[Shoulder instability]. / Skulderinstabilitet.

The importance of the labrum and glenohumeral ligament complex for the stability of the shoulder joint has been known since the beginning of this century. Shoulder instability may be classified into two large groups. TUBS, characterized by Traumatic, Unidirectional instability and Bankart lesion which often requires Surgery. The second group AMBRI, is characterized by Atraumatic, Multidirectional, Bilateral instability that often responds to Rehabilitation, but in case of surgery Inferior capsular shift is indicated. The high recurrence rate after primary traumatic anterior dislocation in young adults has caused an ongoing discussion about the indications for primary surgery. Anatomical reconstruction focusing on the pathoanatomy is recommended due to better results and a lower complication rate as compared to non-anatomical reconstruction that alters the normal anatomy and kinematics. The recurrence rate after arthroscopic Bankart repair is still generally higher than after open surgery but may be improved by better patient selection.

Posterior sternoclavicular dislocation: an American football injury.

Posterior dislocation of the sternoclavicular joint is uncommon, accounting for less than 0.1% of all dislocations. Since 1824 a little more than 100 cases have been reported, and the majority in the past 20 years. A review of published reports suggests that this injury is seen particularly in connection with American football. A typical case is described. The importance of this injury is that there is often a delay in diagnosis with potentially serious complications.

Myonecrosis in the leg caused by Salmonella enteritidis.

Five weeks after an episode of gastroenteritis, a 65-year-old diabetic male developed an extensive myonecrosis, with gas production in the left leg caused by Salmonella enteritidis. The patient was treated with surgical revision and antibiotics. To our knowledge, this is the first case of myonecrosis with gas production in a leg caused by Salmonella enteritidis, in which the patient survived, and the limb was saved.

Displaced femoral neck fractures treated with the Gouffon pin.

One hundred fractures of the neck of the femur, Garden stage III or IV, were treated with Gouffon pins during a three year period. Seventy-nine were followed from 24 to 52 months. Union occurred in 59 fractures. Eighteen fractures did not unite and 2 became redisplaced within the first week. Avascular necrosis was noted on radiographs in 14 of the 59 united fractures. A higher pin migration rate was found in Garden stage IV fractures, and in the failures.

Interphalangeal dislocations of the fingers treated by an elastic double-finger bandage.

A prospective trial of dislocations of the interphalangeal joints of fingers treated by elastic double-finger bandage showed good final results with an almost normal range of motion. The method is found pleasant by the patient, being hygienic and causing no kind of skin reaction.

Hypoacusis among the Polar Eskimos of northwest Greenland.

Audiological tests were conducted on 188 Polar Eskimos (75 males and 43 females) in small, remote, nonindustrialized settlements of Northwest Greenland. Most males of this small Eskimo tribe hunt regularly for food using rifles and shotguns. The means of the pure tone hearing thresholds indicated that 77% of the males in the population sample had a hearing loss (greater than 25 dB HL) in the high frequency range (above 2,000 Hz), in one or both ears. Also, 73% of the males had bilateral hearing losses (greater than 25 dB HL), and 73% had hearing thresholds greater than or equal to dB in one or both ears. A high frequency hearing loss was found in 46% of the males of the younger age groups (less than or equal to 40 years), mainly in the 3,000 to 8,000 Hz range, with the mean loss gradually extending to 2,000 and 1,000 Hz, and increasing in severity with age. The mean pure tone thresholds of 6- to 60-year-old female Polar Eskimos (who do not hunt with firearms) were generally within normal limits over the entire audiometric frequency range for the younger groups, and increased with age to the mild hearing loss range. Among the females, 35% had a hearing loss (less than 25dB HL) in the high frequency range (above 2,000 Hz) in one or both ears, and 21% had thresholds of greater than or equal to 50 dB in one or both ears. Conductive hearing losses in the low frequency range were not widespread among the males or females of this survey. The findings of this study suggest: (1) The high incidence of age-related hearing loss among the Polar Eskimo males is the result of frequent exposure to high intensity, impulse firearm noise, which is the major source of noise for this population, in an otherwise "noise-free" environment. (2) The primary noise-induced permanent threshold shift among Polar Eskimo hunters occurs in the age range of 10-40 years, and increases slowly thereafter, mainly as a result of continual noise exposure and presbyacusis. It is recommended that ear protectors and a comprehensive hearing conservation/rehabilitation program be provided for the Polar Eskimo population at once in order to prevent further hearing impairment and to rehabilitate those persons presently suffering from hearing loss.

The effect of skeletal traction on femoral neck fractures.

Patients with fracture of the femoral neck often undergo skeletal traction until surgery. We found that the fracture position worsened in 5 of 15 patients during the period with skeletal traction. Accordingly, skeletal traction does not prevent further vascular damage to the femoral head. We advocate operating as soon as the patient's condition is stable.

Bacteriologic contamination of suction tips during hip arthroplasty.

We obtained positive cultures from 12 out of 22 suction tips used in total hip arthroplasty performed in operating theaters with conventional ventilation. We recommend that the suction tubes be turned off when not in use and that the tubes be changed during operations.

Wilson shaft osteotomy for hallux valgus.

The results of a modified Wilson shaft osteotomy for hallux valgus in 77 feet of 51 patients were excellent or good in 62 feet after 2 to 4 years. The correction of the hallux valgus angle and intermetatarsal angle was excellent or good in 69 feet. The operation is technically simple provided dorsal angulation of the distal fragment is avoided in the early postoperative period.

Alternative conservative treatment of mallet-finger injuries by elastic double-finger bandage.

A prospective trial of mallet-finger injuries treated conservatively by elastic double-finger bandage showed no disadvantages compared to other kinds of conservative treatment. The method is agreeable for the patient, being hygienic and causing no kind of skin irritation.

Extensor digitorum brevis manus. A case report.

A 45-year-old man presented with swelling on the dorsum of both hands, discomfort and pain, all of which became aggravated with activity. An anomalous muscle, the extensor digitorum brevis was found bilaterally. Division of the extensor retinaculum was performed in one hand, excision of the anomalous muscle in the other. One year after surgery, the patient was asymptomatic in both hands.

Compressed air injuries of the hand.

Two cases of injection of compressed air into the hand are reported. The air was injected under a pressure of 5-15 Atm. Both cases had a benign course. This is in contrast to high pressure injection (40-400 Atm) with foreign material. Both patients had minor skin lesions before the accident.