Turkka Tunturi

Importance of Anatomical Reduction for Subjective Recovery After Ankle Fracture

237 patients with ankle fractures treated during 1977 were evaluated with the object of studying the treatment results and the factors influencing the results. About one half of the patients were treated conservatively and the other half operatively. The type of treatment was determined by the type of injury; hence the milder injuries were usually treated conservatively and the more severe cases operatively. A good radiological primary result was obtained in 82 per cent of the malleoli with operative treatment and in 34 per cent with conservative treatment. The evaluation of the end-result was based on a questionnaire study made 1.5-2.5 years after the accident. All those employed before their injuries had returned to their previous occupations. 27 per cent of the patients responded that they had recovered completely. The subjective end-result was found to correlate with the radiological result at the end of the treatment, but not with the type of injury, the type of treatment, or the patients age.

Bone growth into glassy carbon implants. A rabbit experiment.

This study was designed to evaluate the growth of bone into porous glassy carbon cylinders. Porous carbon cylinders were implanted in 30 rabbits intra-articularly in the metaphysis of the femur opposite from the patella. The rabbits were sacrificed up to 24 weeks after the operation. The bone samples were examined by histologic, fluorochrome and microradiographic methods. The amount of bone ingrowth was measured histomorphometrically. Fluorochrome uptake was seen in the implant pores, which indicated new bone growth originating from surrounding bone. After 3 weeks, microradiographs revealed new bone formation in the pores and with time the bone spicules became more dense. The amount of bone tissue in the pores grew and reached a maximum at 12 weeks, when 45 per cent of the total pore volume was incorporated with bone tissue. No adverse tissue responses were observed.

Cloward's anterior fusion in the treatment of cervical spinal traumatic injury and degeneration.

SummaryThe aim of this study was to evaluate the long-term results of Clowards anterior interbody fusion of the cervical spine and to identify the factors influencing them. The series consisted of 29 patients operated on in 1968–75. The indication for operation was in 12 cases intensive radicular symptoms, not responding to conservative treatment, in connection with considerable degeneration of the corresponding spinal segment only, and in 17 cases instability of the cervical spine caused by traumatic injury followed by dislocation and radicular or medullary symptoms enhancing in spite of conservative treatment by skull traction or collar. Twenty-five patients (86%) attended follow-up after an average time lapse of 6.5 years from operation. The operative result was evaluated considering objective neurological improvement, subjective improvement, present symptoms and working capacity.The operative result was at least fair in 7/11 in the degeneration group and in 12/14 in the traumatic injury group. All fusions were radiologically successful. Adequate correction of a primary flexion deformity of more than 15° was not achieved. Age over 35 years and motor defect preoperatively proved to be statistically significant prognostic factors for a poor operative result in the traumatic injury group. Preoperative sick-leaves and a duration of preoperative symptoms exceeding six months proved to be prognostic factors for a poor result in the degeneration group. In spite of the relatively good clinical results obtained, this study does not justify any conclusions concerning the value of Clowards procedure compared to other methods of treatment, since no control material was available.ZusammenfassungDie Absicht dieser Untersuchung war, die Langzeitresultate der vorderen interkorporalen Fusion (nach Cloward) an der Halswirbelsäule zu bewerten und die die Resultate beeinflussenden Faktoren zu finden. Das Material bestand aus 29 Patienten, die in den Jahren 1968–1975 operiert wurden. In 12 Fällen waren nicht auf konservative Behandlung ansprechende intensive radikuläre Symptome, wobei nur das entsprechende Segment betrdchtlich degeneriert war, die Indikation zur Operation, and in 17 Fällen wurde operiert wegen einer Instabilität nach Verletzung der Halswirbelsäule mit zunehmender Luxation und radikulären oder medulldren Symptomen trotz konservativer Behandlung mit Dauerzug oder Kragen. Eine Nachuntersuchung fand bei 25 Patienten (86%) im Durchschnitt 6,5 Jahre nach der Operation statt. Zur Bewertung der Operationsergebnisse wurden die objektive neurologische Verbesserung, die subjektive Verbesserung, die gegenwdrtigen Beschwerden und die Arbeitsfähigkeit herangezogen.Das Operationsergebnis war zumindest mäßig bei 7/11 in der Degenerationsgruppe und bei 12/14 in der Verletzungsgruppe; röntgenologisch beurteilt waren alle Fusionen erfolgreich. Eine hinreichende Aufrichlung wurde bei den Flexionsdeformitäten über 15° nicht erreicht. Alter über 35 Jahre und ein präoperativer motorischer Ausfall erwiesen sich als statistisch bedeutende prognostische Faktoren für ein schlechtes Operationsresultat in der Verletzungsgruppe. In der Degenerationsgruppe erwiesen sich der präoperative Krankenurlaub und sich fiber sechs Monate hinausziehende präoperative Symptome als prognostisch ausschlaggebend für ein schlechtes Operationsresultat. Trotz der erreichten verhältnismäßig guten klinischen Resultate berechtigt these Untersuchung, weil kein Vergleichsmaterial zur Verfügung stand, nicht zu Schlüssen über den Wert des Verfahrens von Cloward, verglichen mit anderen Behandlungsmethoden.

Shear strength of loaded porous-glassy-carbon/bone interface—an experimental study on rabbits

The aim of the study was to measure the shear strength of bone/porous-glassycarbon interface in rabbit. Glassy carbon pellets were implanted into drill holes made through the medial articular surface of the proximal tibia of 15 rabbits. Shear strengths grew statistically significantly from 1 to 6 weeks ana reached a maximum of 4.6 MN/m2. Microscopical examination of the sheared surfaces revealed that at 1 and 2 weeks the shearing occurred through the tissue surrounding the implant, and at 3, 6 and 12 weeks through the porous coating of the implant. To diminish the fragility of the porous coating, its porosity should be adjusted to 40%. Results of shear strength studies on current implant materials are reviewed.

Head injuries and skull radiography: clinical factors predicting a fracture

Five hundred and ninety-eight cases were studied where the patients had been subjected to skull radiography because of a head injury. Concussion had been established in 231 patients and a more severe brain injury in 8. Forty-nine patients (8.2 per cent) had skull fractures. The relative frequency of fractures was the highest among those aged between 40 and 59 years (16 per cent). From among 16 variables, either clinical or pertaining to the history, 4 had clearly sustained a fracture of the skull, the statistically significant features being amnesia, unconsciousness for over 30 minutes, a wound and subcutaneous haematoma in the scalp and a reduced level of consciousness. On the basis of these signs the patients could be divided into two groups which differed in the frequency of skull fractures by a factor of five. The skull fracture was not observed to have influenced the patients care or recovery, particularly if the patient had a concurrent brain injury. Based on the results, the indications for skull radiography in patients with head injuries can be identified and this can reduce the need for X-ray examinations to one-half and still reveal 80 per cent of skull fractures.

A Prospective Comparative Study on Serum Acid Phosphatases in the Diagnostics of Prostatic Cancer

The diagnostic efficacy of two prostatic tumor markers, S-AP and S-PAP, was compared in a prospective clinical series consisting of 101 BPH- and 39 PCa-patients. As a predictor of prostatic cancer the specificity of S-AP (greater than or equal to 12 U/1) and S-PAP-RIA (greater than or equal to 4 micrograms/1) was 0.97 and 0.96, and the sensitivity 0.21 and 0.41, respectively. The S-PAP-RIA value of over 8 micrograms/1 always predicted an inoperable prostatic cancer (T4 or M1). The authors conclude that neither of these enzymes is suitable for the screening of early prostatic cancer, but the S-PAP-RIA might be a good predictor of inoperability of advanced prostatic cancer.