BRIEF
834
Fig.
ligament).
fibula
not
Fig.
2a
Perry
did
et a! also
stated
fracture,
the
that
if the
medial
in the literature,
none
structures,
suggested
sented
injury.
an earlier
Our case,
of which
had
that
would
cases
stage in the development
ofthe
complete
however,
in which
posterior
dislocation
medial
malleolar
fracture.
Such
an
injury
might
result
Bosworth
ations
also
THE
KNEE
F.
play
Perry
FLEXION
G.
The usual
clinical
the
nerve
roots
are
well
the
femoral-nerve-stretch
roots
local
anatomical
tests
TEST:
CINOTTI,
to detect
forming
The
S.
the
A
NEW
tension
sciatic
FOR
the
L5,
respectively.
the knee-flexion
in
nerve
(SLR)
involve
test
and
51 or 52
Correspondence
to Professor
test,
JBoneJointSurg[Br]
Received 9 December
ofBone
del
Pozzo
‘La Sapienza’,
and Joint
1993; 75-B:834-5.
1992; Accepted
13 January
Fracture-dislocation
behind
ofthe
J Bone
the tibia.
LUMBOSACRAL
indicates
tension
when,
with the
the
knee
buttock
which
ankle
Joint
with
Surg
from a
of this
fixed displacement
1947 ; 29:130-5.
fracture-dislocation
and
ROOT
staging
of
of injury.
J
TENSION
71, 41100
Surgery
1993
Piazzale
in the lumbosacral
patient
in the prone
causes
or
and/or
the
test
herniation
we
F. Postacchini.
British Editorial
Society
030l-620X/93/5R79
$2.00
©1993
DM.
A positive
0.
of Rome,
to
damaged
received
or will be received
or indirectly
to the subject
CR, Rice 5, Rao A, Burdge
R. Posterior
the distal
part of the fibula : mechanism
Bone Joint Surg [Am]
1983; 65-A :1149-57.
Patients,
F. Postacchini,
Professor
ofOrthopaedic
Surgery
Orthopaedic
Clinic,
University
of Modena,
Largo
Modena,
Italy.
Cinotti,
Registrar
S. Gumina,
Resident
I Orthopaedic
Clinic,
University
Aldo Moro
5, 00185 Rome,
Italy.
it is wise
the
J, McBroom
R, Dzioba R. Irreducible
fracture dislocation
of
the ankle due to posterior
dislocation
of the fibula.
J Trauma
1977;
17:397-401.
TEST
and irritation
or the
straight-leg-raising
and the L2 to LA roots
We report a new test,
still
of the
for non-
GUMINA
femoral
test
that
form have been
related
directly
injury
Schatzker
van-
a role.
POSTACCHINI,
known.
Perhaps
of
repair
in any
party
We
type
of the severity
there is no place
believe
of the fibula
external
rotation
of a pronated
foot, or the position
of the foot might
have changed
during
the injury, from
to pronation.
this
2b
REFERENCES
a
from
supination
of
because
damage,
both sides of the ankle
and
both medially
and laterally.
No benefits
commercial
article.
of an intact fibula was combined
with a medial malleolar
fracture
seems to contradict
the proposed
mechanism.
It is unlikely
that external
rotation
of a supinated
foot could cause posterior
dislocation
of the fibula and
nature
management.
explore
structures
repre-
exact
unclear
and
ligamentous
operative
to the medial
three
the
remains
associated
for their theory,
fibula reported
damage
these
Since
dislocated
structures
remain
intact. They referred,
as support
to the three cases with an intact dislocated
and
REPORTS
aggravates
of a lower
methods
examined
pain
posterior
appears
aspect
in
the
of the
lumbar
ipsilateral
thigh
to be a reliable
(Fig.
1).
predictor
of
disc.
and results.
512
roots.
It is positive
position,
flexion
of
patients
Over
with
a three-year
clinical
period
evidence
of
lumbar
disc herniation.
Tension
tests, including
the SLR
and the knee-flexion
tests were performed
in each patient,
and the results
were
or marked.
The knee-flexion
men and 19 women
underwent
refused
these
34
further
graded
test was
aged from
CT,
MRI
investigations
evaluation.
In
THE
as negative,
slight,
positive
in 48 patients
(29
22 to 57 years).
Of these,
and/or
myelography
and seven
did not
32 of
JOURNAL
moderate
the
34
OF BONE
; seven
return
for
patients,
imaging
AND
SURGERY
JOINT
BRIEF
835
REPORTS
the knee-flexion
were
calculated.
test for lower
This
showed
sensitivity
and
(55%)
lumbar
the test
specificity
disc herniation
to have
a low
(25%),
but
a very
high
predictive
value (94%).
Surgery
was required
for 84%
the 32 patients
with a positive
knee-flexion
test compared
with
59% of those
Discussion.
The
disc
MRI
test
useful
there
which
Almost
disc,
most
the
other
patients
disc
had
with
herniation
no
at L4-L5
evidence
positive
of disc
studies,
or L5-S1
disease.
27 had
Of
a large
the
in four.
No patient
had
from the femoral-nerve-stretch
32
neuroradio!ogical
herniation
studies
at L4-L5
The
N.
High
OF
CAPELLO,
failure
patients
THE
A.
for
acetabular
the search
for 246,
was
and
COLYER,
more
present
predictive
MECRON
of cemented
followed
cemented
prompted
available
or both
specificity
R.
rates
were
knee-flexion
1949).
disc
SCREW-IN
C.
Testut
of
is so it may
in any
party
KERNEK,
J. V.
acetabular
components
in
the acetabular
than
ten
years,
of
ron,
was
and
CARNAHAN,
46202-51
J. V. Carnahan,
Department
Champaigne,
Professor
Professor
Correspondence
1 1, USA.
Engineering,
Illinois
61801,
to Professor
University
USA.
W. N. Capello.
©l993
British
Editorial
Society
ofBone
and
0301-620X/93/5R74
$2.00
J Bone Joint Surg [Br] 1993 ; 75-B : 835-6.
Received
18 June 1992; Acceptedafter
revision
VOL.
75-B. No. 5, SEPTEMBER
of Illinois
1993
Surgery
17 August
1992
of sciatic
pain
by this
flexion
in the
prone
knee
high
lumbar
roots,
;
but
slight
could
that stretching
of the
plexus
through
the
explain
why
with
the
test
lower
is positive
lumbar
disc
received
or will be received
or indirectly
to the subject
A, Lataijet
M, eds.
Doin et Cie, 1949.
at Urbana-
component
from a
of this
Trait#{232}d’anatomie
humaine.
to bone.
The
our experience
patients
Patients
and methods.
86 Mecron
and
rings
those
with
Between
were
fixation
this device
undergoing
August
implanted
men ; 36 women).
Their average
was 54 years (25 to 84). Fifty-four
replacement
and
nent was cemented
average
follow-up
Mecring
(Mec-
a titanium-threaded
ring (Fig. 1),
United
States
in 1982 in the hope
provide
firm, immediate
of bone stock.
in young
revision
especially
surgery.
1984 and October
in 79 patients
age at the time
hips underwent
32 had revisions.
The
in 12 and uncemented
of the hips not revised
without
(43
of surgery
primary
femoral
compoin 74 hips. The
was 42 months
to 51).
The posterolateral
approach
was used in 58 hips;
the direct
lateral
approach
(Hardinge
1982) in 28. The
implantation
technique
was that
recommended
by the
(26
Joint
test had a herniated
the lumbosacral
roots
of severe
compression
of patients
Berlin,
Germany),
introduced
in the
that it would
undue
sacrifice
1985,
University
Medical
Drive, Indianapolis,
PhD,
of General
Urbana,
disc
treatment.
J. J. HESS
We report
Indiana
the
form have been
related
directly
JL. In: Lataijet
Seventh
ed. Paris:
B.
J. J. Hess, BA, Clinical Research
Coordinator
Department
of Orthopaedic
Surgery,
Indiana
Centre, Clinical Building,
Room 600, 541 Clinical
lumbar
operative
RING
components
used for their revision
for an alternative
means
of securing
W. N. Capello,
MD, Professor
R. A. Colyer,
MD, Associate
C. B. Kernek,
MD, Associate
knee-flexion
REFERENCE
in 184.
values
If this
No benefits
commercial
article.
test,
and
only
extent,
presence
in only a minority
herniation.
positive
results
the knee-flexion
a negative
or L5-S1
sensitivity,
FAILURE
W.
with
be
be
interconnecting
branches.
This
may
occur
when
the
anastomoses
are larger
or more
numerous
than normal,
or the L5 root is included
in the lumbar
plexus
(Testut
test.
In the 464 patients
be that
elicit sciatic
pain. It is also possible
lumbar
plexus
pulls on the sacral
five
or
with
disc.
The
SLR
test was
and negative
or equivocal
simultaneous
test and
of production
not
also, to a minimal
movements
in the
the
herniamay
may
surgery.
It may
stretches
need
with a positive
needed
is unknown.
position
protrusion
or an extruded
or sequestrated
fragment
; the other
had medium
or small disc protrusions.
A moderately
markedly
positive
knee-flexion
test correlated
well
an extruded
or sequestrated
positive
in 28 of the 32 patients
test
.
When
to be a lower
will probably
all our patients
and
regard.
is likely
The mechanism
Of the
other two patients,
both of whom had a slightly positive
knee-flexion
test, one had a mild disc bulge at L4-L5 and
showed
diagnosis
in this
is positive,
herniation
studies
test.
of lumbar
test
1
a negative
tion and the decision
to perform
CT or
difficult
in some patients.
The knee-flexion
extremely
Fig.
with
clinical
of