Steen Lindequist

Fractures of the proximal humerus in children Nine-year follow-up of 64 unoperated on cases

Fracture of the proximal humerus in children is rare. The records from 1976 to 1977 of 77 patients aged 0-15 years with a fracture or epiphyseal separation of the proximal humerus were reviewed. Totally, 64 of 72 patients had a follow-up examination (median observation time 9 years). Twenty-one children had an epiphyseal separation and 51 a metaphyseal fracture. All but 1 were treated conservatively. Seven had slight sequelae at follow-up, i.e., transient pain or minor restriction of motion. The rest were asymptomatic. Full remodeling of fractures left displaced occurred in all the cases. No avascular necrosis or shortening of the humerus were found. Nonoperative treatment is appropriate for proximal humeral fractures in children, even for those with extensive displacement.

Observer variability in measurements of carpal bone angles on lateral wrist radiographs

Determinations of carpal bone angles are used in the clinical evaluation of carpal malalignment. Eleven frequently referred radiological measures in lateral projection of the wrists in 23 wrists were assessed using different definitions of axes. Interobserver- and intraobserver variations were calculated. The standard deviation of the interobserver variation ranged from 2.60 degrees to 18.15 degrees, and the intraobserver variation from 1.89 degrees to 4.66 degrees depending on the angles measured. The use of three angles for the least observer variability in assessment of carpal alignment is recommended. These angles were defined from the following carpal bone axes: radius, the line through the center of the medullary canal at 2 cm and 5 cm proximal to the radiocarpal joint; lunate, the line perpendicular to the tangent of the two distal poles; scaphoid, the tangent of the palmar proximal and distal margins, and capitate, the tangent of the dorsal margin of the diaphysis of the third metacarpal bone (substitute axis).

Prognosis of fracture of the talus in children: 21 (7-34)-year follow-up of 14 cases

14 children suffering from a fracture of the talar neck or body were examined after 21 (7-34) years. The talar neck was fractured in 10 children and the talar body in 4.3 fractures were displaced and primarily treated with reduction and immobilization. Nondisplaced fractures were treated conservatively. All fractures healed. All patients with displaced fractures had exercise-induced pain at follow-up. Of 11 patients with nondisplaced fractures only 1 had minor complaints. CT and conventional radiographs showed arthrosis in the talocrural joint and normal subtalar joints in those with displaced fractures. The radiographic findings were normal after nondisplaced fractures.

Boneloc® cemented total hip prostheses: Loosening in 28/43 cases after 3-38 months

We report our early results with 43 total hip prostheses (25 Charnley and 18 LMT) inserted during 1991 with Boneloc cement. The indication was primary arthrosis (38) and rheumatoid arthritis (5). After 18 (3-38) months, 28 stems were loose and 18 hips have been revised 1-4 years after primary surgery.

Ultrasound guided needle biopsy of skeletal muscle in neuromuscular disease.

Guided by ultrasonography percutaneous needle biopsy of skeletal muscle was performed in 24 patients, using the one hand held Biopty system and a 2 mm Tru-Cut needle. The specimens were graded with regard to diagnostic quality and utility and almost all specimens (96%) were of highest quality. The use of ultrasonography was helpful in selecting a suitable area for the biopsy and vascular structures could be avoided. The procedure was well tolerated and easy to perform, and no complications were recorded.

Osteochondral lesions of the talar dome in children A 24 (7-36) year follow-up of 13 cases

13 patients who in childhood had had osteochondral lesions (OCL) of the talar dome participated in a long-term follow-up including physical examination, computed tomography (CT) and conventional radiographs. Most of the cases were caused by trauma. Conventional radiographs showed abnormal findings in 4 cases and CT in a further one. In 3 cases the primary lesion could still be seen as an osteochondral defect, and 2 had a loose body in the joint. 3 of these 5 patients had mild symptoms. We conclude that arthrosis following OCL in childhood is infrequent and recommend conservative treatment initially. In those with persisting symptoms, additional imaging evaluation with CT and MRI is recommended.

Radiography of the Carpal Scaphoid: An Experimental Investigation Evaluating the Use of Oblique Projections

An experimental investigation demonstrating the value of oblique projections in radiographic examination of possible scaphoid fractures is described. Three cadaver specimens were used, fractured in different places, and radiographs were obtained at different angulations with respect to the vertical plane. Even non-dislocated fractures were well demonstrated and it was concluded that a p.a. projection with the tube tilted about 40° distally should always be included in radiographic examination of the carpal scaphoid.

Radiography of the Wrist: A new device for standardized radiographs

A number of methods exist for determination of carpal bone angles on lateral wrist radiographs. However, there is no general or precise definition of the angles measured. In this study the positioning of the wrist is emphasized and a device used to obtain standardized radiographs is presented. An analysis of variance of two series of patients revealed no radiological difference between the contralateral wrists in the same person. We conclude that the asymptomatic wrist can be used as normal reference in the assessment of carpal bone angles in the pathological wrist and a difference between the carpal bone angles in the two wrists in the same person exceeding 5 degrees can be considered significant.

Lack of Correlation between Ulnar Variance and Carpal Bone Angles on Lateral Radiographs in Normal Wrists

It has been proposed that negative ulnar variance is a predisposing factor to development of posttraumatic carpal ligamentous instability. However, this implies that no correlation exists between ulnar variance and carpal bone angles in the normal wrist. Carpal bone angles on lateral wrist radiographs and ulnar variance were measured in a series of 75 normal wrists. The mean ulnar variance was −0.03 mm (SD 1.56, range −5 to 5). The correlation coefficients were 0.06, −0.11, and −0.05 between the ulnar variance, and radiolunate, radioscaphoid, and scapholunate angles, respectively. A correlation between the carpal angles on lateral wrist radiographs, and ulnar variance in normal wrists could not be demonstrated, suggesting that the presence of negative ulnar variance may serve as an impartial clue to the presence of ligamentous instability.

Radiography of the Wrist

A number of methods exist for determination of carpal bone angles on lateral wrist radiographs. However, there is no general or precise definition of the angles measured. In this study the positioning of the wrist is emphasized and a device used to obtain standardized radiographs is presented. An analysis of variance of two series of patients revealed no radiological difference between the contralateral wrists in the same person. We conclude that the asymptomatic wrist can be used as normal reference in the assessment of carpal bone angles in the pathological wrist and a difference between the carpal bone angles in the two wrists in the same person exceeding 5 can be considered significant.