Search

Copyright of International Orthopaedics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With a "headless" humerus active abduction and elevation of the arm are hardly possible. Especially if the humeral head was removed because of an infection, shoulder fusion is often the only safe solution for this disabling condition. Large corticocancellous, autologous bone grafts are interposed between the thin humeral stump on one side and its broad glenoid-acromion counterpart on the other. A 4.5 narrow AO-plate stabilizes the fusion. The technique is described and the functional result of two patients is shown. Ten years after the operation, both patients were free of pain and very satisfied about the utility of the arm. The fusion had convincingly healed in the planned position. Shoulder fusion proved to be a safe and good solution for both our patients with a longstanding headless humerus. Ten years after the operation they were free of pain and had regained a useful arm.

Background: Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified., Objectives: The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults., Search Strategy: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field., Selection Criteria: Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion., Data Collection and Analysis: Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test., Main Results: Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences., Reviewer's Conclusions: The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.

We measured radiographically the polyethylene socket wear in 34 hip prostheses with a 32 mm Al2O3-ceramic head with a rotating bearing and in 37 prostheses with a "fixed" ceramic head. The mean follow-up was 12 years in both groups. The mean annual linear wear of the polyethylene was 0.034 and 0.069 mm, respectively, (Mann-Whitney U-test p < 0.0001) in the "rotation" and the "fixed" group. A rotating bearing between the head and neck in a modular total hip system seems to reduce socket wear as compared to fixed taper junctions.

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on 122 of these patients had ligament ruptures. At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures. Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.

We performed reconstruction of the anterior cruciate ligament in 33 patients using the central third of the patellar tendon. In 20 patients we did an arthroscopically-assisted procedure, while 13 patients had an additional mini-arthrotomy through the gap in the patellar tendon. After 2-3 years the subjective knee function, according to the Lysholm score, was excellent or good in 18 knees and fair or poor in 15 knees, mainly due to anterior knee pain. Although 18 patients complained about anterior knee pain, only 1 patient required further surgery. After the operation the patella had a lower position. A flexion contracture was found in 7 patients, and 13 had heterotopic bone formation at the apex of the patella. Although stability was restored in 31 of the 33 reconstructed knees, anterior knee pain was a frequent complication. There were no correlations between the anterior knee pain and patellar height, flexion contracture or heterotopic bone formation.

We studied biopsies of interface membranes of 9 aseptically loosened total hip prostheses. The morphologic resemblance of the cement-facing surface of the membranes to synovial tissue of arthritic joints, as noticed by others, was confirmed by histochemical techniques. High cathepsin B activity was found in the bone-facing surface of the membranes. Since this enzyme also plays an important role in tissue destruction of arthritic joints, further similarities in the mechanisms of tissue breakdown in arthritis and aseptic loosening of cemented hip prostheses may be conjectured.

The AO-plate was used for external fixation in 12 patients. The main indications were severe open fractures of the forearm and infected pseudarthroses at several locations. In 10 cases, the fixation provided enough stability to allow bone healing. The technique is simple, is convenient for the patient, and is always available without additional special equipment.

Radiographic measurements of polyethylene socket wear were performed in 33 hip prostheses with an AI2O3-ceramic head and 33 prostheses with a metal head. At 9-11 years, the average reduction of the diameter of the polyethylene was 0.26 and 0.96 mm, respectively, in the ceramic and the metal group. However, the number of clinically proven or radiographically suspected loosenings did not differ between the two groups.