J Bone Joint Surg Br
-
J Bone Joint Surg Br · Jul 1998
Assessment of the AO classification of intracapsular fractures of the proximal femur.
There are a number of classification systems for intracapsular fractures of the proximal femur, but none has been shown to be practical with satisfactory reproducibility and accurate predictive value. We have investigated the AO classification and evaluated intra- and interobserver accuracy and its value in predicting treatment and outcome. ⋯ A simplified system in which the subdivisions were allocated to one of three groups of undisplaced, displaced and basal fractures was found to be of value. We conclude that this is the only division which is appropriate for these fractures and that the AO system for intracapsular fractures is too complicated and should not be used.
-
J Bone Joint Surg Br · Jul 1998
Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain.
It has been thought that lumbar intervertebral discs were innervated segmentally. We have previously shown that the L5-L6 intervertebral disc in the rat is innervated bilaterally from the L1 and L2 dorsal root ganglia through the paravertebral sympathetic trunks, but the pathways between the disc and the paravertebral sympathetic trunks were unknown. We have now studied the spines of 17 rats to elucidate the exact pathways. ⋯ In the rat, sensory information from the lumbar intervertebral discs is conducted through rami communicantes. If this innervation pattern applies to man, simple decompression of the corresponding nerve root will not relieve discogenic pain. Anterior interbody fusion, with the denervation of rami communicantes, may be effective for such low back pain.
-
J Bone Joint Surg Br · May 1998
Randomized Controlled Trial Comparative Study Clinical TrialReamed versus unreamed femoral nails. A randomised, prospective trial.
We performed a randomised, prospective trial to evaluate the use of unreamed titanium nails for femoral fractures. Of 48 patients with 50 femoral fractures 45 were followed to union; 23 with an unreamed and 22 with a reamed nail. The study was stopped early because of a high rate of implant failure. ⋯ Six implants (13%) failed, three in each group. Four of these six fractures showed evidence of delayed union. To achieve quicker union and fewer implant failures we recommend the use of reamed nails of at least 12 mm in diameter for female patients and 13 mm in males.
-
J Bone Joint Surg Br · May 1998
Comparative StudyEvaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas.
We performed a retrospective analysis to evaluate the ability of whole-body F-fluorodeoxyglucose positron emission tomography (FDG PET) to identify local recurrence and pulmonary metastases in patients with soft-tissue tumours after treatment. We compared the results of FDG PET with those of MRI for the detection of local recurrence, and with CT of the chest for pulmonary metastases. We assessed 62 patients of mean age 51 years, who had 15 types of soft-tissue sarcoma, after a mean follow-up of 3 years 2 months. ⋯ Thirteen other sites of metastases were identified by FDG PET. FDG PET can identify both local and distant recurrence of tumour as a one-step procedure and will detect other metastases. It seems that all three methods of imaging are needed to define accurately the extent of disease, both at initial staging and during follow-up.
-
J Bone Joint Surg Br · May 1998
Case ReportsReconstruction of the coronoid for chronic dislocation of the elbow. Use of a graft from the olecranon in two cases.
Persistent dislocation of the elbow after a fracture of the coronoid process is a difficult problem. We have performed an open reduction with reconstruction of the coronoid by an osteocartilaginous graft from the ipsilateral olecranon for two patients. ⋯ The joint surface of the graft has a similar curve to that of the coronoid giving good congruency and stability. The technique is simple and the graft is obtained through the same incision.