We have reviewed the results of the Sofield-Millar operation on 58 long bones in ten patients. If more than three osteotomies were undertaken the time to union of the bone was significantly prolonged (p< 0.001) with significant thinning of the bone (p< 0.02). We have used a modified technique in order to minimise surgical trauma and devascularisation of the bone. The rod is introduced under the control of an image-intensifier. Small surgical exposures are made only at the sites of corrective wedge osteotomies. The number of osteotomies is kept to the minimum

The palmar ligaments of the wrist were dissected in 15 adult cadaver wrists and demonstrated by MRI in three. Ten fetal wrists (10 to 19 weeks' gestation) were studied in histological sections. The palmar scaphotriquetral ligament was found in them all. Its attachment to the triquetrum is substantial but that to the scaphoid is thin and fan-shaped, its fibres interdigitating with those of the radioscaphocapitate ligament. The contribution of the ligament to carpal stability has yet to be studied, but it may help to support the head of the capitate when the wrist is dorsiflexed

We studied the most superficial layer of macroscopically normal articular cartilage obtained from human femoral heads, using polarising microscopy and SEM. The most superficial layer, 4 to 8 microns thick, was acellular consisting of collagen fibrils. This layer could be peeled away as a thin film, with no broken collagen fibrils on its inferior surface or on the surface of subjacent cartilage layers. The orientation and diameter of collagen fibrils were different on these two surfaces. Our findings suggest that the most superficial layer is an independent one which is only loosely connected to the fibrous structure in the layer deep to it

Aims

Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck.

Aims

We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur.

Aims

The present study investigates the effectiveness of platelet-rich plasma (PRP) gel without adjunct to induce cartilage regeneration in large osteochondral defects in a rabbit model.

Aims

High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.

We have studied aseptic loosening of the femoral component in 76 patients with primary total hip replacement using the Capital prosthesis. The mean follow-up was 26 months (10 to 37). Twelve femoral components (16%) were definitely and eight (10%) were possibly loose. They were characterised by a thin cement mantle (p < 0.001) and excessive residual cancellous bone in the proximomedial region (p < 0.01). We recommend that the cement mantle around the prosthesis should be 2 to 3 mm and that further long-term studies are needed to evaluate the wear properties of titanium-nitride-coated titanium femoral heads

Free osteocutaneous fibular grafts, revascularised by microvascular anastomoses, have been used for one-stage reconstruction of extensive bone and skin loss in the lower leg in seven patients. The addition of an integral skin flap to a vascularised fibular graft makes reconstruction of bone defects with significant skin loss possible, and the technique for designing and raising such a flap is presented. The advantages of this transfer over other microvascular osteocutaneous flaps are the available length of straight cortical bone, the large thin skin flap, the good diameter of the vascular pedicle and the fact that dissection is carried out under a tourniquet

1. A case of vertebra plana (Calvé) is described and serial radiographs throughout the course of the disease are presented. 2. The initial radiographs showed a vertebra of normal depth which collapsed to a thin disc in fifteen days. Since the symptoms had begun twelve days before the first examination the total time taken to reach this stage was twenty-seven days. 3. The literature has been reviewed for evidence of the underlying pathology of vertebra plana. In the case described biopsy of the affected vertebral body was not carried out, and thus the nature of the underlying change could not be determined

The complete removal of the cement mantle at revision arthroplasty can be extremely difficult. Some authors advise a ‘cement-within-cement’ revision technique in which a new layer of cement is applied to the old before insertion of the femoral component. We could find no long-term clinical data regarding the success of this procedure. In a simple biomechanical study, we examined the strength of the cement-to-cement interface in conditions likely to prevail in vivo. We found that the presence of a thin layer of blood and marrow debris at the interface weakened the cement-to-cement bond by 80% to 85%. These biomechanical findings and additional photomicrographic evidence do not support the practice of cement-within-cement revision arthroplasty

Aims

To draw a comparison of the pullout strengths of buttress thread, barb thread, and reverse buttress thread bone screws.

1. Bone changes in the haemoglobinopathies are caused by either (a) chronic haemolysis with marrow hyperplasia, or (b) infarction, when Hb S is present in the red cells in amounts sufficient to allow sickling (and therefore vascular occlusion) in vivo. 2. Marrow hyperplasia produces osteoporosis, widening of the medulla, and thinning of the cortex; it may lead to spontaneous fractures and disturbances of growth. Enlargement of the foramina of the nutrient arteries may be seen especially in the phalanges. Infarcts leading to aseptic necrosis occur in the long bones, and may become infected with Salmonella organisms. The range of radiological lesions caused by these processes is illustrated

Fixation of the glenoid component is critical to the outcome of total shoulder arthroplasty. In an in vitro study, we analysed the effect of surface design and thickness of the cement mantle on the pull-out strength of the polyethylene pegs which are considered essential for fixation of cemented glenoid components. The macrostructure and surface of the pegs and the thickness of the cement mantle were studied in human glenoid bone. The lowest pull-out forces, 20 ± 5 N, were for cylindrical pegs with a smooth surface fixed in the glenoid with a thin cement mantle. The highest values, 425 ± 7 N, were for threaded pegs fixed with a thicker cement mantle. Increasing the diameter of the hole into which the peg is inserted from 5.2 to 6.2 mm thereby increasing the thickness of the cement mantle, improved the mean pull-out force for the pegs tested

The clinical and pathological features of six cases of desmoplastic fibroma of bone are presented. Desmoplastic fibroma is rarely seen as a primary tumour of bone; when it does occur the sites of predilection are the long bones, but other sites such as the scapula and os calcis can be involved. Radiographically the lesion tends to expand the bone from within; it is well-demarcated and lytic, often with a trabeculated soap-bubble appearance. The cellular structure and the morphological arrangement are similar to those of aggressive fibromatosis of soft tissues. Differential diagnosis from malignant spindle-cell lesions of bone is important because the treatment of choice for desmoplastic fibroma of bone is simply excision with a thin layer of healthy tissue

Aims

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

We examined the structure of the digital flexor sheath by dissection and histology. The inner aspect of the sheath was found not to be a continuous smooth surface, as depicted in anatomical and surgical texts. The thin parts of the sheath often overlapped the pulleys before attaching to their superficial aspects, so that the pulleys possessed free edges within the sheath. The frequency of occurrence and sizes of these overlaps were studied in 48 cadaveric fingers; the largest and most frequent overlap was at the distal end of the A2 pulley. Functional studies showed an intricate mechanism of pulley approximation and sheath bulging during flexion. Sutured or partly cut tendons triggered on the free edges; this could be a major contributor to the failures of tendon repairs in "no man's land"

Fifty-three failed knee replacements were revised using minimally constrained implants with smooth uncemented intramedullary stems and metal-backed tibial components. Polymethylmethacrylate was used only to replace lost bone near the surface of the implant. Excluding four knees which had serious postoperative complications, 91% had successful relief of pain, 84% had over 90 degrees of movement and 80% could walk for more than 30 minutes. Review of the radiographs showed that there were no progressive lucencies at the interface between bone and cement, and no subsidence of components or changes in alignment. At the uncemented stem-to-bone interface, thin white lines developed near the metal, and their significance is discussed. This revision technique is an effective treatment for aseptic failure of primary total knee arthroplasty

We have investigated whether the presence of polyethylene (PE) alone is sufficient to cause an aggressive periprosthetic tissue response, or whether certain mechanical interface conditions can allow bone to grow while in the presence of PE. An experimental implant was loaded in the presence and absence of particulate PE under stable and unstable conditions. Bone with a thin, discontinuous fibrous membrane formed in both groups of stable implants, either in the presence or absence of PE. By contrast, a continuous fibrous membrane consistently formed in both groups of unstable implants. The membrane consisted of loose fibrous connective tissue when PE was absent, and dense connective tissue with macrophages and a synovial lining when PE was present. In this model, if the interface was stable, the presence of PE was not sufficient to prevent the formation of bone or to produce a phagocytic tissue response. Only when the interface was unstable did a fibrous membrane form, and only then in the presence of PE