A biomechanical investigation of the static stabilisers of the glenohumeral joint in the dog.

The aim was to determine the relative contribution of the glenohumeral ligaments/joint capsule complex and the limited joint volume/adhesion-cohesion (UV/AC) mechanisms to the static stability of the canine glenohumeral joint (GHJ). The GHJ of 32 complete cadaver specimens were manipulated to determine the presence of gross laxity (> 2mm translation) at joint angles of 150 degrees, 135 degrees and 90 degrees. Following the removal of the peri-articular muscles, laxity was measured by applying a 15N force to the scapula in a variety of directions whilst the humerus was fixed to a jig. This was repeated for the abovementioned angles in intact joints and after venting and flushing to eliminate the UV/AC mechanisms. Results of clinical palpation and biomechanical studies were compared. Manipulation revealed a marked variation between joints although there was a tendency for progressive laxity as the joint was flexed. This finding was supported by the biomechanical study that also demonstrated no significant difference between intact and vented joints except in a cranio-caudal direction at 135 degrees and 90 degrees, and in a medial/lateral direction at 135 degrees. Static stabilisers permitted a wide range of motion. Individual clinical palpations did not correlate well with biomechanical findings. Manipulation was difficult to perform and is unlikely to be a reliable method for determining subtle joint laxity. The static stabilisers do not appear to play a significant role in providing joint constraint during normal range of motion (except extension). Diagnoses of pathological laxity attributable to the static stabilisers should be made with caution and surgical treatments should take cognizance of the above-mentioned biomechanical features.

Proximal radial resection for posttraumatic radioulnar synostosis: a new technique to improve forearm rotation.

BACKGROUND: Heterotopic ossification about the elbow joint can lead to considerable functional disability, including the loss of forearm rotation. Many procedures have been described for the treatment of proximal radioulnar synostosis. Varying degrees of success have been achieved with regard to the improvement of the flexion arc, but less success has been reported in terms of the restoration of forearm rotation. The success of treatment is associated with the extent of heterotopic ossification, soft-tissue scarring, and anatomical distortion. A new and simple technique to address the unresectable proximal radioulnar synostosis is described. METHODS: Seven patients were managed with a partial proximal radial resection distal to the synostosis and were followed for an average of eighty months (range, twenty-four to 144 months). RESULTS: Forearm rotation improved from an average fixed pronation of 5 degrees to an average arc of 98 degrees (range, 40 degrees to 175 degrees ). The average functional score improved from 57 points preoperatively to 81 points at the time of the final review. Complications included reankylosis at the site of the resection and ulnar-nerve sensory neurapraxia in one patient each. CONCLUSIONS: Resection of a 1-cm-thick section of the proximal part of the radial shaft provides a safe and reliable method of improving forearm rotation in patients with heterotopic ossification of the elbow. A single technical factor that seems to positively influence the result is the application of bone wax at the resection site. This simple procedure is ideally suited for patients who have a proximal radioulnar synostosis that (1) is too extensive to allow a safe and discrete resection, (2) involves the articular surface, and (3) is associated with an anatomical deformity.

Operative treatment of elbow contracture in patients twenty-one years of age or younger.

BACKGROUND: Elbow contracture is a recognized sequela of traumatic and developmental elbow disorders, but little information is available regarding the surgical treatment of elbow stiffness in the pediatric population. METHODS: Thirty-seven patients who had had open surgical release of an elbow contracture at a mean age of sixteen years (range, ten to twenty years) were retrospectively studied after a mean duration of follow-up of fifteen months (range, six to forty-four months). The elbow contracture was posttraumatic in twenty-eight patients. The operation consisted of a capsular release with removal of osseous impediments to motion as necessary. No patient had muscle or tendon-lengthening. RESULTS: The total arc of motion improved from a mean of 66 preoperatively to a mean of 94 postoperatively; however, only twenty-eight patients (76%) had an improvement of 10 and only seventeen (46%) achieved a functional arc of motion of 100 (from 30 to 130 ). Two patients lost motion after surgery. These results are less favorable than the results of previous studies of both pediatric and adult patients. Patients in whom the contracture had been caused by a simple dislocation of the elbow or an extra-articular fracture tended to have better results than those in whom the contracture was due to other causes. CONCLUSIONS: The results of surgical treatment of elbow stiffness in pediatric patients are less favorable and less predictable than those in adult patients.

The rheumatoid wrist in black South African patients.

The wrist and hand X-rays of 75 black patients with rheumatoid arthritis were scored according to the Larsen criteria. The mean Larsen score for left hands was 9.6 (range 0-100) and for the right hands was 10:3 (range 0-100), whereas the score for the wrists were 2.5 (range 0-5) for the left and 2.7 (range 0-5) for the right. Our conclusion is that rheumatoid wrist involvement in black patients was more or less the same as reported in other series, but finger joint involvement was considerably less. This finding must influence surgical decision-making and also the interpretation of results of drug trials, whenever black patients are involved.

A radiological study of the rheumatoid hand in black South Africans.

OBJECTIVE: To determine wrist and hand involvement in black South African patients with rheumatoid arthritis. METHODS: Larsen scoring of the wrist and hand was done in 75 patients. The mean finger score was 9.67 (range 0 - 100) on the left hand and 10.3 (range 0 - 100) on the right. Scores for the wrists were 2.5 (range 0 - 5) for the left and 2.7 (range 0 - 5) for the right. CONCLUSION: Finger and thumb involvement were considerably less in the South African black population than in other series consisting mainly of white patients.

Epidermal cysts of the femur. A case report.

Epidermal inclusion cysts involving bone are rare in comparison with epidermal cysts of the dermis. Previously reported cases involved the skull and distal phalanges. In this paper we describe the findings in a case of epidermal cysts of the femur.

Piracetam in the management of spasticity in cerebral palsy.

This article is a preliminary report of a new indication for the drug piracetam (Nootropil; UCB). It was found that piracetam was useful for the control of spasticity in 8 out of 16 patients with cerebral palsy. Side-effects were minimal.

Computed tomography in tuberculosis of the spine.

In a study of the CT appearance of 30 patients with confirmed tuberculosis of the spine, criteria for the diagnosis of tuberculosis of the spine are suggested. From a comparison with plain radiographs it is concluded that bony lesions are more apparent on radiographs than on CT while soft tissue lesions and calcifications are more readily detected on CT. The value of CT in cases who may come to surgery is discussed.