Primary obturator pyomyositis: a diagnostic challenge.

Pyomyositis of the obturator muscles is a rare condition, characterised by pain in the hip and features of systemic infection. It may follow minor trauma to the hip, sometimes in the presence of an apparently innocuous infective source. All previously reported cases have been diagnosed conclusively on the initial CT or MR scan. We present a case of obturator pyomyositis in a 21-year-old football player in which the first MR scan was misleading. A radiolabelled, white blood cell scan was also negative and the resultant delay in diagnosis proved dangerous. The crucial importance of careful and repeated clinical examination is emphasised.

Early femoral loosening in one design of cemented hip replacement.

We have studied aseptic loosening of the femoral component in 76 patients with primary total hip replacement using the Capital prosthesis. The mean follow-up was 26 months (10 to 37). Twelve femoral components (16%) were definitely and eight (10%) were possibly loose. They were characterised by a thin cement mantle (p < 0.001) and excessive residual cancellous bone in the proximomedial region (p < 0.01). We recommend that the cement mantle around the prosthesis should be 2 to 3 mm and that further long-term studies are needed to evaluate the wear properties of titanium-nitride-coated titanium femoral heads.

Excision or Silastic replacement for comminuted radial head fractures. A long-term follow-up.

This report comprises a follow-up of 39 patients after simple excision and 16 patients after Silastic replacement of the radial head for displaced comminuted fractures. Prostheses were used when similar fractures were associated with an unstable elbow. The excision group was followed up for 6.1 years on average, and the replacement group for 5.7 years. The objective result after simple excision was good in 55% of cases, fair in 26% and poor in 19%. The results in the replacement group were only 13% good, 38% fair, 37% poor and in 12% the prostheses had to be removed.

Fractures of the adult distal humerus. Elbow function after internal fixation.

We reviewed 57 adult patients at an average of 37 months after early internal fixation for displaced fractures of the distal humerus. Two-thirds had intercondylar (Müller type C) fractures, and one-third had articular comminution (type C3). A chevron olecranon osteotomy was used, with early active movement after fixation. Results were good or excellent in 76% with an average range of movement of 115 degrees. Early stable fixation by an experienced surgeon is recommended for these fractures.

Fracture dislocation of the trapezio-scaphoid joint--the missing link?

Fracture-dislocation of the trapezio-scaphoid joint is an extremely rare injury. We report a case treated using Herbert's compression screw technique.

Fractures of the radial head--the benefit of aspiration: a prospective controlled trial.

The clinical progress of 80 adults with fractures of the radial head was followed prospectively. Early active movement of the elbow and forearm was encouraged in all patients. Better functional results were achieved by the study group than by retrospective controls in whom active movement was delayed. Aspiration of the elbow and instillation of local anaesthetic were carried out in a randomly selected half of the patients. This afforded relief of pain in 92 per cent and made early movement more comfortable. The fracture was more common in women. Functional recovery was best in younger patients and was closely related to the severity of the fracture.

Nerve tumours in the upper limb. A clinical review.

Tumours arising from the peripheral nerves in the upper limb are rare. This paper reviews eighteen such cases and the clinical outcome. Problems of pre-operative diagnosis are emphasized.

Methods of fixation of olecranon fractures. An experimental mechanical study.

This study was designed to compare the rigidity of the more commonly used techniques of internal fixation of fractures of the olecranon. Cadaveric elbow joints were mounted in a jig and controlled osteotomies performed to simulate transverse, oblique or comminuted fractures. Five techniques of internal fixation were tested by measuring movement at the fracture site after applying a bending moment to the ulna. At transverse osteotomies tension-band wiring with two tightening knots allowed least movement even at high loads. Intramedullary cancellous screw fixation gave erratic results; adding a tension band with a single know was little better. In oblique osteotomies, no statistically significant difference was shown between one-third tubular plate fixation and double-knot wiring. Comminuted osteotomies were held most rigidly by contoured one-third tubular plate fixation.

Elbow function following tension band fixation of displaced fractures of the olecranon.

Fifty-two patients were reviewed following displaced fractures of the olecranon fixed by the tension band technique. Symptoms, range of movement and strength in flexion and extension were assessed, together with the accuracy of reduction. Eighty-five per cent of patients regained very good function. The results confirm that tension band fixation can yield excellent functional results whatever the degree and severity of fracture of the olecranon. The wires must be totally buried to allow full excursion of the triceps tendon.