Avascular necrosis of the femoral heads in a compressed air worker / by R.I. McCallum [and others].

Date:
[1954?]
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Licence: In copyright

Credit: Avascular necrosis of the femoral heads in a compressed air worker / by R.I. McCallum [and others]. Source: Wellcome Collection.

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    evidence of disturbance of the vascularity of a fragment of bone within six weeks of the causal incident, but one of us (J. K. S.) has recognised such evidence at three weeks. It is noteworthy that six months after this patient ceased work in the tunnel, at a time when he was already suffering severe pain, the radiograph of the hips (Fig. 1) showed no abnormality, but twenty-one months later gross changes in both femoral heads were apparent (Fig. 2). From our experience of avascular necrosis in bone from other causes (for instance, osteochondritis dissecans), immobilisation of the joint and protection from weight bearing is not a practical possibility, because complete revascularisation, if it ever occurs, would probably take years rather than months. Judet arthroplasty is of particular value in a case of this type because the femoral head has been destroyed, and therefore cup arthroplasty is impracticable. Furthermore, it is undesirable to sacrifice the articular cartilage of the acetabulum which, in the early stages of this condition, is little affected. The Judet arthroplasty permits complete study of the damaged femoral head, previously impossible. However, although arthroplasty is undoubtedly the operation of choice in bilateral disease, arthrodesis might still be the correct procedure in a unilateral case. The material for this paper has been gathered from many sources and the authors wish to acknowledge their indebtedness to the heads of the Departments of Orthopaedics, Industrial Medicine, Radiology and Pathology in the Royal Victoria Infirmary, Newcastle-upon-Tyne, and to the Medical Research Council Unit investigating decompression sickness. REFERENCES Allan, J. H. (1943): Decompression Disease of Bone. Journal of Aviation Medicine, 14, 105. Bassoe, P. (1911): Compressed Air Disease. Journal of Nervous and Mental Diseases, 38, 368. Bassoe, P. (1913): The Late Manifestations of Compressed-Air Disease. American Journal of the Medical Sciences, 145, 526. Behnke, A. R. (1951): In “ Decompression Sickness,” p. 60. National Research Council. Philadelphia and London: W. B. Saunders Company. Bell, A. L. L., Edson, G. N., and Hornick, N. (1942): Characteristic Bone and Joint Changes in Compressed-Air Workers: A Survey of Symptomless Cases. Radiology, 38, 698. Bornstein, and Plate, (1911-12): Uber chronische Gelenkveranderungen, enstanden durch Presslufterkrankung. Fortschritte auf dem Gebiete der Rontgenstrahlen, 18, 197. Brailsford, J. F. (1944): The Radiology of Bone and Joints. Third edition. London: J. & A. Churchill Ltd. Coley, B. L., and Moore, M., Jun. (1940): Caisson Disease with Special Reference to the Bones and Joints. Annals of Surgery, 111, 1,065. Colonna, P. C., and Jones, E. D. (1948): Aeroembolism of Bone Marrow. Archives of Surgery, 56, 161. Gordon, J. O., and Heacock, C. H. (1940): Roentgenologic Demonstration of Localized Gas in Caisson Disease. Journal of the American Medical Association, 114, 570. James, C. C. M. (1945): Late Bone Lesions in Caisson Disease. Lancet, ii, 6. Kahlstrom, S. C. (1942): Bone Infarcts. American Journal of Roentgenology, 47, 405. Kahlstrom, S. C., Burton, C. C., and Phemister, D. B. (1939a): Aseptic Necrosis of Bone. 1. Infarction of Bones in Caisson Disease Resulting in Encapsulated and Calcified Areas in Diaphyses and in Arthritis Deformans. Surgery, Gynecology and Obstetrics, 68, 129. Kahlstrom, S. C., Burton, C. C., and Phemister, D. B. (19396): Aseptic Necrosis of Bone. II. In.farction of Bones of Undetermined Etiology Resulting in Encapsulated and Calcified Areas in Diaphyses and in Arthritis Deformans. Surgery, Gynecology and Obstetrics, 68, 631. McCallum, R. I., and Walder, D. N. (1953): Compressed-Air Illness on Tyneside. Lancet, i, 464. Milne, R. (1948): Joints—Caisson Disease of. In British Surgical Practice, Under the General Editorship of Sir Ernest Rock Carling and J. Paterson Ross, 5, 192. London: Butterworth & Co. (Publishers) Ltd. Rendich, R. A., and Harrington, L. A. (1940): Roentgen Findings in Caisson Disease of Bone, with Case Reports. Radiology, 35, 439. Swain, V. A. J. (1942): Caisson Disease (Compressed-Air Illness) of Bone. British Journal of Surgery, 29, 365. j! Taylor, H. K. (1944): Aseptic Necrosis in Adults: Caisson Workers and Others. Radiology, 42, 550. Twynam, G. E. (1888): A Case of Caisson Disease. British Medical Journal, 1, 190. Walker, W. A. (1940): Aseptic Necrosis of Bone Occurring in Caisson Disease. Journal of Bone and Joint Surgery, 22, 1,080.