High-pressure injection injuries of the hand

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.

Nailing versus prosthesis for femoral-neck fractures. A critical review of long-term results in two hundred and thirty-nine consecutive private patients

In a follow-up study of 239 consecutive patients with fractures of the femoral neck treated by six surgeons in one hospital by Pugh nailing, Austin Moore prosthesis, or Knowles pinning, 96 per cent could be followed for a minimum of two years or until a definitve result had been reached. The incidence of unsatisfactory results was 39.3 per cent after Pugh nailing, 18.2 per cent after prosthetic replacement, and 14.2 per cent after Knowles pinning (mostly undisplaced or impacted fractures). Thirty-five unsatisfactory results following Pugh nailing were due to: aseptic necrosis which was definite in eighteen cases and probable in two; early mechanical failure in twelve cases; infection in one; and late non-union in two. Eight poor results followed prosthetic replacement and were due to erosion of the acetabulum in six and dislocation in two. The four poor results that followed Knowles pinning were due to aseptic necrosis in three and to pain, probably the results of aseptic necrosis, in another. From this study it was concluded that aseptic necrosis was more influenced by the original displacement than by the accuracy of reduction or fixation, and that in displaced femoral-neck fractures in the elderly, prosthetic replacement gave a more reliable result.

A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint

The volar approach to open reduction of the complex dislocation of the index metacarpophalangeal joint as described by Kaplan proved to have certain disadvantages. Digital nerves are easily damaged during exposure and there is a limited view of the entrapped fibrocartilaginous volar plate dorsal to the metarcarpal head. A direct dorsal longitudinal incision through the skin and extensor tendon gives full exposure. The volar plate attached to the proximal phalanx and trapped over the dorsal aspect of the metacarpal head is in full view. The volar plate is split longitudinally and the dislocation reduces spontaneously as the flexor tendons and lumbrical muscle slip by the metacarpal head. The advantages of this approach as compared with the volar approach are: (1) there is full exposure of the fibrocartilaginous volar plate, the main structure blocking reduction; (2) digital nerves are not as apt to be damaged; and (3) accurate reduction and fixation of the osteochondral fracture of the metacarpal head, frequently seen with this dislocation, is possible.

Accidental high-pressure injection-gun injuries of the hand; the role of the emergency radiologic examination

High-pressure injection-gun injuries of the hand are serious accidents and constitute a surgical emergency. Radiography is an important part of the pre-operative evaluation. Without adequate films, it is frequently impossible to estimate the extent of underlying trauma. It is imperative that physicians who initially care for injection-gun accident patients be aware of the unique features of these injuries. Delay in the institution of adequate therapy may result in needless and permanent disability.