Unreamed intramedullary tibial nailing - Fatigue of locking bolts

Between January 1990 and October 1993 toe investigated 72 consecutive patients who had an unreamed tibial nail inserted for fractures of the tibial shaft; 75 per cent (N = 54) were closed fractures and 25 per cent (N = 18) were open fractures. The mean follow up was 15.2 months. Of the patients 91.7 per cent (N = 66) were interlocked, 58 per cent (N = 38) statically and 42 per cent (N = 28) dynamically. Union rate was 98.6 per cent, time to union was 18.5 weeks, 17.3 weeks for closed fractures, 22 weeks for open fractures. Shortening greater than 1 cm occurred in 1.4 per cent (N = 1), varus and valgus deformity in 4.1 per cent each (N = 3). There was no rotational deformity. Of the locking bolts 30 per cent broke 8-10 weeks after partial weight bearing was allowed. Electron microscopy investigations showed that failure of the bolts was due to fatigue. It was not associated with any clinical problems with regard to union times or incidence of malunion. Bolt failure is however a problem if you try to remove the nail. (C) 1996 Elsevier Science Lt

The Birmingham hip resurfacing procedure - A rare complication

A case is described of the rare complication of anterior ischemic optic neuropathy following a Birmingham hip resurfacing procedure. Because there is no proven effective treatment, prevention is the key to managing this condition

The medium-term results of a cemented Freeman femoral neck-retaining prosthesis

After cemented total hip arthroplasty (THA) there may be failure at either the cement-stem or the cement-bone interface. This results from the occurrence of abnormally high shear and compressive stresses within the cement and excessive relative micromovement. We therefore evaluated micromovement and stress at the cement-bone and cement-stem interfaces for a titanium and a chromium-cobalt stem. The behaviour of both implants was similar and no substantial differences were found in the size and distribution of micromovement on either interface with respect to the stiffness of the stem. Micromovement was minimal with a cement mantle 3 to 4 mm thick but then increased with greater thickness of the cement. Abnormally high micromovement occurred when the cement was thinner than 2 mm and the stem was made of titanium. The relative decrease in surface roughness augmented slipping but decreased debonding at the cement-bone interface. Shear stress at this site did not vary significantly for the different coefficients of cement-bone friction while compressive and hoop stresses within the cement increased slightly

Revision of distal femoral endoprosthetic arthroplasty with impacted morsellized allograft

The purpose of this study was to review the clinical results of irradiated fresh frozen osteochondral allografts for large osteochondral defects of the knee using the Mega-OATS technique

Paraplegia Following a Rivet Gun Injury - the Use of Magnetic-Resonance-Imaging in the Management

We describe the case of a 39-year-old man who was accidentally shot in the back by a rivet gun. This resulted in paraplegia and partial sensory loss. Magnetic resonance imaging (MRI) was helpful in the accurate localization of the foreign body and in the assessment of the spinal cord damage. MRI enabled accurate pre-operative localization of the rivet and provided information on the degree of damage to the spinal cord. The artefact produced on computed tomography plus the limited anatomical detail of the spinal cord in the absence of intrathecal contrast makes this technique unhelpful

Contamination of banked femoral head allograft: Incidence, bacteriology and donor follow up

Background: Allograft donations are not uncommonly found to be contaminated. The issue of contaminated donations from live donors at the time of surgery, and the significance of this to the patient in terms of subsequent sepsis of the arthroplasty, were examined