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PubMed1996

Local distribution of mepivacaine after distal interphalangeal joint injection in horses.

OBJECTIVE: To evaluate the distribution of mepivacaine hydrochloride after distal interphalangeal (DIP) joint injection in horses. DESIGN: Prospective, uncontrolled study. ANIMALS: 10 adult horses. PROCEDURE: 30 minutes before euthanasia, 8 ml of 2% mepivacaine hydrochloride was injected into the dorsal pouch of a forelimb DIP joint. Synovial tissue from the DIP joint and podotrochlear (navicular) bursa and bone tissue from the medullary cavity of the distal sesamoid (navicular) bone were taken from both forelimbs immediately after death. All synovial and bone specimens were analyzed for tissue concentration of mepivacaine by high-performance liquid chromatography. Synovial tissue and bone specimen concentrations from the injected forelimb were compared with corresponding specimens from the noninjected forelimb. All synovial tissue and bone specimen concentrations were compared with an estimated effective tissue concentration of mepivacaine (0.3 microgram/mg) for local anesthesia. RESULTS: Specimen concentrations of mepivacaine from the injected forelimb were significantly greater (P < 0.05) than those in the corresponding tissues of the contralateral noninjected forelimb. All DIP joint and navicular bursa synovial tissue specimens from the injected forelimb had greater than the estimated effective tissue concentration of mepivacaine for local anesthesia. Of the 10 navicular bone specimens from the injected forelimb, 4 were higher and 2 were within 20% of the estimated effective tissue concentration of mepivacaine for local anesthesia. CONCLUSIONS: Mepivacaine hydrochloride deposited into the DIP joint should anesthetize pain arising from navicular bursa synovia and may decrease pain arising from the medullary cavity of the navicular bone. CLINICAL RELEVANCE: DIP joint injection of mepivacaine hydrochloride is not specific for DIP joint pain.

Animals↗
PubMed1982

Pisiform area pain treatment by pisiform excision.

Thirty-three patients with pisiform area pain have been treated. Of these, the pisiform bone was excised in 21 patients who had intractable pisiform bone pain that was not relieved by the conservative methods of immobilization, local steroid injection, and anti-inflammatory medication. The indications for excision were painful union or nonunion of pisiform fractures, pisiform-triquetrial arthritis, and tendonitis of the flexor carpi ulnaris (FCU) insertion. Wrist strength and mobility was maintained by doing a subperiosteal dissection and removal of the pisiform bone. This technique preserves the insertion of the FCU tendon and its distal extension, the piso hamate and the piso metacarpal ligaments.

Adult↗
PubMed1989

Development of the navicular bone in foetal and young horses, including the arterial supply.

A macroscopic, arteriographic and histological study of the development and the arterial anatomy of the navicular bone of 33 foetuses and 55 young horses is described. After 125 days of gestation the blood supply consists of two routes: one situated in the superficial layer of the fibrocartilage and the other similar to the blood supply of the navicular bone of the normal mature horse. After 270 days gestation, the blood vessels in the fibrocartilage gradually regressed and retracted until they have disappeared at six months after birth. At two months after birth the first macroscopic thinning of the fibrocartilage was noticed. From seven months to one year about 45 per cent of the navicular bones showed a slight thinning of the fibrocartilage. A positive correlation was found between radiographic abnormalities (ie enlargement of the nutrient foramina) and the frequency of thinning of the fibrocartilage. Radiographic abnormalities were first recognised 14 days after birth, whereas the arteriogram showed the first changes such as fewer or no arteries entering distally at the distal extremities at 10 weeks after birth. At four weeks after birth the first arterial wall changes were found, ie intimal thickening with or without splitting of the internal elastic membrane. From that age onward, the number of navicular bones with arterial wall changes gradually increased. Starting at five months after birth only 6 to 20 per cent of the arteries in the navicular bones without radiographic abnormalities showed arterial wall changes. However, the navicular bones with radiographic abnormalities showed arterial wall changes in 25 to 80 per cent of the arteries.

Angiography↗
PubMed1985

Digital fractures and dislocations. Diagnosis and treatment.

A detailed discussion of the often underestimated dilemma of digital fractures and dislocations is presented. Illustrations accentuate the important concepts. An aggressive attitude should be adopted to avoid mismanagement and prolonged convalescence. Should the need arise, surgical intervention is emphasized.

Athletic Injuries↗
PubMedDate not supplied

Retrospective analysis of the Mau osteotomy and effect of a fibular sesamoidectomy.

The purpose of this study was to evaluate retrospectively outcomes of the Mau osteotomy for hallux abducto valgus deformity. Twenty-two patients were evaluated by the senior author on an average of 14 months (range, 3-34 months) following their surgery. Preoperative and postoperative intermetatarsal (IM) and hallux abductus (HA) angles were evaluated as well as range of motion of the first metatarsophalangeal joint and patient satisfaction. The mean preoperative IM and HA angles were 16.1 degrees and 35.8 degrees. The mean reduction in IM and HA angles was 10.5 degrees and 23.5 degrees, respectively. Joint range of motion was 58 degrees of dorsiflexion (range, 42 degrees-80 degrees) and 11 degrees of plantarflexion (range, 0 degree-20 degrees). There were no cases of delayed healing or avascular necrosis. There were two patients (9%) with radiographic values consistent with hallux varus; however, neither patient had a clinical appearance of hallux varus and neither patient was displeased with the outcome. Ninety-one percent of patients returned to a soft shoe or sneakers in an average of 5.1 weeks following surgery. Eighty-two percent of patients had no pain at the time of their evaluation, and 96% of patients stated they were satisfied or very satisfied with the surgery. Comparing the subgroup of patients who underwent a Mau-Reverdin procedure with another subgroup undergoing a Mau-Reverdin fibular sesamoidectomy, there was a 3.7 degrees greater reduction of IM angle and 6.7 degrees greater reduction in HA angle in the subgroup with the fibular sesamoidectomy.

Adult↗
PubMedDate not supplied

Surgical management of a ruptured peroneus longus tendon with a fractured multipartite os peroneum.

Injury of the peroneus longus tendon with concurrent fracture of the os peroneum is a seldom reported injury. This injury is probably underdiagnosed or misdiagnosed. The mechanism of this injury often involves sudden inversion, and therefore may often be misdiagnosed as a lateral ankle sprain or tendonitis. From the author's research review, this is the first reported case involving a fractured multipartite os peroneum with rupture of the peroneus longus tendon. The injury was diagnosed preoperatively by magnetic resonance imaging (MRI) as well as radiographs.

Fractures, Bone↗