Severe irreducible slipping of upper femoral epiphysis: a review of 14 cases treated by subtrochanteric osteotomy

Children with signs of slipping of the upper femoral epiphysis often present in an Accident Service, particularly after a severe, acute slip. In some cases the displacement is irreducible and correction of the persistent deformity by either cervical or trochanteric osteotomy is required. This paper is a review of 14 cases of irreducible slipped upper femoral epiphysis treated by subtrochanteric osteotomy. Clinical and radiological assessment of these cases some years later shows a high proportion of successful results and suggests that this is a safe and satisfactory method of treating this condition.     

Prevention of extensor lag after indicis proprius tendon transfer.

An experiment on fresh cadaver hands showed that a longitudinal incision of the hood did not affect index extension when traction was made on the common extensor tendon, but that excision of a portion of the hood containing the indicis proprius caused an extensor lag. The lag was eliminated by repair of the hood, providing that the closure was not too tight to prevent normal excursion of the hood. These findings were correlated with findings in patients who had undergone indicis proprius tendon transfer. Extensor lag after indicis proprius transfer is not caused by removal of the force of the tendon per se, but by factors which cause either disruption of normal hood function or tethering of its normal excursion.     

Denis Browne: Maverick or Master Surgeon?

The current generation of surgeons may remember Denis Browne only as an inventor of surgical instruments which few people use, an innovator of procedures condemned as inadequate, and a personality bristling with controversy: a maverick indeed. And yet this assessment belies his influence as the founder of modern paediatric surgery in the development of British surgery. Further, his innovative operations in a range of paediatric lesions were revolutionary in the context of the time. Browne was born in 1892 and educated in Australia, although his whole surgical career was in England. He had a remarkable family background; unique Australian experiences in childhood, when he commenced to display independence and individuality of spirit, through University, where he gained ‘Blues’ in tennis and shooting, to war, where he served in Gallipoli and France; and to controversies that surrounded him in his battle to establish paediatric surgery as a legitimate surgical discipline. He certainly had a prickly personality and a particular venom reserved for orthopaedic surgeons and anatomists, but his achievements may have been possible only by one possessed of such a strong and towering character.     

Increasing Public Interest in Stem Cell Injections for Osteoarthritis of the Hip and Knee: A Google Trends Analysis

BackgroundStem cell injections are being offered to patients as a nonoperative treatment for osteoarthritis of the hip and knee. To our knowledge, no peer-reviewed data exist to document the usage frequency of these injections nor to quantify the public interest in these injections. We sought to use Google Trends to provide a quantitative analysis of interest in hip and knee stem cell injections at the population level.MethodsGoogle Trends search parameters were set to obtain query data from January 2010 through December 2017. ‘Arthritis,’ ‘osteoarthritis,’ ‘stem cell,’ ‘injection,’ ‘knee,’ and ‘hip’ were entered in various combinations to obtain the highest yield search volume. Trend analyses were performed.ResultsSix linear models were generated to show trends in the volume of searches for the United States and the World. Model fit was good, and regression analysis showed significant trends over time for all searches. Use of search terms increased significantly over time (all models P < .001). Adjusted R-square values ranged from 54.4% to 78.1%. All trends showed an upward trajectory for the entirety of the study time period.ConclusionThere has been a marked and statistically significant rise in search query volume related to stem cells and osteoarthritis of the hip and knee since 2010. Online interest in stem cell injections may suggest increased utilization of these procedures. Well-designed clinical studies are required to keep pace with the rising popularity and public interest in this intervention for hip and knee arthritis.     

Methodological problems in studies of burn survivors and their psychosocial prognosis

As the psychological adjustment of burn survivors is a subject of increasing interest, 21 studies on psychosocial adjustment to burns in adults and children are reviewed. These studies are commonly cited as a basis for determining the direction of future research. Eight methodological guidelines are applied to these studies of prognosis. Limitations are identified with the major focus of the paper being to assist in the development of more rigorous methodology in order to promote the optimal rehabilitation for burn survivors.     

Sir Denis Browne,the father of modern pediatric surgery

Sir Denis John Wolko Browne (1892–1967), while not the first in the British Isles to devote his entire surgical practice to pediatric surgery, is accepted as “the father of pediatric surgery in the United Kingdom.” He made contributions to operations as varied as tonsillectomy, pyloromyotomy, and hypospadias repair, and provided fundamental insights into the proper treatment of club foot, congenital dislocation of the hip, and cryptorchidism. He introduced the transverse laparotomy incision, primary repair of congenital intestinal obstruction, and the end-to-back anastomosis for intestinal atresia, techniques so commonly used that it is difficult to think of pediatric surgical operations done any differently. In addition, he invented the elegant Denis Browne retractor that remains in use today, one of the few eponymic instruments known by its originator's first and last name. He was among the founders of the British Association of Pediatric Surgeons, one of the first professional organizations in the field, and served as its first president. His legendary status was enhanced by an acerbic temperament that often surfaced in an outspoken and uncompromising advocacy on the behalf of the proper care of children. A larger-than-life figure in pediatric surgery, Browne's legacy is so wide-ranging and enduring that his unofficial title has been broadened to “the father of modern pediatric surgery.”     

Patients With Multiple Sclerosis are at Increased Risk for Postoperative Complications Following Total Hip and Knee Arthroplasty

BackgroundMultiple sclerosis (MS) is a chronic inflammatory demyelinating disease affecting the central nervous system. Patients with MS are living longer due to improved medical therapy and thus the demand for arthroplasty in this population will increase. The objective of this study is to evaluate MS as a potential risk factor for postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA).MethodsPatients with a diagnosis of MS who underwent THA or TKA from 2005 to 2014 were identified in a national insurance database. Rates of death, hospital readmission, emergency room visits, infection, revision, and dislocation (for THA) or stiffness (for TKA) were calculated, in addition to cost and length of stay. MS patients were then compared to a matched control population.ResultsIn total, 3360 patients who underwent THA and 6436 patients who underwent TKA with a history of MS were identified and compared with 10:1 matched control cohorts without MS. The MS group for both TKA and THA had significantly higher incidences of hospital readmission (THA odds ratio [OR] 2.05, P < .001; TKA OR 1.99, P < .001), emergency room visits (THA OR 1.41, P < .001; TKA OR 1.66, P < .001), and infection (THA OR 1.35, P = .001; TKA OR 1.32, P < .001). MS patients who underwent THA had significantly higher rates of revision (OR 1.35, P = .001) and dislocation (OR 1.52, P < .001). Diagnosis of MS was also associated with significantly higher costs and hospital length of stay for patients undergoing both TKA and THA.ConclusionA diagnosis of MS is associated with increased risk of postoperative complications and higher costs following both THA and TKA.     

Oral necrosis accompanying giant cell arteritis

Necrosis of the oral tissues developed in two elderly patients following their admission to the hospital for hypothermia and massive subcutaneous blood loss, respectively. One had necrosis of the fingertips, a feature sometimes associated with giant cell arteritis. Biopsy of the oral lesion in this patient demonstrated an ischemic catastrophe. Although these vascular accidents arose without histologic confirmation of giant cell arteritis, the two consultant physicians and the consultant dermatologist in charge of these patients considered the diagnosis to be that of giant cell arteritis.     

Central dislocation of the hip with complications.

A case of severe central fracture-dislocation of the acetabulum is described. This lesion was complicated by a small-bowel rupture and occlusion of the iliac vessels. In order to reduce the dislocation, iliopubic osteotomy and excision of the hip joint capsule was necessary.