Marvin H. Meyers

Fracture of the Intercondylar Eminence of the Tibia

1. Fracture of the intercondylar eminence of the tibia, although not a common fracture, occurs more frequently in children than adults. Its greatest incidence is between the ages of eight and thirteen. See table in the PDF file 2. In children, this fracture occurs as an isolated injury without damage to the other supporting ligaments or gliding surfaces of the knee joint; the prognosis for complete recovery without difficulty is excellent. 3. In adults, fracture of the intercondylar eminence of the tibia is so often accompanied by serious injury to the supporting structures of the knee or other bone injury that serious permanent disability often results. 4. Fractures of the intercondylar eminence of the tibia in children may be divided into three types as demonstrated by roentgenograms: Type I, in which there is no dislodgment of the fragment from its bed of origin; Type II, in which there is partial dislodgment of the fragment, but still good apposition of a large portion of the avulsed fragment; and Type III, in which there is complete dislodgment of the avulsed fragment from its bed and no bone apposition of the fragment. 5. Type I and Type II fractures of the intercondylar eminence of the tibia require only immobilization for a length of time adequate to allow bone union. Open reduction is not indicated in Type I and Type II fractures. 6. Forceful manipulation of the knee into hyperextension with the patient under anaesthesia is not indicated. 7. Type III fracture of the intercondylar eminence of the tibia with complete dislodgmnent of the fragment requires open reduction followed by immobilization. 8. Elaborate metallic internal fixation of the fragment is not required.

Traumatic dislocation of the knee joint

The results in thirty-three of fifty-three traumatic dislocations of the knee followed for more than one year confirmed our conclusion, made in 1971, that early repair of all torn ligaments gives the best results, and that the vascular status following this injury must be observed carefully since vascular repair or thrombectomy within eight hours of injury gives the best chance of preventing gangrene of the leg. The twenty associated fractures in these thirty-three patients were treated successfully with conventional methods, except for three displaced fractures of the medial tibial plateau in which closed reduction failed and internal fixation was required.

Traumatic Dislocation of the Knee Joint: A Study Of Eighteen Cases

Eighteen traumatic dislocations of the knee treated at the Los Angeles County-University of Southern California Medical Center in recent years have been analyzed.The findings in this series differ from those in some of the studies reported in the literature. No one individual has had enough experien

Closed biopsy of musculoskeletal lesions.

Five hundred and thirty-one closed biopsies have been done in our general hospital since 1967. Four hundred and eighty-four were for lesions of bone and forty-seven were for soft-tissue lesions. More than half of the lesions were infections or nonspecifically reactive. The procedure was done under local anesthesia in 73 per cent and roentgenographic or image-intensifier control was generally required. The Craig needle was used for cancellous bone near vital structures; the Michele trephine, for cortical or sclerotic bone at a distance from vital structures; and a special needle was used for soft tissue. Closed biopsy provided an adequate specimen that was accurately diagnosed in 66 per cent of bone lesions and in 76 per cent of soft-tissue lesions. This compared favorably with both aspiration and open-biopsy success rates reported by others, and was accompanied by a 1 per cent complication rate, mostly neural and mostly in association with vertebral lesions.

Treatment of displaced subcapital and transcervical fractures of the femoral neck by muscle-pedicle-bone graft and internal fixation. A preliminary report on one hundred and fifty cases.

Beginning in 1967, all qualified patients (under seventy years of age, ambulatory with a displaced femoral fracture in the neck or subcapital) were treated either by use a fibular graft (twenty-one not considered in detail in this report) or by an iliac graft with quadriceps muscle pedicle in addition to Hagie pins. Four of the 150 patients were lost to follow-up. There were seven deaths and three infections which required removal of the femoral head. Of the remaining 136 patients, there were fifteen non-unions (11 per cent). When, in addition, a posterior defect was found and was filled with bone graft, union occurred in 97 per cent (sixty-four of sixty-six). Of the fifteen non-unions, eight had unsatisfactory reductions or were in uncooperative patients. Late segmental collapse occurred in five patients (of sixty-three followed eighteen or more months) and varus position in sixteen. At follow-up, five patients were practically confined to a wheel chair, fifteen used a walker and seventeen a cane, while the rest were freely ambulatory.

Collateral ligament laxity of the knee. Long-term comparison between plateau fractures and normal

Bilateral varus-valgus knee-stress roentgenograms were made in 208 patients with unilateral single tibial-plateau fracture. Martins so-called clear space was used to measure the laxity of the collateral ligaments and statistical analysis showed no increased laxity in the possibility injured ligaments. A vacuum phenomenon was produced in 36 per cent and ligament calcification was noted in 16 per cent of the knees tested.

Fracture about the ankle joint with fixed displacement of the proximal fragment of the fibula behind the tibia.

Its ,January U)47, Bosw’oi’th reported a series of five cases of fractured ankle in which a situatious existed that prevented adequate reduction. He called this “ posterior fixation of the fibula hehitsd the tibia”. He Poitited out. that this situat.ioui is not recognizedunless otse is awau’e that it (‘an occul’ ausd that reductioti is possible only through open operation. The article (‘leal’lv set fou’th the (liagnostic criteria, the mechanism, ausd the pathology en(’(iutstet’e(l. Re(’eustly, Flemitsg atl(1 Sussith reported a similar case. However, they were able to reduce the fracture without opeu’atioii. Soon after Bosworth’s article appeared, the author was cousfrousted with just such a situation ausd, fortuuiately, recognizing the type of fractw’e from Bosw’orth’s description, it was possible to secure an adequate open