Biomedical subjects
Publications and source records attributed to R Mosheiff.
Five adults with fractures of the capitellum (Hahn-Steinthal type) were treated by a modified improved technique of open reduction and internal fixation in 1988 and 1989. Full range of motion was achieved in all cases at 4 months.
The scapula is a rare location for osteoid osteoma, which in most cases does not involve the flat bones. The en bloc excision in this uncommon location can be problematic since the surgical exposure is difficult, and shoulder joint function can be affected if the lesion is subchondral. In an 18-year-old man, an osteoid osteoma was located in the subchondral area of the glenoid. A guided needle biopsy of the nidus resulted in complete healing. This mode of treatment, with proper follow-up examination, is acceptable for a benign lesion situated in a problematic location.
Prospective evaluation of the one-stage procedure in 32 patients who suffered from 37 severe friction-avulsion injuries was carried out. Most injuries (81%) were in the lower extremity. Split-thickness skin excision was used for immediate diagnosis of flap vascularity and wound coverage. Split-thickness skin was harvested from the avulsed flap surfaces after they were temporarily sutured back to their original bed. Dermal capillary bleeding served as an indicator for tissue viability, thus delineating a clear line for debridement. All compartments were decompressed, and debridement of all devascularized tissues was performed. Most fractures were fixed with interfragmentary screws and external fixators. Viable parts of the avulsed flaps were sutured back to their original bed and exposed bones were covered with transposed muscles. Skin defects were grafted with the split-thickness skin that was harvested in the first stage and was meshed 1:3 to allow drainage. Most patients (26 out of 32) had only one surgical procedure for their extensive injuries. The split-thickness skin excision is effective in the establishment of debridement borders and helps in saving maximal viable flap area (49.4%). All wounds healed with no major wound complications. The split-thickness skin excision can be used immediately in the care of severe crush injuries, compartment syndromes, and open fractures as a one-stage procedure with the following advantages: (1) reliable diagnosis of flap vascularity, (2) immediate wound coverage with the possibility of drainage, (3) elimination of further debridements procedures, (4) elimination of distant skin donor wounds, and (5) less hospitalization.
Severe crush injuries with compartment syndrome were treated in five patients by an immediate one-stage procedure. This procedure included the assessment of skin flap viability with accurate debridement of devascularized tissues. It was performed according to the split-thickness skin excision technique. Compartment pressures were measured and the fasciotomies were performed through open wounds or separate medial and lateral incisions. The medial incision was extended to release the tarsal tunnel. Fractures were reduced and internally fixed and exposed bones were covered with locally transposed muscles. Skin grafts, taken earlier for the skin viability assessment, were meshed and applied to replace skin loss. All wounds and fractures healed uneventfully with no major functional loss. In multiple trauma, the physician should maintain a high index of suspicion for early diagnosis and treatment of severe foot injuries. Early treatment leads to more desirable results, shorter hospitalization, and faster rehabilitation.
Split-thickness skin excision can be used as a one-stage procedure for the accurate diagnosis of flap viability and the immediate treatment of friction-avulsion injuries in severe open fractures. After cleaning the wound, the avulsed flap is temporarily sutured back to its original bed and a split thickness graft is taken from it and meshed to a 1:3 ratio. Surface dermal capillary bleeding then serves as an indicator of viability, clearly displaying a line for the excision of devascularized skin and correlating well with a concomitant fluorescein test. The wounds are re-opened and, after fixation of the fracture, the viable part of the flap is returned to its original bed and the remaining defects are covered with the meshed graft. We have treated 16 patients with extensive degloving injuries in this way, 15 needing only the single surgical procedure. All retained flaps survived, no other donor sites were needed and the split-thickness grafts took with 90% to 100% success.
Simultaneous bilateral fractures of either the femoral necks or the humeral heads are rare injuries. Four simultaneous fractures of both femoral necks and humeral heads have not been previously described. The case reported occurred after an epileptic convulsion in a woman with multiple metastases from breast cancer.
Legg-Calve-Perthes disease (LCPD) is an avascular necrosis of the femoral head with an annual incidence of 5-15/100,000. The estimated incidence of Gaucher disease, a lysosomal recessive storage disease, is 1:850, with a carrier rate of 1:17.5 for the 1226G (N370S) mutation among Ashkenazi Jews in whom there is a predilection. Since clinical and radiological findings of avascular hip necrosis due to either Gaucher disease or LCPD may be indistinguishable, misdiagnosis may occur. The purpose of this study was to evaluate the incidence of 1226G Gaucher mutation in a cohort of radiologically confirmed LCPD patients (diagnosed 1986-2000) in Israel. Enzyme assay was performed for confirmation of affected versus carrier status in patients with the 1226G mutation. In all, 78 LCPD patients, 86% males, 51% with severe bone disease, were studied. Family history was negative for Gaucher disease. Ethnic origin was 39% Ashkenazi Jewish, 6% Arab, and 55% other ethnicities. One Ashkenazi Jewish LCPD patient was homozygous for the 1226G mutation, and 4 LCPD patients were carriers: 3 Ashkenazi Jewish and 1 Arab patient. The frequency of the 1226G mutation among the LCPD patients was increased relative to historical Ashkenazi Jewish Israeli controls (P = 0.01). Since Gaucher disease may be misdiagnosed as LCPD, glucocerebrosidase enzyme testing is recommended among Ashkenazi Jewish children diagnosed with LCPD.
Coronal fractures of the femoral condyle (Hoffa fractures) are intraarticular fractures that are commonly treated surgically by open reduction and internal fixation. Surgical fixation is demanding because anatomic reduction is mandatory and adequate exposure is often difficult. Herein we describe a new technique that permits excellent visualization and fixation of lateral Hoffa fractures based on osteotomy of Gerdy's tubercle and reflection of the attached iliotibial band.
As the proportion of elderly in the population grows, the incidence of femoral fractures distal to previous proximal osteosynthesis is increasing. When the gap between two rigid load-bearing fixations consists of osteopenic bone, the risk of further fractures increases. Herein the authors describe a load-sharing device that stabilizes the fracture and eliminates the osteopenic gap, allowing early mobilization and rapid return to the preinjury level of activity.
We report a 5-year clinical follow-up and the operative details of a patient who was born with popliteal pterygium and ipsilateral upper amelia. There were no craniofacial, genitourinary, or other extremity abnormalities, other than severe pes equinovarus. At age 3 weeks, excision of the pterygium and partial release of the hind foot had accomplished a significant but incomplete release of the knee contracture. At age 11 months, a second release of the pterygium, combined with complete reconstruction of the foot, accomplished a straight limb. Presently at the age of 5, the boy has 40 degrees limitation to full extension at the knee but walks, runs, and behaves like all the other children in the nursery school. This combination of congenital malformations and early surgical intervention has never been described in the orthopedic literature.
Three patients with ankle fractures are presented to demonstrate poor results due to improper application of a syndesmotic screw. In these cases failure of surgical treatment caused accelerated disruption of the ankle mortise with cartilage wear, or instability and joint distraction. Simple internal fixation with a single screw requires strict awareness of the potential harm that can be inflicted on the joint. The syndesmotic screw has to be inserted with a proper understanding of the biomechanics of ankle joint structures.