Carl E. Badgley

Stabilization of the cervical spine by anterior fusion.

This paper recounts chronologically the development and application of an original procedure for anterior fusion of the cervical spine. Twenty patients with various pathological lesions of the cervical spine were treated by this operation. No complications specifically related to this technique occu

Correlation of Postreduction Roentgenograms and Thirty-One-Year Follow-up in Congenital Dislocation of the Hip

Fifty-three patients with seventy-five congenital dislocations of the hip were evaluated on the average of thirty-one years after reduction. The adequacy of reduction was determined roentgenographically by comparison with fifty normal hips from a comparable age group. The adequacy of the initial reduction was then correlated with the end-result evaluation based on pain, range of motion, and roentgenographic appearance of the hip. Only eleven of the seventy-five hips were normal with respect to freedom from pain, range of motion, and roentgenographic appearance after thirty-one years. Seven hips, perfectly reduced, were normal at follow-up. Fourteen other hips, also reduced to a theoretically normal position, were not normal by these criteria. Only four hips, outside the range of a theoretically normal reduction, were normal thirty-one years later. It can be concluded that a perfect reduction must be achieved if one is to expect the long-range result to be a normal hip. However, all perfect reductions were not followed by the development of perfect hips. This finding indicates that a perfect reduction is a significant factor, but certainly not the only one. Prevention of the vascular complications of reduction and perfection in the initial reduction emerge as the factors which in this series would have improved results.

Operative therapy for slipped upper femoral epiphysis; an end-result study.

With careful selection of cases and the proper operative approach, the authors feel that open operative correction by transcervical osteotomy and internal fixation gives the best chances for good function of the hip joint. In the slipped upper femoral epiphysis with malunion, because of the re-establishment of a normal anatomical relationship, the chance of this good function persisting into later life is excellent. Sixty-eight per cent. of the hips operated upon by this method had good hip-joint function, some having been observed as long as twelve years after the operation. We feel that this percentage justifies our continuance of this operative procedure. Blind fixation of the epiphyseal line in the preslipped and early phases of slipping insures against the possibility of subsequent, more extensive, displacement. Such a procedure does not predispose the hip to the development of arthritis. The two major complications arising as a result of the operations on the hip for this condition are traumatic arthritis and aseptic necrosis. Only 4 per cent. of the hips which were operated upon revealed roentgenographic evidence of aseptic necrosis; consequently it is not a frequent complication of the operation. Definite evidence of traumatic arthritis was present in 24 per cent. As this developed in two patients in whom no therapy had been attempted and in two in whom blind nailing had been performed, it has led the authors to conclude that the operative procedure is not the only factor contributing to this complication, but that some intrinsic predisposition toward this complication exists in this peculiar condition.

Radiation sterilization of homogenous-bone transplants utilizing radioactive cobalt; preliminary report.

Radioactive cobalt has been proved to be an effective means of sterilizing bone transplants. When combined with a freeze-drying process, radiation sterilization utilizing radioactive cobalt has proved an effective method of maintaining a bone-bank. It has been found that irradiated bone transplants function satisfactorily both experimentally and clinically. In 104 surgical procedures in which irradiated homogenous-bone transplants were used, five postoperative wound infections occurred. The irradiated bone transplants were not felt to be the source of these infections. The encouraging over-all clinical results in 104 operative procedures prompt continued use of irradiated homogenous-bone transplants.

HYPERTENSION, ANOTHER COMPLICATION OF THE LEG-LENGTHENING PROCEDURE. REPORT OF A CASE.

A case of hypertension complicating femoral lengthening is reported. Femoral lengthening is a difficult and formidable procedure plagued by numerous complications. It should be undertaken by only the most experienced surgeons. When entertaining the idea of doing such a procedure one must think long and carefully, leaving plenty of room to retreat. Hypertension should be added to the list of complications. The exact mechanism of the hypertension is as yet unknown.

Athletic injuries to the elbow, forearm, wrist and hand

LTHOUGH competitive sports produce more A major injuries to the lower extremity, a sufficient number of injuries to the upper extremity do occur to make a thorough review of their recognition and management worthwhiIe. Furthermore, since most of these injuries involve one of the major joints, such as the elbow or the wrist, inadequate treatment wiI1 often Iead to permanent disability. A number of factors are present which determine the type of injury sustained. Such factors are: the type of game (e.g., footbalI, basebalI, wrestling), experience and conditioning of the players, the type of forces applied to the extremity and the age of the pIayer. Since the vast majority of college athletes are beyond the age of epiphyseal closure, it is obvious that epiphyseal injuries are rarely seen in the colIege group, whereas, they are common in the junior high school and high school group. Baseball produces frequent injuries to the fingers and thumb, while football and wres-