Biomedical subjects
Publications and source records attributed to G I Baker.
A brief history and the evolution of the Swanson implant hemi-arthroplasty of the first metatarsophalangeal joint introduces this small series of cases. Preoperative criteria, surgical technique, and results are presented along with the follow-up. Long term follow-up suggests that there are some additional complications to this especially in cases of arthritis associated with systemic diseases.
Thirty-eight displaced intracapsular fractures of the femoral neck treated by the Deyerle method of internal fixation have been added to the previously reported series of sixty-three cases from the Walter Reed Army Medical Center Orthopaedic Service. A significant change in the incidence of non-union was found. In the over-all series of 101 patients, the incidence of non-union was 13.8 per cent and the incidence of segmental collapse due to avascular necrosis was 13.8 per cent. The roentgenographic and functional over-all end results were rated excellent in 67.7 per cent and poor in 32.3 per cent of the fractures. Some difficulties arising from the multiple-pin and plate technique and the associated morbidity are discussed. We now think that Deyerle method produces no better results than other methods of internal fixation of displaced intracapsular fractures.
Stress fractures, well-known occurrences in military recruits, also occur in civilians. There is a gradual alteration of the bone resulting from repeated unaccustomed stresses. Pain usually precedes positive x-rays by one to two weeks. Serial films are therefore required. Differential diagnosis can be a problem but treatment is simple. Femoral neck stress fractures can become complicated.
A review of 129 hand tumors suggests that diagnosis of a swelling in the hand is often uncertain because of the close proximity of many different tissues in a small volume. Histologic diagnosis is necessary to assure appropriate treatment; excisional biopsy should be done whenever possible; if the lesion is benign, treatment has been completed; in the event the lesion is malignant, further treatment will not have been materially compromised. The margin of normal tissue around malignant lesions often precludes treatment of such tumors of the hand by ray resection or wide local excision because adequate wide excision will frequently leave nothing functional. Attempts at wide local excision are ofter compromised by the surgeon's natural desire to preserve function; this frequently results in incomplete removal of the tumor. The function preserved will be of little benefit to a patient with widespread metastases.
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