Biomedical subjects
Publications and source records attributed to R R Fakih.
We report a displaced body of hamate fracture in the coronal plane with dislocation of the ring and little metacarpals and interposition of these metacarpals between the two hamate fragments. The diagnosis, radiographic studies and the treatment of this unusual injury are discussed.
A case of recurrent dislocation of total hip arthroplasty with intra-articular migration of broken trochanteric wires and interposition between the articulating surfaces of the prosthetic components is reported. The patient was treated with revision total arthroplasty with good result. This unusual complication should always be considered when performing trochanteric osteotomy in total hip replacement.
Current algorithms for lower limb injuries recommend amputation for most Gustilo type III-C injuries with a limb salvage index score of 6-8 or more. Recent improvements in the timing and technique of microvascular flaps with the reduction in bone healing time as a result of better fixation devices and early bone grafting make the option of limb salvage after such severe injuries a valid and acceptable therapeutic approach. We present a case of severe shot gun injury to the leg with a limb salvage index score of 9 that was successfully salvaged by vascular reconstruction followed three days later with a microvascular osteocutaneous scapular flap anastomosed to the divided limbs of a preliminary arteriovenous fistula that had been constructed at the time of the initial vascular repair. The patient was able to walk unaided one year after the injury.
A case of a soft tissue mass of the dorsum of right hand in a 25-year-old, right-handed male is described. The preoperative diagnosis was a ganglion. On exploration the mass was found to be an atavistic extensor digitorum brevis manus replacing the extensor indicts proprius tendon. Division of the extensor retinaculum resulted in improvement of the symptoms. This muscle has been encountered rarely and few cases have been reported in the literature. It presents as a mass on the dorsum of the wrist. The symptoms are pain after activity. It is nearly always diagnosed as a ganglion preoperatively. The authors conclude that extensor digitorum brevis manus muscle should be included in the differential diagnosis of soft tissue tumors of dorsum of hand. Symptomatic patients are treated by division of the extensor retinaculum.
Our experience with 118 patients who underwent surgery for a total of 178 popliteal vessels injuries is reported. Forty-nine per cent had injury to both artery and vein and 44% had associated bony fractures. Fourteen patients subsequently needed amputation for a rate of 11.9%. There were no deaths. Delay in repair (> 6 hours from injury), associated fractures, and a shocked condition resulted in increased limb loss. Arterial as well as venous repair, external skeletal fixation, and fasciotomy when necessary lead to improved limb salvage.