Biomedical subjects
Publications and source records attributed to T J Bray.
Bilateral hamate fractures in a physician sportsman were treated successfully by surgical excision of the fracture fragment. This case demonstrates the importance of carpal tunnel roentgenograms and of a high index of suspicion in making an accurate diagnosis in wrist injuries.
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Preiser's disease, or avascular necrosis of the scaphoid, is an exceedingly rare although debilitating pathologic process. A case of progressive avascular necrosis of the carpal scaphoid is presented together with a review of the possible etiology of this rare syndrome. Histologic evaluations of resected specimens have demonstrated a localized sequestrum of necrotic bone, leading to the belief that disruption of blood supply is a major predisposing factor. The diagnosis of Preiser's disease or avascular necrosis of the carpal scaphoid should be exclusively reserved to those cases that demonstrate a progressive clinical and radiographic sequence of osteosclerosis and subsequent fragmentation of the scaphoid.
Femoral neck fractures constitute one third of all hip fractures in the United States. The literature suggests union rates from 85% to 95% and late segmental collapse between 7% and 12% in fractures treated by internal fixation. We advocate percutaneous pinning in situ for all nondisplaced fractures of the femoral neck (Garden stages I and II). Displaced fractures of the femoral neck (Garden stages III and IV) are manually reduced, fluoroscopically evaluated as described, and percutaneously pinned. Postoperatively these patients are allowed immediate full weight bearing. Although hemiarthroplasty has been advocated, complications including dislocation, deep wound infection, loosening, protrusio, and component migration, far outweight the relatively minor problems facing the surgeon with a failed percutaneous pinning. Secondary femoral head replacements for failed percutaneous pinnings have a substantially lower incidence of complications than primary replacements for the treatment of acute femoral neck fractures.