Sequential use of technetium 99m MDP and gallium 67 citrate imaging in the evaluation of painful total hip replacement.

Fourteen patients with 20 total hip joint replacements were studied for 14 painful prosthetic hips. Clinical examination, plain film radiographs and 99Tcm-MDP bone scans failed to differentiate between infection and mechanical loosening of a prosthesis. Sequential use of 99Tcm-MDP and 67Ga-citrate bone scans were performed in an attempt to discover underlying infectious process. Increased focal uptake of both radiopharmaceuticals over the same hip indicated an infectious process responsible for prosthetic loosening. There were no false positive gallium examinations. Sequential use of 99Tcm-phosphate compounds and 67Ga-citrate is recommended for differentiation between mechanical loosening of a prosthesis and loosening of a prosthesis secondary to an infectious process.

The use of external skeletal fixation in the treatment of fractures of the humeral shaft.

A method of external fixation is presented which has been applied in 8 patients with a fracture of the humeral shaft. The indications and technique are described.

The fate of injected trigger fingers.

Patients who were scheduled for surgical release of their trigger fingers underwent an injection of the involved tendon sheath prior to surgery. In thirty-six patients the injection of methylene blue was undertaken in a proximal-distal direction and in forty-three the direction of the injection was reversed. The success rate of the injections was 61 per cent. in the proximal distal group and 37 per cent in the second group. There was no significant statistical difference with regard to age, but duration of the disorder and mode of injection regarding the different fingers did have statistical significance.

Anterior transposition of the ulnar nerve.

Twenty-four patients with 26 ulnar neuropathies in the elbow region were treated by anterior transposition of the ulnar nerve. The dominant arm was involved in 14 of these patients. Improvement of paresthesia was found in 17 out of 21 (75 per cent) in this series of patients; 10 out of 18 (55 per cent) had improvement of sensation; 7 out of 14 (50 per cent) had less pain; 10 out of 14 (71 per cent) showed an increase in motor power, but only 2 out of 12 patients (16 per cent) with long-standing muscle atrophy showed any improvement in their condition. Electromyographic studies (EMG) were carried out before and after operation. The postoperative studies revealed increased motor conduction velocity within the elbow segment of the ulnar nerve in 15 patients. Slowing in ulnar nerve conduction velocity was found in 3 patients, and in 8 the EMG remained unchanged. Our EMG series indicated that patients with a conduction velocity of less than 40 m/s will certainly benefit more from anterior transposition of the ulnar nerve than will patients whose measurements are within the normal range.

Rigid fixation in diastasis of symphysis pubis.

Two cases of Peltier's Type II C fracture of the pelvis without any internal organ involvement are presented. Lack of hemodynamic or respiratory complications and failure of conservative treatment enabled open reduction and internal fixation. The resultant rigid fixation allowed an early mobilization and contributed to the rapid recovery of these aged patients.

Leg lengthening in achondroplastic children.

Bilateral simultaneous elongation of the lower limbs was performed in 3 achondroplastic children. A total of 10 bones were elongated with Wagner's distraction apparatus, mainly by a modified Wagner technique. Maximal elongation of 34 to 44% of the original bone length resulted in relatively minor complications. Elongation of the lower limbs in achondroplastic children improves trunk-to-lower-limb proportions.

Osteoarthritis of the trapezio-metacarpal joint. Results of treatment with a silicone cap implant.

The results of surgical treatment for arthritis of the first carpometacarpal joint using Kessler's silicone implant were examined in a group of 23 patients. The mean follow-up period was 24 months. Pain relief was obtained in 18 patients (78 per cent), functional improvement in daily activities in 16 patients, and power of pinch and power of grasp were improved in 10 out of 13 patients. Limitation of abduction complicated surgery in 6 patients. A high incidence of subluxation was found without correlation to the subjective results. Most of our patients were satisfied with the functional end results.