"Metaphyseal" cysts in Legg-Calve-Perthes' disease.

Radiographic changes in the femoral metaphysis in Legg-Calve-Perthes' (LCP) remain poorly understood. Our hypothesis was that these "cysts" are not truly metaphyseal but are metaphyseal changes radiographically projected onto the metaphysis. Surface epiphyseal changes were made on a normal hip and a hip with LCP. These "lesions" appeared metaphyseal on radiograph, and in the specimen with LCP, projected deep within the metaphysis due to flattening and three-dimensional distortion. "Metaphyseal" cysts in LCP may be epiphyseal changes superimposed on the metaphysis. This would explain the correlation between the presence of a "metaphyseal" lucency and final result, since it is simply another indicator of the extent of epiphyseal involvement.

Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture.

In a prospective study, 87 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Mean follow-up was 22 months. Thirty-six percent (31/87) of all ganglions treated showed a successful outcome. Twenty-seven percent (16/60) of dorsal carpal, 43% (6/14) of palmar carpal, and 69% (9/13) of palmar digital ganglions did not recur. Immobilization significantly improved the results of treatment of dorsal carpal ganglions. Forty percent (12/30) of those in the immobilization group and 13% (4/30) of those in the early mobilization group had a successful outcome (p less than 0.05).

Femoral anteversion. A clinical assessment of idiopathic intoeing gait in children.

Hip rotation in extension and flexion was studied in 23 patients with idiopathic intoeing gait. In extension all the hips had markedly increased medial rotation and limited lateral rotation, fulfilling the criteria of excessive femoral anteversion. In flexion, however, rotation varied widely; in one group of patients medial rotation remained greater than lateral, but in the second group lateral rotation was equal to or greater than medial. CT scans showed that the hips in the first group were significantly more anteverted than those in the second. Clearly measurement of hip rotation in extension alone does not provide a dependable indication of femoral anteversion in children with intoeing gait; rotation in flexion also needs to be measured.

Complex dislocations of the metacarpophalangeal joint.

A dorsal longitudinal incision provides excellent exposure for reducing complex dislocations of the metacarpophalangeal joints of the thumb and index finger. Within the past four years, we have successfully treated five patients with irreducible dislocations of the metacarpophalangeal joint of the thumb and four with dislocations of the index finger by open reduction through a dorsal incision. This approach exposes the joint and the major structure blocking reduction, the volar plate. The digital nerves, which are tented volarly over the metacarpal head, are not prone to injury and osteochondral fracture fragments can be easily removed from the joint. All of the dislocations were stable following reduction.

A controlled study of the indications for and the results of femoral osteotomy in Perthes' disease.

We have considered the reasons for securing containment of the femoral head in Perthes' disease and have reviewed briefly the methods used. The present investigation describes the outcome in a controlled series of forty-eight hips treated by containment by femoral varus-rotation osteotomy in selected patients. In assessing the results we have emphasised that controls are essential, and for this purpose we have used two comparable groups, one untreated and the other treated by methods other than containment. The same factors were considered in assessment--namely age, duration, group, and the presence or absence of "at risk" signs. The results were graded similarly as good, fair and poor in all groups. We have concluded that containment by femoral osteotomy is the treatment of choice in patients with "at risk" signs provided that severe deformity has not already occurred. There is no evidence that treatment of any kind favourably influences the course of the disorder in the remainder. Although this is predominantly a radiological study some clinical features are discussed.

Ulnar variance in Kienböck's disease.

The distal extent of the radius and ulna (ulnar variance) was compared on roentgenograms of normal wrists in randomly selected black and white patients and of fifteen affected wrists in patients with Kienbock's disease. The results establish a statistically significant association between negative ulnar variance and Kienbock's disease. Blacks have more positive ulnar variance and the disease is less likely to develop in them than in whites.