1. Three cases are reported of avascular necrosis of the head of the femur after undisplaced fractures of the neck of the femur in childhood. 2. It is suggested that the diaphysial vessels play a more important part in the supply of the epiphysis than has previously been recognised. 3. The prognosis for any fracture of the neck of the femur in a child given at the time of the injury should be guarded.
1. Seventy-five injuries of the cervical spine are reported. Fifty-three were dislocations and fracture-dislocations involving the third to the seventh segments. 2. The importance of careful examination in all neck injuries is stressed. 3. The injuries are divided into stable and unstable types and the causation of the instability is discussed. 4. Plaster immobilisation for more than six months failed in some patients to prevent recurrence of dislocation. 5. Operative treatment was advised in all cases of dislocation, the spine being wired and grafted with iliac bone. This prevents recurrence and shortens the period of convalescence.
Today, alloarthroplasty is one of the many standard therapeutical procedures in osteoarthrosis of the hip, or coxarthrosis. With this operation, many patients can be completely relieved from pain and regain their ability to walk to an excellent degree. However, long-term observations have shown that the stability of the prostheses does not always correlate with the life expectation of the operated patient. Dislocations and states of irritation, over and above infections, may necessitate repeat surgery. It must be borne in mind that such repeated operations are by no means certain to produce safe results. Hence, it is recommended to employ for the first implantation a prosthesis model which offers a better chance of interchangeability. This possibility is supplied by the double-cup prosthesis of the type described by Wagner and other authors. Certain limitations are imposed by the prosthetic form and by the surgical approach; these limitations should be taken into account when choosing the double-cup prosthesis.
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