Primary pyogenic abscess of the psoas muscle.

Nine children who were less than nine years old and had a primary pyogenic abscess of the psoas muscle were treated in a five-year period. This rare lesion often simulated septic arthritis of the hip. Ultrasonography was found to be the most reliable and easily performed diagnostic study. Because of the rarity of the lesion, the diagnosis requires a high index of suspicion. The best treatment is early operative drainage and administration of systemic antibiotics.

Interplay of matrices in cartilage synovial fluid combine under moderate & high loadings.

Interplay of the constituents of the articular cartilage synovial fluid combine and its role was examined through the biochemical and rheological studies on bovine joints. The results showed an inverse relationship between the changes in the hyaluronic acid of synovial fluid and the proteoglycans content in articular cartilage together with alterations in the rheological properties of synovial fluid. The study indicated that the inter-movement of fluid solutes across the cartilage and synovial fluid may have an important role in the pathophysiology of osteoarthritis.

Aneurysmal bone cyst in the metacarpal of a child: a case report.

An unusual case of aneurysmal bone cyst in the metacarpal of a five-year-old girl is described. The lesion was initially diagnosed and treated as a simple bone cyst. Subsequently the affected metacarpal was excised and replaced by an autogenous fibular graft, with good results. A discussion of the pathogenesis of the lesion is given, with a review of the literature.

Comparative study of knee function after patellectomy and osteosynthesis with a tension band wire following patellar fractures.

In order to assess the relative merits of patellectomy and osteosynthesis with tension band wires in patellar fractures, 66 patients given patellectomy and 30 given tension band wiring for almost identical fractures of the patella have been analysed. Following patellectomy only about half the patients achieved excellent results while after osteosynthesis excellent results were in 80%. We, therefore, recommend that whenever possible patellar fractures should be treated by accurate reduction and tension band wiring. When needed patellectomy should be performed without hesitation as the operation produces a negligible number of poor results, although excellent results will be achieved in only about half the cases.

Microstructural organization of carbon induced neotendon.

Experiments have been conducted in guinea pigs to replace the calcaneal tendon with carbon fibers. The new tendon formed has been studied macroscopically, histologically and by scanning electron microscopy, and shows a close resemblance to the normal tendinous structure but is adherent to the surrounding tissues. It is suggested that the surface characteristics of carbon fibers play an important role in that these attract and allow fibrinous exudate to spread on their surface, into which fibroblasts grow. This, together with the large surface area available, is probably responsible for the orderly longitudinal arrangement of collagen fibers parallel to the carbon fiber implant.

Modified Phemister grafting in potentially infected non-union of tibial shaft fractures.

Modified Phemister bone grafting consisting of the raising of an osteoperiosteal flap, bone petalling and a cancellous onlay graft for non-union of tibial shaft fractures was tried in 43 cases. Thirty-eight out of 43 fractures united after one bone grafting procedure, giving a success rate of 88%. The procedure can even be used in the presence of low-grade, active infection. This method of bone grafting is simple and has no significant complications. Knee motion recovers well but ankle and toe stiffness do not improve appreciably from the preoperative status. We recommend that Phemister grafting be performed early.

Open reduction and internal fixation of displaced supracondylar fractures of the humerus.

The results of open reduction and internal fixation were analysed in 200 displaced supracondylar fractures of the humerus in children. Overall, excellent results were obtained in 65% of cases, good in 15% and unsatisfactory in 20%. Delay in surgery was found to lead to unsatisfactory results. The operation was performed within 48 hours of injury in 140 cases and gave an excellent result in 120 cases, whereas delayed surgery, in 60 cases, gave an excellent result in only 10 cases. Open reduction provides an accurate, stable reduction, is easy to perform and has been found to give consistently good results.

Value of osteomedullography in the early diagnosis of non-union in tibial diaphyseal fractures.

Osteomedullography was performed in 17 diaphyseal fractures of the tibia at ten to 12 weeks from injury to assess the reliability and sensitivity of the procedure in predicting non-union. It was found to be accurate in more than 80% of cases in predicting the ultimate outcome early in the course of fracture healing.

Temporomandibular joint ankylosis: an Indian experience.

Seventy-five condylectomy and coronoidectomy specimens of temporomandibular joint ankylosis in 61 patients were studied. Fourteen patients had bilateral ankylosis, six of whom had fibrous ankylosis on one side. There were two types of ankyloses: intra-articular and juxta-articular. Intra-articular ankylosis was seen only in reankylosis or in postinfective cases. Sixty-six cases were posttraumatic juxta-articular ankylosis. A rudimentary temporomandibular joint with an atrophic condylar articular surface was found in all juxta-articular ankyloses. The size of new bone in the specimens varied from 0.5 to 3 cm. Fusion of the extra-articular bone mass with tympanic plate was also observed. Contracture of temporalis muscle was noted in all the cases, which made excision of the coronoid processes mandatory in all the arthroplasties. Arthroplasty early in childhood did not hamper growth; instead, facial remodeling was enhanced.

Experimental scoliosis in monkeys.

Scoliosis was produced experimentally in monkeys, by excision of ribs and costo-transverse ligaments. Unilateral excision of these structures produced mild reversible scoliosis, while bilateral excision caused a severe structural curve. We feel that scoliosis so produced is due to instability of the spine which is more pronounced in bilateral operations.

High valgus tibial osteotomy for osteoarthritis of the knee.

We report a statistical analysis of the results of 65 tibial osteotomies for primary osteoarthritis of the knee followed up at 3 and 5 years. Preoperative walking ability and the severity of pain are the factors with which the long term prognosis can best be correlated. The preoperative range of motion and mild subluxation become important at 5 years, but these factors were not important at 3 years. Mild instability did not have any influence. The severity of the osteoarthritis in radiographs and the postoperative femoro-tibial angle did not have any important association with the result. The results are therefore best predicted by preoperative pain and activity. The degree of correction did not affect the result.