[Traumatic hip dislocation with "spontaneous" reposition and re-luxation]. / Traumatisk hofteluksation med "spontan" reposition og reluksation.

A case of traumatic hip dislocation with spontaneous reduction of the hip joint is presented. The patient was involved in a car accident, and characterized as multitraumatized. On admission to the Emergency Department there were no clinical signs of traumatic hip-dislocation, but because of the severity of the trauma an X-ray of the pelvis was performed and a fracture of the acetabulum diagnosed. The patient was taken to the operating theatre for surgery of several fractures of both upper and lower extremities. This was followed by control X-rays including both anterior-posterior and lateral views of the right hip. This demonstrated that the right hip was now dislocated. The dislocation was reduced. CT showed a larger fracture of the acetabulum, and this was treated with osteosynthesis. Patients with an unstable hip due to trauma, should as a general rule have the hip X-rayed in two planes. It is further suggested that in cases of severely traumatized patients X-ray of the pelvis should be routinely performed.

Lateral hindfoot instability treated with the Evans tenodesis: a biomechanical analysis.

The stabilizing effect of the Evans tenodesis on movements in the tibiotalocalcaneal joint complex was studied in 10 amputation specimens, using a kinesiologic testing device. The tenodesis was tested following solitary lesion of the anterior talofibular ligament and after combined lesions of the anterior talofibular and calcaneofibular ligaments. All tenodeses were performed with the joint complex in the neutral position. Regardless of the extent of ligamentous damage, the tenodesis frequently restricted adduction and internal rotation to a level below that recorded at intact ligaments. Instability in external rotation in the joint complex and anteroposterior laxity of the talus were never completely reconstructed, regardless of what degree of flexion in the joint complex the tenodeses were tested. The study demonstrates that, if performed with the tibiotalocalcaneal joint complex in the neutral position, the Evans tenodesis cannot reconstruct normal hindfoot kinematics, irrespective of the extent of ligamentous damage. However, severe instability in adduction and internal rotation, both part of clinical supination, were effectively prevented by the tenodesis.

Antibiotic prophylaxis in lower-extremity amputations due to ischemia. A prospective, randomized trial of cephalothin versus methicillin.

The efficiency of prophylactic antibiotic therapy in amputation surgery was studied in a prospective, randomized trial of a first-generation cephalosporin (cephalothin) compared with a narrow-spectrum beta-lactam stable penicillin (methicillin). Eighty-eight patients received cephalothin 2 g X 4 on the day of operation, while 86 patients received methicillin 1 g X 4. The patients were followed up for 21 days. Infected wounds occurred in 14.8% of the patients in the cephalothin group, compared with 14% in the methicillin group. The frequency of deep infections was 10.2% versus 4.7% (P = 0.1611). The reamputation frequency was 18.2% in the cephalothin group compared with 12.8% in the methicillin group; the frequency of below-knee reamputation was 18.4% versus 7.7% (P = 0.1469). No clostridial infections were found. The study did not demonstrate any significant difference between cephalothin and methicillin in the prophylaxis for lower-extremity amputations, although the latter drug tended to be the best choice.

Watson-Jones tenodesis for ankle instability. A mechanical analysis in amputation specimens.

The stabilizing effect of a modified Watson-Jones ankle tenodesis was studied in 10 lower extremity amputation specimens using a kinesiologic testing device. Cutting of the lateral ligaments caused maximal instability in adduction of the entire hindfoot joint complex, as well as of the talocalcaneal joint. The tenodesis restricted adduction and internal rotation when compared with the movement pattern with intact ligaments. Instability in external rotation persisted because the tenodesis did not restore the function of the calcaneofibular ligament. Our study confirms clinical observations that the Watson-Jones ankle tenodesis prevents abnormal inversion of the hindfoot, but does not restore hindfoot kinematics.

Stabilizing effect of the tibiocalcaneal fascicle of the deltoid ligament on hindfoot joint movements: an experimental study.

The tibiocalcaneal fascicle of the deltoid ligament was studied in 10 lower leg amputation specimens to evaluate its stabilizing effect on movement in the tibiotalocalcaneal joint complex and the talocalcaneal joint complex. Cutting of the fascicle resulted in minor numerical increases in movement in all three planes in the tibiotalocalcaneal joint complex as well as in the talocalcaneal joint complex. The maximum median increase in the tibiotalocalcaneal joint complex was 6.1 degrees in abduction, whereas the maximum median increase in the talocalcaneal joint complex was 3.6 degrees in abduction. However, the percentage of increase in the total range of movement in a single plane was large for abduction-addition in both the tibiotalocalcaneal joint complex and the talocalcaneal joint complex, at 28% and 31%, respectively. The largest percentage of increase, 40%, was found in the total range of plantarflexion-dorsiflexion in the talocalcaneal joint complex. Our data suggest that the tibiocalcaneal fascicle is an important stabilizing structure of abduction, external rotation, and plantarflexion movements in the tibiotalocalcaneal joint complex, especially in the talocalcaneal joint complex.

Total condylar knee arthroplasty in osteoarthritis. A four- to six-year follow-up evaluation of 103 cases.

One hundred and three consecutive total condylar knee prostheses in patients with gonarthrosis inserted from 1979 to 1981 have been prospectively followed for four to six years. According to the New York Hospital for Special Surgery Knee Rating Scale, 58 knees (56%) were rated excellent; 34 (33%), good; seven (7%), fair; and four (4%), poor at the latest follow-up evaluation. The median preoperative score was 57 points and the median postoperative score 87 points. Thirteen knees (13%) had a radiolucency with a width of 2 mm or more beneath one or more of three tibial zones. In only one case did this represent a clinical loosening. Six knees (6%) had complications requiring reoperation. One deep infection was treated with an arthrodesis, one patellar button was revised after a traumatic patellar fracture, and three superficial skin necroses were surgically managed. Moreover, in one mechanically loosened tibial component, a revision has been planned. No complications were fatal. The modified total condylar I prosthesis is an excellent prosthetic design with a low failure rate in gonarthrosis.

Comparison of three different treatments for ruptured lateral ankle ligaments.

Two hundred consecutive patients with arthrographically verified rupture of one or both of the lateral ankle ligaments were allocated to treatment with either an operation and a walking cast, walking cast alone, or strapping with an inelastic tape - all for 5 weeks. Eighty-seven percent of the patients attended follow-up after 1 year. Only 5 percent in each treatment group were unsatisfied with the result. There were no differences between the treatment groups in ankle stability or symptoms during different activities, regardless of rupture of the anterior talofibular ligament alone or combined with rupture of the calcaneofibular ligament. However, the patients treated with tape had fewer symptoms, fewer complaints when running, and more ankles recovered to the preinjury state. Therefore, in lateral ankle ligament rupture, tape bandages seem preferable.

The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot. An experimental study.

Three-plane kinesiology of hindfoot instability was studied after lesions to the ligamentous structures in the sinus and canalis tarsi in 20 amputation specimens. Neither a lesion of the cervical ligament nor of the interosseous talocalcaneal ligament resulted in an increase in the total range of movements above 2.6 degrees in any of the three planes. However, the percentage increase in the total range of movements after cutting of the ligaments was generally largest in the talocalcaneal joint compared to the increase in the total hindfoot joint complex. The largest percentage increase (43%) in the talocalcaneal joint occurred at dorsiflexion after cutting the interosseous talocalcaneal ligament. The demonstrated minor instability after experimental lesions of the ligamentous structures in the sinus and canalis tarsi may have a clinical identity in the sinus tarsi syndrome. Patients with that syndrome rarely present an objective hindfoot instability, although a major complaint is a feeling of hindfoot instability.

Hemoglobin and hematocrit as risk factors in below-the-knee amputation for incipient gangrene.

The relationship between complication rate and preoperative levels of hemoglobin and hematocrit was investigated in 186 consecutive below-the-knee amputations for incipient gangrene. Arteriosclerotic amputations had successively higher rates of wound complications and reamputation with increasing hemoglobin and hematocrit. No such association was found among diabetics. Thus, hemoglobin greater than or equal to 7.0 mmol/l and hematocrit greater than or equal to 40 were significant preoperative risk factors in below-the-knee amputation for arteriosclerotic incipient gangrene.

Lateral talocalcaneal instability following section of the calcaneofibular ligament: a kinesiologic study.

In the evaluation of the role of the calcaneofibular ligament in stabilizing the talocalcaneal joint, an experimental set-up was prepared. In 10 osteoligamentous specimens, the talocalcaneal motion was measured under a constant well defined moment by using a specially constructed apparatus. By using a moment of 1.5 Nm, increment in adduction in the talocalcaneal joint after section of the calcaneofibular ligament was found between 3.1 degrees and 4.6 degrees, still increasing with dorsiflexion. This increment, shown to constitute 61 to 77% of the total increment in adduction in the hindfoot after section of the calcaneofibular ligament, was found to increase gradually with dorsiflexion. The study has shown the calcaneofibular ligament as an important structure in stabilizing the talocalcaneal joint. Increment in adduction in the hindfoot after section of the calcaneofibular ligament was shown primarily to take place in the talocalcaneal joint.

Effect of the calcaneofibular ligament on hindfoot rotation in amputation specimens.

A kinesiologic study of the range of rotation in the hindfoot after cutting of the calcaneofibular ligament was performed in amputation specimens. Cutting of the calcaneofibular ligament results in a significant increment in the external rotation of the tibial-talocalcaneal joint complex and the talocalcaneal joint, maximum 5.4 degrees and 2.9 degrees, respectively. The total range of rotation in the tibial-talocalcaneal joint complex and the talocalcaneal joint increased 32 and 20 per cent, respectively. The calcaneofibular ligament is an important structure in the rotatory stabilization of the hindfoot.

Knee arthroplasty in rheumatoid arthritis. Four- to six-year follow-up study.

A consecutive series of total condylar knee arthroplasties in patients with rheumatoid or related arthritis, with a 4-6-year follow-up period, was studied. Eighty-seven percent had an excellent or good overall result (score of 70 or more on the HSS knee rating scale). The median total score increased from 45 points before operation to 83 after operation. Sixteen complications, mostly minor, occurred in 14 patients. There were no early infections. Two prostheses were removed for deep infection, after 3 and 5 years. One patient had patellectomy for avascular necrosis. The crude prosthesis survival rate was 97%. Tibial radiolucencies were noted in 76% of cases; in 29% they were significant (2 mm or more in one or more of three zones). Two tibial components (2%) were believed to be mechanically loose, but no revisions for mechanical loosening were done. The presence of radiolucencies did not signify an inferior clinical result.

An unusual lesion in the knee of a breaststroke swimmer.

In a 21-year-old male breaststroke swimmer with characteristic symptoms in the medial aspect of the knee joint, synovial leakage suggesting medial capsular rupture caused by the whip kick was demonstrated arthrographically.