Aims

The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon.

Objectives

The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration.

Aims

The treatment of patients with allergies to metal in total joint arthroplasty is an ongoing debate. Possibilities include the use of hypoallergenic prostheses, as well as the use of standard cobalt-chromium (CoCr) alloy. This non-designer study was performed to evaluate the clinical outcome and survival rates of unicondylar knee arthroplasty (UKA) using a standard CoCr alloy in patients reporting signs of a hypersensitivity to metal.

Aims

Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are few prospective studies that directly compare these agents. The purpose of this study was to compare the benefits of intraoperative intravenous TXA with EACA.

We studied the complications after open-wedge osteotomy by hemicallotasis in 308 consecutive patients, most of whom had osteoarthritis of the knee. The participating surgeons, who worked at 17 hospitals, used their discretion in selecting patients, operating techniques and external fixators. The general complications included 11 cases of deep-vein thrombosis (4%), six of nonunion (2%) and one of septic arthritis of the knee. There were technical complications in 13 patients (4%). In 157 patients (51%) pin-site infections were recorded; of these, 96% were minor and responded to wound toilet and antibiotic treatment. A total of 18 revision procedures was carried out

We have carried out a retrospective review of 11 Souter-Strathclyde primary total elbow arthroplasties in ten patients with osteoarthritis, over a period of nine years. The diagnosis was primary osteoarthritis in nine elbows and post-traumatic arthritis in two. The mean follow-up was 68 months (15 to 117). Although no patient was symptomatic, radiological review revealed evidence of loosening affecting three humeral and two ulnar components, one of which subsequently failed and was revised at 97 months. There were no dislocations, deep infections or mechanical failures. Complications included two superficial wound infections and two neurapraxias of the ulnar nerve which resolved. This study shows that the unlinked Souter-Strathclyde total elbow arthroplasty can be considered for patients with osteoarthritis and gives good symptomatic relief and improvement in function

A prospective trial was performed, comparing the use of silver sulphadiazine occlusive dressings with Fucidin gauze compressive dressings in the treatment of injuries to the finger-tip in patients presenting at the casualty department. Sixty-four patients were seen, four of whom had severe injury with extensive loss of pulp. The time taken for the wound to heal, the incidence of infection, and the duration of absence from work were compared for both types of treatment. The results showed that silver sulphadiazine occlusive dressings were the most effective in the treatment of these injuries even when they were severe

1. A modification of the Keller's arthroplasty is described, in which one of two types of distractor–intramedullary wire and external staple–is used to maintain normal length of the great toe for three weeks after operation. 2. The results of the modified operation are analysed. They appear to show that the use of a distractor can be expected to produce an improved end result and to aid post-operative wound healing. 3. The possible reasons for the improvement in results are discussed. 4. The intramedullary wire and the external staple are compared with respect to ease of introduction, effectiveness in maintaining distraction and end results

Exposure to blood is a hazard for all surgeons. We assessed the incidence of glove perforation and needlestick injury from a new blunt taperpoint needle designed to penetrate tissues other than skin with the minimum of force. We performed a prospective, randomised trial comparing the incidence of perforations of surgical gloves with the new needle and a standard cutting needle during wound closure after hip arthroplasties. There was at least one glove perforation in 46 of 69 such procedures (67%). The use of the taperpoint needle produced a significant decrease in perforations (p = 0.049)

A randomised double-blind study was carried out on 60 patients undergoing elective lumbar discectomy. Patients in the study group (n = 30) received an injection of 10 ml of 0.5% bupivacaine into the wound; the control group (n = 30) received none. Postoperative pain was measured by a visual analogue pain scale and by the amount of morphine administered by a patient-controlled analgesia system. Patients in the study group had lower pain scores, used less morphine, waited longer until their first demand for analgesia and reported their postoperative pain to be less severe

In two hospitals, 115 consecutive open femoral shaft fractures were treated by meticulous wound excision and early locked (97) or unlocked (18) intramedullary nailing. All the fractures united; union was delayed in four, three of which required bone grafting. The average range of knee flexion at follow-up was 134 degrees (60 to 148). Five patients had a final range of less than 120 degrees, but three of these improved after manipulation under general anaesthesia. Three patients developed staphylococcal infections and required further surgical treatment. All eventually healed

Aims

The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee.

Clean air in the operating room is important during joint replacement surgery. We compared monochromatic ultraviolet radiation of 254 nm with the use of a Charnley-Howorth air enclosure by bacterial air-sampling during 113 total hip arthroplasties. Air samples were taken continuously at the edge of the wound and every 15 minutes at a site 130 cm from the operating table. We also tested the effect of occlusive clothing for all personnel. Ultraviolet light was more efficient than the ultra-clean air enclosure, and occlusive clothing on its own or in combination also produced improvement. The implications of these findings are discussed

Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. We report 31 total hip arthroplasties in 21 renal transplant recipients with an average follow-up of six years. There were no problems with wound healing or infection despite full immunosuppression. Four hips developed symptomatic loosening but the other results were excellent, comparing well with other methods of treatment for osteonecrosis. Ten patients died during the follow-up period. Total hip replacement is a safe and effective treatment for transplant recipients and, in view of their limited life expectancy, should be considered at an early stage in their treatment

The results of 132 Attenborough total knee replacements after a follow-up period of from four to 10 years are presented. Long-term relief of pain and improvement in stability and walking distance were maintained in over two-thirds. The cumulative survivorship with the prosthesis in situ, little or no pain and no radiological loosening was 65% at six years. Problems with wound healing were common, and there was a complication rate of 20% in primary replacements, including a deep-infection rate of 3.5%. Almost 20% of the prostheses needed revision because of aseptic loosening, and there is evidence of radiological and clinical loosening in a further 7.5%

Crushing of the radial side of the hand results in a wide spectrum of injuries varying from contusion of muscles to total loss. The main problem concerns the function of the thumb. The results of such injuries in 161 hands were reviewed. Those with mild injuries treated conservatively or by debridement alone had good results. When skin flaps were required for wound coverage, the results were still satisfactory. However, when bones and joints were injured, the results were poor. In certain patients opponensplasty through scarred tissue proved to be a good procedure to improve the function of the thumb

1. A method of medullary nailing of fractures of the shaft of the tibia with a straight clover-leaf nail of large calibre is described. The nail is introduced, without exposure of the fracture, through the deep infrapatellar bursa. No external splint is used and the patient is usually allowed to walk as soon as the wound is healed. The technique is essentially that of Küntscher. 2. The results obtained in the first fifty patients so treated are described. The average period of absence from work for those twenty-five whose treatment was satisfactory was eleven weeks. There were no cases of sepsis or non-union; the only difficulties encountered were mechanical ones

1. The success of any method of treating the injured hand is to be measured by the use that is made of the remnant. 2. Careful, prompt surgical treatment of the wound will usually allow prompt healing. 3. Skin-grafts, internal fixation of fractures and the eking out and rearrangement of tissues that have escaped injury have an important place in primary treatment. 4. Many hands so treated are ready for use after one operation and within a few weeks of being injured. 5. Reconstruction in several stages should not be carried out unless it offers a reasonable prospect of improvement that will be useful to the particular patient

1. Twenty-seven patients with a Brown-Séquard syndrome resulting from trauma have been studied, fourteen of the left side of the cord and thirteen of the right. There were sixteen gunshot wounds and eleven closed injuries. 2. The prognosis for recovery is much better than the initial catastrophic nature of the symptoms and signs would indicate. 3. The pattern of recovery is discussed in detail and the long and rather tedious course of the treatment is indicated. 4. Spasticity on the side worse affected still presents a difficult problem, but a less severe one than that presented by flaccid paralysis

Aims

The purpose of this study was to identify factors associated with limitations in function, measured by patient-reported outcome measures (PROMs), six to nine months after a proximal humeral fracture, from a range of demographic, injury, psychological, and social variables measured within a week and two to four weeks after injury.