We studied 45 patients with 46 fractures of the scaphoid who presented sequentially over a period of 21 months. MRI enabled us to relate the pattern of the fracture to the blood supply of the scaphoid. Serial MRI studies of the four main patterns showed that each followed a constant sequence during healing and failure to progress normally predicted nonunion.
In 13 patients (18 fingers) we used two types of external fixator as progressive static splints for the preoperative correction of the deformities of severe Dupuytren’s disease before conventional fasciectomy. The duration of treatment was from one to four weeks. At a mean follow-up of 18 months the mean total fixed flexion deficit had been reduced from 138° to 39° and the mean proximal interphalangeal joint contracture from 80° to 29°. The mean total active range of movement had increased from 123° to 175°. These preliminary results are promising, but continued follow-up is needed since recurrence is common.
We have reviewed 15 patients with infected total knee replacements after removal of the prosthesis, rigorous debridement, antibiotic irrigation, and prolonged systemic antibiotics. Infection was permanently eradicated in all patients; they were left with a functioning limb, on which they could walk with either a caliper (8 patients), a simple splint (3), crutches, or sticks. Three were disappointed because of residual pain. We believe that, if exchange arthroplasty is inappropriate, this procedure is preferable to arthrodesis or amputation for persistent and disabling infection, particularly where constrained artificial joints have been used.
Eight women had 10 toes treated for hallux rigidus by dorsal wedge osteotomy of the proximal phalanx and were reviewed after an average follow-up of 22 years. Five toes were symptom-free, four others did not restrict walking, and only one had required metatarsophalangeal fusion. We conclude that dorsal wedge osteotomy affords long-lasting benefits for hallux rigidus in the adolescent female.
Four children are described, each with spontaneous osteonecrosis affecting nearly one-third of the lateral femoral condyle. All the children had a motor and a sensory deficit in the affected limb: two had been previously treated for neuroblastoma of the spine, one for an infected lumbar dermoid cyst and one had spina bifida. We consider that these disorders, singly or in combination, may lead to repeated excessive loading of the lateral femoral condyle, which cannot be appreciated in a knee that is not protected by normal sensation.
Intramedullary spinal cord tumours may present as scoliosis without neurological signs. Those treating spinal deformities should be alert to this possible aetiology. The clinical features of 12 such cases are discussed with reference to early diagnosis and treatment. Patients with a painful scoliosis should be investigated with myelography as well as bone scintigraphy. Many intrinsic spinal cord tumours are now amenable to surgical removal. The prognosis for neurological recovery is poor once a severe deficit becomes established. The importance of early diagnosis and joint orthopaedic and neurosurgical management is emphasised.
