Biomedical subjects
Publications and source records attributed to M Waizenegger.
In a prospective study we investigated 12 clinical features for scaphoid fractures in 52 patients: 23 in whom a fracture of the scaphoid was diagnosed radiologically and 29 patients in whom a fracture was clinically suspected but could not be confirmed by radiography or scintigraphy. The signs were tested within a few days of injury and again 2 weeks later. None was reliable in diagnosing a scaphoid fracture.
In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine "scaphoid view" radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. In 19 there was localized increased uptake in the scaphoid bone. In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.
The Kapandji procedure was performed on 14 patients who presented with chronic pain at the distal radioulnar joint, limited forearm rotation or poor grip after an injury involving the distal radioulnar joint. Ten patients were able to resume their original occupation and leisure activities. Some complained of mild aching after heavy use. Postoperatively, grip strength on the affected side was, on average, 84 per cent that of the opposite side. Forearm rotation in the affected arm averaged 129 degrees before operation and 170 degrees afterwards, compared with 171 degrees on the normal side, while wrist flexion-extension averaged 129 degrees preoperatively, 126 degrees postoperatively and 148 degrees on the normal side. Four patients had less satisfactory results because of pain and a feeling of insecurity due to an unstable proximal ulna. However, two of these had severe residual problems in relation to the initial forearm component of the injury, the symptoms from which were difficult to separate from the distal radioulnar injury. Although the Kapandji procedure can yield excellent results, it is difficult to predict which patients will suffer from an unstable ulna.
25 patients with 26 intraosseous ganglia in carpal bones are described, 14 in the scaphoid and 12 in the lunate. In most cases, attention was drawn to the lesion when X-rays were performed after a recent injury to the wrist. Typically, they occurred eccentrically and were surrounded by a radio-dense rim of bone. In a few cases the cortex was breached but never expanded by the lesion. Curettage and bone grafting were performed only if symptoms persisted and no other source for the pain could be found. Most contained the typical jelly-like material also found in soft tissue ganglia and the histology showed an identical structure. A suggested format for the management of these lesions is presented.