in their disability

The Short Form-36 (SF-36) health questionnaire has been put forward as a general measure of outcome in health care and has been evaluated in several recent studies in the UK. We report its use in three groups of patients after spinal operations and have compared it with the Oswestry and Low Back Pain disability scales. There was a significant correlation between all variables of the SF-36 and the low-back scores. The mental-health items had the weakest correlation. Our study shows that the SF-36 questionnaire is valid and has internal consistency when applied to these patients