Role of synovial fluid cells in the healing of flexor tendons

A 1-cm segment of repaired rabbit flexor tendon was first subjected to 10,000 rads of x-radiation and then placed in the synovial cavity of a rabbit's knee joint. Macroscopic examination revealed healing at the repair site and rounding of the tendon ends without adhesions. Light- and electron-microscopic studies revealed cells resembling fibroblasts at the repair site and the periphery laying down collagen. Healing of this irradiated nonviable tendon was brought about by the cells present in the synovial fluid.

Long term outpatient intravenous antibiotic therapy for orthopedic patients

This study evaluates the feasibility of outpatient intravenous antibiotic therapy in orthopedic patients. A team was organized to run the outpatient antibiotic therapy program and criteria were outlined for the selection of patients. A total of 16 patients were treated in this manner. A substantial reduction in health care cost was achieved without sacrificing quality. We conclude that outpatient intravenous antibiotic therapy is safe and effective in controlling infection and that it decreases the health care cost.

Isolated tears of the triangular fibrocartilage of the wrist: results of partial excision

Sixteen patients who underwent partial excision of the triangular fibrocartilage (TFC) to treat chronic wrist pain were studied retrospectively. Eleven patients (69%) had no symptoms at follow-up: Five other patients later underwent distal ulnar resection. All patients over 40 years of age did poorly after the operation. The patients who had no symptoms showed no significant alteration in wrist function after partial excision of the TFC. Removal of a perforated TFC is contraindicated in the presence of radiocarpal or distal radioulnar arthritis.

Reconstruction of the metacarpophalangeal joint with autogenous metatarsal

Restoration of the articular surface of a damaged or lost metacarpal head is necessary for adequate function of the metacarpophalangeal joint. Although several salvage procedures have been described, none has been as satisfactory as the metatarsal transfer. This report describes the functional outcome of a patient who had a metatarsal transfer to replace the metacarpal involved by giant cell tumors. Follow-up 2 1/4 years after the transfer showed good maintenance of the joint space and excellent joint function.

The problem of trapeziometacarpal degenerative arthritis

Trapeziometacarpal arthritis commonly afflicts women older than 40 years of age. This may be due to the inherent shallowness of the saddle joint and the laxity of the volar ligaments. Compressive forces across this joint may be as high as 120 kg during strong grasp; hence, it is not surprising that it is frequently the site of osteoarthritis. Pain and swelling over the trapeziometacarpal joint are the earliest symptoms. As the disease progresses, subluxation of the metacarpal base and, later, collapse deformity of the thumb develop. Surgical treatment is indicated if all nonsurgical treatment fails. A bewildering array of surgical techniques is available to treat trapeziometacarpal arthritis, each having its proponents. Each of these procedures provides some degree of pain relief in a majority of patients. However, none of them fulfills the criteria of an ideal arthroplasty. Criteria for good results in the literature differ among authors. Quantitative analysis of objective measurements, e.g., grasp and pinch, although valuable in comparing the results of different techniques, vary so much among individuals that they provide inadequate information about the functional status of the hand. Range of motion of the operated thumb is frequently omitted, while compensatory motion at the distal joints is not given proper credit. No procedure can claim absolute superiority over another. In comparison with other techniques, interpositional arthroplasty, using the flexor carpi radialis tendon, is less complex and radical yielding satisfactory results when compared both objectively and subjectively.

Interphalangeal joint destruction: a complication of cryotherapy

Chondrocytes of the digital epiphyses, physes, and articular cartilage are particularly susceptible to the direct lethal effects of extremely low temperatures. We have treated a 13-year-old patient with chondral necrosis of the proximal interphalangeal joint following cryotherapy. Focal contact with the probe tip caused isolated, asymmetric physeal destruction.

The effects of mobilization on the vascularization of healing flexor tendons in dogs

The vascularization of healing flexor tendons in dogs was outlined by use of microangiographic techniques, applied on freshly amputated limbs. The tendons were studied during various stages of mobilization after repair. The responsiveness of the tendon's extrinsic vascularity to the process of protected mobilization was characterized by consistent changes in peritendinous vessel density and orientation. A gradually increasing range of passive motion between the 21st and 84th postoperative days was associated with a gradual reduction in vessel density and an orientation on the longitudinal plane comparable to the structure of control tendons.

The peripheral pulse following arterial injury

There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the etiology or frequency of this phenomenon. Eighteen patients with documented complete radial or ulnar artery transections were evaluated. Nine of the 18 patients had persistently palpable pulse distal to the transections. Seven of the pulses were due to retrograde flow and two were due to transmission from the proximal arterial stump or large collaterals. The Allen test was accurate in demonstrating arterial occlusion in each case. Digital compression of the intact artery eliminated the pulse in those cases due to retrograde flow. Documentation of flow direction and collateral vessels was performed with the Doppler directional velocity meter. The fallibility of the peripheral pulse following complete arterial injury is stressed. The Allen test, digital compression of the intact artery, and Doppler studies should be performed on patients with suspected arterial injuries. The exploration of all wounds in the region of major arteries from which profuse bleeding has occurred is recommended.

Traumatic femoral nerve neuropathy treated by interfascicular nerve grafting: a case report and literature review

A case of traumatic femoral nerve neuropathy secondary to a close range shotgun wound in the groin is described. Spontaneous recovery did not occur because of the segmental defect in the nerve and extensive scarring over the groin. Reinnervation of the quadriceps mechanism was achieved by interfascicular nerve grafting. Interfascicular nerve grafting is a useful technique in lower extremity nerve injuries.

The vascularity of the scaphoid bone

The extraosseous and intraosseous vascularity of the carpal scaphoid was studied in 15 fresh cadaver specimens by injection and clearing techniques. The major blood supply to the scaphoid is via the radial artery. Seventy to eight percent of the intraosseous vascularity and the entire proximal pole is from branches of the radial artery entering through the dorsal ridge. Twenty to thirty percent of the bone, in the region of the distal tuberosity, receives its blood supply from volar radial artery branches. There is an excellent collateral circulation to the scaphoid by way of the dorsal and volar branches of the anterior interosseous artery. An explanation for the cause of scaphoid necrosis on the basis of the vascular anatomy is proposed. The volar operative approach would be least traumatic to the proximal pole's blood supply.

The vascularity of the lunate bone and Kienböck's disease

The extraosseous and intraosseous vascularity of the lunate was studied in 35 fresh cadaver limbs. The specimens were injected with latex, debrided by a nondissection technique, and cleared by a modified Spalteholtz method. The extraosseous vascularity was profuse through two to three dorsal and three to four volar vessels feeding dorsal and volar capsular plexuses. One ot two nutrient vessels were observed entering the dorsal and volar poles of the lunate from both plexuses. The intraosseous vascularity formed one of three consistent patterns with anastomoses of dorsal and volar vessels in each specimen. The vascular patterns support a theory of compression fracture from repeated trauma as the most likely cause of Kienböck's disease.

Keratoconus and coexisting atopic disease

The association of keratoconus and atopic disease has been reported on several occasions but the only controlled clinical study that has so far been published found no evidence to support this view. Since it is now known that atopy is often associated with changes in various immunoglobulins, particularly IgE, it was considered desirable to determine the immunological profiles of a large series of keratoconus cases in order to seek evidence for coexistence of the two conditions in one individual. In this study of 182 cases of keratoconus a definite history of atopy was found in 35% compared with 12% in the matched control group. The serum IgE was significantly raised (P less than 0.001) in keratoconus and markedly so in those cases with associated atopic disease. Serum levels of IgG and IgM were also raised, but contrary to the findings of other observers IgA levels were normal. These findings suggest that atopic traits are more common in patients with keratoconus than in general ophthalmic patients.