Biomedical subjects
Publications and source records attributed to O A Mikkelsen.
A surgical procedure of replacing a destroyed metacarpal head with a metatarsal graft is described. With this method internal fixation with foreign material as well as postoperative immobilisation can be avoided. A follow up of 25 autotransplantations in rheumatoid patients is presented, showing no complications and fair function of the new operated joint.
The influence of handedness, work and previous hand trauma is studied in 901 persons with Dupuytren's disease, collected in an epidemiological study of 15,950 citizens in a small, Norwegian town. Dupuytren's disease occurred in all occupational groups, but the prevalence was higher and the contracture more severe in people doing hard manual work than in people doing light or non manual work. Persons with Dupuytren's disease has sustained previous hand trauma more frequently than the general population, and the interval between trauma and first sign of disease was usually a few years. Previous hand injuries were definitely more common among people doing hard manual work, but even when these were excluded from the work material, Dupuytren's disease was still more common among people doing hard manual work, than in people doing light or non manual work. The study has indicated that Dupuytren's disease in certain cases is precipitated and/or aggravated by both work and definite hand injury.
647 men and 254 women with Dupuytren's disease of the hands were questioned about how, where and when the disease had started. Usually the disease started in the right hand, and nodules in the ulnar part of the palm were the first symptom in 90%. In 10% of the cases with bilateral disease, it started simultaneously in both hands. One woman and two men noticed the first symptom before 10 years of age. In about 50% of the men, the disease started between 40-59 years of age (women 40-69 years). In men the contracture increased rather constantly during the first twenty years, followed by a stationary phase from about 20 to thirty-five years of duration, whereafter it definitely decreased. In women the disease increased gradually with the duration of the disease.
Knuckle pads are not exclusively found in persons with Dupuytren's disease, but they occur four times more often in these patients than in the general population (in Norway). Occurrence of knuckle pads in persons with Duputyren's disease does not seem to imply a higher predisposition or a more aggressive disease.
The distribution and stages of contracture in the digits are examined in 901 persons with Dupuytren's disease and collected into an epidemiological study of 15,950 persons in a small Norwegian town. The frequency of contracted digits counted from the total number of affected hands, are for men (women in parentheses): Thumb 3.0% (0.6), Index finger 1.2% (1.7), Middle finger 28.3% (27.9), Ring finger 85.1% (92.3) and Little finger 45.4% (39.5). The most common combination of affected fingers are ring and little fingers. At corresponding ages, the contracture is more severe in men than in women, and more severe in the right than in the left hand. With the exception of the index finger, the degree of contracture increases from the thumb to the little finger, 29% of the men and 12% of the women examined had contracture of such an extent that surgical treatment was advisable. Only 5.7% of the men and 3.1% of the women had been operated on because of the disease, which indicates that operation statistics are based upon very selected patients. Many aspects of this disease can only be properly studied in epidemiological material.
A follow-up study of 201 flexor tendon synovectomies of the hand in patients with rheumatoid arthritis is presented. The operations were performed from 1/2-49 years after onset of the disease, and the patients were between 16 and 76 years of age. The follow-up study is based on questionnaires and, in addition, 78% of the patients also had a physical re-examination. The follow-up time spanned 12-78 months. Nearly 70% of the operated hands were subjectively improved; the others were unchanged or worse. The poor results were often caused by progression of arthritis in finger joints. Recurrence of the tenosynovitis was observed in about 37% of the hands, but in very few to such an extent that reoperation has been necessary.
Ten hemiarthroplasties were performed with the Oscobal (Daubenspeck) his prosthesis, which consists of a metal stem and a nonrotating ployethylene head. Five patients died 1-150 days after the operation. Signs of massive wear of the polyethylene head were demonstrated in four out of the five patients still alive 16-28 months after the operation. We can therefore not recommend the Oscobal system for hemiarthroplasty of the hip.
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