Book Review

Book reviewed in this article:
Nicholas J. Lowe & Nadim A. Shaath (eds): Sunscreens: development, evaluation and regulatory aspects.     

Radiographic Instability of the Ankle Joint After Evans' Repair

Forty-two unstable ankle joints were treated surgically by Evans' operation. the clinical postoperative results were correlated with the objective radiological stress examinations. the mean age of the patients was 29 years (15-60 years). the clinical and radiological follow-up examinations were performed 6 months after the operation. in the stress X-ray examinations a modified stress frame was used. Clinical instability was noted in four patients. in the radiological examination one patient had a pathological finding in the talar tilt test and 18 patients in the anterior drawer sign test. the radiological instability correlated poorly with the subjective end results. Six patients were estimated to have a poor result of the operation. Five of these patients had a positive anterior drawer sign in the stress X-ray examination and one had degenerative changes in the ankle. Although Evans' repair is a simple and reliable method of reconstructing ruptures of the lateral ligaments of the ankle joint, it is associated with a relatively high frequency of positive anterior subluxation on radiological stress examination. This finding can be explained by the anatomical and geometrical factors on the lateral side of the ankle joint.     

Intrauterine hypoxia as a cause of hearing impairment in children

Among more than 10,000 mothers giving birth during 1974–1977, there were 20 known cases of severe placental insufficiency in connection with hypertensive disease during pregnancy. Well-documented signs of intrauterine hypoxia were observed in all the cases. In 50% of the fetuses intrauterine growth retardation was found to be below the 10th percentile curve. In most cases the baby was delivered by means of a caesarean section. The hearing level of these infants was examined at the age of 2–5 years. In these 20 children there were no signs of sensorineural hearing loss; however, because of the size of the population, the conclusions drawn from this thorough work must be tentative. It seems that with good maternity care and thorough treatment hearing loss due to intrauterine hypoxia can be prevented.     

Total rupture of pectoralis major muscle in athletes

Total rupture of the pectoralis major muscle is rare. It may follow a severe trauma or strenuous athletic exercise or performance. Five cases of total rupture of the pectoralis major muscle treated in athletes are reported. Two of them had made an extremely exerted effort in weight lifting, one was injured during a parachute landing, one was tackled in an ice hockey match, and one injured his pectoralis major muscle while pushing himself up from a swimming pool. In two cases the diagnosis was made early and in three cases 2-4 months after the injury. All of the patients were male and were treated successfully with surgery. Later they were able to exercise their sports. The weight lifters did not go on with competitive sports.     

Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes

Summary Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6–8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.

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Zusammenfassung In einem Zeitraum von 11 Jahren wurden 15 Fälle von Ermüdungsfrakturen des Sesambeines am I. MTP-Gelenk diagnostiziert und behandelt. Das Durchschnittsalter betrug 22,3 Jahre, die Geschlechtsverteilung: 6 Frauen und 9 Männer. Alle Patienten waren Sportler, bei denen die Beschwerden während des Trainings auftraten, ohne direktes Trauma. In 8 Fällen befand sich die Fraktur im medialen, in 6 im lateralen Sesamoid und in einem Fall waren beide Sesambeine betroffen. Zur genauen Diagnose kam man durch die Anamnese, wie auch durch die Röntgen- und Isotopenuntersuchung. 10 Patienten wurden konservativ behandelt, Vermeidung excessiver Belastung und das Tragen von besseren Trainingsschuhen wurden vorgeschrieben. In 5 Fällen mußte chirurgisch vorgegangen werden, das fragmentierte, Schmerz verursachende Sesambein wurde entfernt. Die Nachbehandlung verlief komplikationslos und die Sportler konnten ihr Training nach 6 bis 8 Wochen post Op wieder aufnehmen. Die histologische Untersuchung der extirpierten Sesambeine ergab: fibrotisch veränderte Frakturflächen, was die Diagnose einer Stressfraktur bestätigte. 3 der konservativ behandelten Sportler haben immer noch leichte Beschwerden bei intensivem Training, die anderen sind beschwerdefrei.