Biomedical subjects
Publications and source records attributed to P B Jacobs.
Eight patients with delayed rupture of the extensor pollicis longus tendon are presented. Six had suffered from a fracture of the wrist without dislocation. This is in our opinion a predisposing factor in the etiology of delayed tendon rupture. Our treatment of choice is transfer of the extensor indicis proprius tendon. In all patients satisfactory thumb function was restored.
The case of a patient who was involved in a car crash is presented. On the right side her wrist and zygomatic arch were fractured. At both localizations she developed a painful syndrome. The diagnosis of reflex sympathetic dystrophy of her arm was made within 3 weeks after the injury and therapy instituted. The pain in her face and skull were accompanied by vasomotor changes which increased after exercise and by hypesthesia, hyperpathia, paresis, and hyperhidrosis. Disorders of the cranial nerves were excluded by physical examination and electromyography and structural disorders by CT scanning. The diagnosis reflex sympathetic dystrophy of the head was made one year after the injury. The problems in diagnosis are discussed.
Treatment of proximal femoral fractures is difficult. A retrospective analysis of 92 patients treated with a custom-made extended gamma nail with a mean follow up of 4 months is presented. The early results of this new method are promising. The indications for the use of the long gamma nail were intertrochanteric fractures with extension to the subtrochanteric region, imminent and pathologic fractures of the intertrochanteric and subtrochanteric region, mostly in elderly patients, proximal femoral fractures, and combination injuries in multiple trauma patients and delayed unions. In 67 cases the patients were primarily treated with a long Gamma nail. In 25 cases the nail was used after the failure of initial treatment. Complications occurred in 32 patients; however, 88 patients were able to walk at the end of the study. The advantage of this new method is that with a closed surgical technique full weight bearing directly after the operation is achieved. The long Gamma nail provides a procedure by which most complex fractures in the proximal femur can be managed.
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The results of operative treatment of unstable distal radial fractures were evaluated in 46 patients according to the criteria of Steinmann and Spier. The overall results were excellent or good in 35 patients (76.1%) and fair in 11 patients (23.9%). There were no poor results. Intra-articular fractures with volar dislocation (Smith type II) and fractures with severe comminution (Sarmiento type IV) are unstable and require surgery. Special attention must be paid to the Sarmiento type-II fracture with severe comminution of the dorsal cortex, severe radial shortening (greater than 10 mm) and dorsal tilt (greater than 25 degrees). Although not intra-articular, this fracture type may also prove to be unstable. The treatment of a Smith type-II fracture is a volar buttress plate unless extended comminution is present. Then, and in all other unstable fracture types, external fixation should be employed. In cases with severe loss of the dorsal cortex, bone grafting may be indicated.