J Bone Joint Surg Br
-
J Bone Joint Surg Br · Jul 1992
Posterior fracture-dislocation of the shoulder. A superior subacromial approach for open reduction.
We describe 11 cases of posterior fracture-dislocation of the shoulder that required open reduction and fixation. Difficulties with access through anterior approaches led us to use the superior subacromial approach. ⋯ The proximity of the axillary nerve limits the exposure of the proximal humeral shaft. The superior subacromial approach is ideal for posterior dislocation with fracture of the articular segment, but is not suitable when there is a fracture of the proximal humeral shaft.
-
J Bone Joint Surg Br · May 1992
Comparative StudyMRI and discography of annular tears and intervertebral disc degeneration. A prospective clinical comparison.
We attempted to correlate the findings of MRI and discography in patients with low back pain, examining 108 lumbar intervertebral discs in 33 consecutive patients. MRI results were assessed from the intensity and shape of the signal obtained from the central part of the disc. Discography was classified according to the pattern of contrast material, the pressure accepted and the pain reproduced. ⋯ Of 39 asymptomatic discs, 33 had normal MRI signals and 24 had normal discograms. None of the 15 discs showing severe degeneration on MRI sustained high levels of intradiscal pressure, but only six of the 60 discs giving normal MRI had low pressure. With current techniques, discography is more accurate than MRI for the detection of annular pathology: a normal MRI does not exclude significant changes in the peripheral structure of the intervertebral disc which can produce low back pain.
-
J Bone Joint Surg Br · Mar 1992
Comparative StudyOveruse injuries of the olecranon in young gymnasts.
We report overuse injuries in 14 elbows of ten élite young gymnasts. In 12 elbows of eight patients aged 11 to 15 years there was a spectrum of radiological abnormalities including widening of the olecranon physis and fragmentation of the epiphysis. ⋯ Two older boys, aged 18 and 19, had stress fractures through the olecranon growth plate. Conservative management was successful in all except one case of stress fracture which required internal fixation.
-
J Bone Joint Surg Br · Mar 1992
Case ReportsCompartment pressures after closed tibial shaft fracture. Their relation to functional outcome.
We measured pressures in the anterior and deep posterior compartments continuously for up to 72 hours in 20 patients with closed fractures of the tibial shaft treated primarily in plaster casts. All were examined independently after periods of three to 14 months. Pressures above 40 mmHg occurred in seven (35%) and above 30 mmHg in 14 (70%). ⋯ Abnormalities at review did not correlate with the maximum consecutive time periods during which the compartment pressures were raised. Thus, in the absence of symptoms the monitored pressures did not relate to outcome. Routine monitoring in this type of patient is therefore of doubtful benefit.