Recurrent post-traumatic anterior shoulder dislocation--open versus arthroscopic repair.

A total of 41 consecutive patients (11 women and 30 men, median age 29 (18-51) years) with unilateral, isolated, posttraumatic, recurrent anterior shoulder dislocation and a Bankart lesion were operatively repaired, either by an arthroscopic technique including a capsular plication, or by an open procedure with Mitec anchors. All the patients were followed prospectively and evaluated after a median of 36 (30-52) months follow-up by a "blind" observer. Nineteen patients in each group had excellent or good results, and one in each group was graded as fair. One patient in the arthroscopic group had a traumatic dislocation 5 months after the operation and was graded as poor. Three patients experienced subluxations postoperatively, one in the arthroscopic and two in the open group. There was no significant difference in anterior-posterior shoulder laxity measured objectively with Donjoy. The open Bankart repair group had a statistically significantly longer hospitalization (P = 0.001), a slight decrease in external range of motion, and more frequent cosmetic complaints. Apart from this, the results revealed no major differences between the two methods after a median of 36 months in this selected group of patients with longstanding problems.

Complications using the Seidel intramedullary humeral nail: outcome in 31 patients.

Thirty-one patients with humeral shaft fractures were operated using the Seidel intramedullary humeral nail. Three categories of patients entered the study: 6 with pathological fractures, 7 with nonunion and 18 with severely displaced fractures. The operation could be considered a partial success only in the pathological fractures. The failure rate and complication rate were very high. Both complications not specific for the nail and some directly related to it were encountered. The latter consisted in loss of both proximal and distal fixation and refractures occurring at the distal end of the nail several weeks after surgery. In consequence we have discontinued using the nail.

Bilateral stress-fracture of the calcaneal tubercle.

A case of bilateral stress fracture of the calcaneal tubercle (beak-fractures) in a 67-year-old woman is presented. The pathogenesis and treatment are discussed, followed by some general considerations on stress fractures.

Problems of removal of the Harrington instrumentation after spinal fusion.

Eight patients in which the Harrington instrumentation had to be removed are presented. In four patients a hook had dislocated, two further cases were due to infection, and in two cases the rod was too long causing discomfort in the neck. The removal was difficult in two cases because both hooks had become firmly anchored. In two subsequent cases we therefore used a high-speed drill mounted with a diamond disc to cut the Harrington rod thus facilitating the removal of the hooks and rod. Technical errors in insertion of the Harrington device are discussed.

Low-dose heparin in proximal femoral fractures. Failure to prevent deep-vein thrombosis.

The effect of heparin, 5000 units every 8 hours, on deep venous thrombosis in patients with proximal femoral fractures was investigated in a controlled, double blind, randomised study. Heparin or placebo was administered as soon as possible after the fracture, and before 6 hours had passed, and was continued for 14 days. The diagnosis of deep venous thrombosis was made using daily I125 fibrinogen scans. A total of 130 patients endured the trial and the results were registered on a sequential diagram. This showed that the 0-hypothesis could not be rejected, and that consequently no difference in the frequency of deep-vein thrombosis was detected.

Fracture-suspending effect of the patellar-tendon-bearing cast.

In order to evaluate the fracture-suspending effect of the patellar-tendon-bearing cast, experiments using a load cell under the heel were carried out on four subjects. Measurements were made using a conventional below-knee cast, the PTB cast, and an above-knee cast. There were no differences between the forces transmitted by the same subject wearing the three types of casts in turn and consequently the choice of cast must be based on other factors.

Ankle fractures treated by fixation of the medial malleolus alone. Late results in 29 patients.

A review of 29 patients with unstable ankle fractures treated by fixation of the medial malleolus alone is presented. At follow-up the result in 16 patients was classified as unsatisfactory or a failure and all of these patients showed radiological signs of posttraumatic arthrosis deformans. The importance of the position of the lateral malleolus in order to prevent joint incongruity and subsequent arthrosis is emphasized.

The value of routein intravenous urography in acute epididymitis.

The urographies of 106 patients with acute epididymitis are reviewed. In 71 cases the urogrpahy was completely normal, while in the remaining 35 patients abnormalities were found. In 25 patients the findings were consistent with hypertrophy of the prostate. More than half of the patients had known urological diseases and had undergone cystoscopy and/or catheterization prior to the onset of acute epididymitis. All 35 patients had demonstrated symptoms that would otherwise have resulted in intravenous urography independent of the epididymitis. No cases of urogenital tuberculosis were found. The authors conclude that routine urography under the age of 50 is not recommended. Over the age of 50 concomitant urological diseases are so common that urography is often indicated, but acute epidiymitis in itself is only a relative indication.

Nephrectomy. A five-year material.

A review of 158 consecutive nephrectomies is presented. The pathological findings are listed and compared to other author's findings. In the present series a very low rate of nephrectomy necessitated by stone and infection is noted. Surprisingly, 14 normal kidneys were removed. The specific diagnostic problems in each case are discussed, and better diagnostic procedures in the future are mentioned.

Fibrinogen related antigens in acute pancreatitis.

The fibrinogen related antigens were measured in 22 consecutive patients with acute pancreatitis. During the attack a marked elevation was seen, the values normalizing in the quiet phase. This may be due to either intravascular and/or extravascular degradation of fibrinogen-fibrin. As other authors have demonstrated intravascular coagulation experimentally in animals with pancreatitis, the authors stress that intravascular coagulation may play an important role in the patheogenesis of acute pancreatitis.