Biomedical subjects
Publications and source records attributed to S Maloon.
A patient is described who was stabbed in the upper arm and two years later developed a radial nerve palsy. X-rays showed that the tip of the knife had broken off in the arm. At operation this bit of blade was loose and had completely divided the radial nerve.
We performed 41 core decompressions in 32 patients for stage I or stage II osteonecrosis of the femoral head. The intra-osseous pressure at the intertrochanteric level was raised in 28 (68%) and there was histological confirmation of necrosis in 36 hips (88%). After a follow-up of 10 to 84 months (mean 31) nine of the 12 stage I hips (75%) showed significant clinical or radiological deterioration; no evidence of necrosis had been found in the core specimens of the other three hips. Of the 29 hips in stage II, 25 (86%) showed significant radiological deterioration, and only five (17%) had improved clinically. We believe that once necrosis has occurred, core decompression will not significantly influence the subsequent course of the disease.
Eight patients with 9 calcaneal fractures were reviewed. Of the fractures 6 were intra-articular and 3 extra-articular, but in children this distinction appears to have little relevance to treatment or prognosis. While these fractures are relatively uncommon in children, clinical suspicion is important in making the diagnosis, since the presentation may be subtle. The overall prognosis in children is excellent.
Ten patients with closed multiple carpo-metacarpal dislocations have been reviewed. Closed manipulation was found to be successful if performed within two days of the injury. Plaster cast immobilisation supplemented by percutaneous Kirschner wire fixation is recommended to maintain the reduction, due to the unstable nature of the dislocation. Early appropriate treatment of these injuries carries a good prognosis.
This study is a critical analysis of results obtained following primary repair and post-operative controlled mobilisation of flexor tendon injuries which were treated by registrars with up to six months experience in hand surgery. 70 (55%) of 125 patients who underwent repair of a complete flexor digitorum profundus or flexor pollicis longus tendon injury during a 14-month period attended for review and these had a total of 140 injured digits. 93 (67%) were rated by Lister's standards as an "excellent" or "good" result. 39 (28%) occurred in "no man's land" (Zone 2) and only 19 (49%) in this area were rated "excellent" or "good". Isolated flexor digitorum superficialis tendon injuries have been excluded from this study, as have partial tendon injuries.