Front Matter - The Journal of Bone & Joint Surgery

Adv 48
JBJS [Br] Abstracts Now Available
Trauma
The undiagnosed Essex-Lopresti injury
P. Jungbluth, T. M. Frangen, S. Arens, G. Muhr; and T. Kälicke
From BG-Kliniken Bergmannsheil Bochum, Bochum, Germany
J Bone Joint Surg (Br) 2006;88-B:1629-33
The Essex-Lopresti injury is rare. It consists of fracture of the
head of the radius, rupture of the interosseous membrane and
disruption of the distal radioulnar joint. The injury is often
missed because attention is directed towards the fracture of the
head of the radius. We present a series of 12 patients with a
mean age of 44.9 years (26 to 54), 11 of whom were treated
surgically at a mean of 4.6 months (1 to 16) after injury and
the other after 18 years. They were followed up for a mean of
29.2 months (2 to 69). Ten patients had additional injuries
to the forearm or wrist, which made diagnosis more difficult.
Replacement of the head of the radius was carried out in ten
patients and the Sauve-Kapandji procedure in three. Patients
were assessed using standard outcome scores. The mean postoperative
Disabilities of the Arm, Shoulder and Hand score was
55 (37 to 83), the mean Morrey Elbow Performance score was
72.2 (39 to 92) and the mean Mayo wrist score was 61.3 (35 to
80). The mean grip strength was 68.5% (39.6% to 91.3%) of
the unaffected wrist.
Most of the patients (10 of 12) were satisfied with their
operation and in 11 the pain was relieved. When treating the
chronic Essex-Lopresti injury, we recommend accurate realignment
of the radius and ulna and replacement of the head of the
radius. If this fails a Sauve-Kapandji procedure to arthrodese
the distal radioulnar joint should be undertaken to stabilise the
forearm while maintaining mobility.
Hip
going resurfacing (57%; 36) had an offset ratio 0.15 pre-operatively
and required greater correction of offset at operation than
the rest of the group. In the non-arthritic hips the mean offset
ratio was 0.137 (0.04 to 0.23), with the offset ratio correlating
negatively to an increasing angle. An offset ratio 0.15 had a
9.5-fold increased relative risk of having an angle 50.5°. Most
hips undergoing resurfacing have an abnormal femoral head/
neck offset, which is best assessed in the sagittal plane.
Knee
Determining the rotational alignment of the tibial component at
total knee replacement
A COMPARISON OF TWO TECHNIQUES
M. Ikeuchi, N. Yamanaka, Y. Okanoue, E. Ueta, and T. Tani
J Bone Joint Surg Br 2007 89-B: 45-49
We prospectively assessed the benefits of using either a rangeof-movement
technique or an anatomical landmark method to
determine the rotational alignment of the tibial component during
total knee replacement. We analysed the cut proximal tibia
intraoperatively, determining anteroposterior axes by the rangeof-movement
technique and comparing them with the anatomical
anteroposterior axis.
We found that the range-of-movement technique tended to
leave the tibial component more internally rotated than when
anatomical landmarks were used. In addition, it gave widely
variable results (mean 7.5°; 2° to 17°), determined to some
extent by which posterior reference point was used. Because of
the wide variability and the possibilities for error, we consider
that it is inappropriate to use the range-of-movement technique
as the sole method of determining alignment of the tibial component
during total knee replacement.
The femoral head/neck offset and hip resurfacing
P. E. Beaulé, N. Harvey, E. Zaragoza, M. J. Le Duff, and F. J. Dorey
J Bone Joint Surg Br 2007 89-B: 9-15
Because the femoral head/neck junction is preserved in hip
resurfacing, patients may be at greater risk of impingement,
leading to abnormal wear patterns and pain. We assessed femoral
head/neck offset in 63 hips undergoing metal-on-metal hip
resurfacing and in 56 hips presenting with non-arthritic pain
secondary to femoroacetabular impingement. Most hips under-
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