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1. Fifty-five giant-cell tumours of bone are described in fifty-two patients of whom thirty-five were women. The highest incidence was in the third and fourth decades.
2. The tumours were characteristic radiologically: they all occurred in skeletally mature patients, and chiefly in the expanded extremities of long bones.
3. Histological grading was not done, the tumours being designated typical or malignant.
4. Curettage and graft, resection, radiotherapy and amputation were the basic forms of treatment. Amputation has an occasional place in primary treatment and radiotherapy should be confined to tumours in surgically inaccessible sites.
5. Resection is the method of choice for tumours in suitable sites, such as the upper end of the fibula ; careful curettage and grafting should be used to preserve the function of a large joint.
6. Recurrences within two years should be treated by limited resection without preliminary biopsy. Late recurrences must have a biopsy taken to establish the diagnosis before planning treatment.
1. A study of serial radiographs of 138 children with infantile scoliosis starting under the age of two years has resulted in a method of early differentiation between resolving and progressive curves.
2. The method involves careful measurement of the rib-vertebra angles at the apex of the curve and observation of the relationship of the head of the rib to the body of the vertebra as seen in antero-posterior radiographs.
3. The influence of the infantile growth spurt upon progressive curves is examined and the importance of early diagnosis and treatment is stressed.
1. Hemiarthroplasty is a method of dealing with painful deformities of advanced osteoarthritis and rheumatoid arthritis of the knee.
2. The indications and contra-indications for this procedure are discussed. Careful selection of patients is essential.
3. The technique of operation and management after operation are described.
4. The results of such a procedure, as done by one surgeon, are given. Good results have been obtained in 80 per cent of the osteoarthritic knees and in 69 per cent of the rheumatoid knees.
5. The complications, place of associated operations and value of revision procedures are discussed.
1. Thirty-nine patients with rheumatoid arthritis who had had a MacIntosh tibial plateau hemiarthroplasty are reviewed.
2. From the clinical findings it is possible to suggest a basis for the selection of suitable patients for the procedure.
3. Eighty-five per cent of the patients obtained relief of pain with good function of the knee.
4. The complications were infection and instability of the prosthesis.
1. Opinion is divided as to the value of synovectomy of the knee in juvenile rheumatoid arthritis.
2. Between 1964 and 1970 thirty synovectomies of the knee were performed in twenty-seven children, who have now been kept under review for one to eight years. Three have required a second operation.
3. The operative findings at various stages are presented and discussed, with special reference to the effect on growth of the limb.
4. Synovectomy is a useful procedure which should be reserved for cases where effusion persists despite nine months of conservative treatment and performed before signs of bone erosion appear.
1. Correction of equinus deformity in cerebral palsy either by elongation of the tendo calcaneus or by gastrocnemius recession gives satisfactory results without splintage or bracing after operation.
2. Gastrocnemius recession is the operation of choice in paraplegic spastic cerebral palsy, and wherever possible in tetraplegic cerebral palsy. In hemiplegia the whole of the triceps surae is usually involved, and elongation of the tendo calcaneus is almost always needed.
3. Correction at operation should aim to result in a mild degree of equinus deformity at the end of the growth period in hemiplegic spastic cerebral palsy. Over-enthusiastic gastrocnemius recession can lead to excessive weakness of the calf in some patients.
1. Skeletal and other clinical features in twenty-three patients with homocystinuria have been compared with those in sixteen patients with Marfan's syndrome.
2. The two diseases are clinically similar but florid arachnodactyly and scoliosis are commoner in Marfan's syndrome, whereas widening of epiphyses and metaphyses of long bones is a distinctive feature of homocystinuria.
3. Patients with homocystinuria frequently have osteoporosis at a young age with a high incidence of vertebral involvement including biconcavity and flattening. Patients with Marfan's syndrome do not have osteoporosis and may have excessively tall vertebrae.
4. Mental retardation and thrombosis are common in homocystinuria and uncommon in Marfan's syndrome.
5. Homocystinuria is most probably inherited as an autosomal recessive and Marfan's syndrome as an autosomal dominant.
6. The two diseases should be differentiated because of the thrombotic risk in homocystinuria, and also because in this disease there is a possibility of treating the biochemical defect.
7. Although patients with homocystinuria may present to the orthopaedic surgeon with osteoporosis, severe genu valgum or scoliosis, the disease is an uncommon cause of these defects.
1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically.
2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin.
3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset.
4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series.
5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary.
6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series).
7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis.
8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.
1. A critical analysis of the findings in 200 knees examined by arthroscopy at least one year previously has been carried out to assess its value in the management of a wide variety of disorders.
2. Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complications.
3. The increased accuracy of diagnosis helps to avoid unnecessary operations and to base methods of treatment on a better knowledge of the pathology.
1. Three new cases of injury to main arteries at orthopaedic operations are described, and a follow-up of two previously described cases is given. The rarity of these accidents is a credit to those engaged in orthopaedic surgery, for many orthopaedic operations are done very close to great vessels, and often under the bloodless conditions of a tourniquet. Nevertheless, it is well to have the risk of great vessel injury in mind because such an accident, although rare, may be a serious threat to life or limb.
2. It is important to repair the damaged artery rather than ligate it because the risk to the growth or viability of the limb is lessened.
3. The aim should be a return to full function with as near normal a vascular anatomy as possible.
1. Kyphosis and kyphoscoliosis associated with myelomeningocele are discussed.
2. It is suggested that the condition be treated by osteotomy of the spine, with removal of one or more vertebral bodies.
3. Sixteen patients treated by this method of spinal osteotomy are presented.
4. Although almost a third of the patients died, a high operative and post-operative mortality in this condition is considered acceptable.
1. Two cases of pseudomalignant osseous tumour of soft tissue are reported and added to the nineteen cases in the literature.
2. The clinical and histological features are described and distinguished from myositis ossificans, osteogenic sarcoma in soft tissue and parosteal fasciitis.
3. In one case the non-malignant nature of the lesion has been confirmed by its spontaneous regression.
Two cases are reported in which
1. Two cases of congenital diastasis of the inferior tibio-fibular mortise are described.
2. No previous description of this condition has been found in the literature.
3. it is suggested that the cause is osteochondrosis of the distal tibial epiphysis associated with a club foot.
1. Experimental arthritis was induced in rats by the intradermal injection of modified Freund's adjuvant.
2. The granulation tissue occurring in and around the joints was examined with the electron microscope.
3. Intracellular collagen was demonstrated in many of the cells.
4. Collagen formation by these cells was studied by autoradiographic techniques using tritiated proline as a label.
5. The proline turnover was rapid, as most of the labelled proline had become extracellular one hour after its injection.
6. It was concluded that the collagen was present within the cells as a result of phagocytosis despite the fact that the cells had the electron microscopic features of fibroblasts.
Subtotal synovectomy was performed in the knee joints of New Zealand white rabbits. The changes noted in the articular cartilage as manifest by decreased metachromatic staining of the matrix were considered to indicate matrix degradation caused by the altered joint environment. The documentation of the enzyme changes suggests that the histological alteration in the articular cartilage noted after synovectomy may be mediated through the activation of endogenous chondrocyte lysozomal enzymes, particularly cathepsin and acid hydrolases.
