Orthopaedic clinician scientists.
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Biomedical subjects
Publications and source records attributed to D Hanel.
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An ideal replacement for the scapholunate ligament (SLL) has not been found. The carpometacarpal bone-ligament-bone complex at the base of the second and third metacarpal is proposed as a replacement for the SLL in this study. A cadaveric study of matched SLL, second metacarpal-trapezoid ligament, third metacarpal-capitate ligament, and dorsal periosteal retinaculum was performed. Stiffness and strength were obtained from fresh-frozen specimens tested to failure with a hydraulic distractor. The second metacarpal-trapezoid ligament and the third metacarpal-capitate ligament most closely approximated the stiffness and strength of the SLL. The dorsal periosteal retinaculum was significantly less stiff and was significantly weaker than the SLL. This study indicates that the second or third carpometacarpal ligaments are grafts that approximate the mechanical properties of the SLL.
To determine if small avulsion fractures of the thumb ulnar collateral ligament (UCL) with minimal (< or = 2.0 mm) displacement can successfully be treated by cast immobilization, the authors reviewed 9 patients with minimally displaced fractures initially treated by casting. Despite immobilization within an average of 2 days of the initial injury (range, 0-6 days), a minimum of 6 weeks of immobilization in a cast, and adequate rehabilitation, all 9 patients had persistent thumb pain, especially with activities requiring strong pinch. After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). Grip strength increased from 77% to 93% (p < .05), but the ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were not significantly altered. Minimally displaced UCL avulsion fractures frequently have significant rotation that prevents successful fracture healing even with prompt cast immobilization.
In a multicentre study, a clinical evaluation of the new titanium implants of the sizes 2.7, 2.0 and 1.5 mm was done. In seven centres, 133 patients were operated on and the personal, subjective opinions of the surgeons were recorded. In the opinion of these surgeons experienced in using steel implants, the outcome of the internal fixations was the same for titanium as for steel implants. Three metal-related complications occurred in the smallest size screw type (1.5 mm), namely, one screw broke and two bent. In the cases in which the implant had been removed, good tissue contact with the implant could be seen. Only in one case was there discolouring of the soft tissue due to titanium. It is recommended that surgeons who are used to handling stainless steel screws should be aware of the slightly different behaviour of titanium screws.
OBJECTIVE: To determine whether human T cell lymphotrophic virus (HTLV) infection is associated with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. METHODS: Three patients presenting with RS3PE syndrome and 7 controls were examined for the presence of HTLV crossreactive antigens. RESULTS: Our patients were elderly men who presented with typical symptoms of abrupt onset of synovitis of the wrist, carpal joints, metacarpophalangeal, proximal interphalangeal, distal interphalangeal joints, and flexor tendons, associated with remarkable pitting edema of the hands. Transmission electron microscopy and immunohistochemical analysis for HTLV-1 P19 and P20 related antigens failed to detect retroviral presence in the sample specimens or controls. CONCLUSION: Our investigation suggests there is no evidence for HTLV synovial infection associated with RS3PE.
Foreign bodies with metal content ingested by 16 patients were removed from the upper gastrointestinal tract by means of a magnet inserted into the end of orogastric tube. In only one case did the foreign body uncouple from the orogastric tube-magnet arrangement during retrieval. The procedure is an alternative to endoscopic or surgical removal in some cases of metal foreign body ingestion.
Metallic foreign bodies ingested by eight patients (seven children) were removed from the upper gastrointestinal tract by means of a magnet inserted into the end of an orogastric tube. No patient required hospitalization, anesthesia, surgery, or subsequent radiography, and all patients remained asymptomatic. In no case did the foreign body uncouple from the orogastric tube-magnet arrangement during retrieval. The procedure is an alternative to endoscopic or surgical removal in some cases of metallic foreign body ingestion.
The most important determinants of the functional ability of an amputated part are proper patient selection and the recognition of vascular compromise. Ideally, a well-performed anastomosis should need no pharmacologic assistance, but the ideal is often the exception. The authors present an empirical approach to use of anticoagulation medication.
The extraction of foreign bodies by means of a magnet often failed, because the field strength of the used magnet was not sufficient. Using a Vacomax -magnet we were able to remove a little battery of a photographic flash-light from the stomach. We recommend this method for further experimental use.