Biomedical subjects
Publications and source records attributed to I Zion.
Subtalar distraction bone block arthrodesis has been described to treat late complications of displaced calcaneal fractures. A "ramp cage" can be used to restore the talocalcaneal relationship by providing stable correction in the coronal and sagittal dimensions.
BACKGROUND: Failed manipulative reduction of avulsion fractures of the tibial insertion of the anterior cruciate ligament has been attributed to interposition of soft tissues, particularly the anterior horn of the medial meniscus. The objectives of the present report were (1) to show that the failure to reduce Meyers and McKeever type-III tibial eminence fractures was not due to interposition of soft tissues and (2) to discuss the relevance of the finding that the anterior third of the lateral meniscus was attached to the avulsed anterior cruciate ligament insertion site in all patients studied. METHODS: Twelve patients who had had a failed manipulative reduction of a type-III tibial eminence fracture underwent arthroscopic reduction and fixation of the avulsed fragment. RESULTS: A number of consistent findings were noted. The avulsed intercondylar eminence was displaced superiorly into the intercondylar notch. Attached to this fragment was not only the anterior cruciate ligament, but also, in all cases, the anterior horn of the lateral meniscus. The anterior third of the lateral meniscus had been torn from its tibial attachment and displaced together with the osseous fragment into the intercondylar notch. No interposition of bone or soft tissue was observed. Reduction of the osseous fragment was facilitated by traction on, or sutures passed around, the anterior horn of the lateral meniscus. Standard fixation methods were utilized. CONCLUSIONS: The concept that avulsion fractures of the tibial insertion of the anterior cruciate ligament cannot be reduced by manipulation because of soft-tissue interposition was not supported by the findings of the present study. The attachment of the anterior horn of the lateral meniscus to the avulsed tibial insertion of the anterior cruciate ligament may not be an irrelevant incidental finding. The observation that the displaced osseous fragment was attached simultaneously to the anterior cruciate ligament and to the anterior horn of the lateral meniscus, both pulling in different directions, may explain why type-III tibial eminence fractures are irreducible by manipulation.
The use of double staples is an accepted method for fixation of hamstring anterior cruciate ligament (ACL) grafts at the distal tibial site. In the last year, we have modified the 2-staple technique that we have been using for distal tibial fixation of our double loop hamstring ACL autografts. Previously, we had impacted the graft with 2 toothed staples onto the cortex distal to the opening of the tibial tunnel. The modification we report here involves driving the proximal staple into the tibial tunnel roof, thus collapsing the tunnel onto the tendon during fixation. The distal staple is introduced in the usual manner. Clinical follow-up including subjective and objective KT-1000 arthrometry has indicated no difference in the early results compared with the former staple technique. Radiologic follow-up showed tunnel obliteration and filling in the area of the proximal staple, suggesting early graft incorporation in callus. While early results are encouraging, long-term follow-up and pullout studies will be reported. It would appear that collapsing the bony tunnel by the proximal staple may be a simple method of providing fracture callus to increase the stiffness of the tibial graft fixation, with no major or minor complications. Animal experiments are being carried out to objectively define the mechanical advantage of the graft incorporation by callus.
Between December 1981 and June 1986, 52 women examined by ultrasonography were found to have clear pelvic cysts more than 5 cm in average diameter, without septa or solid areas. The cysts were persistent and did not respond to contraceptive pills for four to eight weeks. In all cases, there were histologic or cytologic results from surgical specimens or fluid aspirated from the cysts. In 15 women, the cysts were aspirated and revealed no malignant cells. Thirty-seven women underwent laparotomy, of whom 11 (29%) were found to have benign ovarian neoplasms (nine cystadenomas and two dermoid cysts). Because benign ovarian neoplasms are potentially malignant, and because a large number was found in our study, we recommend removal of the cysts by excision rather than aspiration.