Biomechanical evaluation of the ST-knot: A new suture for flexor tendon repair

PURPOSE

Although tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler).

MATERIALS AND METHODS

Forty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle.

RESULTS

There was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4.

CONCLUSIONS

The ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury.

Field study of the efficacy of halofuginone and decoquinate in the treatment of cryptosporidiosis in veal calves

Ninety, seven- to 10-day-old calves were allocated to three groups of 30 and treated daily for seven days with either 100 microg/kg halofuginone hydrobromide or 2.5 mg/kg decoquinate orally or left untreated as controls. The levels of diarrhoea and dehydration were monitored daily for 28 days from the first day of treatment (day 0) and samples of faeces were collected on days 0, 7, 14, 21 and 28, to quantify the excretion of Cryptosporidium parvum oocysts. The calves were weighed on days 3 and 28. The treatments had no effect on the levels of diarrhoea or dehydration, the proportions of diarrhoeic calves or the proportions of calves shedding oocysts. However, unlike decoquinate, halofuginone significantly reduced the excretion of oocysts on day 7 (P<0.0001), and decoquinate increased the average daily weight gain of the calves (P=0.049).

Medical responsibility and air transport

When a medical emergency occurs during a flight operated by a commercial airline, the assistance of a physician-passenger fortuitously present aboard may be requested. This physician becomes bound by both his professional and civil responsibilities. However, in the case of a serious problem, he would usually ignore the question of the jurisprudence of the country where the emergency occurs. In discussing this issue, this paper analyses different situations and risks that the physician may incur and points out various defects in the law not currently covered by existing international conventions.

[Echographic aspects of collections of fluid in the gallbladder space following cholecystectomy. Apropos of 11 cases]

Fifty seven patients (51 women and 6 men) undergoing cholecystectomy had ultra-sound evaluation on the 3rd, 5th, 7th and 9th post-operative days. In all the cases, the right upper quadrant has been observed correctly with a phased array 3.5 MHg transducer. Eleven of the fifty seven patients (19%) were found to have fluid collection in the gallbladder fossa. The collection has a rounded or an oval configuration, in the proportion of 11 and 55 mm, surrounded by an echogenic area. These fluid collections were of no clinical and biological significance and disappeared in 2 or 4 days time. The authors discuss the relationship between the presence of fluid and the use of drains or different surgical techniques.

[Acute intestinal invagination. Ultrasonic aspects]

The sonographic pattern of an intussusception in a 21 months old child is reported. The value and the meaning of this pattern is discussed according clinical and anatomical presentation of intussusception.

[Nodular lymphoid hyperplasia. Diffuse form extending from the duodenal bulb to the rectum, associated with agammaglobulinemia]

The authors study a case of nodular lymphoid hyperplasia, extending from the duodenal bulb to the rectum, associated to an agammaglobulinemia; they observe the variations of the roentgenology appearance and the distribution of the elementary pictures; they discuss the meaning of the disease, the association or the evolution to a lymphoid carcinoma.