At re-examination of all osteosarcomata recorded in the Swedish Cancer Registry during the years 1958 to 1968, 11 cases of parosteal osteosarcoma were found. No case of so-called periosteal osteosarcoma was identified. The tumours constituted 1.6 per cent of all proved primary malignant bone tumours. The ages of the 11 patients (six women and five men) ranged from 17 to 62 years (average 33 years). The clinical and histopathological findings of this study and of those collected from a review of the literature suggest the occurrence of two different types of parosteal osteosarcoma: the predominant type is originally benign but has a definite malignant potential, causing metastases after long symptom-free intervals; the other type is highly malignant from the beginning. Primary amputation is recommended for the latter category of tumours, and compartmental, radical en bloc resection followed by regular review is recommended for the former

We have reviewed 32 patients with rheumatoid disease of the cervical spine who underwent a total of 40 operations aimed at correcting instability and improving any associated neurovascular deficit. Apart from four patients with intractable pain, the main indication for surgery was progressive neurological impairment. Of the 32 primary operations, 19 (60%) were successful; the remainder failed to achieve their objective and there were two deaths in the immediate postoperative period. Of eight secondary operations performed for recurrence of symptoms or failure to relieve cervical myelopathy, only four were successful. Of nine operations for bony decompression to relieve cord compression from irreducible subluxation, only four were successful. The overall results show a success rate of 57% and a failure rate of 35% with early operative mortality in 8%. Indications for operation are discussed and earlier diagnosis is considered to be the key to improved results

We reviewed the results of 545 consecutive total hip replacements using a cementless non-coated high-density polyethylene acetabular component combined with a cemented Muller stem at five to 10 years. In all, 421 patients (445 hips) were available for review, 118 by questionnaire and 303 by examination and radiography. Of these, 86% had a good or excellent result. We found a high rate of radiological loosening of the cup after the sixth year, and a high rate of clinical loosening after the eighth year. Loosening was commoner in women, in younger patients and where a smaller size of acetabulum had been used. Calcar resorption was significantly related to loosening of the acetabulum. Loosening appeared to be mainly due to polyethylene debris produced by micro-movement of the acetabulum against the bone, which had resulted in a giant cell foreign body reaction and subsequent bone erosion. We have abandoned the use of this prosthesis and suggest that direct contact between bone and polyethylene should be prevented by a coating of metal or some other material

We reviewed 1085 consecutive compound limb fractures treated in 914 patients at the University of Louisville over a nine-year period. Of these fractures, 240 (group 1) received only systemic antibiotic prophylaxis and 845 (group 2) were managed by the supplementary local use of aminoglycoside-polymethylmethacrylate (PMMA) beads. There were no significant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious wound irrigation, meticulous debridement and skeletal stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p < 0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type-IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adjuvant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures

A long-term review of 131 children fitted with upper limb prostheses at the Ontario Crippled Children's Centre between 1965 and 1975 is reported. There were 116 children with congenital deficiencies and 15 who had had amputations. Follow-up ranged from 7 to 17 years. A total of 42 children had abandoned their prostheses, 37 of whom had congenital deformities and five were amputees. The level of deficiency was of fundamental importance in determining whether the prosthesis would be accepted; in the forearm, the longer the stump, the more likely it was that the child would discard the prosthesis. Overall, 50 per cent of children fitted over the age of two years abandoned their prostheses compared with only 22 per cent of patients who had been fitted before the age of two years. The highest drop-out rate was at the age of 13 years when the children became more conscious of their cosmetic appearance. Suggestions for reducing the high drop-out rate in the early teens are put forward

Thirty-five patients (28 children and seven adults) were reviewed six months to 22 years after sustaining the common childhood fracture of the intercondylar eminence of the tibia. The aim was to assess both short-term and long-term results and prognosis by clinical and radiological examination and to discover whether conservative treatment was adequate for those severe fractures where a fragment of the tibial crest had been totally displaced. All the less severe fractures and 14 of the 17 severe fractures were treated conservatively. Early improvement occurred in more patients when the knee was immobilised in extension rather than in flexion, but long-term results were similar. Seven patients had slight discomfort, two of whom had had operative treatment. Radiographs of all patients showed a projection at the fracture site but its size did not correlate with the extent of displacement of the fragment nor with the degree of discomfort suffered; in the severe group a smaller projection developed after open reduction and after immobilisation in extension than after immobilisation in flexion. There was no instability due to functional lengthening of the cruciate ligaments and no increased incidence of degenerative change

In 1957 Somerville and Scott presented their principles of management for the older child with congenital hip dislocation. They advocated preliminary traction followed, in those hips which remained dislocated, by excision of the limbus and subsequent derotation varus osteotomy of the femur. As alternative regimes are advocated it becomes increasingly important to subject each method to detailed long-term review. One hundred and forty-seven hips in 121 patients aged between 12 months and three years and treated by the standard Somerville and Scott regime have been reviewed. The age at review ranged from 16 to 31 years. The recall rate was 91 per cent. Each patient was seen regularly in a special clinic where detailed notes, radiographs and records were available. The results have been assessed clinically and radiographically by modifications of Severin's criteria to enable comparisons to be made with other published series. Attention has been focused on the good and the bad prognostic factors and on the long-term complications. The most worrying feature has been the premature onset of degenerative arthritis even in hips which seemed to have been satisfactorily reduced

Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method

We present the case of a 65-year-old man who developed a malignant fibrous histiocytoma at the lesser trochanter five months after a cementless hip replacement. We have reviewed reports of similar cases and discuss them in terms of the possible mechanisms of sarcomatous degeneration and the latency of such changes

Malignant transformation of fibrous dysplasia to chondrosarcoma is rare. We report a case in which malignancy developed in an area of fibrous dysplasia in the ilium. We believe this to be the second reported case at this site. Treatment was by excision of the hemipelvis including the ala of the sacrum. A review of the literature is presented

We reviewed the records and radiographs of 387 cemented revisions of aseptic loose sockets after total hip replacement at a mean follow-up of 5.5 years. The clinical results were satisfactory, but at the last radiological assessment 38 sockets (9.8%) had a continuous zone of demarcation greater than 1 mm thick and another 35 (9%) showed migration. Poor acetabular bone stock had a profound influence on the outcome of revision surgery, but the results of cemented revision were comparable to those reported for cementless revision at similar mean follow-up

The early results of revision osteoarticular allografts in weight-bearing joints are reported. Sixteen consecutive patients underwent surgery over a six-year period between 1982 and 1988. At the time of review eight patients (50%) had surviving second allografts with an average follow-up time of 48 months (range 12 to 87). Five patients were graded excellent according to the Mankin scale, one good and two fair. Eight patients (50%) required further surgery, but only two patients came to amputation

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed

Seventy-nine cases of fracture of the femoral shaft treated by cast-brace and early walking have been reviewed. Discrepancy in femoral length was assessed by scanogram. The cases were analysed to relate the incidence of shortening greater than 2 centimetres to the type and site of the fracture, and the time which elapsed from injury until the cast-brace was applied. Such shortening was encountered most frequently when the cast-brace was applied within the first two weeks from injury or after six weeks and in those patients with comminuted fractures of the middle third of the femoral shaft

Of 64 patients with stab wounds involving the brachial plexus operated on by one surgeon, 18 were followed up in detail, with a view to reviewing operative techniques, results and the lessons to be learned. Primary nerve grafting produced better results than end-to-end repair, even in fresh cases. The recognition of nerve compression by a false aneurysm is important, since in these cases, vascular repair alone may not give recovery and neurolysis may be necessary. The overall results of operation were good; lesions of C5 and C6 roots recovered better than those of more distal roots

A review is presented of 41 patients with traumatic tetraplegia on whom reconstructive surgery of the upper limb was carried out. Twelve patients were followed up for more than 10 years after operation and the average period overall was seven and a half years. Tendon transfers were made with the aim of providing extension of the elbow or restoring a useful grasp or a combination of both. The assessment was carried out on four main aspects: the function of the elbow, the function of the hand, the ability to carry out the activities of daily living and the effect of the surgical reconstruction on the personal and social achievement of the patient

Successful management of late presenting hip dislocation in childhood is judged by the outcome not just at skeletal maturity but well beyond into adulthood and late middle age. This review considers different methods of treatment and looks critically at the handful of studies reporting long-term follow-up after successful reduction.

Cite this article: Bone Joint J 2015;97-B:729–33.

Solitary benign peripheral-nerve tumours are rare and may be difficult to diagnose correctly. Surgical excision may increase the patient's symptoms and may not be necessary. We have reviewed the presentation, clinical findings and histology of 104 solitary tumours presenting at one centre between 1959 and 1990. Male patients predominated for both schwannoma and neurofibroma. There was considerable but variable delay before presentation; 94% of patients complained primarily of a mass and less than half had pain or paraesthesia. The correct diagnosis had been made in only a few cases before operation, and the incidence of neurological symptoms doubled after exploration. We emphasise the need for vigilance, accurate preoperative diagnosis, and careful surgery

We reviewed at a minimum elapsed time of five years a consecutive series of 143 primary Exeter hip replacements in which matt-surfaced femoral stems had been used. Twenty-five patients had died and six stems and two sockets had been revised before follow-up. The remaining 110 hips were all examined clinically and radiographically. In 15 hips there were radiographic signs of definite loosening of the stem and in eight suspected loosening. The acetabulum was loose in four hips. In another eight hips localised bone resorption was present without signs of loosening. Half the patients with loosening or localised bone resorption had mild pain or no pain at all. The late complication rate with the matt-surfaced Exeter femoral stem is unacceptably high