Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation.

We have reviewed 19 patients who have had Matti-Russe bone grafting and 16 patients who have had Herbert screw fixation for symptomatic non-union of the carpal scaphoid. The success rate in both groups was similar, 74 per cent in the Matti-Russe group and 71 per cent in the Herbert screw group. Only five patients in the Herbert screw group had bone grafts. The advantages and disadvantages of both methods of treatment are discussed.

Treatment of displaced subcapital fractures with the Charnley-Hastings hemiarthroplasty.

Between December 1982 and June 1986, 98 displaced subcapital femoral neck fractures were treated using the Charnley-Hastings bipolar hemiarthroplasty. Although the patients were elderly, often with associated medical problems, the operation was well tolerated and the mortality at one and six months was 14.4% and 24.5% respectively. Fifty-four hips were reviewed after an average follow-up of 33 months; 64.8% of patients had a good or excellent result. The fair or poor results were seen mainly in patients with poor pre-operative mobility and multiple medical problems. A significant cause of morbidity was dislocation (two interprosthetic) which occurred in six hips. There were two cases of deep sepsis but neither patient was fit for further surgery. There were no cases of acetabular erosion requiring revision surgery.

The Essex-Lopresti injury: a variation.

The Essex-Lopresti fracture-dislocation consists of a radial head fracture associated with dislocation of the inferior radio-ulnar joint. We report a variation of this injury in which there was an additional fracture through the scalphoid.

A radiological assessment of interprosthetic movement in the Charnley-Hastings hemiarthroplasty.

Forty-six patients with acute displaced subcapital fractures of the femur were treated between December 1982 and December 1984 with Charnley-Hastings bipolar prostheses. The interprosthetic movement in 23 patients was assessed radiologically at least 1 year after surgery. Four patients (17.4 per cent) had no interprosthetic movement in abduction but the remainder (82.6 per cent) had some movement, although only 3 patients (13 per cent) had more than 5 degrees of abduction within the prosthesis.

Is conservative treatment of displaced tibial shaft fractures justified?

All tibial shaft fractures treated at one hospital during a five-year period were studied in a prospective trial. Ninety-one displaced fractures in adults were treated using a conservative policy that included early bone grafting when indicated. Sound bony union was obtained in all cases. Those that healed primarily took on average 16.3 weeks whereas the 24 per cent that required bone grafts took 35.1 weeks. The number of complications, most of which were minor, was considered acceptable. It is concluded that provided early bone grafting is performed when necessary, a basically conservative policy of treatment is satisfactory; bony union of all displaced tibial fractures is achieved in a reasonable period of time.

Late failure of the Manchester prosthesis. Its relationship to the disease process.

The results of thirty-one Manchester knee arthroplasties performed on twenty-eight patients are reviewed. There were sixteen patients with rheumatoid arthritis all of whom were satisfactory at the time of follow-up. Of the fifteen patients with osteoarthritis over half the arthroplasties failed after between twelve and thirty-six months. We suggest that resurfacing arthroplasty of the knee using the Manchester prosthesis should be used only for rheumatoid patients.