Stress fractures of the pars interarticularis of the lumbar spine in professional fast bowlers have become commonplace in modern times with a recently reported prevalence of 16.1%. We report 25 years of experience in the management of this patient group. Between 1982 and 2007, we diagnosed pars defects in 21 professional cricketers. 8 were managed conservatively by a combination of rest, supervised rehabilitation, bowling action analysis and re-training to a ‘safe’ action. Surgery was considered in those players who did not respond to these conservative measures and this group essentially compromised of the fast bowlers. Surgery was by Buck’s direct repair of the pars lesion. This treatment regime has given very good results enabling all of these players to return to professional sport with an average follow-up of over 5 years. Two of the surgical group have over 10 years follow-up and 4 have played to international level subsequent to their surgery. We recommend treatment of this group of sportsmen in a unit consisting of a specialist physiotherapist, a bowling coach and a spinal surgeon. Should conservative measures fail, we recommend Buck’s repair as the operation of choice.
We present the results of 228 consecutive Charnley low friction arthroplasties, inserted in 193 patients between July 1972 and December 1976. All hips were inserted by the posterior approach without trochanteric osteotomy. All patients were enrolled into a prospective study and pre-and post-operative findings recorded. This series was reviewed in 1985 and once again in 2002. The pre-and peri-operative findings are similar to contemporary series. Due to our stable population only two patients were lost to follow-up. Our survivorship results show a 10-year survival of 93%, 20-year survivorship of 84% deteriorating to a 30-year survival of 73%. Of the 26 hips revised 6 were for recurrent dislocations and these were satisfactorily stabilised using acetabular augments. There were 8 revisions for fracture of the femoral component (all flatbacks), 8 revisions for aseptic loosening of the femoral component and 6 revisions for aseptic loosening of the acetabulum. There was one revision for deep infection and the remaining 3 were for periprosthetic fractures. The survivors were scored clinically using the Merle d’Aubign-Postel score with a mean value of 12. None of the survivors were on the waiting list for revision arthroplasty or felt that it was indicated. Overall our results are comparable to other studies and vindicate the choice of approach, which at the time was a source of some controversy
The physical demand of the modern game of cricket on the fast bowler is known to cause stress fractures of the lumbar spine. Between 1983 and 2001, we diagnosed pars interarticularis defects in 18 professional cricketers contracted to a single English county cricket club. Initial management was conservative based on a combination of rest, supervised rehabilitation, bowling action analysis and re-education if indicated. Re-deployment (for example an all rounder to concentrate on batting alone) was also considered. 8 of the patient group responded to these measures. The remaining 10 were treated surgically, 9 by Buck’s repair of the spondylolytic lesion. All 9 returned to professional sport with an average follow-up of 5 years 8 months and a maximum follow-up of 10 years. We recommend treatment of this group of sportsmen in a unit consisting of a specialist physiotherapist, a bowling coach and a spinal surgeon. Should conservative measures fail, we recommend Buck’s repair as the operation of choice. Whether treated conservatively or surgically, we believe the vast majority of this patient group should be able to return to full professional sport
A prospective, randomised and independently assessed trial of the Ring UPM total hip replacement showed that the quality of the early result was better if the femoral prosthesis was cemented than if it was not. More patients with cemented prostheses were painfree at four months (58% cemented:42% uncemented) and at one year (63% cemented:50% uncemented), but at two years pain relief was equal in both groups. At two years significantly more patients with cemented prostheses could walk without support (96% cemented:62% uncemented, p = 0.01 to 0.05). There is a need for more similar trials to compare the results of contemporary designs of cemented and uncemented total hip prostheses.
We report the clinical and operative details of seven cases of fracture of the femoral stem of the Ring TiMESH cementless hip prosthesis (two were cemented and five uncemented). Six fractures occurred in the proximal one-third of the stem and one at mid-stem. The failures are attributed mainly to two defects in stem design, the narrowness of the anteroposterior dimensions and the depth of the recess for the titanium mesh pads. Great difficulty was experienced in removing the osseo-integrated distal fragments of the broken stems.
In a five-year period, 153 feet in 101 patients were treated by a Wilson's osteotomy of the first metatarsal for hallux valgus. Postoperative support was provided by either a below-knee or a forefoot plaster, and was continued for either three weeks or six weeks. The results showed overall success in 91% with no significant difference between the four groups. We suggest that a forefoot plaster for three weeks is adequate support after a Wilson's osteotomy.
