Edward D. Henderson

Chondrosarcoma, a surgical and pathological problem; review of 212 cases.

1. Chondrosarcoma is a neoplasm of slow growth that usually kills by local enlargement but that may metastasize through the blood stream or the lymphatic system. It is important to differentiate it from the non-malignant chondromatous variants. 2. Microscopic examination of biopsy material permits prediction of malignant course. 3. Local control of the tumor by adequate surgical treatment is the chief problem in therapy. Recurrence of the tumor in the proximal part of the extremity or in the trunk represents an irrevocable failure of treatment in most cases. 4. The ease with which chondrosarcoma implants locally in surgical wounds, including biopsy wounds, constitutes a major problem in management. 5. Conclusions as to the results of treatment of chondrosarcoma that are based on follow-up periods of less than ten years after the last surgical treatment are invalid. 6. Osteogenic sarcoma with a prominent chondroid component should not be grouped with chondrosarcoma.

Results of the surgical treatment of spondylolisthesis.

A review of the literature indicates that the recent consensus is that spondylolisthesis is an acquired anomaly. The cause appears to be either a single major trauma (which is very rare) or a series of minor traumata that result in stress fractures through the pars interarticulars or the pedicles of the vertebrae involved. This study concerns 216 patients operated on consecutively. Spondylolisthesis was present at the lumbosacral level in 190 of them; between the fourth and fifth lumbar segments in nineteen; and between the third and fourth lumbar segments in seven. In only seven cases was the slipping greater than Grade 2. The procedure performed was spine fusion except for the Gill operations in twenty-five patients. Spine fusion was established by the Meyerding techisique, and a comparison is made between results achieved with iliac bone grafts and results obtained with tibial bone grafts. In only twelve patients were plaster casts used. All other patients were allowed to be up with a belt or corset within two weeks of the day of operation, and no other form of immobilization was used. In this series, the best results were obtained for patients in whom iliac fusion was done with concurrent removal of loose dorsal elements. Iliac fusion was definitely more satisfactory, in respect to both clinical results and the percentage of successful fusion, than was tibial fusion. Removal of loose dorsal elements had no adverse effect on the number of instances of successful fusion and the procedure seemed to improve the clinical results to a significant degree. In more than 60 per cent of the patients, exploration of the nerve roots was done at the time of operation, and in forty-six instances definite protrusion or extrusion of intervertebral dises was found. This is a higher incidence of this defect than is reported in most series of spondylolisthesis.

Tendon transfers to restore function of hands in tetraplegia, especially after fracture-dislocation of the sixth cervical vertebra on the seventh.

The number of surviving patients with tetraplegia following trauma is increasing. Many of these patients are injured between time sixth and the seventh cervical vertebra. These patients have on one side, and often on both, the following muscles functioning below the level of the elbow: extensor carpi radialis longus, extensor carpi radialis brevis, brachioradialis, flexor carpi radialis, and pronator teres. By two-stage surgical transfer of tendons in each upper extremity, active extension and flexion of all digits, the correction of clawing, and opposition of the thumb can be accomplished. These tendon transfers utilize time function of automatic motion of the fingers that accompanies movement of the wrist. Arthrodesis of the wrist rarely, if ever, should be done in patients who have tetraplegia. Patients in whom such tendon transfers are done regain the function of hooking, light pinching, and grasping. They are able to discard special hand appliances and become more independent.

Transfer of wrist extensors and brachioradialis to restore opposition of the thumb.

Transfer of Wrist Extensors and Brachioradialis to Restore Opposition of the Thumb Edward Henderson; The Journal of Bone & Joint Surgery

The use of hydrocortisone acetate (compound F acetate) in the treatment of some common orthopaedic conditions.

A study has been made of the results after local injections of hydrocortisone acetate (compound F acetate) in the treatment of some common orthopaedic conditions. In the treatment of rheumatoid arthritis, marked improvement was noted in the condition of 49 per cent. of the injected joints, whereas improvemenst was moderate in 35 per cent. and mild in 13 per cent.; no relief was obtained in 3 per cent. of the joints into which this material was injected. The relief of symptoms persisted for two to eight days in most cases. When improvement was more prolonged, some additional factor usually was present; among the more important of these was general improvement in the status of the rheumatoid arthritis, either sponstaneous or induced by other forms of treatment. Brief systemic effects were noted in 21 per cent. of the patients who had rheumatoid arthritis and who received injections of hydrocortisone acetate. Intra-articular injection of hydrocortisone acetate appears to be a helpful adjunct in the treatment of rheumatoid arthritis, especially in patients who have involvement of only a few joints or in whom other measures of treatment are generally adequate except in a few joints. Marked improvement occurred in 38 per cent. of the injected joints in patients who had osteo-arthritis; moderate improvement was noted in 34 per cent., mild in 7 per cent., and insignificant in 21 per cent. The improvement usually lasted for one to eight days; when more prolonged improvement was noticed, other factors, such as increased rest ansd limitations of weight-bearing activities, appeared to play a role. This form of treatment apparently is helpful as an adjunct in the management of osteo-arthritic patients, particularly those suffering from acute or subacute flare-ups or those in whom maximal applications of other conservative measures has failed to relieve discomfort. Limited experience with intra-articular injections of hydrocortisone acetate in the treatment of traumatic synovitis, psoriatic arthritis, and acute gouty arthritis suggests that its temporary antirheumatic effect might be helpful in the management of these conditions. Use of hydrocortisone acetate in the treatment of epicondylitis (tennis elbow) has proved discouraging to date. The most favorable response to local treatment by injection of hydrocortisone acetate apparently occurs in self-limited conditions, such as traumatic bursitis. Injection of hydrocortisone acetate appears to hasten the recovery and shorten the period of convalescence.

Traumatic Anterior Dislocation of the Hip with Acute Common Femoral Occlusion in a Child

Traumatic anterior dislocation of the hip rarely occurs in children . Choyce collected and review-ed ten cases from the literature prior to 1924. Since then, eighteen additional cases have been reported in the English-language literature 7,8.9,10,51,58,24,28 We Isowreport an additional case with an unusual complicatiors, acute occlusion of the commo s femoral artery. This combination has been reported its f-he English literature only once before “.