Biomedical subjects
Publications and source records attributed to F C McCue.
This article deals with soft-tissue injuries of the upper extremity incurred by competitive athletes. The authors describe the pathophysiology, conservative and operative management of musculotendinous elbow injuries, entrapment neuropathy, tendinous disorders, vascular injuries, and dermatologic conditions in athletes. Protective gear for many of the aforementioned injuries are also described.
Closed tendon injuries in the hand are common in the athlete. Neglect of such injuries may result in irreparable damage to the hand. Even seemingly minor injuries must be carefully evaluated and treated by a physician. Early diagnosis, accurate and precise treatment, and proper rehabilitation are extremely important to regain optimal function after these injuries. Most of the injuries can be controlled by conservative means. However, when surgical repair is indicated, it is important for the surgeon to be trained and familiar with the anatomy and techniques of surgery of the hand.
Three men with thumb injuries sustained during rodeo roping competition have been treated recently. Two of the thumbs were amputated, and the third was partially avulsed. The mechanism of injury was identical in all three cases. The thumbs were entwined between the rope and saddle horn while reducing the slack in the rope and then subjected to shearing and crushing forces as tension was placed on the rope. These injuries emphasize the importance of keeping the thumb upward and clear of the rope to avoid entrapment between the rope and saddle horn.
Kienböck's disease has been a well-recognized disorder of the wrist since it was first described in 1910. It has not been reported to occur bilaterally. We have recently treated two men who presented with bilateral Kienböck's disease.
This report describes a hand infection caused by an alga. Prototheca wickerhamii. This rare organism presents most often as chronic dermatitis or bursitis of the upper extremity. Routine stains and cultures are easily confused with fungi. Only early, radical excision of the involved structures will effect a cure.
This paper reviews 218 patients who had outpatient meniscectomy at the University of Virginia between January 1974 and June 1977. Only one patient (0.46%) returned before his scheduled visit. Three patients (1.4%) had superficial wound infections. One (0.46%) had a pulmonary embolus several weeks postoperatively. Twelve percent underwent knee aspiration at two weeks after operation and 3.8% at six weeks. Twenty-seven patients had two meniscectomies at the University of Virginia, and 23 had both procedures as outpatients. None who had the first as an outpatient chose admission for the second. The average hospital bill for meniscectomy performed at a private hospital in Virginia in 1978 was +1,238.99. This would have been reduced by about 50% if meniscectomy had been done on an outpatient basis. In selected patients, outpatient meniscectomy can be done with a low complication rate, at a decreased cost, and with satisfaction to the patient and doctor.
Twenty cases of Achilles tendon injury treated surgically at the University of Virginia Medical Center from 1970 to 1979 were reviewed and reevaluated with up to 9 years of follow-up. Three treatment groups were identified: Group I--primary repair of a lacerated Achilles tendon; Group II--primary repair of an acutely ruptured Achilles tendon; and Group III--subacute repair of Achilles tendon rupture (performed more than 72 hours after injury). Acute repairs were performed by end-to-end suture. In subacute cases the anastomosis was reinforced with one or 2 flaps from the gastrocnemius tendon. Strenuous exercise accounted for nearly all the cases of acute tendon rupture. Surgical complications and overall functional results were determined for each treatment group. Open repair provides excellent results when applied to lacerations. A good-to-excellent overall result can be expected for patients with acute ruptures and primary repair, but an awareness of the possible postoperative complications is necessary. Achilles tendon ruptures that go unrecognized for more than 72 hours are best treated conservatively.
Single and double contrast arthrographic techniques were compared in 951 patinets with suspected meniscal injuries. Exploratory surgery of the knee was performed in 384 of these patients and good clinical follow-up was obtained in 135 patients. In the latter two groups of patients, the single contrast technique was 97% accurate in assessing the medial meniscus and 96% accurate in assessing the lateral meniscus. Double contrast arthrography was 97% accurate in assessing the medial meniscus and 93% accurate in assessing the lateral meniscus. Numerical differences in the results from the two techniques were not statistically significant. Therefore both techniques can be considered equally effective diagnostically.
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Angiographic findings characteristic of osteoid-osteoma are described in two cases of osteoid-osteoma of the bones of the wrist. While the etiology of the disease is not understood, a developmental relationship between the osteoid-osteoma nidus and increased vascularity is suggested.
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Chondrosarcomas of the hand are relatively rare. Chondrosarcomas may arise by malignant transformation of a pre-existing enchondroma, but this causal relationship has been difficult to establish in solitary enchondroma. This is a case report of a chondrosarcoma of the proximal phalanx of the right index finger in a 66-year-old woman demonstrating histologic evidence of malignant transformation of a pre-existent benign solitaary enchondroma. Careful analysis of the preoperative X-ray for punctate endosteal calcification or cortical expansion and ample histologic sampling of the endosteal component of chondrosarcomas arising from within bone may demonstrate a greater incidence of preexistent enchondroma.
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