Journal of Orthopaedic Surgery

We performed a comparative study of iliac bone graft (the iliac bone group) and carbon cage with local bone graft (the cage group) in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score), and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse.

The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60–88 years) and the mean follow-up period was 24 months (range, 12–53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were ‘excellent’ in 64% of fractures and ‘good’ in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7°, ulnar variance was 4.0 mm, and palmar tilt was −2.7° respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the nondominant hand injured.

Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur.

This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture.

The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90° of movement, these were old fractures and noncooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil.

Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.

The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80–84 years old), group B (85–89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure.^1,2,4 This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses.

Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients.

In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty.

Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm⁵. A modular prosthesis allows versatility at surgery.

A modified lateral approach of Hardinge allows adequate access for orientation of the implant was described. Although this approach is more difficult than the posterior approach, there is a learning curve, when mastered, it'll definitely reduce the incidence of dislocation. In the Author's opinion, this approach should be used routinely for total hip arthroplasty for fractured neck of femur where the incidence of dislocation is unacceptably high using the posterior approach.

We conducted a study on dried cadaveric pelvic bones to determine the relation between acetabular diameter and thickness of the acetabular wall.

The acetabulum was divided into four quadrants: antero-superior, postero-superior, postero-inferior, and anteroinferior. The diameters of the acetabulum were measured for 152 pelvic bones. The thickness of the center of the acetabulum was measured with the use of a caliper at four quadrants of the acetabulum. The average acetabular diameter was found to be 51.8224 mm for all the acetabuli. The average thickness in the posterior quadrant has been calculated to be about 50% of the acetabular diameter, which is about 26 mm. The acetabular diameter and the thickness of the acetabulum correlated very well though there was very little significance statistically (0.099) due to the lack of full data for all the individual bones.

Linear correlation between the thickness and the diameter is definitely collinear but the correlation is not statistically significant. Some additional factors such as bone density, body mass, etc, are required to correlate the thickness and the diameter. Further study is required in this field.

The authors showed the data of congenital amputation in 36 cases among the physically handicapped individuals (who attended a district level hospital for the purpose of obtaining a handicap certificate) during the period from 1 January 1999 to 31 December 2000.

Out of 3,550 individuals, we found 612 with congenital orthopaedic anomalies, which accounted for 17.2%. Of these 612 individuals, we noted 36 cases with congenital amputation (amputation through digits and toes were not included). Both unilateral and bilateral congenital amputations were much more common in the upper extremity as compared to lower extremity. Not a single case of simultaneous upper and lower extremity involvement was seen. The most common transverse deficiency in the upper limb was through the forearm, and in the lower limb it was through the foot. Congenital amputation was common in males with a gender ratio of 3.5:1. Left limb involvement was twice as much as right limb involvement, and it was common in both sexes. Bilateral limb involvement was seen only in males.

The use of local antibiotics from a biodegradable implant for chronic osteomyelitis is an attractive alternative. The implant delivers high tissue levels, obliterates dead space, aids bone repair and does not need to be removed. The purpose of this paper is to review our early clinical experience with custom-made calcium sulfate (Osteoset bone void filler) antibiotic-impregnated implants.

An adequate calcium intake and vitamin-D status is important for bone mineralization in adolescents. In Northern China, calcium intake and plasma vitamin-D level of adolescents is low due to low consumption of dairy foods and inadequate sunshine exposure. True fractional calcium absorption (TFCA) in Chinese adolescents has never been performed.

This study aims to evaluate nutritional adaptation namely, TFCA and urinary calcium excretion among Chinese adolescents in northern China.

The objective of using wave-form analysis to assess compound muscle action potential (CMAP) in entrapment neuropathy had not been fully developed. We applied the power spectrum analysis to patients with carpal tunnel syndrome (CTS) for this purpose. 24 patients with CTS were divided into three stages according to Mackinnon's classification, and 50 normal volunteers were examined. CMAP was obtained from the abductor pollicis brevis with supramaximal stimulation to median nerve. Mean and peak frequencies were measured by power spectrum analysis.

The distal latencies of CMAP and the sensory nerve conduction velocities showed some prolongation in CTS patients. Integral values of CMAP were also decreased in CTS patients. Mean and peak frequencies of power spectrum of CMAP in volunteers were 134Hz and 98 Hz, respectively. These values shifted into lower frequencies in CTS patients, namely 102Hz and 61Hz.

Regardless of clinical stage, distal latency of CTS patients correlated with mean frequency.

Four cases of sciatica due to osteophytes impinging on the sciatic nerve at the sacroiliac joint are reported. Of these 4 cases, 2 were treated conservatively and the other 2 required surgical excision of the osteophyte. The report highlights the importance of keeping this uncommon etiology in the differential diagnosis of sciatica.

The occurrence of massive retroperitoneal schwannomas is extremely rare and their presence may only be expressed by insidious onset of non-specific and misleading symptoms with a predominance of lower back pain. MRI scan as the imaging procedure of choice will demonstrate the tumour location and its relation to the surrounding structures, but due to heterogeneity and degeneration in some tumours, it may mimic malignancy. Hence tissue sampling through needle biopsies are essential to verify the diagnosis prior to surgery.

Tumour excision in toto is considered the treatment of choice, but it can be hazardous especially if the tumour is adherent to the presacral venous plexus. Severe bleeding complications due to the damage of venous structures have to be encountered, and establishing lasting haemostasis may pose considerable difficulties. Hence surgery should be attempted with full precautions, and preoperative counseling of the patient. If malignancy can safely be excluded, laparoscopic ‘piecemeal’ excision should be considered as an alternative treatment as recurrence is unlikely. Definition of the originating nerve might not always be possible and a minor degree of neurological impairment has therefore to be anticipated.

Skeletal-extraskeletal angiomatosis is defined as a benign vascular proliferation involving the medullary cavity of bone and at least one other type of tissue. It has also been known as cystic angiomatosis in which multiple cystic lesions are scattered diffusely throughout the skeleton often with similar angiomatous changes in other tissues, usually the spleen.

A case of skeletal angiomatosis in association with gastro-intestinal angiodysplasia and paraproteinemia is reported.

True aneurysms of the digital artery are very rare. We report a case of true aneurysm of a proper digital artery of the right thumb in a radiographer. Treatment by ligation and excision resulted in complete relief of symptoms.