Biomedical subjects
Publications and source records attributed to B Helal.
A simple method of ankle stabilization using a long trifin nail, inserted from below, is described. The method is particularly suitable in the elderly, when a short period of bed rest and early weight bearing is desirable. The procedure is contraindicated if subtalar joint motion is present and should be preserved.
We report the use of a silicone elastomer ball-shaped spacer for the treatment of hallux valgus and hallux rigidus. One hundred and eleven operations were performed in 77 patients over a 5-year period. The best results were obtained in patients with hallux rigidus. Good results were obtained in hallux valgus, but it was found that in patients with severe preoperative deformity the correction obtained was inadequate, and an additional procedure would be required for full correction. There were no cases of silicone synovitis.
31 patients have been received between one and five years (average 2 3/4 years) after replacement of the trapezium with a silicone elastomer universal small joint spacer for carpo-metacarpal arthritis. Good pain relief was achieved in 84% and most patients retained 80% of power and movement compared to the other hand. Two prostheses fractured and two more subluxed painfully; another two were too big, causing pain, and had to be removed. Minor damage to the radial nerve occurred in four patients.
The anatomy of the tibialis posterior muscle and tendon is described. It is the main stabilizer of the hind foot. Clinical and radiographic signs of tibialis posterior tendon rupture and the various operative techniques used, are reviewed. The Cobb method, using half the tibialis anterior tendon passed through a hole drilled in the navicular into the tarsal tunnel and anastomosed to the proximal end of the tibialis posterior, seems to give results superior to other methods.
A new prosthesis for the metcarpo-phalangeal joint is presented. Its advantageous design features and the early results following its use suggest that it is of value in treating the painful, stiff and ulnar deviated metacarpo-phalangeal joint in the rheumatoid hand.
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Thirty-five of 44 nonunited scaphoid fractures that were at least 6 months old healed in a mean time of 4.3 months during pulsed electromagnetic field (PEMF) treatment using external coils and a thumb spica cast. The mean time from the onset of the fracture to treatment was 40 months. No concurrent operation was performed. Follow-up time averaged 8.4 months. Eight of nine fractures with avascular necrosis healed. Five of eight fractures in the proximal third healed. Twelve (75%) of 16 patients treated in short-arm thumb spica casts and PEMF healed versus 22 (92%) of 24 patients treated initially in long-arm thumb spica casts and PEMF. We have found PEMF to be a reliable alternative method of treating nonunited scaphoid fractures. Because of the low risk, simplicity of use, and reliability, we recommend its consideration in the treatment of undisplaced, nonunited fractures without carpal instability less than 5 years after the injury. Treatment should initially begin with a long-arm cast.
Experiments have been carried out to test the feasibility of using cryo-irrigation as a means of ablating the synovium in the rheumatoid knee joint. Cryo-irrigation was performed by a cooling machine and pump, which circulated cold 200/10 centistoke (cSt) silicone through the knee joint of rabbits anaesthetised with intravenous (IV) 'Saffan'. Fluid left the joint at -5 to -10 degrees C. Sixteen normal New Zealand rabbits received cryo-irrigation of one knee joint for 10-20 minutes and were killed at one day, and one, two, and 12 weeks thereafter. Judged by radioactive sulphate incorporation there was no impairment of chondrocyte function in the articular cartilage of irrigated joints. Histological examination showed mild synovitis and some loss of staining of superficial cartilage in 6/16 irrigated joints (v 1/16 control joints). Similar treatment of rabbit joints in which the Glynn model of synovitis had been induced showed marked reduction of synovitis 14-45 days after silicone treatment. Nine of 26 animals in which synovitis was induced in both knees and cryo-irrigation performed in one knee died either immediately postoperatively or during the next week. These deaths remain unexplained. A single dog received cryo-irrigation of one knee (-6 to -9 degrees C for 22 min) and remained perfectly well up to sacrifice at six months, when the joint appeared histologically completely normal.
Osteoid osteoma of the pisiform seems not to have been previously reported. In both the cases reported in this paper there was diagnostic difficulty and delay. Complete surgical removal of the nidus was curative.
Four patients whose sport involved wielding a racquet presented with symptoms at the base of the hypothenar eminence which were due to minor degrees of subluxation of the pisiform. In two there was in addition a chondromalacia of the articular cartilage of the joint.
Three squash racquets and one badminton player presented with pain in the base of the hypothenar eminence, due to minor degrees of subluxation of the pisiform bone. Two of them also showed chondromalacia of the articular cartilage of the pisotriquetral joint. All four patients were relieved by excision of the pisiform bone and had returned to their normal daily and sporting activities within three months of their operation.
Four cases of unstable fracture-dislocation of the fifth carpometacarpal joint are reproted, including 3 isolated dorsal fracture-dislocation and 1 dorsal fracture-dislocation associated with a fracture of the fourth metacarpal bone. All cases required open reduction and Kirschner wire fixation which resulted in good function. Attention is drawn to the frequent delay in diagnosis. The applied anatomy is discussed.
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A case report of a ganglion in the pisiform bone, accompanied by pain and instability in the wrist joint.