Digital flexion contractures secondary to tophaceous gout. A report of three cases.
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Aged↗
Biomedical subjects
R J Caudle
Publications and source records attributed to R J Caudle.
Avulsion fracture of the lateral acetabular margin. A case report.
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Acetabulum↗
Tendon transfers for elbow flexion.
This article reviews the causes of loss of elbow flexion. It outlines the necessary preoperative considerations for elbow flexorplasty. The techniques, advantages, and disadvantages of flexorplasty, including the Steindler, pectoralis major, triceps, sternocleidomastoid, and latissimus dorsi, are discussed.
Brachial Plexus↗
Ogden plate and other fixations for fractures complicating femoral endoprostheses.
Treatment of femoral shaft fractures complicating endoprostheses remains controversial. Nineteen such fractures were treated with open reduction and internal fixation using the Ogden plate. This modified plate allows for proximal fixation with heavy-duty Parham bands and distal fixation with screws. Sixteen of 19 patients healed their fractures in an average of 3.5 months. Two fractures developed delayed unions, one resulted in non-union. At final follow-up examination, results were rated as excellent (12), satisfactory (5), and poor (2). The procedure is not technically difficult. It can be applied to fractures both above and below the prosthetic tip as well as those with and without cement. Use of the Ogden plate provides immediate rigid fixation allowing early mobilization, preventing the complications of traction and/or cast immobilization.
Adult↗
Unstable intertrochanteric fractures of the hip.
In spite of a host of operative techniques and fixation devices, no one method of treatment has gained universal acceptance for the treatment of unstable intertrochanteric hip fractures. Although it is important to determine if a fracture is stable or unstable, stability should be considered a relative term. Degree of stability should be assessed by a careful review of the preoperative radiographs as well as postreduction films and palpation of comminution at surgery. Those fractures with minimal to moderate posteromedial comminution are probably best managed by anatomic reduction and compression hip screw fixation. The collapsing device will allow the fracture to obtain its own stability (Figure 5). However, in severely comminuted fractures the screw may slide completely prior to the stable apposition of cortical surfaces of the proximal and distal fragments. Fixation failure will result in a significant percentage of these fractures unless a stable reduction is obtained surgically. Medial displacement osteotomy, valgus osteotomy, or augmentation with cement should be considered in these high-risk fractures. Regardless of the reduction technique the proximal fragment must be aligned properly with the femoral shaft. If the major fracture fragments are prevented from reaching a stable configuration, fixation failure will likely occur (Figure 6).
Bone Nails↗
Severe open fractures of the tibia.
Sixty-two Type-III open fractures of the tibial shaft are reported on. Eleven were Type IIIA, and three of them had non-union while none were associated with deep infection or required secondary amputation. Forty-two were Type IIIB, and fifteen of them had non-union, twelve were associated with deep infection, and seven required secondary amputation. However, in the twenty-four Type-IIIB fractures that were treated with early restoration of the damaged soft tissue by local flaps or free tissue transfer, the rate of complications was significantly reduced to five non-unions, two deep infections, and two secondary amputations. Unfortunately, of the nine Type-IIIC injuries, seven ultimately required secondary amputation, from two days to sixty-three months after the initial injury, because of pain, sepsis, non-union, or failure of the vascular repair. Only two patients who had a Type-IIIC fracture have avoided amputation to date, and their results were poor.
Adolescent↗
Melorheostosis of the hand. A case report with long-term follow-up.
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Adult↗
Childhood acute lymphoblastic leukemia presenting as "cold" lesions on bone scan: a report of two cases.
"Cold" lesions on bone scan have been reported in a variety of disease processes, including infection, avascular necrosis, and cysts. We present two cases of children who presented with large "cold" areas on technetium bone scans and were treated initially for septic processes. Acute childhood leukemia frequently presents with bone or joint pain, fever, and elevation of the erythrocyte sedimentation rate. Although the diagnosis may be difficult if the characteristic clinical signs and laboratory findings are absent, the presence of anemia should alert the physician to the possibility of malignancy. Bone scanning provides a sensitive method of localizing pathology, but diagnosis requires biopsy or marrow aspiration.
Arthritis, Infectious↗