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D Della Santa

Publications and source records attributed to D Della Santa.

30 records · Page 2Linked to original sources
PubMed1991

Radiolunate arthrodesis in rheumatoid wrist (21 cases).

Surgical radiolunate arthrodesis appears to be an appropriate procedure to stabilize ulnar translation of the carpus, to correct radial deviation of the wrist and consequently ulnar drift of the fingers and restore neutral orientation of the lunate when collapse occurs. From 1979 to 1988, radiolunate arthrodesis was performed on 21 unstable rheumatoid wrists with subluxation of the lunate (20 cases combined with an ulnar head resection and one case without). Average follow-up was 4 years and 1 month. Wrist collapse increased in 3 cases and remained stable in 6 cases (9 documented cases). When ulnar drift of the fingers is present (6 cases), the ulnar angulation of the third finger shows a 14-degree average improvement. Thirteen wrists were painfree, one presented a painful click, 4 patients were dissatisfied because of pain and recurrence of the disease. Three patients had died. Average ROM was 41 degrees in extension, 28 degrees in flexion, 8 degrees radial deviation and 23 degrees ulnar deviation. Grip, measureable in 9 wrists, showed improvement with an average range of 12,6 kg on right side and 9 kg on left side. Surgical procedure and complications are described.

Aged↗
PubMed1991

Late lesions of the brachial plexus after fracture of the clavicle.

Fractures of the clavicle, particularly those which are markedly displaced, may, in rare instances cause injury to the subclavian vessels and the brachial plexus which manifest progressively days or weeks after the initial trauma. More often than not, however, a costo-clavicular compression syndrome appears months or years after the clavicular fracture as a result of constriction by scar which invests the neuro-vascular bundle, by a secondary aneurysm or by hypertrophic callus. The authors report 16 such cases, one of which was treated conservatively, thirteen treated by surgical intervention while two cases are awaiting operation. These patients represent just over 1% of brachial plexus lesions seen over a period of twenty years in two surgical centres. Operative treatment consists of reduction of the clavicular deformity, possibly first rib resection, liberation of the plexus and correction of a vascular lesion as required. The outcome is usually good.

Adolescent↗
PubMed1991

Evaluation of the effect of perineuronal morphine on the quality of postoperative analgesia after axillary plexus block: a randomized double-blind study.

A randomized, double-blind study was performed on 50 patients scheduled for elective hand and forearm surgery under axillary plexus block to evaluate the effect of perineuronal morphine on the quality of postoperative analgesia. Patients were divided into two groups. In group A (n = 25) 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline was added to the local anesthetic solution (20 mL of 1% plain lignocaine, 20 mL of 0.5% plain bupivacaine). They also received an intramuscular placebo injection of 1.0 mL of 0.9% saline in the upper thigh. In group B (n = 25), 1.0 mL of 0.9% saline was added to the local anesthetic solution and patients received an intramuscular injection of 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline in the thigh. The addition of morphine to the local anesthetic solution for the axillary block did not shorten the onset time of the block, improve the quality of postoperative pain relief, or provide longer lasting analgesia than that obtained with intramuscular morphine.

Adolescent↗
PubMed1988

[Post-radiation brachial plexopathy. Persistent conduction block. Myokymic discharges and cramps].

The distinction between radiation and tumor brachial plexopathy may be difficult. The electrophysiological recording of myokymic discharges, frequently present in the former but rare in the latter type of plexopathy, can be helpful for the diagnosis. However, the pathophysiology and the site of origin of these discharges remain unclear. We describe a patient presenting with radiation brachial plexopathy, clinical myokymia, cramps and pain. In this patient, the myokymia--due to abundant myokymic discharges--and the cramps, were related to the existence of persistent conduction block of several years duration. Several findings suggest that the myokymic discharges were generated on blocked axons: voluntary activity did not influence their occurrence nor modify their course; the motor unit potentials involved in the discharges were not evoked by stimulation proximal to the site of the conduction block, whereas the stimulation distal to this site could evoke, modify the rhythm, or interrupt the course of the discharges; the latency of these evoked responses indicated that the site of reflection was proximal on the axon, and likely coincided with that of the conduction block. Recent observations (Roth and Magistris, 1987b) indicated that myokymia, produced by numerous single or grouped fasciculations generated on axon terminals, may be related to persistent conduction blocks of various etiologies. The present case demonstrates that myokymia provoked by myokymic discharges may as well be related to persistent conduction block. The reason why these blocks are accompanied by fasciculations in some situations and by myokymic discharges in others remains an unsolved question. The cramps observed in this patient were also of interest as they occurred in the muscle territory of blocked axons and were provoked by passive muscle shortening. Their origin, distal to the conduction block, is unknown. Finally, a neurolysis did not prevent the progressive transformation of conduction block into axonotmesis.

Brachial Plexus↗
PubMed1987

Mallet fractures.

Contrary to our observations, reports in the literature maintain that only a third of mallet finger deformities are caused by intra-articular fractures of the posterior margin of the distal phalanx. As functional impairment sometimes remains after treatment, there is still much discussion as to the relative merits of conservative and surgical management of this lesion. This article presents 21 cases of mallet finger deformities with fracture of the distal phalanx, of which 17 received surgical treatment. The operative technique is described, followed by a discussion of the results.

Adolescent↗
PubMed1985

[Fractures of the long metacarpals. Long-term results].

Sixty-seven of long metacarpal fractures have been followed for more than one year. Digital mobility and strength of grasp of the traumatized hand were measured and then compared with the healthy hand, the result being modified, according to the patient's own appreciation. This clinical examination enabled a medium and long term assessment of functional results. Control radiograms helped us draw up a chart of the various types of fractures, their topographical distribution and eventual anatomical modifications according to displacement. When comparing clinical and radiographic results, a correlation is--or is not--possible between the functional deficit and the degree of deformation of the metacarpals. Clinical results also depend on other factors which may influence the final result.

Adult↗
PubMed1983

Radiolunate arthrodesis. Factor of stability for the rheumatoid wrist.

Spontaneous radiolunate arthrodesis found in nearly 13% of rheumatoid wrists confer on this joint a durable physiologic orientation with reduced but sufficient mobility. Twelve cases of this type of fusion were studied radiologically and clinically with an average follow-up of 5 years. The authors advise surgical arthrodesis as a supplementary procedure with synovectomy every time there is instability of the carpal articulation with ulnar disalignment. Seven cases are reported, 4 of which are presented in detail. The operative technic and indications are discussed briefly.

Adult↗
PubMed1983

[Treatment of unstable fractures of the wrist using Hoffmann's external fixator. Study of a series of 40 cases].

Forty cases of unstable fracture of the distal end of the radius were treated by distraction and fixation using a Hoffmann external fixator. Most of the fractures were both epiphyseal and metaphyseal. They were followed up for between 6 months and 4 years. The anatomical and functional results were generally good; the range of movement of the wrist and its strength were satisfactory. However 4 instances of secondary collapse of the bone could probably have been avoided by a cancellous bone graft. Two severe algodystrophies were observed.

Adult↗