Eilif Larsen

Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result.

The factors predisposing to recurrent dislocation and the results of conservative treatment were investigated in 79 cases of patellar dislocation. Patella alta and subluxation were significantly more common in patients without than in those with a history of injury. No single predisposing factor caused more redislocation than any other. The tendency to redislocation was significantly greater in patients younger than 20 years of age than in those older than 20 years of age at the time of primary dislocation. Corroborating reports in a large literature on the disorder, the present experience validates conservative management for primary dislocations and surgical treatment for redislocations of the patella.

Partial versus total meniscectomy. A prospective, randomised study with long-term follow-up

Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total meniscectomy in a random manner. The results were compared at one year and at 6.3 to 9.8 years (median 7.8). After one year more patients with partial meniscectomy (90%) than with total meniscectomy (80%) had no complaints. At the later review these figures were 62% and 52%, respectively (p = 0.18). However, patients with partial meniscectomy had higher functional scores. The deterioration in function between the first review and the second showed no significant difference in the two treatment groups. The incidence of mediolateral instability rose from 8% to 47% and was more frequent after total than after partial meniscectomy. Between the two reviews the radiological signs of knee degeneration increased with no difference between the two treatment groups.

Metastasis size in pathologic femoral fractures

Radiographic assessment was made of metastases in 69 consecutive patients with pathologic femoral fractures. The following variables were considered: width of metastasis, ratio between width of metastasis and bone, axial length of cortical destruction, and proportion of cortical bone destroyed of the circumference. Differences in size of the metastases were not related to location in the femur or histologic type. In 62 of 69 fractures the ratio between width of the metastasis and bone was greater than or equal to 0.60, axial cortical destruction in the neck was greater than or equal to 13 mm and in other parts of the femur greater than or equal to 30 mm, and cortical destruction of the circumference greater than or equal to 50 percent. Prophylactic internal fixation need not be considered for femur metastatic lesions that do not reach these limits.

Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation.

The functional results of 28 cases of rupture of the quadriceps and patellar tendons are reported. Excellent or good results were noted in 15 of 18 quadriceps and 7 of 10 patellar tendons. Radiographic comparison with the opposite knee disclosed incongruences between the patella and the femoral groove in the tangential view and/or cranial-caudal position of the patella in the lateral view in 13 of the quadriceps tendon ruptures and seven of the patellar tendon ruptures. Patients with residual pain had patellofemoral incongruity but since two-thirds of the patients with incongruity were asymptomatic, incongruity alone may not be the cause of the symptoms. There was no positive correlation to muscular strength or range of movement. Nevertheless, exact adaptation of the patellar tendon and periarticular tissue seems necessary to obtain correct patello-femoral articulation. Reinforcement of the tendon with a wire cerclage is recommended to decrease the tension on the suture line and the consequent risk of a secondary rupture. In acute ruptures of the quadriceps tendon end-to-end sutures are sufficient.

Experimental Instability of the Ankle: A Radiographic Investigation

For determination of the optimal position in examining the ankle joint for anterior drawer sign and talar tilting, 12 legs freshly amputated above the knee were radiographically examined after successive transection of the lateral ankle ligaments in three different sequences. Apparatuses secured the position of the ankle joint in 25 degrees of inward rotation and 10 degrees and 30 degrees, respectively, of plantarflexion. Examination for anterior drawer sign gave significantly greater displacement with the foot in 10 degrees than with the foot in 30 degrees of plantarflexion and was most pronounced after the cutting of the anterior talofibular ligament. Examination for talar tilt gave a non-significantly greater displacement at 10 degrees of plantarflexion, except when cutting both the posterior talofibular and the anterior talofibular ligament. Isolated cutting of the calcaneofibular ligament gave only little displacement irrespective of the method used. Radiographic examination should be performed with 10 degrees of plantarflexion to obtain maximal displacement and 25 degrees of inward rotation of the leg to obtain a free ankle mortise in the anteroposterior projection and concentric arcs of the joint surfaces in the side projection.

Tension-band wiring of olecranon fractures with nonsliding pins: Report of 20 cases

Twenty consecutive patients with displaced fractures of the olecranon were operated on using the tension-band wiring technique with a nonsliding pin. The patients were followed until clinical and radiographic healing or removal of the implant. Healing was uneventful in 19 patients after a median of 6 weeks. Redislocation occurred in 1 patient with a severely comminuted fracture. The design of the nonsliding pin eliminates outward pin migration, as well as migration into the medullary canal.

Tendon transfer for lateral ankle and subtalar joint instability

Seventy-three patients suffering from lateral instability of the ankle joint, bilateral in 6 cases and combined with subtalar instability in 25, were operated on using the distal part of the peroneus brevis tendon. The tendon was pulled through two bore canals in the lateral malleolus and fixed in a bore hole in the calcaneus. The direction of the tendon in relation to the calcaneus and the talus was varied depending upon the type of instability. At 9 and 24 months follow-up, all but 2 patients had substantial reduction of the radiographically measured instability. No subtalar instability could be disclosed, and all the patients could return to normal levels of activity. The operation can be recommended for chronic lateral ankle and subtalar joint instability.

Remodeling of angulated distal forearm fractures in children

Seventy children treated for distal forearm fractures were clinically and roentgenologically reexamined with a median follow-up time of 3.5 years (range, 1.5-6.0 years). The angulation of the fractures and of the epiphyseal plates was measured at the time of healing and at the follow-up examination. The patients were divided into three age groups of 0-5 years, 6-10 years, and 11-15 years at the time of fracture. In children younger than 11 years of age with residual angulation after distal forearm fractures, the change of orientation of the epiphyseal plate toward normal seemed to account for nearly all the actual correction at the site of fracture, up to 28 degrees. In children older than 11 years of age the capacity of correction of the orientation of the epiphyseal plate was preserved, but its influence upon the correction of distal forearm fractures decreased. This did not prevent correction of possible residual angulation at the fracture site--up to 18 degrees. This may be because, in this age group, appositional bone formation and resorption are the most important remodeling factors. The importance of the orientation of the epiphyseal plate is related to the distance between the fracture site and the epiphyseal plate and by the age of the patient.

Dislocation of the tibialis posterior tendon in two athletes

Dislocation of the tibialis posterior tendon occurred in an 18-year-old man and in a 36-year-old woman during running activities. Several years earlier both patients had suffered minor injuries to the affected ankle. The mechanism of the current injury was dorsal flexion and inversion of the foot. Suturing the flexor retinaculum to the posterior margin of the medial malleolus obtained good results in both cases. Dislocation of the tibialis posterior tendon is rare, but should be considered in athletes with even minor traumas to the foot accom panied by pain on the inside of the ankle.

The HPC-Device: A Method to Quantify the Heel Pad Shock Absorbency

Previous studies have indicated that the shock absorbency of the heel pad is significant in the pathophysiology of pain conditions connected with heel strike. The purpose of this study was to develop a simple clinically usable method for quantification of the heel pad shock absorbency. The results of our efforts was the HPC-device which consists of a fixing device and a transducer. The HPC-device was found suitable in the evaluation of the heel pad force/deformation characteristics. The reproducibility of heel pad deformation was 0.96. Tests of six cadaver heel pads revealed a high correlation between the HPC result and the shock absorbency found by drop tests. In a normal material (200 heel pads), it was found that the shock absorption decreased with age and that men had significantly higher shock absorbency than women. Men also had significantly thicker heel pads than women. However, there was no linear correlation between the thickness of the heel pad and the shock absorbency, although the thinnest heel pads had the lowest shock absorbency. The HPC-device was found clinically usable and will be used in further testing of the significance of heel pad shock absorption for the development of heel strike dependent over-use injuries.