Biomedical subjects
Publications and source records attributed to W Y Chew.
A case of total ischemia of the triquetrum after a crushing injury to the right wrist by a dumbbell is reported. He was treated conservatively with splinting and analgesia. There was complete clinical and radiological recovery after a follow-up of one year.
Extraarticular pigmented villonodular synovitis (PVNS) is very rare in the distal forearm. There has only been one previous case report of this disease in the extensor tendons of a child. We report a case of PVNS of the distal forearm that presented as two nodules over the radial aspect and a separate nodule on the ulnar aspect beneath the flexor carpi ulnaris tendon. Surgical exploration revealed an extensive extraarticular PVNS over the first and second dorsal compartment extensor tendons. On the anterior aspect it extended in the deep plane between the flexor tendons and the pronator quadratus and encased the radial artery completely. Complete excision of the tumour with the radial artery was done.
Major amputations remain a challenge to the replantation surgeon. Proper patient selection, good surgical skills, and cooperation among the patient, surgeon, and rehabilitation team help achieve a better outcome.
INTRODUCTION: Kapandji described intra-focal pin fixation of distal radial fracture in which the pins pass through the fracture line and anchor to the far cortex. These pins aid reduction of the fracture and maintain reduction by buttressing the distal fragments. MATERIALS AND METHODS: Between January 1996 to December 1997, 186 distal radial fractures were treated with intra-focal pin fixation. One hundred and seventy-seven patients were available for review after an average follow-up of 30.8 months, ranging from 24 to 36 months. In 133 fractures, a trans-styloid pin was inserted to supplement the intra-focal pin fixation. The fractures were classified according to AO classification into 126 A2, 9 A3, 39 C1 and 3 C2. The anatomical results were evaluated by using Sarmento's criteria and the functional results by Mayo wrist score. RESULTS: Radiological union was achieved in 123 fractures by 2 months, 51 fractures by 3 months and 3 fractures by 4 months. Anatomical results were excellent in 46 fractures, good in 118, fair in 10 and poor in 3. Functional results were excellent in 54 cases, good in 109, fair in 9 and poor in 5. Complications included 2 cases of reflex sympathetic dystrophy and 2 cases of rupture extensor pollicis longus. CONCLUSION: Intra-focal pinning with or without supplementation of a trans-styloid pin is an effective method for treating unstable fractures of the distal radius.
Between January and December 1992, 54 diabetic patients with 60 below knee amputations performed in the Department of Orthopaedic Surgery O, Singapore General Hospital were available for evaluation. The average follow-up period was 16.3 months with a range of 13 to 24 months. Five patients had stump necrosis and above knee amputation was performed. Eight patients had partial stump necrosis and required debridement with or without secondary procedures. The other patients had uneventful stump healing which was defined as healing of the stump wound without complications and remained intact for at least 6 months after surgery. Absence of popliteal pulse, presence of central cardiovascular disease and absence of intraoperative skin flap bleeding were found to be associated with higher incidence of stump necrosis.
Seven patients who had free vascularized fibular grafts for bone defects > 6 cm (mean, 16.6 cm) were studied retrospectively. There were 5 cases of tumor, 1 pseudoarthrosis, and 1 chronic osteomyelitis. The average followup period was 9.2 years (range, 5.2-11.3 years). Of the 5 patients with grafts to the lower limb, 1 showed a 30% reduction in bone width as seen on anteroposterior radiographs, whereas 4 patients had increases ranging from 44% to 100% (average, 66%). There were 4 graft stress fractures, of which 1 developed eventual shortening of 2.5 cm. One graft had pseudoarthrosis involving the proximal graft-host junction that required secondary procedures with autogenous cancellous bone grafting, with eventual limb-length shortening of 5 cm. All other graft-recipient junctions healed primarily. The Functional Evaluation Score ranged from 60% to 100% of normal function (mean, 85%). Three patients were able to return to sports participation. Mild weakness of the extensor hallucis longus in the donor limb was observed in 5 patients. Two patients had mild loss of plantar flexion, and 4 had limitation of dorsiflexion affecting the ankle of the donor limb.