Biomedical subjects
Publications and source records attributed to D W Lamb.
A plea is made for greater recognition of the differences between triphalangeal thumb and five-fingered hand. Both conditions can benefit from surgical management but the methods required are entirely different.
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Radial and dorsal subluxation of the base of the first metacarpal is a frequent clinical and radiological phenomenon in association with the common condition of osteoarthrosis of the base of the thumb. In an attempt to determine if any ligamentous instability could be responsible for this displacement, a series of seventeen joints was dissected. The ligamentous structure is constant. Division of the first intermetacarpal ligament was alone found to be responsible for the development of the characteristic displacement of the base of the first metacarpal. In two specimens in which there was advanced osteoarthrosis, spontaneous attenuation of the first intermetacarpal ligament was demonstrated. In attempts at operative reconstruction it is the first intermetacarpal ligament which must be reinforced to provide stability.
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Twenty-four patients who attended the Edinburgh Limb Fitting Centre with 26 healed amputations through the middle part of the foot have been traced. The results in patients with Chopart's ablation through the midtarsal joints and in those with amputation through or near the tarsometatarsal region, were surprisingly good. Three of the patients who also had a contralateral Syme's stump reported that the shortened foot was superior in almost all respcts.
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The neuroanatomical and physiological aspects of pain derived from the spine are reviewed. An explanation is presented of the influence of passive movement as it relates to the interaction of the mechanoreceptor afferent nerves' modulation of nociceptive input.
The growth of the stump has been studied in eighteen children with below-knee amputations. Measurements were available shortly after operation and later at skeletal maturity. It was found that all patients achieved less than expected growth and that the reduction was greater in those patients who had had amputation for congenital deformity.
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Based on a review of the embryology, genetics, and anatomy of radial club hand, it is suggested that damage to the apical ectoderm on the anterior aspect of a developing limb bud leads to the deformity. Study of the families of thirty-five children with radial club hand suggested that the condition is not genetically patterned. The anatomical findings and associated congenital abnormalities in the cases known to be related to thalidomide and in those in which thalidomide was not a factor were similar except that the incidence of other skeletal deficiencies was higher in the thalidomide group. Thirty-one of the 117 radial club-hand deformities (in sixty-eight patients) under my personal supervision were treated by centralization of the carpus on the ulna with satisfactory improvement of the deformity. In three cases wrist deformity recurred mainly in a volar direction, apparently the result of muscle imbalance. No significant impairment of ulnar growth occurred and straightening of the wrist did not affect function adversely. Pollicization of the index finger was done on twenty-eight occasions. Although problems developed in the early cases, these can be avoided using the methods described and the operation can improve both function and appearance. A scheme of management is recommended.
Palmar fascia from six men with Dupuytren's contracture has been grown in tissue-culture and examined cytogenetically; and in three of these cases skin was also studied. Four of the six cases showed mosaicism, but only in cultures of the fascia; the mosaicism was therefore unlikely to be an artefact. Since the abnormalities were inconsistent and absent from skin-cultures they are very unlikely to indicate any mechanism of inheritance. Similar chromosome abnormalities have been reported from experimentally induced tumours.
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