Heterotopic Bone Formation in Male and Female Rabbits--Berton R. Moed, MD; Ronald B. Resnick, MD; Anton J. Fakhouri, MD; Balajee Nallamothu, MD

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We performed mechanical induction of heterotopic ossification in the quadriceps of the right hind limb of six male and six female sexually mature New Zealand white rabbits of similar size. The effect of sex difference on heterotopic bone was assessed by analyzing plain radiographs of the femur. The results indicate that a male/female sex difference in heterotopic bone formation cannot be demonstrated.

Total Hip Arthroplasty: Imaging Evaluation--B. J. Manaster, MD, PhD

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Total hip arthroplasty is a common procedure with rare complications but is necessarily followed up by plain radiographs. In this article, I describe a logical approach to evaluation of the arthroplasty, both at its initial implantation and in follow-up. Criteria regarding loosening and other complications are outlined.

Isometry of the Anterior Cruciate Ligament: An Intraoperative Perspective*--Lynne P. Garner-McElhinney, MD; James H. Garner, Jr, MD; Ronald R. Weis, MD

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The emphasis our society places on physical fitness has produced an ever increasing number of injuries to the anterior cruciate ligament (ACL). To successfully replace the anterior cruciate deficient knee, physicans need to determine the “ideal” location for the femoral tunnel. In the search to find this “isometric point,” if there is one, we draw attention to the origin of the distal fascicles of the anterior cruciate from the lateral femoral condyle. Visualizing this surgical landmark can facilitate and expedite accurate placement of the isometric device and thus influence the results of the surgical procedure. Also, magnetic resonance imaging may help the surgeon in locating the origin of the ACL.

Cognitive-behavioral Techniques in the Treatment of Chronic Low Back Pain: Preliminary Results--J. Monroe Laborde, MD, MS

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Review of the literature reveals chronic low back pain has not responded well to conventional medical treatment with medication and surgery. The addition of cognitive-behavioral approaches to complement conventional medicine seems to improve the results and lessens pain in this group of patients.

Delayed Union of the Distal Ulna in a Child After Both Bone Forearm Fracture*--Edgar A. Fike, MD; Ely Bartal, MD

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Fractures of the distal third of the forearm are common in children. These fractures are known to heal readily and rapidly. We describe a 10-year-old boy who had a closed, lowenergy fracture of the distal radius and ulna. The radius healed promptly, but the ipsilateral ulna had radiographic evidence of delayed union. We have not found a report of a nonunion of this kind in the literature. With the increasing use of internal fixation and the lack of guidance in the literature, we questioned the standard use of closed treatment. We treated this patient nonoperatively, despite the delay in union, and the fracture healed in 4 months.

Simultaneous Purulent Flexor Tenosynovitis of Multiple Digits*--Mark H. Gonzalez, MD; Paul Prinz, MD; Robert F. Hall, Jr., MD

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Acute suppurative tenosynovitis is a well-described hand infection that is usually due to penetrating trauma or hematogenous spread.1-3 We describe a case of simultaneous hematogenous seeding to four flexor tendons. To our knowledge this has not been previously described.

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