Tor Steinar Raugstad

Effect of Instability on Experimental Fracture Healing

Bilateral tibial osteotomy with fracturing of the fibula was performed on ten Wistar rats weighing 300--350 g. Intramedullary nailing was performed with 1.4 mm nails after reaming. On the left side solid stainless rods were used, while on the right side the nails had a middle part made of titanium-nickel wire covered with polyvinylchloride (PVC), giving the nail a high degree of flexibility. After 8 weeks, nine of the ten flexible nails showed fracture of the central wire. The continuity was, however, maintained by the PVC tube. The bones with flexible nailing always showed hypertrophic callus while there was only scanty callus on the side with rigid nailing. Strength, deformation at fracture and stiffness were measured in a three-point bending test after removal of the solid nails and the fibulae. The strength of the tibiae was greatest on the side with flexible nailing, as was the deformation at fracture. The mean stiffness was higher in the bones with rigid nails, but the difference here was not statistically discernible.

Primary repair in posterior cruciate ligament injuries

A retrospective study of 32 consecutive patients with acute injury of the posterior cruciate ligament (PCL) treated by primary repair is presented. Only six patients had isolated injuries of the PCL, five of these as avulsion of a bone fragment from the tibia. The remaining 26 patients sustained combined ligament injuries, including 18 total ACL tears. All ruptured ligaments were repaired. At follow-up after 4 (1-7) years, function in 26 patients was excellent-good and in six fair-poor. Moderate or severe posterior instability was found in seven patients by clinical examination but their function was as good as in those with stable knees. Inferior functional results, however, were more often related to rotatory instability. Primary repair of PCL-injuries, including all associated ligament injuries, is recommended.

Effects of a distal venting hole in the femur during total hip replacement

SummaryIn 18 patients who underwent total hip replacement, the intramedullary pressure in the femur was measured during the insertion of the femoral prosthesis component. Half the patients had a pressure release hole (diameter 4.5 mm) drilled into the medullary canal at the distal end of the femur, the other half not. In the patients without a venting hole, the intramedullary pressure increased transiently to a median of 390mm Hg during the insertion of the femoral stem, while those with a venting hole only showed an increase to 23 mm Hg. A drop in arterial oxygen tension of 2.2kPa and in thrombocytes of 51 × 109/1 was found in those without a venting hole, while the corresponding values in those with a venting hole were 0.9kPa and 20 × 109/1. Furthermore, a significant correlation was demonstrated between the increase in intramedullary pressure and the drop in oxygen tension and in blood platelets. No significant change in blood pressure was measured during operation in either group.ZusammenfassungBei 18 Patienten, die einen totalen Hüftgelenkersatz erhielten, wurde der intramedulläre Druck im Femur während des Einsetzens der femoralen Prothesenkomponente gemessen. Bei der Hälfte der Patienten war im distalen Femur ein Druckentlastungsloch von 4,5 mm Durchmesser gebohrt worden. Beim Einsetzen des Prothesenschaftes kam es bei den Patienten ohne Entlastungsloch zu einem vorübergehenden Anstieg des intramedullären Druckes bis zu einem Medianwert von 390mmHg, während mit dem Entlastungsloch die Drucksteigerung nur 23mmHg betrug. Ohne Entlastungsloch wurde ein Absinken des arteriellen Sauerstoff-Partialdrucks von 2,2kPa and der Thrombocyten von 51 × 109/1gefunden,miteinemEntlastungsloch betrugen these Werte 0,9kPa bzw. 20 × 109/1. Ferner wurde eine signifikante Korrelation zwischen der Steigerung des intramedullaren Drucks and dem Abfall des Sauerstoff-Partialdruckes and der Thrombocytenzahl gezeigt. Eine signifikante Veränderung des Blutdrucks während der Operation wurde bei keiner der beiden Gruppen gemessen.

Knee function following suture of fresh tear of the anterior cruciate ligament.

A retrospective consecutive series of 60 patients treated with primary suture of knee ligament injuries is presented. All patients had an anterior ligament (ACL) tear. In 54 patients this injury was combined with a medial compartment tear. Four patients had isolated tears of the ACL. At follow-up after 4 years, 11 patients complained of instability, and in eight of these an anterolateral rotatory instability was demonstrated by the Slocum test. In contrast, only five of 49 patients with subjectively stable knees had positive Slocum tests. Thirty of 47 patients with negative Slocum tests had excellent function, compared with four of 13 patients with positive tests.

Internal fixation of fractures of the neck of the femur using von Bahr screws and allowing immediate weight bearing: a prospective clinical study

This article presents the results of von Bahr screw fixation in 103 patients, allowing immediate weight bearing. After a follow-up period of 1 year, a failure rate of 18% was recorded. Analysis of the series shows that the failures are due to inadequate reduction of the displacement during operation, especially when the head is in varus, and to bad positions of the screw. The high failure rate was not related to the initial displacement of the fracture.

Immediate Weight-Bearing after Internal Fixation of Femoral Neck Fractures Using Von Bahr Screws: Preliminary Report of a Prospective Clinical Trial

Osteosynthesis of displaced femoral neck fractures using von Bahr screws was performed in 50 patients. Immediate postoperative weight-bearing was allowed. After a follow-up period of 1 year a high incidence (20 per cent) of early failure (dislocation of the fractures with or withour screw movement) was found. Analysis of the material showed that the failure rate was influenced by the peroperative reposition of the fracture, especially the valgus/varus position of the caput fragment, and the position of the screws.

Fractures of the lateral part of the distal tibial epiphysis (Tillaux or Kleiger fracture).

Six cases of fracture of the lateral part of the distal tibial epiphysis are presented. Five were operated on and 1 was treated with a plaster cast only. The results were excellent, and we advocate operative treatment of this fracture if more than minimal dislocation exists.

Patellofemoral Disorders Treated by Operations

Thirty-six patients with patellofemoral disorders treated with various operative procedures were evaluated after an average follow-up period of 29 (6 to 72) months. Instability of the patella, either recurrent dislocation or subluxation, was present preoperatively in 27 knees (Group A). Twelve patients (Group B) were operated on for chondromalacia, which was not combined with a history of instability. Good results were obtained in 15 cases in Group A and in only three cases in Group B. Simple procedures, lateral release alone and medial duplication alone appeared to be ineffective methods.

Interaction between Acute Gastric Ulcer and Epinephrine-Induced Mucosal Erosions in the Rat: the Significance of Gastric Acid Secretion

Gastric mucosal erosions were produced in rats by pyloric occlusion and intraperitoneal injection of epinephrine. Gastric ulcer was induced by application of acetic acid to a limited area of the stomach. pH, total amount of acid and volume of gastric juice were determined 5 h after pyloric occlusion. The presence of an acute acetic acid ulcer partly inhibited the development of mucosal erosions induced by pyloric occlusion and epinephrine. The gastric ulcer was associated with decreased acid secretion. A positive correlation was obtained between the degree of mucosal erosions and the total amount of acid in the stomach.

Extra-articular stabilization of the knee a.m. Losee

During 1979-81, 34 patients were operated according to Losee for chronic disabling anterior cruciate insufficiency. Twenty-nine patients were available for follow-up after 2 (1-4) years. At follow-up, 20 patients had a negative Slocum test. Twenty-one patients had a Lysholm knee score greater than 77 points, and were classified as good or excellent, with a significant relation to anterolateral stability.