Nils E. Westlin

Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study.

Two hundred consecutively seen patients who had an injury to either the anterior cruciate ligament or the medial collateral ligament, or both, were randomly allocated to treatment by either conservative or a surgical regimen. Injuries to the medial collateral ligament could not be demonstrated to benefit from surgical treatment in any respect--with or without surgery the results were excellent. With injuries to the anterior cruciate ligament, recovery was more rapid without surgery but otherwise the results differed between the groups in only one respect: the pivot-shift test was more often positive after conservative treatment. The results were good in both treatment groups even though most of the patients who had an injury of the anterior cruciate ligament were somewhat less pleased with the outcome after a period of time.

No effect of piroxicam on achilles tendinopathy : a randomized study of 70 patients

70 consecutive adult, nonrheumatic patients with a painful achilles tendinopathy were randomized to treatment with either a nonsteroid antiinflammatory drug (piroxicam) or placebo. Both groups received adjunct treatment with a period of rest combined with stretching and strengthening exercises. 52/70 cases were engaged in various sports, notably running. All subjects were evaluated on days 3, 7, 14, and 28 with respect to pain, tenderness, swelling, ankle joint movement and muscle strength. Results were judged from residual symptoms and an overall assessment of the efficacy. No differences were seen between the groups at any time during the study. The overall result was identical with a rate of success slightly better than 50 percent which corresponds to the placebo response reported in other studies.

Chronic calcaneal pain in athletes: Entrapment of the calcaneal nerve?

In 11 heels in 10 athletes with chronic heel pain unre lieved by conservative therapy, the symptoms and physical findings caused a suspicion of entrapment of the calcaneal branches of the tibial nerve. The nerves were, therefore, surgically decompressed. No macro scopic signs of compression of the nerves were noted, but an entrapment of the anterior calcaneal branch could occur where the nerve passes between the tight and rigid edge of the deep fascia of the abductor hallucis and the medial edge of the os calcis. Followup of 58 months after surgery revealed that 10 of the 11 heels were asymptomatic and the patients had re sumed athlete participation after an average of 5 weeks.

Morphological bone changes in shin splints.

Intermittent pain in the lower leg with excessive physical activity is not unusual, and in athletes and soldiers, may even be disabling. This condition is sometimes referred to as “shin splints,” a concept which has also been accepted in the medical literature: “The standard nomenclature of athletic injuries shin splints, is defined as pain and discomfort in the leg from repetitive running on a hard surface or forcible, excessive use of foot flexors; diagnosis should be limited to musculotendinous inflammations, excluding fracture or ischemic disorder.”2 This definition, broad because of the difficulties with differential diagnosis, includes several pathologic conditions, e.g., compartment syndromes and stress fractures, and inflammatory reactions of tendons, tendon attachments and muscles.” Shin splints may be distinguished by pain along the medial edge of the tibia, found particularly among runners and jumpers. This particular entity has also been referred to as “the medial-tibia1 ~ y n d r o m e . ” ~ . ~ Roentgenographic examinations and isotopes scintigraphies4,5,8,9,12.141 6-1 8 have, in some instances, diagnosed stress fractures as the cause of the pain. However, in most cases,

Bone mass in primary coxarthrosis.

The bone mineral content was measured by gamma absorptiometry at two levels on the forearms, proximally on the shafts and distally close to the wrist, in 53 cases of primary coxarthrosis. The bone mineral content at the distal measuring site, representing trabecular bone, was increased in coxarthrosis cases as compared with normal controls; the difference was significant only in women. At the proximal measuring site, representing cortical bone, there was no significant difference. The findings support the concept of impairment of the resilience of the juxta-articular trabecular bone as one factor contributing to the pathogenesis of arthrosis.

The incidence of Achilles tendon rupture

During the years 1950-1973, 229 cases of Achilles tendon rupture were diagnosed in the city of Malmö. More than half of the injuries were caused by sporting activities, the most common being badminton and football (soccer). Ruptures caused by injuries other than sports injuries were found in considerably older subjects. During the period investigated the incidence of Achilles tendon rupture increased in the city more than could be accounted for by changes in the population. This increase could only be partly explained by the increasing interest in sporting activities in the population at risk.

THE BONE MINERAL CONTENT IN THE FOREARM OF WOMEN WITH COLLES' FRACTURE

Buhr & Cooke (1959) pointed out the rather specific epidemiological pattern of fracture of the distal end of the forearm. This pattern was studied in greater detail by Alffram & Bauer (1962) and it was demonstrated that the risk of fracture in women over the age of 40 increased dramatically. Later, Alffram ( 1964) demonstrated that women with fracture of the upper end of the femur also more frequently than could be expected from the incidence of the population at risk had sustained fracture of the distal end of the forearm. Bauer (1960) interpreted data on fracture incidences and suggested that fracture of the distal end of the forearm is an early symptom and fracture of the upper end of the femur a late symptom of disturbed skeletal metabolism. The objective of the present study was to compare the bone mineral content of the forearm in women with Colles’ fracture and in a control sample of women without fracture.

Ibuprofen and Compression Bandage in the Treatment of Ankle Sprains

One hundred patients with sprained ankles were randomly allocated to treatment with Ibuprofen 800 mg X 3 daily and placebo and to treatment with two qualities of compression bandaging. Neither Ibuprofen nor high quality bandaging had a significant effect on the swelling, pain or tenderness.

Bone mineral content in the forearm after fracture of the upper limb

The bone mineral content was measured by gamma absorptiometry in patients who had sustained fractures of the upper limb. Measurements were taken on the shafts of the forearm and in the trabecular bone immediately proximal to the wrist. Fractures of the surgical neck of the humerus and fractures of the shaft of the humerus did not significantly influence the bone mineral content of the ipsilateral forearm. Fracture of the radius and the ulna, however, caused a 15% loss of the bone mineral content in the trabecular bone proximal to the wrist, whereas the mineral content on the shafts of the fractured forearms increased or decreased depending on the fracture site. The findings suggest that measurements of bone mineral content of the forearm are not necessarily invalidated if there has been a fracture of the same limb. Only if the forearm itself is fractured should measurements on this site be avoided.

Anterior tibial compartment pressure during race walking

In 14 race walkers the intramuscular pressure in the anterior tibial muscle was measured with a wick cath eter. At rest the pressure was 10 to 15 mmHg and increased by a factor of 10 during full speed walking. Those walkers who experienced pain in the anterior tibial muscle also had a higher than average pressure. Fasciotomy decreased the intramuscular pressure and relieved the pain.