Patella partita.

Patella partita is a malformation of the knee cap, generally characterized by one or a few vertical lines of discontinuity in sagittal planes, caused by incomplete ossification within a single ossification center. In other cases, disorder of ossification in frontal planes results in frontal subdivision of the patella. While patella partita is sometimes diagnosed as a coincidental radiographic finding, in other cases, especially in elderly individuals, it is a finding associated with symptoms which require treatment.

Acute bacterial arthritis in the adult.

Suppurative arthritis can be a complex and vexing problem. Formal arthrotomy is among the many successful approaches for the treatment of septic joints in the adult, however, it is not without morbidity and may not always be required. The clinical features, pathophysiology, and treatment of this disorder are reviewed.

The nature and designation of osteoarthritis determined by its histopathology.

Specimens of synovial tissue and articular cartilage removed at operations of patients with primary degenerative joint disease were scrutinized for defined histopathological parameters. The findings in the synovial membrane were subsequently compared as to frequency and intensity with identical parameters ascertained in specimens removed from patients with definite rheumatoid arthritis. These examinations disclosed the presence of synovial inflammatory features, although at lesser incidence and intensity than in rheumatoid arthritis; therefore the designation of arthritis is indicated. On the basis of the concurrently examined tissue specimens of the articular cartilage, and in consensus with the generally acknowledged start of the degenerative joint disease by disintegrating changes in the articular cartilage, the prefix of chondrosis is appropriate.

The alterations of the synovial membrane in rheumatoid arthritis treated with corticosteroids.

Sections of synovial tissue removed from patients with rheumatoid arthritis treated, for a long period of time or a brief period of time or not at all, with corticosteroids were examined for the incidence of histopathologic changes. Comparison of the quantification of these changes in the differently treated groups revealed that prolonged administration of corticosteroids had an inhibiting effect on the occurrence of lymphocytes and histiocytes in inflammatory infiltrates as well as on the hypertrophy of synoviocytes, on the proliferation both of fibroblasts and fibrocytes, and on the formation of villi and collagen fibers.

Evaluation and diagnosis of cervical spine injuries: a review of the literature.

Cervical spine injuries pose devastating potential problems for surgeon and patient alike. This review will stress the early diagnosis of cervical spine injuries, with emphasis on early suspicion of injury. This review will focus on the radiology and types of lesions found with cervical spine injury.

Bilateral simultaneous achilles tendon ruptures. A case report and review of the literature.

Bilateral simultaneous Achilles tendon ruptures are rare, with only ten cases reported in the English literature. Our case is that of a 44-year-old woman, along with a review of the literature. Affected persons usually are on chronic steroid treatment and in the fifth to seventh decades of life. The patient may have concomitant systemic disease, and the injury occurs with relatively mild trauma. The goals of treatment are mainly preventative, i.e., cessation of steroids as soon as possible and protective bracing of the remaining intact Achilles tendon.

Functional evaluation of nonsensate free flaps to the sole of the foot.

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

[Spondylolisthesis and related conditions; pathology, clinical aspects and treatment]. / Spondylolisthese und verwandte Zustände; Pathologie, Klinik und Behandlung.

Close pathogenetic and morphologic relationships exist between the alterations of the lumbosacral spine designated as spondylolysis, spondylolisthesis and praespondylolisthesis. The initial management of 105 patients with such conditions was conservative. However, of this group 34 patients with persistent instability and/or intractable neurologic symptoms were subsequently treated surgically, and the majority of them obtained lasting benefits.

Spondylolisthesis and related disorders. A correlative study of 105 patients.

A close relation exists among the alterations in the lumbosacral spine designated as spondylolysis, isthmic spondylolisthesis, degenerative spondylolisthesis, and prespondylolisthesis. While the former two conditions are probably caused by faulty development and subsequent minor traumata or repeated stresses, the third condition is caused by degenerative changes associated with anatomic variations; the fourth condition is a static insufficiency leading to faulty alignment. In 105 patients, the initial preferred management of these conditions was conservative. Thirty-four patients who developed persistent symptoms of spinal instability and/or intractable neurologic deficits were treated surgically. The results were generally successful.

Total knee arthroplasty in 1984.

In total knee arthroplasty, as little bone as possible should be removed, all intact ligaments should be saved, and fixation by biologic ingrowth, rather than methylmethacrylate, should result in the lowest incidence of loosening.

Heterotopic ossification. Incidence and relation to trochanteric osteotomy in 100 total hip arthroplasties.

Heterotopic ossification can impair the functional results of total hip arthroplasty. The causative role of trochanteric osteotomy in heterotopic ossification is uncertain. Postoperative radiographs of 100 total hip arthroplasties were analyzed for incidence of heterotopic ossification. Forty procedures were performed with trochanteric osteotomy and 60 without. There was a 17% overall incidence of clinically significant heterotopic ossification, 22% with osteotomy and 13% without. High- and low-risk categories revealed clinically significant heterotopic ossification in 25% of the high-risk group and in 8% of the low-risk group. In the high-risk group there was a 32% incidence with trochanteric osteotomy and 22% without osteotomy. In the low-risk group there was a 16% incidence without trochanteric osteotomy and a 3% incidence with trochanteric osteotomy. The increase in clinically significant heterotopic ossification in the high-risk group over that of the low-risk group was statistically significant. The present study showed that trochanteric osteotomy tended to increase the incidence and severity of clinically significant heterotopic ossification. These data suggest that trochanteric osteotomy should be avoided, if possible, during total hip arthroplasty to decrease the risk of heterotopic ossification.

The synovial changes in rheumatoid arthritis under corticosteroid treatment.

Light microscopic examination of histological sections of synovial membrane from patients with rheumatoid arthritis revealed that prolonged administration of corticosteroids had an inhibiting effect on the participation of lymphocytes and histiocytes in inflammatory infiltrates, as well as on the hypertrophy of synoviocytes, the proliferation of fibroblasts, the accumulation of fibrocytes, the deposition of fibrous tissue, and the formation of villi. Short-term (i.e., 12- to 24-h) steroid administration inhibited proliferation of fibroblasts only.

The morphologic and pathogenetic bases of heterotopic bone formation in the extremities.

Heterotopic bone formations, involving the insertional portion of a tendon, fascia or ligament, were observed in the extremities. Histopathological examinations suggest that the connective tissue is transformed by direct metaplasia into bone tissue. The development of ossification is favored by the special structure of the connective tissue in these areas. Whereas in a small number of these cases a trauma could be identified as the competent cause, in the majority of the cases excessive or repeated minor stresses probably accounted for the ossification; in other cases with no obvious stresses a constitutional overreaction of the connective tissue had to be assumed as an explanation for the occurrence of ossification.

[Changes in the synovial membrane in psoriatic arthritis]. / Les altérations de la membrane synoviale dans l'arthrite psoriasique.

The structural changes of the synovial membrane in psoriatic arthritis are described. Typical features include focal and diffuse cell infiltrates with predominance of plasmocytes, pronounced response by synoviocytes, fibroblasts and fibrocytes, marked regressive alterations of small and middle-sized blood vessels, and finally dense extensive fibrosis. However, none of these histopathologic features solely occures as a pathognomonic change in psoriatic arthritis to permit the diagnosis of psoriatic arthritis on the basis of microscopic examination alone.

The giant cells in the synovial membrane.

Histopathological examinations of synovial tissues, obtained in 393 operations, disclosed the presence of foreign body giant cells or synovial giant cells or both in 51 cases. The presence of the former could be related to the occurrence of material foreign to the location, whereas for the latter group fo coincidence of precipitated fibrin only was noted in a significant number of cases. The patients operated upon were classified by 10 diagnosed entities of joint disease, and the synovial giant cells, lysing among synoviocytes or in the subsynoviocytic tissue, were observed in 8 of these categories. Thus no diagnostic significance could be attributed to the giant cells.

Radiation exposure during scoliosis screening radiography.

Screening programs to detect scoliosis in the adolescent population are active in most communities. Two percent of children screened will be referred for treatment or observation. Increasing concern has been voiced regarding the amount of the potential effects of the radiation administered in such screening programs. Radiation dosage was directly measured on 19 children participating in an established school scoliosis screening program, using lithium fluoride thermoluminescence dosimeters. The mean gonadal doses are measured to be 19 mrem in males and estimated at a maximum 95 mrem in females. The mean entrance skin dose was 174 mrem. A lack of uniformity in the radiographic techniques employed by individual technician was identified. The measured doses were within established acceptable limits and are comparable or below the average dose of 100 mrem received annually by the general public from the environment.

The Harris and Beath footprinting mat: diagnostic validity and clinical use.

Pain on the plantar aspect of the forefoot is a common malady whose specific cause is often difficult to diagnose. Using the Berkemann Laboratory version of the original mat of Harris and Beath, and a calibration curve, the patterns on a footprint can be translated into their actual pressure values withhin the range of 0.27 kg/cm2 to 4.80 kg/cm2. Using the procedure presented here, inexperienced subjects were able to estimate the pressure values of random prints of unknown pressure within a standard deviation of 0.28 kg/cm2 from their actual values. The mat is valuable for diagnosis of pressure metatarsalgia and other disorders of the foot. The specificity was 0.77, sensitivity was 0.57, with the sum being equal to 1.34. These results indicate that there is a relatively large population of normal people wit excessive localized pressure under their metatarsal heads who do not complain of pain. The apparently low sensitivty of the mat in this study does not seem to be a limitation, but is an indication of the haziness involved in the differential diagnosis of forefoot pain. Pressure metatarsalgia can be quantitated by analysis of the Harris footprint.