Biomedical subjects
Publications and source records attributed to A R Swafford.
Bilateral hamate fractures in a physician sportsman were treated successfully by surgical excision of the fracture fragment. This case demonstrates the importance of carpal tunnel roentgenograms and of a high index of suspicion in making an accurate diagnosis in wrist injuries.
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Patients with ulnar midcarpal instability have a characteristic pattern of clinical signs and symptoms related to the midcarpal joint. The usual presenting complaint is a painful wrist click which can be reproduced by ulnar deviation, axial compression, and pronation of the wrist. Routine x-rays are usually normal, but cinefluoroscopy reveals sudden dissociation between the proximal and distal carpal rows resulting in a dorsiflexion collapse deformity. In six of our patients, conservative therapy sufficed to relieve symptoms. Four other patients required surgical stabilization. We close to stabilize the triquetrohamate joint because it was a relatively easy procedure and eliminated instability in most instances. Laboratory studies aided in understanding the pathomechanics of midcarpal instability, which consisted of dorsal subluxation of the capitate and hamate on the lunate and triquetrum. We believe that midcarpal instability is not a rare condition but may often be confused clinically with more common carpal dissociations.
Pyogenic vertebral osteomyelitis may follow any process which initiates bacteremia and should be considered in a differential diagnosis of back pain occurring in the convalescent phase of septicemia. The two cases discussed here, following abdominal stab wounds, illustrate the principles of diagnosis and management of this problem. Diagnosis is based on gradual onset of low back pain with spinal tenderness and paravertebral muscle spasms, without neurologic symptoms. Serial X-rays are helpful, as are technetium phosphate or gallium bone scans. Appropriate antibiotic plus immobilization are recommended.
This study compared two isometric-grip testing devices and considered the efficacy of combining data from the two as a means of identifying both functional status and consistency of effort for physical capacity evaluations (PCEs). Two groups (26 healthy subjects and 40 patients who had upper-extremity impairments) were used to establish the reliability of applying force on a jamar dynamometer, and on an Isometric Strength Testing Unit (ISTU). Many of the patients had been referred because of inconsistencies between subjective complaint and medical presentation. The results indicate that power-grip force outputs are highly related across the two test devices, which validates their utility as part of a PCE for wrist-hand involvement. A simple index (2-ratio) of functional status and consistency was developed by combining test data from the two devices. The sensitivity of the 2-ratio, in combination with other indices of consistency, is discussed.