Biomedical subjects
Publications and source records attributed to C B Howard.
Sixteen ganglia were treated by injection with sclerosant (Sodium Tetradecyl Disulphate), fifteen failed to respond. We present radiological and electron microscopical data together with animal studies to explain the failure and to show the inherent dangers of this therapy.
A case report of true aneurysm of a digital artery is presented. Only one other case of this condition has been found in the literature. The treatment for this condition and possible reasons for its rarity are discussed.
Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.
Ten cases of a complication of Garden screw fixation of subcapital fracture, namely subtrochanteric fracture through the lower screw hole, are presented. Their possible aetiology, prevention and difficulties in management are discussed. It is recommended that, during the insertion of Garden screws, care should be taken to avoid multiple attempts at passing the guide wire. If subtrochanteric fracture occurs internal fixation with a nail plate or screw plate is advised. Ideally the nail or screw should be inserted along the track of one of the existing screws.
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Osteochondral fracture of the dome of the talus is a well known complication of an inversion injury of the ankle. Recently the authors encountered a patient having a talar dome fracture associated with intra-articular fracture of the medial facet after inversion injury of the ankle. The authors have been unable to find a medial facet intra-articular fracture reported in the English literature. The talar dome fragment was removed arthroscopically and the medial facet fragment was removed using an open surgical approach. The mechanism of injury and the operative approach are discussed.
Three cases are presented: a congenital dislocation of the patella, a congenital dislocation of the radial head, and an epiphysiolysis of the distal humerus. In all three cases the pathology involved unossified parts of the skeleton poorly demonstrated by plain radiographs. Ultrasonography proved useful in diagnosis and treatment of these cases.
The pathologic anatomy of clubfoot is complex, and the opportunities to examine neonatal specimens are inevitably rare. Three clubfeet were dissected and compared with a normal foot. The shape, orientation, and alignment of the bones were gauged, and tibial torsion was measured. Particular attention was paid to the "medial tie," and its etiologic role was considered.
The use of ultrasound in the evaluation of effusion of the hip is well established. We performed ultrasound examinations on 87 children who presented with a limp and with pain in the hip region. We confirm the diagnostic value of ultrasound in detecting an effusion in the hip. Furthermore, ultrasound examination revealed effusion in two cases (psoas myositis), an unexpected effusion in the contralateral hip in two cases, and the cause of the pain in eight cases without effusion.