Biomedical subjects
Publications and source records attributed to F Schuind.
A case of post-traumatic locked metacarpo-phalangeal joint is described. The locking was caused by an intra-articular fracture of the metacarpal head which was not diagnosed on the pre-operative radiographs.
S-shaped force transducers were developed for measurement of the forces along intact tendons. After calibration, the transducers were applied to the flexor pollicis longus and flexor digitorum superficialis and profundus tendons of the index finger in five patients operated on for treatment of carpal tunnel syndrome. The tendon forces generated during passive and active motion of the wrist and fingers were recorded. For pinch function, the amount of the applied load was measured with a special pinch meter. Tendon forces in the range of 0.1 to 0.6 kgf were measured during passive mobilization of the wrist. Tendon forces up to 0.9 kgf were present during passive mobilization of the fingers. Tendon forces up to 3.5 kgf were present during active unresisted finger motion. Tendon forces up to 12.0 kgf were recorded during tip pinch, with a mean applied pinch force of 3.5 kgf. These results have potential application in determining the amount of force that a tendon repair would have to resist during passive as well as active postsurgical mobilizations.
The techniques of vascularized transfer of a bone segment, or of revascularization of a conventional bone autograft by a pedicle or a microsurgical muscular flap represent one of the most significant advances made during the last years for the treatment of large bone defects of the tibia with associated skin injury. The authors present their experience with 16 cases, including 5 microsurgical transfers.
The mechanical roles of the triangular fibrocartilage have been examined in three experiments. Kinematic analysis by a stereophotogrammetric method revealed that the palmar radioulnar ligament was taut in supination and that the dorsal radioulnar ligament was taut in pronation. In full pronation, the palmar radioulnar ligament decreased to an average of 71% of its length in tension. In full supination, the dorsal radioulnar ligament decreased to an average of 90% of its length. Mechanical testing of the triangular fibrocartilage under axial load disclosed a significant laxity (mean: 10.4 mm), which was decreased in pronation. Transverse loading tests demonstrated that the triangular fibrocartilage is less stiff in neutral forearm rotation. Study of the material properties of the palmar and dorsal parts of the triangular fibrocartilage showed these structures to be strong ligaments with material properties similar to those of the radiocarpal ligaments.
External minifixators were used in the treatment of 63 closed diaphyseal metacarpal bone fractures. A simple half-frame configuration was applied in all the cases. Open reduction was performed in 26%. The mean duration of external fixation was 30 days. There were no cases of nonunion. Anatomical reduction was obtained in 86.6% of the cases. There were no cases of reflex sympathetic dystrophy. The general functional results were very good or good in 96.6%. Open reduction did not significantly alter the final results. External minifixation is usually accepted as a treatment of open metacarpal fractures. Because of the excellent results obtained in our series, we believe that the indications of external minifixation could be enlarged to closed metacarpal bone fractures.
Ninety-three patients with acute fractures of the diaphysis of one or both bones of the forearm were treated by a Hoffmann external fixator, using a half-frame configuration. Whenever possible, closed methods of reduction were used. The versatility of the Hoffmann external fixator allows multiple attempts and possible secondary resumption of the reduction. The half-frame configuration is stable enough, allowing the restoration and maintenance of the precise anatomy of the forearm bones and early active postoperative motion. The median length of retention of the external fixator was 13 weeks. Because of the elastic type of fixation, a solid periosteal callus was usually obtained. Non-union occurred in 8.5% of the patients. One refracture at the former fracture site was observed.
The histologic lesions in flexor tendon synovium of 21 patients seen initially with idiopathic carpal tunnel syndrome have been studied. The findings were similar in all biopsy specimens and were typical of a connective tissue undergoing degeneration under repeated mechanical stresses.
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We present the case of a young man with 13 cm of bone and soft-tissue loss in the tibia and a severe traction injury of the brachial plexus. A free vascularised composite transfer of the bone and soft tissues of the ulnar side of the forearm was undertaken to reconstruct the defect. Bony union was achieved after a year and was followed by complete functional recovery of the lower limb.
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Madura foot is the most frequent clinical form of mycetoma, which is a tumor-like destructive fistulized infection of the foot, caused by fungi. The only effective treatment is complete resection of the lesions. Leg amputation is frequently required.
The development of microvascular surgery has allowed the transfer of revascularized bone grafts. The surgical techniques of the most useful transfers are explained. The advantages, disadvantages and indications of these procedures, as compared with the other techniques of bone reconstruction, are discussed.
Twenty-four fractures or nonunions of the clavicle were treated by a Hoffmann external fixator, for selected indications. No vascular or pleural complications were observed. All clavicles healed, after a mean duration of 52 days.
Development of microsurgery has involved the use of revascularized bone grafts in maxillo-facial surgery. They are essentially indicated in rebuilding of complex tissues lost including bone. Their utility is well know in maxillofacial surgery, cervico-facial cancerology, ballistics trauma and in the cure of some mandibular osteoradionecrosis. Only scapular and iliac autogenous bone transplants were used by the authors. Following their short experience, they preferred the pediculated iliac transplants on the deep circumflex vessels more easy to handle and more secure. They brought some modifications in the graft technics in order to decrease the functional and the esthetic damages at the donor site: the incisions were parallel to the iliac crest an to the crural arch. The transplant respected the integrity of the antero-superior-iliac-spine and the crural arch. At the receiving site the muscle was left denuded in the oral cavity. The reepithelialization was observed in a short time.
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There is a rare and special type of macrodactyly that is called the hyperostotic variety. This disease occurs later than the classical forms of macrodactyly and shows massive osteocartilaginous deposits around the joints. A new case is reported. The cause of this disease could be previous trauma.
A new technique is presented for the treatment of comminuted intraarticular fractures of the base of the thumb metacarpal. A triangular Hoffmann external radius and first- and second-metacarpal fixator is used. The reduction is maintained by prolonged distraction and abduction of the first metacarpal bone. The application of the technique in three cases is reported.
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