Biomedical subjects
Publications and source records attributed to F J Harvey.
A patient with osteomyelitis of the scaphoid in childhood resulting in a pathologic fracture with nonunion is presented. This ununited fracture of the scaphoid was successfully grafted eight years later with a satisfactory outcome.
Ninety-one wrists in 82 consecutive patients with Quervain's disease were treated by the one surgeon between 1978 and 1987. The treatment of 79 wrists in 71 patients who had received their entire treatment from this surgeon is analyzed. Uniformity of injection technique is thus ensured. Initial treatment in 63 wrists was an injection of steroids and local anesthetic into the tendon sheath, which gave complete relief in 45 cases. Seven wrists received two injections before the pain abated. Only 11 of the 63 injected wrists had an operation. In 10 of these the extensor pollicis brevis tendon was in a separate compartment. It is concluded that injection of steroids is the preferred initial treatment in de Quervain's disease, giving complete and lasting relief in 80% of cases. If injection fails, it appears likely that the extensor pollicis brevis tendon lies in a separate compartment.
A case of synovial chondromatosis of the distal interphalangeal joint of the long finger with an 8-year follow-up is presented. The lesion recurred 4 years after simple synovectomy, requiring a second operation with arthrodesis.
We reviewed 21 patients with 22 ruptures of the extensor pollicis longus at a mean of 5.3 years after transfer of the extensor indicis proprius tendon. Of these, 19 with 21 transfers described the result as good, and two as fair. The mean deficit of extension between the operated and unoperated thumbs was 1.4 cm, and the mean flexion deficit 0.6 cm. Pressure gauge measurements showed that the strength of the transfer was 51% of that of the uninjured extensor. The two fair results had an extensor lag of over 1.5 cm. Independent extension of the index was maintained in all patients, none having a discernible lag, but the strength of index extension was reduced to 49% of that of the normal finger. There was no evidence of functional loss. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon is a simple and reliable procedure with few complications. It gives satisfactory long-term extension of the thumb.
Three unusual cases of rupture of finger extensor tendons by attrition are reported. In one instance it was associated with long-standing nonunion of a scaphoid fracture, with a posttraumatic dorsal subluxation of the lower end of the ulna in another, and with a Madelung's deformity in the third. Extensor tendon rupture has not been previously recorded in the English-language literature after the first two conditions.
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Congenital fusion of the carpal bones is fairly common and may be associated with other congenital deformities in the hand. This report deals with an unusual congenital anomaly of the little fingers associated with fusion of the triquetrum and lunate. Both little fingers were adducted and rotated giving crude resemblance to thumbs on the ulnar borders of the hands. The deformity was easily corrected by osteotomy through the base of the fifth metacarpals.
A new method of conservative treatment of Bennett's fracture is presented, the thumb being immobilised in moderate adduction rather than radial abduction. Anatomical dissections are outlined to demonstrate the rationale of this procedure.
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Intramedullary nailing of thirty acute displaced open fractures of the tibia and fibula resulted in union with only one superficial infection. The low incidence of sepsis is attributed to the use of the curved malleable Hodgkinson tibial nail which requires no reaming, renders the operation less difficult and traumatic, and interferes minimally with bone vascularity. Fibular nailing was an effective means of stabilizing nine of the twelve fractures close to the ankle joint.
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