Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old.

Over a ten-year period, fifty-one congenitally dislocated hips in forty-one patients, whose ages ranged from twelve to thirty-six months, required open reduction. Supplemental procedures such as derotational osteotomy, pericapsular (Pemberton) osteotomy, and femoral shortening were performed as necessary. All of the patients have been followed for at least two years (average, 6.1 years). No patient had a significant limp, Trendelenburg gait, or avascular necrosis. Using Severin's classification of radiographic evaluation, twenty-nine hips (57 per cent) were rate as excellent and eighteen hips (35 per cent), as good. In our experience, open reduction of the hip together with correction of acetabular and femoral deformities affords the patient in the one to three-year-old age range an excellent chance of obtaining an anatomically satisfactory hip.

Office carpal tunnel release with wrist block and wrist tourniquet.

Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. Over the past 5 years we have performed carpal tunnel releases in the office setting using wrist block anesthesia and a wrist tourniquet. There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.

Obliteration of traumatically induced articular surface defects using a porous implant.

Trauma to articular surfaces penetrating through the subchondral bone can result in areas of incomplete healing. Intraarticular adhesions can originate from these loci of disorganized fibrous bone and cartilage and, along with the incongruous surface, limit motion. In a group of 28 white New Zealand rabbits, 44 standard size defects were created in the prepatellar intercondylar femoral grooves. Twenty-seven were filled with Proplast, a porous implant material. Seventeen were left as controls. The animals were killed at intervals from 3 to 51 weeks. The implant areas were studied grossly and histologically. Granulation outgrowth and adhesions were not seen. From 12 weeks on, normal-appearing hyaline cartilage covered the surface, and bone ingrowth was found within the implant.

Treatment of comminuted distal radial fractures with preliminary horizontal finger trap traction and a Roger-Anderson external fixation device.

Over a five-year period, 43 patients with comminuted distal radial fractures were treated with a Roger-Anderson external fixation device after the fracture was aligned in Strong's horizontal finger trap traction. Nineteen patients (21 wrists) were available for personal interview and radiographic follow-up. A 0.5-mm loss of radial height and an average loss of 2.4 degrees of palmar angulation presented. Range of motion (ROM) was excellent, stiffness was nonexistent or minimal in 81%, pain was nonexistent or minimal in 86%, and weakness of grasp was nonexistent or minimal in 81%. Complications were minimal; they included three pin tract infections, two of which required pin removal before they resolved. One patient fractured a pin that also required removal. Strong's horizontal finger trap traction and the Roger-Anderson external fixation device simplified the sometimes difficult treatment of this fracture. It seems to be most effective in young athletic individuals who have good bone stock and very comminuted fractures.