Total hip arthroplasty with the Charnley prosthesis in patients fifty-five years old and less. Fifteen to twenty-one-year results.

Data on 240 primary Charnley total hip arthroplasties, performed in 211 patients from October 1968 to July 1974, were recorded prospectively. Fifty-two prostheses were implanted in forty-six patients who were thirty-four to fifty-five years old, and 188 prostheses were implanted in 165 patients who were more than fifty-five years old. The results for the younger patients were compared with those for the older patients. Twenty hips were revised over-all, and all five of the infections and four of the five fractures of the femoral stem that occurred in this group were in the older patients. However, the rate of aseptic loosening was similar for the two age-groups (three of the hips in the younger patients and five in the older patients). The probability of revision after twenty years for the two groups, as determined with Kaplan-Meier analysis, was 11.7 per cent for the younger patients and 10.7 per cent for the older patients. There was no significant difference between the two groups with regard to either the number of revisions or the percentage of patients who had radiographic signs of loosening. The median Charnley hip scores during the course of the study were also similar for the two groups. We recommend that Charnley low-friction arthroplasty be used even in younger patients, as the long-term results were excellent and were comparable with those in the elderly age-group.

Long-term results of Charnley total hip replacement. Review of 92 patients at 15 to 20 years.

We made a prospective study of 241 Charnley total hip replacements performed between 1968 and 1974. In 1990, we reviewed 92 patients with 103 hips (96.3% of surviving hips) at a mean follow-up of 17.6 years (15 to 20.6) The clinical results were excellent, with Charnley scores of 4 or more for pain in 95% of the patients, for function in 73% and for movement in 93%. Of the whole series, 8.3% had been revised, and Kaplan-Meier survival analysis showed a probability of revision at 20 years of 10.7%. These results are similar to those from the few other series with extended follow-up, and make it difficult to justify the present widespread use of uncemented hip prostheses. It would seem that some aspects of the design of the first-generation Charnley stem were beneficial for long-term survival of the arthroplasty. We found no correlation between the clinical results and radiological loosening on the Harris scale.

Polyurethane film (Opsite) vs. impregnated gauze (Jelonet) in the treatment of outpatient burns: a prospective, randomized study.

As it has been shown that re-epithelialization of partial skin thickness wounds can be accelerated if the wound is kept moist, a prospective, randomized clinical study compared the water vapour-semipermeable polyurethane film, Opsite, with the conventional impregnated gauze dressing, Jelonet, in the treatment of outpatient partial skin thickness burns. Fifty-five patients were included: 30 were treated with the polyurethane film and 25 with the conventional dressing. The patients were followed at regular intervals until healing had occurred and were seen 3 months later for evaluation of residual scars and pigmentation. The burns treated with polyurethane films healed with a median of 10 days, while the conventionally treated burns healed with a median of 7 days (P greater than 0.05). Residual scars were noted in 21 per cent of the patients treated with polyurethane films and in 8 per cent treated conventionally (P greater than 0.05). Prophylactic methods should be publicly stressed since one-quarter of the patients were children of 3 years or less who were scalded by split hot liquids. Furthermore the patients' wounds were only briefly cooled before attending medical care. With small burns we advise that cooling should be prolonged until the pain fades then professional assistance should be sought.

[Riding injuries]. / Rideulykker.

The aim of this study was to investigate accidents which occur in connection with horse-riding. The material was found in a data base covering 14% of all case registered in Casualty Departments in Denmark. The number of horse-riding accidents has increased by 150% from 1986 to 1996. The majority of these were girls. The age group 10-19 years accounted for 61% of the accidents. The majority of injuries occurred on falling from the horse and particularly involved the upper part of the body. Out of 1250 injuries, 24% sustained a fracture: 64% were located to the upper extremities, and 19% lower extremities. One hundred patients required hospitalization: 29 for observation for concussion; 51 for reduction of fractures and osteosynthesis; 13 for contusion. Forty-five percent of the accidents happened in a riding arena and 25% in a stable. It is concluded that the proportion of horse-riding accidents is strongly on the increase in Ribe County.

[Long-term results after Charnley hip replacement]. / Langtidsresultater efter total hoftealloplastik ad modum Charnley.

We made a prospective study of 241 Charnley total hip replacements performed between 1968 and 1974. In 1990 we reviewed 92 patients with 103 hips or 96% of surviving hips at a mean follow-up of 17.6 years (15 to 20.6). The clinical results were excellent with Charnley scores of four or more for pain in 95% of the cases, for function in 73% and for movement in 93%. Of the whole series, 8.3% had been revised and Kaplan Meier survival analysis showed a probability of revision at 20 years of 10.7%. No significant difference concerning the results was found between young patients operated between the ages of 34 to 55, and older patients operated between the ages of 56 to 79 years. These results are similar to those from the few other series with extended follow-up and make it difficult to justify the present widespread use of uncemented hip prostheses.

[Discoid lateral meniscus. The importance of MRI scanning for the diagnosis]. / Diskoid lateral menisk. MR-scannings betydning for diagnostik.

This article reports a case of a complete discoid lateral meniscus with an anteriomedial cleavage tear in a 4-year-old boy diagnosed by MRI. The patient underwent arthroscopy with findings of a torn complete discoid lateral meniscus. As the peripheral rim of the meniscus was stable, a partial meniscectomy with reshaping was done. At follow-up two years postoperatively, the patient had recovered uneventfully.

[Magnetic resonance imaging in musculoskeletal tuberculosis]. / Magnetisk resonans-scanning ved muskuloskeletal tuberkulose.

The incidence of tuberculosis in Denmark has increased over the last years. Two cases of primary osteoarticular tuberculosis are described: tuberculous ostitis of the scapula and surrounding soft tissue, and tuberculosis of the elbow. We have emphasized the appearance on magnetic resonance imaging (MRI), as the role of this modality has only been sporadically described for osteoarticular tuberculosis in areas other than the vertebral column. The cases show that MRI can contribute to a more precise determination of the extent of osteoarticular tuberculosis and its soft tissue involvement.

[Surgical treatment of forearm fractures]. / Operativ behandling af antebrachiumfrakturer.

A retrospective investigation was undertaken on 62 patients with 103 fractures. Of these, 61 fractures were treated with Rush pin, ten with plate osteosynthesis and three with cerclage. Fifty-three patients were followed up. This revealed that 50% of the patients achieved excellent or satisfactory results. 39% did not have satisfactory results while six patients (9.7%) developed pseudoarthrosis and thus unacceptable results. The healing percentage was 92.3 and the infection rate 3.1. These results are considerably better than previously reported series of forearm fractures treated with medullary osteosynthesis and they are comparable with the results of plate osteosynthesis. Rush pin osteosynthesis appears to be as good as plate osteosynthesis but this should be illustrated by means of a controlled investigation.

[Subscapular elastofibroma]. / Subskapulaert elastofibrom.

Elastofibroma dorsi (EF) is a rare and benign connective-tissue tumour, typically localized between the lower part of the scapula and the chest wall. Two case stories of EF are presented. The etiology, symptoms, diagnostics and treatment are discussed.

Isolated dislocation of the tarsal navicular.

An unusual case of isolated dorsal dislocation of the tarsal navicular bone due to hyperextension of the foot is presented. The treatment was closed reduction with percutaneous fixation with a Kirschner wire and immobilization for 8 weeks. The end result was satisfactory. To prevent redislocation leading to arthritis, the Kirschner wire should be left in place for at least 6 months.

Complicated fractures of the neck of the talus.

Seven patients with a complicated fracture of the neck of the talus were followed up by a clinical and radiographic investigation. One had an excellent result and four had good results. Four developed avascular necrosis of the body of the talus and the treatment of this serious complication is discussed.

Haematogenous osteomyelitis of the first metatarsal sesamoid. A case report and review of the literature.

A rare case of haematogenous osteomyelitis of the sesamoid of the first metatarsophalangeal-joint visualized by a CT-scan have been presented. The characteristics of this disease have been stressed. When the diagnosis had been considered treatment should be surgical drainage with debridement of all infected tissues. Previous authors recommend antibiotic treatment, but it was not given to this patient. There was total cure after three months.

[Evacuation of patients from the North Sea]. / Patientevakuering fra Nordsøen.

In 1986 and 1987 the department of orthopaedic surgery at the Central Hospital of Esbjerg dealt with 135 medical problems by radio-telephone contacts to persons at sea. Of these, 28% needed a chartered helicopter. This eguals one third of all chartered helicopter evacuations from Danish waters. 77% of the evacuations were from fishing boats and the rest from offshore structures or other kinds of ships. The mechanism of trauma and the diagnosis agreed with the findings in an earlier Danish publication.

Subtalar dislocations: a review of the literature.

Subtalar dislocations are rare and represent approximately 1% to 2% of all dislocations. This article reviews the literature concerning treatment, complications and late complications with prognosis. Lateral dislocations often lead to poor results due to the frequency of open injuries and associated fractures. This may result in arthritis requiring subtalar arthrodesis.