Biomedical subjects
Publications and source records attributed to F De Schrijver.
We report 2 new cases of isolated fracture of the capitate. The diagnosis and follow-up were made with MRI. Conventional radiographs initially failed to reveal the fracture. Both fractures were treated conservatively; one healed completely; the other went on to a well-tolerated nonunion.
A patient with fracture of the hook of the hamate is described, in whom the diagnosis was delayed for 1 year after the initial trauma. This delay in correct diagnosis is often seen, as routine anteroposterior and lateral roentgenograms of the wrist are unlikely to show the fracture. The trauma is often misinterpreted as a "wrist sprain." Nevertheless, with a careful trauma history and a detailed clinical examination and with minimal additional roentgenographic views, it should be possible to correctly diagnose the fracture. Relief of the disabling pain can then be offered by removal of the un-united fracture fragment.
Although often reported in the literature, 'isolated' traumatic radial head dislocation in children is a rare condition which has not been studied extensively. There is very often a delay in diagnosis and treatment. Lincoln and Mubarak described the 'ulnar bow sign' in 1994. They accurately described the plastic deformity of the ulna and explained how to make a correct diagnosis from the radiographs. Probably most 'isolated' radial head dislocations in children are associated with plastic deformation of the ulna as stated in 1984 by Dubuc et al. (2). The recognition of these "plastic" Monteggia fractures is mandatory, as action on the ulna plays a central role in the treatment. On the other hand, the 'ulnar bow sign' may be used to detect subtle changes in the position of the radial head. We present 4 cases of chronic radial head dislocation associated with plastic deformation of the ulna. Open reduction of the radial head and reconstruction of the annular ligament was performed. An osteotomy of the ulna was deemed necessary in 3 cases.
Ganglion cysts that compress the common peroneal nerve frequently arise from the proximal tibiofibular joint. We report three cases of such ganglia. In one case the ganglion cyst arises from the proximal tibiofibular joint, finds its course along the common peroneal nerve causing pain, but no neurological deficit. In the two other cases the cysts have the same origin but they are the cause of a progressive peroneal nerve palsy. Treatment in these three cases was successful resection of the cyst with non mutilating surgery for the nerve and ligation of the stalk connecting the ganglion to the proximal tibiofibular articulation. A review of the controversial pathogenesis of the intra- and extraneural ganglia is exposed, and the anatomy, the diagnosis, the surgical treatment and the prognosis is discussed in light of relevant literature.
This is a review of 20 patients (22 operations) with symptomatic osteoarthritis of the first carpometacarpal joint who were treated by simple trapezectomy without interposition material. They were all women with a mean age of 60 years (46-77). The average follow-up was 2 years, ranging from 8 months to 3 years. Pain relief is the main contributor to the good clinical results of this procedure. Sixteen patients professed to be very satisfied, two had a fair result and four cases claimed to be unsatisfied. Range of motion (opposition and counter opposition) and first web space were very well preserved. Mean values of grip strength showed reduction of grip power on the operated side though not statistically. However, we did find a statistically significant difference in pinch strength between operated and non-operated side. In general, simple trapezectomy is our preferred surgical therapy in the treatment of carpometacarpal osteoarthritis in the elderly population.
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