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33 patients with injuries to the radial nerve were reviewed, on average, 12.1 (5-20) years after secondary repair. 24 were male and nine female, with a mean age of 29.8 (7-54) years. Most of the nerve lesions were blunt (17) or sharp (14) injuries. Division was total in 24 cases and they were mostly injured at the upper arm level (21 cases). The average interval between injury and repair was 6.0 (1-19) months. The procedures used were fascicular grafting in 21 and direct suture in 12 cases. Motor and sensory recovery were evaluated quantitatively. Useful results were obtained in 65.0% and useless in 25.0%. Fascicular grafting restored a useful level of motor function in only 8/21 cases (38.1%). Pre-operative delay had a significant influence. Associated lesions proved to be the critical factor for restoration of radial nerve function.

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110 patients with injuries to the ulnar nerve were assessed, on average, 12.7 (3-20) years after secondary repair. 89 were male and 21 female, with a mean age of 27.9 years. Most of the nerve lesions were sharp (63) or blunt (41) injuries. Division was total in 76 cases and most were at the forearm level. The average delay from the injury to the operation was 10.1 (1-48) months. Secondary repair was performed in 34 cases and fascicular grafting in 76 cases. The mean graft length was 5.4 (1-30) cm. Four factors of motor and sensory function were assessed and the quantitative evaluation was compared with the MRC classification. Useful results were obtained in only 51.8% and poor in 30.9%. The age of the patient, the width of contusion, the pre-operative delay, and the level of the injury influenced the results significantly.

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We report the short-term results of 100 cementless total hip replacements in 52 severely dysplastic and 48 totally dislocated hips, with some new technical solutions to the problems involved. In cases with a very narrow iliac bone, the acetabular screw ring is seated below the true cotyloid area. In hips with tight flexor and abductor muscles or with deformities of the proximal femur, various osteotomies were performed. Special attention was paid to careful pre-operative planning and precise operative technique. In spite of a high complication rate the results were generally good and even patients who required reoperation were satisfied with the final result.

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Revitalization of the femoral head in cases of aseptic necrosis was attempted in 13 hips of 11 patients 15-33 years of age. The necrotic bone was replaced by a vascularized pedicular iliac bone graft and free cancellous transplants. The results after an average follow-up of 53 months are satisfying in some cases. The surgical technique used is simple and applicable when a vascularized bone graft is needed in the hip region.

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Osteonecrosis of the femoral head with deformity was treated with vascularized iliac crest grafts or with free microanastomosed fibular grafts in 20 young adults (22 hips). The clinical and radiographic results at two years and five years are presented. The overall results are promising. The hips gradually improved both clinically and radiographically during the first two years. The changes after that were less significant. The Danielsson pain score decreased from 91 (preoperative) to 28 during the first two years and declined to 18 during the second period of observation. Walking ability (measured by the Merle d'Aubigné method) improved from a preoperative score of 46 to 29 during the first two years and then to 10 during the three following years. The range of joint movement first decreased, and then increased again during the second follow-up period. There was radiographic evidence of graft fusion to the surrounding bed in 18 hips during the first two years and in all 12 hips of the second series with a two to five year follow-up. Homogenization of the femoral head was observed in 18 cases in the first two year follow-up series and in 10 in the second two to five year follow-up series. Stabilization of the femoral head shape was observed in 19 hips in the first series and in 12 hips in the second series. During the second period of observation, 9 patients were able to return to their former occupation and 2 were retained for new occupations.

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Vascularized pedicular bone graft was used for the purpose of achieving a sufficient bone stock for cementless total hip arthroplasty in patients with major acetabular bone defects. A useful bed for the acetabular prosthesis was obtained in all three cases. The ordinary prosthetic arthroplasty was performed in the second phase. The vitality of the grafted bone was then controlled. The results after a follow-up time of 23, 32 and 40 months respectively are good.

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Fifty-five patients with malacia of the carpal lunate treated by Swanson's silicone implant arthroplasty were reexamined. The follow-up period averaged 3 years. The operation had a favorable effect on pain, but the range of motion and the grip strength remained impaired. Arthrosis progressed in half the cases, and there were five dislocations of the implant and 11 cases of cystic changes of carpal bone.

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This paper reports the long term results of dynamic gracilis or semitendinosus transfer in chronic cruciate ligament instability of the knee. During the period 1968-1983, 76 dynamic reconstructions were performed. Sixty-one patients (63 knees) were evaluated. There were 42 males and 19 females. The mean age at operation was 29.5 years and the average time before operation was 3.7 years. The anterior cruciate ligament was reconstructed in 54 cases, the posterior in 7 and the anterior and posterior in 2. Altogether 32 ligaments (12 cruciates) had been repaired and 28 menisci removed at previous operations. A scoring system (up to 50 points, with 16 parameters) was used. An excellent result was achieved in 21 cases, good in 15, fair in 18 and poor in 19 cases at an average follow-up of 7.4 years. The average score was 33.2 points. Subjectively only 4 patients described the end result as poor. The anterior cruciate alone was reconstructed in 25 patients with an average score of 35.4 points. In 12 cases the operative delay was less than one year and in these the average score was 41.2. In 6 cases three ligaments were reconstructed and the average score was 24.0. There were advanced degenerative changes in 6 knees (average score 24.3).

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Seven patients had osteotomy for traumatic varus deformity of the humeral neck following fracture. Indications for the operations were limited active abduction and forward flexion of the arm. The result was good in five cases.

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The principles and difficulties of surgery of brachial plexus lesions in 52 cases are reported. In 22 cases there was avulsion of one or more roots. Six lesions were infraclavicular. Reconstruction by means of autologous grafts was performed in 24 cases, neurolysis in 14 cases, direct suture in two cases, and intercostal neurotization in 12 avulsion cases. Fifty-one patients were evaluated on average 4 years after the operation. The result was good in 19 cases, fair in 13 cases and poor or nil in 19 cases. Regained function was best at the level of the elbow. Functional recovery of M. biceps after fascicular grafting was achieved in 16 cases. In neurotization cases, functional recovery was achieved in four cases.

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A series of 13 patients with an injury of the accessory nerve in the posterior cervical triangle is reported. In 11 patients the nerve was damaged during a lymph node biopsy and in two cases there was a sharp glass injury. Paralysis of the trapezius muscle occurred with resulting deformity and loss of function of the shoulder. Nine patients were operated on. In five cases neurolysis, in two cases neurorrhaphy and in two cases reconstruction with a sural nerve graft were performed 3-17 months after the injury. The result was good or fair in six operative cases. Five of these were neurolyses. In one instance good and in three cases fair recovery was achieved without operation. All but one of the patients were able to return to their former employment. The mean follow-up time was 20 months.

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The results of a new operative technique of reconstruction of the rotator cuff are described in 112 cases. The principle of the method is the restoration of the anatomy in order to restore function. Results so far have been encouraging, as 80% of the patients have benefited from the operation.

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Silastic implants for a wide variety of medical purposes are in current and frequent use worldwide. Only recently there have been reports of the migration of silicone to the surrounding tissues via lymphatics. In the present material of nine cases with carpal implants followed for more than two years, bone cysts developed in the surrounding bones on five occasions. The only cysts so far investigated thoroughly contained foreign body reaction, and silicone could be detected by electron probe microanalysis. A long-term follow-up is suggested whenever these implants are used.

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A series of 28 neurovascular island flaps are presented together with a series of three radial innervated pedicled flaps. The former method gave superior results compared to the latter. The mean follow-up period was 4.3 years. All the flaps survived and 21 of the neurovascular flaps were classified good to excellent, 4 cases gave fair results and in three cases the result was classified poor. Only one of the neural pedicled radial innervated flaps could be classified as fair whereas both of the others gave poor results. The neurovascular island flap method is regarded a valuable alternative to a tree vascularized composite tissue graft.

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