Ian Goldie

Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion.

In an in vivo investigation of eight healthy volunteers, three dimensional ankle/foot kinematics were analyzed by roentgen stereophotogrammetry in 10° steps of motion from 30° of plantar flexion to 30° of dorsiflexion of the foot. The study included all of the joints between the tibia and the first metatarsal, as well as the talocalcaneal joint, and was performed under full body load. Although the talocrural joint was found to account for most of the rotation around the transverse axis occurring from 30° of plantar flexion to 30° of dorsiflexion, there was a substantial contribution from the joints of the arch. This was seen particularly in the input arc from 30° of plantar flexion to the neutral position, where the dorsiflexion motion of these joints amounted to 10% to 41% of the total transverse axis rotation.

Kinematics of the Ankle/Foot Complex—Part 2: Pronation and Supination

The influence of pronation and supination of the foot on the joints of the ankle/foot complex was analyzed three dimensionally by roentgen stereophotogrammetry in eight healthy volunteers. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones. The subjects stood on a platform that was tilted in 10°-steps from 20° of pronation to 20° of supination. Pairs of x-ray exposures were made in each position. Calculation of resulting joint deviations from the neutral position showed that the largest amounts of motion occurred in the talonavicular joint followed by the talocalcaneal joint, in the latter case mainly in supination. The joints proximal and distal to the medial cuneiform also participated substantially in the total motion registered. The tibia showed an average of 0.2° of external rotation for each degree of supination of the foot.

A Study of the Arterial Supply of the Patella in the Normal State, in Chondromalacia Patellae and in Osteoarthrosis

The arterial supply to the patella has been studied in 21 specimens. Fifteen were obtained at autopsy and six at amputation. Nine of the specimens were normal, six were diagnosed as chondromalacia patellae and six as osteoarthrosis. Micropaque was injected into the arteries, and the Spalteholtz clearing technique was used. Radiography was also performed. In addition to previously reported observations, arteries were found to penetrate into the patella from the interior of the quadriceps tendon, from the synovial tissue and from the medial and lateral retinaculae. Moreover, it was found that with increasing degree of cartilage destruction the arterial pattern within the patella became disturbed and irregular with formation of anastomoses.

Fracture of the neck of the talus. A clinical study.

A clinical evaluation of 46 patients treated for fractures of the neck of the talus has been made after a mean follow-up period of 6 years. The cause of injury was most frequently motor vehicle accidents (26) and falls from heights (11). In non-displaced fractures plaster with immobilization was used and displaced fractures were treated by closed or open reduction. At follow-up most of the patients complained of symptoms hampering daily activities. Objectively, excellent to good results were obtained in 75 per cent of the non-displaced fractures and in 42 per cent of the displaced. Delayed union occurred in 15 per cent. Avascular necrosis was found in 15 per cent and degenerative changes in 97 per cent. A decreased density of bone under the articular cartilage, called subchondral atrophy, was seen in 50 per cent.

Fixation of Pelvic Fractures and Dislocations: An Experimental Study on the Loading of Pelvic Fractures and Sacro-Iliac Dislocations after External Compression Fixation

A trapezoid external compression fixation frame, assembled with the Hoffman instruments, was used for stabilizing experimental injuries to the pelvic skeleton of ten cadaver specimens. The resistance to loading in a position corresponding to upright standing was tested in 17 experiments and related to the calculated load in vivo. The results indicated that ipsilateral injuries, either presenting as dislocations of the sacro-iliac joint and symphysis or as unilateral fractures of the sacrum or ilium in combination with fractures of the pubic rami could be stabilized by the external compression frame well enough to permit weight-bearing in the upright standing position. Bilateral injuries to the pelvic skeleton, vertical or oblique, could not, however, be stabilized enough to resist more than a fraction of the normal load in the upright standing position.

Total hip arthroplasty: A comparison between cemented and press-fit noncemented fixation

Abstract This study compares cemented (Charnley) with noncemented (Honnart Patel-Garches) total hip arthroplasty. 150 patients with osteoarthritis, rheumatoid arthritis, and miscellaneous conditions were randomized into either group with 75 in each. Patients were evaluated over 5 postoperative years with examinations at 6 months, at 1 year, and then annually. Each examination involved clinical assessment, objective gait analysis, and radiographic examination. The Charnley group improved faster than the HP-Garches group during the first 2 years. At the last evaluation the results were excellent or good in 79% in the Charnley group and 70% in the HP-Garches group. In the HP-Garches group midthigh pain occurred, in 64%. Five, patients with Charnley prostheses (6.7%) and 14 patients with HP-Garches prostheses (18.7% had revision surgery to correct mechanical, loosening. Standard radiography revealed radiolucent zones in both groups, but this could not be related to the clinical outcome despite radiolucency being present in all noncemented replacements on the femoral side. Objective gait analysis confirmed inferior clinical results at 6 months in the HP-Garches group. There was no significant difference between the groups at the most recent evaluation. Our findings are not consistent with earlier optimistic expectations on press-fit noncemented total hip arthroplasties

Subsidence of the femoral component in the noncemented total hip: A roentgen stereophotogrammetric analysis

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in eight noncemented femoral components of the HP-Garches prosthesis. After 2 years, seven components had subsided 0.6-3.9 mm, i.e., more than observed in some cemented prostheses. No distinct symptoms related to the micromotion appeared.

Metatarsal head resection in the treatment of the rheumatoid forefoot.

When conservative treatment in the management of the painful rheumatoid forefoot fails, surgery should be advocated. The aim is to relieve the sole from pressure on the metatarsal heads, which causes callosities on and pain in the forefoot. Various surgical procedures have been described, but they have in common to replace or remove the fat pad under the metatarsal phalangeal joints, to resect the metatarsal heads and, in doing this, restore the metatarsal ends to a flat arc. For if the intermediate metatarsals are left too long, new pressure points may develop, with ensuing pain. In this investigation a 4 1/2-year follow-up is presented of 32 patients operated on with metatarsal head resection in 59 feet. Twenty-two patients representing 39 feet were very satisfied, whereas 8 patients representing 15 feet were dissatisfied. Walking ability improved considerably; standing on toes improved; muscle power of toes improved. Despite attempting to maintain the metatarsal arc as a flat curve, this proved to be uneven in 25 feet, but did not jeopardize the results. The complications were minor and did not influence the final results. These, however, were decidedly influenced by the functional class of the patient at the time for investigation. Surgical management of the painful rheumatoid forefoot appears to be a recommendable procedure.

Intramedullary pressure of the patella in chondromalacia

SummaryDegenerative changes in load-bearing joints are often combined with altered intramedullary circulation. This may cause an alteration in intramedullary pressures. It has been said that articular symptoms are connected with a change in intramedullary pressures being high they are suspected to cause pain.In this investigation the intramedullary pressure has been evaluated in chondromalacia and osteoarthrosis of the patella. A comparison has been made with normal patellae.A biopsy needle was drilled into the intramedullary bone of the patella and connected with a registering unit.In a control group an average value of 19 mm Hg was registered. In the condromalacia group the mean intramedullary pressure was 44 mm Hg and in osteoarthrosis 37 mm Hg.

The Arterial Supply of the Odontoid Process of the Axis

A study has been carried out of the arterial supply of the odontoid process of the axis. Among the arterial sources there are paired anterior and posterior ascending arteries arising from the vertebral artery. Arteries penetrate into the odontoid process at its base from both the anterior and posterior ascending arteries. A transverse arterial arcade is formed above its top by the anastomosing anterior and posterior ascending arteries. In this investigation it was demonstrated that a branch of the ascending pharyngeal artery (from the external carotid artery) joined this arcade after passing through the canalis hypoglossi of the occipital condyle. Moreover, there were inferior and superior horizontal arteries apparently coming from the internal carotid artery, which supplied the odontoid process. It was shown that the superior horizontal arteries penetrated the anterior atlanto-occipital membrane and ran across to the supraodontoid arterial arcade. There were also arteries which reached into the odontoid ...