Biomedical subjects
Publications and source records attributed to S Boe.
We investigated the diagnostic value of two different ultrasound scanning methods for the early diagnosis of acute scaphoid fractures. Fifty-seven patients with ten scaphoid fractures were assessed within a week of injury. The accuracy of the ultrasound assessment was 84% and its specificity was 91%. However, its sensitivity was only 50%. We conclude that ultrasound examination is unreliable for the diagnosis of acute scaphoid fractures.
A 30 year old woman presented with pain in her right wrist a year after operation for de Quervain's tenosynovitis. Magnetic resonance imaging showed avascular necrosis of the scaphoid without loss of volume. She was instructed to wear a brace on her wrist while working. A year later she was free of symptoms but the scan was unchanged. Avascular necrosis of the scaphoid not associated with injury is extremely rare.
Fifty-three consecutive patients were treated for a symptomatic plica mediopatellaris of the knee joint with arthroscopic resection of the plica. Forty-six patients were followed up 43 months after the operation. Preoperatively, 40% of the patients had anterior knee pain on exertion, and 60% had mechanical symptoms. The symptoms were preceded by a knee trauma in 50% of the patients. The overall results after arthroscopic resection were satisfying, with 80% excellent or good results according to the Lysholm score, and 59% of the patients were completely free of symptoms. The presence of chondromalacia of the patella or femoral condyles or malalignment of the patella did not worsen the results. It is concluded that arthroscopic resection of a pathological plica mediopatellaris generally gives good results, even if other pathology of the knee joint is present.
A combination of rupture of the ulnar collateral ligament in the first metacarpophalangeal joint and a concomitant spiroid fracture of the proximal phalanx in the thumb is described. Suture of the ligament was performed ten weeks posttraumatically, and a good result was achieved.
A case of subungual keratoacanthoma in a 64-year-old man with psoriasis is described. Important differential diagnoses are squamous cell carcinoma and epidermoid cyst. The treatment recommended is local removal. Follow up should be prolonged, as recurrence has been reported more than two years after primary operation.
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A case of median nerve paralysis due to intra-articular entrapment occurring after closed reduction of a dislocation of the elbow joint is reported. In the present case, as in most other reported cases, diagnosis and treatment was delayed. If median nerve paralysis occurs following elbow dislocation and is accompanied by an unusual amount of pain, or if it occurs following reduction, entrapment should be suspected and the nerve explored without delay.
Patellofemoral alignment was determinant by arthroscopy according to the degree of knee flexion at which the lateral facet, the patellar ridge, and the medial facet of the patella gained contact with the femur. The intraarticular pressure was 75 mm Hg. In 17 patients with a normal patellofemoral joint, the lateral facet aligned at a mean knee flexion of 20 degrees, the patellar ridge at 35 degrees, and the medial facet at 50 degrees. Twelve patients with patellar subluxation showed no difference in the alignment of the lateral facet, but differed significantly with regard to alignment of both the ridge and the medial facet with contact at a mean flexion of 55 degrees and 85 degrees, respectively. The median measurements in 20 patients with idiopathic anterior knee pain did not deviate significantly from the normal material. However, the dispersion was increased significantly, with eight patients having increased measurements consistent with malalignment and three having decreased measurements below the lower limit of normal alignment. Patients with idiopathic anterior knee pain apparently can be reclassified according to the arthroscopically determined alignment, which may prove important in the treatment of these patients.
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The technique and results of 11 arthroscopies of the ankle joint are presented. The main indications were post-traumatic pain and osteochondritis dissecans of the talus. As a result of arthroscopy, a radionegative loose body was found, exploratory arthrotomy was avoided in one case, incisions and operative procedures were changed, and loose bodies were removed by arthroscopic operation in one case.
Seventy-six children under 16 years of age (mean age 14.5) underwent diagnostic arthroscopy of the knee. Seventeen were examined under local anaesthesia as outpatients. The referring doctors suspected a meniscal lesion in 25 cases, but in only 6 of these was the diagnosis confirmed. The surgeon's diagnosis was verified in 9 out of 31 cases; unsuspected lesions of both menisci in one knee make a total of 10 patients with meniscal lesions (10 knees, 11 menisci). The most frequent lesion found was rupture of the anterior cruciate ligament (12). Because of the arthroscopy, three minor meniscal lesions could be observed without treatment, and no menisci were totally removed. In two cases an arthrotomy would have been done on the wrong side of the knee if the operation had not been preceded by arthroscopy. Fifteen arthroscopic operations were done but only three for meniscal lesions.
At arthroscopy, a 22-year-old woman with repeated spontaneous hemarthrosis of the knee was found to have a synovial hemangioma, which was removed by arthrotomy. In cases of spontaneous hemarthrosis without abnormal bleeding tendency, arthroscopy is recommended to identify and, if possible, treat the cause of bleeding, as repeated bleedings may damage the joint.
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Arthroscopy of the elbow was performed in 35 cases of suspected loose bodies. Loose bodies were found in 13 cases. Preoperative radiographs were falsely negative in two cases and falsely positive in 12. In ten cases arthroscopic removal was attempted; it succeeded in six cases. When no loose bodies were found, the most common diagnosis was degenerative joint disease. Arthroscopy is recommended for diagnosis and treatment of loose bodies in the elbow joint.
Periosteal grafting was performed in 4 patients with osteochondritis dissecans of the medial femoral condyle and 1 patient with osteonecrosis of the lateral femoral condyle following prednisone therapy. The lesions were drilled out deep into the cancellous bone. The periosteal graft was taken from the medial facet of the tibia and fixed to the excavated bony defect by the tissue glue Fibrinkleber Human Immuno (Tisseel). The patients were followed clinically, by arthroscopic examination and by radiography at 3, 6, and 12 months. After 1 year the borderline between the new and surrounding cartilage was hardly visible.
Previous animal studies and a preliminary clinical trial of the addition of nifedipine to cardioplegic solution demonstrated salutary effects in terms of postischemic performance. This report examines the combined results of extended clinical trials conducted in two centers: Barnes Hospital, St. Louis, and Allegheny General Hospital, Pittsburgh. From an open-heart population of 4,777 patients, 205 highest-risk persons were selected for study. One hundred seventy of them were given nifedipine in cardioplegic solution. The remaining 35 served as controls to compare with 39 treated patients in the randomized subset of 74. Thirty-eight percent were women; the average age was 61 +/- 1 year; and most were in New York Heart Association Class IV. One-third had valve replacement, one-quarter had coronary artery bypass grafting (CABG), and 37% had valve, CABG, and other procedures in combination. Characteristically, these patients had a 50% increase in end-diastolic volumes, low cardiac indexes (1.7 +/- 1 L/min/m2), and low left ventricular stroke work indexes (22 +/- 2 gm-m/m2). Average cross-clamp time was 77 minutes. At Allegheny, an extracellular hyperkalemic solution was used to deliver an average dose of 407 +/- 22 micrograms per patient. At Barnes, a low-sodium hyperkalemic solution was used; the average dose was 476 +/- 22 micrograms. The results of hemodynamic studies in the randomized subset demonstrated approximately a twofold greater improvement in the treated group in cardiac index, stroke volume, left ventricular stroke work index, and pulmonary vascular resistance immediately after bypass. The incidence of acute low cardiac output death was 4% versus 11% in the nontreated group. The hospital survivorship for all treated patients was 84%. It is concluded that the addition of a calcium antagonist, nifedipine, reduced the incidence of acute global cardiac failure in the immediate postoperative interval.
On 34 osteoligamentous ankle preparations the function of the various components of the deltoid ligament has been elucidated by tracing mobility patterns after successive transection of the components in varying sequence. The anterior and posterior talofibular ligaments were included in the study to investigate the interaction between these structures and the deltoid ligament. The tibiocalcaneal and the intermediate tibiotalar ligaments control abduction of the talus. The anterior tibiotalar and talofibular ligaments control plantar flexion, while dorsiflexion is inhibited by the posterior tibiotalar and talofibular ligaments, and partly by the anterior talofibular ligament as well. In combination, the anterior and intermediate tibiotalar ligaments control external rotation, while the intermediate and posterior tibiotalar ligaments control both external and, together with the anterior talofibular ligament, internal rotation of the talus. Isolated, neither the anterior nor the posterior tibiotalar ligament appears to play any major role in ankle stability.
Knee replacement using the Total Condylar Prosthesis was carried out on six large cadaveric knees. Tibiofemoral articulation was studied radiographically with the tibial component placed anteriorly as well as posteriorly on the tibial plateau. It is concluded that, in this model, when using the Total Condylar Prosthesis for big-sized knees, a tall, posteriorly placed tibial component gave the best placement of the femoral component and the most central tibio-femoral articulation, entailing optimal distribution of the load on the trabecular bone beneath the tibial component.