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Biomedical subjects

S Houshian

Publications and source records attributed to S Houshian.

At least 19 recordsLinked to original sources

Chronic flexion contracture of proximal interphalangeal joint treated with the compass hinge external fixator. A consecutive series of 27 cases.

Twenty-seven chronic flexion contractures of the proximal interphalangeal joint were treated with the Compass((R)) hinge external fixator without open surgery. The fixator was removed after a mean of 33 (range, 14-68) days. The mean time from injury to operation was 4 (range, 1-19) years and all patients were reviewed at a mean follow-up of 21 (range, 12-50) months. The mean extension gain was 38 degrees (range, 0-70 degrees), and the mean flexion-extension arc improved by 42 degrees (range, 0-80 degrees). Complications included superficial pin-track infection in 11 cases and pin loosening in four cases.

Adolescent↗

[Discoid lateral meniscus. The importance of MRI scanning for the diagnosis].

This article reports a case of a complete discoid lateral meniscus with an anteriomedial cleavage tear in a 4-year-old boy diagnosed by MRI. The patient underwent arthroscopy with findings of a torn complete discoid lateral meniscus. As the peripheral rim of the meniscus was stable, a partial meniscectomy with reshaping was done. At follow-up two years postoperatively, the patient had recovered uneventfully.

Arthroscopy↗

[Ultrasonographic scanning of patients with severe abdominal injuries].

INTRODUCTION: The aim of this study was to describe our experiences with ultrasonography (US) of severely traumatised patients, and to show whether it is a safe and fast procedure when screening for intra-abdominal lesions. MATERIAL AND METHODS: In a period from 1996 to 1999, 876 patients were received by the trauma team. The number of patients with an injury severity score (ISS) > 15, was constant during the period. Seventy-five per cent of the patients were men. One hundred and fifty-five patients (18%) died, 111 before US was carried out. RESULTS: Over the four-year period, the number of patients received by the trauma team increased from 150 in 1996 to 365 in 1999. The number of US examinations increased from 61 (1996) till 303 (1999). The number of pathological US scans was constantly about 20 per year, where as the number of pathological CT scans was between ten and 20 per year. The number of patients that went on to explorative laparotomy was between seven and 17 per year and 49 in the whole period. The sensitivity of US to detect abdominal lesions is 0.74 and the specificity 0.97, whereas that to detect free abdominal fluid is 0.88 and the specificity 0.99. DISCUSSION: US of the abdomen is a fast and safe procedure to carry out on the severely traumatised patient. An algorithm for diagnosis is suggested.

Abdominal Injuries↗

The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures.

We present a study of the pattern of elbow fractures in children under 15 years of age, during a 5-year period, with special reference to supracondylar humerus fractures. The incidence was 308/100 000 per year; 58% of the children had a fracture in the supracondylar area of the humerus. There were 355 elbow fractures, and there were 164 boys (46%) and 191 girls (54%). The mean age for the entire group was 7.9 years (for boys, 7.2 years; for girls, 8.5 years). Of 209 supracondylar fractures (including 5 combination fractures), 134 were type I, 40 were type II, and 35 were type III (as classified by Gartland). Associated temporary nerve injuries involving the median, radial, and ulnar nerves were seen in 15 patients with type III supracondylar fractures. Associated brachial artery injuries were seen in 6 patients, 5 of whom had type III fractures.

Adolescent↗

Metacarpal and phalangeal lengthening by callus distraction.

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9-88) months. The median age of the patients was 15 (range, 4-39) years. The median lengthening was 21 (range, 13-34) mm which was a median of 82% (range, 38-162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.

Adolescent↗

Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases.

In a 4 year period (1996-1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19-72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienböck's disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann's contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6-50) months. The Buck-Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.

Adult↗

Comparison between in-line and rollerskating injury. A prospective study.

Rollerskating is an activity that has become increasingly popular over the past several years among children and adults in Denmark. During a 7-month period in 1997, 300 in-line skaters and 107 roller skaters were treated in the Emergency Department, Esbjerg County Hospital. Of these, 60.4% had minor injuries (sprains, bruises, lacerations) and 39.6% fractures. There was no statistical significant difference in the types of injury between skater groups. The most common serious injury was fracture of the wrist, which occurred in both skater groups (25%, n=102). Almost all of the fractures of the wrist and elbow occurred among skaters who did not wear wrist or elbow guards Only 20% of the skaters used protective equipment. In-line skaters used protective equipment more often than did roller skaters. Of all accidents, 69% occurred on public roads (street and sidewalk).

Adolescent↗

Bone and joint tuberculosis in Denmark: increase due to immigration.

We studied the epidemiology of bone and joint tuberculosis (TB) in Denmark during the period 1993-1997, using data in the national Danish TB register. We found 95 cases, accounting for 4% of all tuberculosis cases and 15% of extrapulmonary cases, giving a mean annual incidence of 0.4 per 10(5) in the period. 26 cases were found among native Danes (3-8 cases per year) with a median age of 66 (10-92) years and giving a mean annual incidence of 0.1 per 10(5). Among immigrants, an increasing number of cases of bone and joint TB were diagnosed, increasing from 5 in 1993 to 28 in 1997, giving a total of 69 cases with a mean age of 35 (11-75) years and a mean annual incidence of 4 per 10(5) in the period. The spine was affected in half of the cases. 28 patients had active TB elsewhere in the same period. In most patients, there were no predisposing or risk factors for disease except for ethnicity. Compared to a study of bone and joint TB in Denmark in the 1980s, the total incidence is the same, but there has been a shift in patients from old Danes to young immigrants. The increasing number of bone and joint TB cases among immigrants is due to recent immigration of Somalian refugees, who have a high incidence of TB and a high proportion of extrapulmonary TB. The diagnosis was often delayed several months or years. This study shows that attention must be paid to this condition, particularly in young patients from an endemic immigrant population.

Adolescent↗

Duration of postoperative antibiotic therapy following revision for infected knee and hip arthroplasties.

In the period from 1990 to 1998 28 patients (14 males and 14 females) were treated for infected hip (19 cases) and knee (9 cases) arthroplasties. The median age at index operation was 72 y (range 34-82 y) and at revision surgery 74 y (range 36-83 y). The primary diagnosis was osteoarthritis (16 cases), rheumatoid arthritis (5 cases), failed femoral neck fracture (6 cases) and arthritis secondary to congenital hip dislocation (1 case). Nine cases were infected early, i.e. within 3 months postoperatively, and 19 had late infections. The median interval from index operation to diagnosis of the infected arthroplasty was 18 months (range 1-156 months). Postoperatively, all patients received antibiotics based on susceptibility studies of the causative organism according to culture specimens. The erythrocyte sedimentation rate and CRP level were controlled twice a week during hospitalization and antibiotics were continued until normalization of CRP. The indication for the shift from intravenous to oral antibiotics was a rapid fall in CRP. Antibiotic therapy was terminated when CRP was close to or below 10 mg/l and there was evidence of clinical recovery. Based on the screening of ESR and CRP in this study we believe that CRP is a valuable parameter in deciding when to stop antibiotic therapy. However, it is not clear whether a shorter treatment period is effective or not.

Adult↗

Traumatic duodenal rupture in a soccer player.

Traumatic duodenal rupture resulting from blunt trauma during soccer is an extremely rare occurrence. A case report of this unusual condition is presented together with a review of the literature.

Abdominal Injuries↗

[Hypothenar hammer syndrome].

Hypothenar Hammer Syndrome (HHS) is a rare injury. It usually occurs in the dominant hand of middle-aged men whose occupational or recreational activities require the use of the hypothenar of the hand as a hammer. A case of HHS with Raynaud's phenomenon is presented. Ultrasound duplex and colour scanning revealed an aneurysm with thrombosis of the ulnar artery adjacent to the hook of the hamate. Ligation of the ulnar artery was performed which eliminated the flow in the pseudoaneurysm and prevented further microembolisation to the fingers.

Aneurysm, False↗

Gigantic benign schwannoma in the lateral peroneal nerve.

While schwannomas of the lateral peroneal nerve at the neck of the fibula are rare, this entity should be considered in the differential diagnosis of popliteal cysts and in all cases of pain or paresthesia of the leg and foot. Magnetic resonance imaging is the diagnostic tool of choice for diagnosis of schwannoma.

Female↗

[MRI scanning in suspected fractures of the scaphoid bone].

MR examination was performed in 20 patients clinically suspected of having a fracture of the scaphoid bone. The patients also followed the normal routine with conventional radiographs in the acute fase and after 10-12 days. The MR was in most cases performed within a day after the trauma. All fractures seen on conventional radiographs were depicted on MR. MR further showed four fractures, five bone contusions (bone bruise) and lesions of the soft tissues in 75% of the patients. In patients with suspected fracture of the scaphoid, MR seems to be the best primary imaging method and displays a wide range of lesions.

Adolescent↗

[Riding injuries].

The aim of this study was to investigate accidents which occur in connection with horse-riding. The material was found in a data base covering 14% of all case registered in Casualty Departments in Denmark. The number of horse-riding accidents has increased by 150% from 1986 to 1996. The majority of these were girls. The age group 10-19 years accounted for 61% of the accidents. The majority of injuries occurred on falling from the horse and particularly involved the upper part of the body. Out of 1250 injuries, 24% sustained a fracture: 64% were located to the upper extremities, and 19% lower extremities. One hundred patients required hospitalization: 29 for observation for concussion; 51 for reduction of fractures and osteosynthesis; 13 for contusion. Forty-five percent of the accidents happened in a riding arena and 25% in a stable. It is concluded that the proportion of horse-riding accidents is strongly on the increase in Ribe County.

Accidental Falls↗

[Lifet-threatening hemorrhage from a mandibular hemangioma].

A case of a nine year-old girl with a life-threatening episode of profuse bleeding after extraction of a loose deciduous molar is reported. An angiography confirmed the presence of a haemangioma in the right side of the mandible. The lesion was superselectively embolized. Two days later exploration of the haemangioma and resection of the bone was performed, and the bleeding stopped. Special concern must be exercised in cases with hypermobility of the teeth, and when episodes of spontaneous haemorrhage are encountered.

Female↗

The epidemiology of Achilles tendon rupture in a Danish county.

The epidemiology of Achilles tendon ruptures was examined during the 13-year period 1984-1996 in a Danish county. Five hospitals, serving a population of 220,000 cooperated. There were 718 ruptures, 544 men (75.8%) and 174 women (24.2%). The male to female ratio was 3:1. The average age was 42.1 years (3-82) and 62% were between 30-49 years. 74.2% of the ruptures were sport-related and 89% of these occurred in ball and racket games. The annual incidence of achilles tendon ruptures increased from 18.2/10(5) inhabitants in 1984 to 37.3/10(5) in 1996. The peak incidence in sport-related ruptures occurred in the age group 30-49 years, but ruptures not related to sport occurred in older patients with a peak incidence in those 50-59 years.

Achilles Tendon↗