Bilateral locked facets in the thoracic spine

Two cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine. the diagnosis should be considered in any patient with a fracture-dislocation of the thoracic spine. In these cases additional lateral tomographs are required. Early open reduction of bilateral locked facets and internal fixation are mandatory

Failure of tibial bone grafting for femoral head necrosis

We treated 20 hips with femoral head necrosis in 16 patients using the Phemister tibial bone grafting procedure. After a mean follow-up of 3 years, the Harris hip score had improved in 15 out of 18 hips, however without radiographic improvement. In 2 hips, an arthrodesis and an arthroplasty were per-formed. We concluded that the aim of our treatment was not achieved

Rotational deformities after femoral shaft fractures in childhood: A retrospective study 27-32 years after the accident

Fifty femoral shaft fractures sustained in childhood and for the most part treated conservatively were studied in retrospect 27-32 years after the accident, with special reference to rotational deformity. Femoral rotation was measured by means of so-called anteversion X-rays according to Dunn-Rippstein, and the same radiological examination was carried out in a control group of 100 adult volunteers. the L/R differences in femoral rotation were studied in the patient group in comparison with the control group. Persistent rotational dislocation was found in only one case, and had had no demonstrable untoward consequences. the established view that rotational dislocation is incapable of spontaneous correction is refuted with the aid of clinical and experimental data from the literature and personal observations. It is concluded that, in the patients studied, good results have been obtained by the conventional traction methods of Bryant and Russel. the use of the so-called Weber Bock to replace these methods is therefore not recommended

Weight bearing after arthrodesis of the first metatarsophalangeal joint: A randomized study of 61 cases

We performed a prospective randomized study of 61 cases of arthrodesis of the first metatarsophalangeal joint in 56 patients. In the first group, full weight bearing was allowed after 2-4 days and in the second group at 4 weeks. Radiographic union of the arthrodesis in the two groups did not differ

Chronic instability of the foot and foot geometry: A radiographic study

Multiple factors are involved in chronic lateral instability of the ankle. The geometry of the foot may be of importance. A cavovarus foot may predispose to lateral ligament injuries. In the present study, standardized lateral X-rays were obtained of the feet of patients with chronic instability and of a control group. Four parameters were used: (1) the tarsal index as described by Benink; (2) the talocalcaneal angle; (3) the talometatarsal angle; and (4) the calcaneal angle. No relationship between lateral instability of the foot and foot geometry was found. The talocalcaneal angle as defined in this study was found to be a less appropriate parameter in measuring the longitudinal foot arch

Two year cumulative incidence of trunk abnormalities in a schoolpopulation in Rotterdam, the Netherlands

We conducted a study of the 2 year cumulative incidence of trunk abnormalities in a cohort of 3,071 11 year old children (1,621 boys, 1,450 girls). The following data were recorded: height, weight, signs of puberty and menarche. Trunk abnormality was assessed in the erect child (asymmetry of shoulders and waistline, imbalance of the trunk, scoliosis, lordosis, kyphosis, swayback and flexibility) and by the forward bending test (FBT) (rib hump or lumbar prominence, persisting scoliosis, kyphosis and deviant lateral aspect). A normal FBT both at baseline and at follow-up was found in 84% of the boys and in 79% of the girls. The 2 year cumulative incidence of an abnormal FBT was 10% in boys and 13% in girls

The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip

In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken

Incidence of osteonecrosis after renal transplantation

The incidence of osteonecrosis was 24% in 248 patients who had received 262 kidney transplants 1971-1982. However, based only on patients at risk, i.e. alive with functioning transplants, the incidence at 1, 3 and 6 years was found to be 13, 27 and 36%; after six years no new cases were found. the relative increase in body-weight at 180 days was predictive as regards risk for osteonecrosis, while the cumulative dose of steroids was not. This suggests that individual sensitivity to steroids rather than the absolute cumulative dose is involved in the development of osteonecrosis

Oxidative phosphorylation in human muscle in patients with ocular myopathy and after general anaesthesia

Abstract The fuel preference of human muscle mitochondria has been given. Substrates which are oxidized with low velocity cannot be used to detect defects in oxidative phosphorylation. After general anaesthesia, the oxygen uptake with the different substrates is much lower than after local analgesia. The latter was therefore used in the subsequent study. In 15 out of 18 patients with ocular myopathy, defects in oxidative phosporylation could be detected in isolated muscle mitochondria prepared from freshly biopsied tissue. Measurement of the activity of segments of the respiratory chain in homogenate from frozen muscle showed no, or minor defects. In two of these patients showing exercise intolerance, decreased oxidation of NAD+-linked substrates and apparently normal mitochondrial DNA, further study revealed deficiency of pyruvate dehydrogenase in a girl with ptosis and a high Km of complex I for NADH in a man. Both patients responded to vitamin therapy