Biomedical subjects
Publications and source records attributed to F Schernberg.
Proximal row carpectomy is a controversial operative technique for difficult wrist problems. Based upon resection of bones, it represents in fact a reconstructive technique of a new joint. The majors steps of the technique are described in detail.
The precise appearances and relationships of the carpal bones have been studied in 53 normal wrists, 15 lax wrists, and 80 injured wrists, using frontal and lateral projections with the wrist in neutral and in various other positions. The findings are discussed and analysed.
The standard and positional views of 53 normal wrists have been compared to views taken under stress. The stresses applied can be divided into normal and abnormal ones. All the injured wrists with pathological roentgenographic appearances were operated on and thus the findings confirmed. Roentgenographic examination of the wrist under stress appears to be a valuable and reliable diagnostic aid. Two types of laxity of the wrist and a radio-anatomical classification of wrist instabilities are defined.
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Seventy-five patients with Steinbrocker stage III et IV rheumatoid wrists underwent arthroplasty with Swanson implant. Sixty-two implants were reviewed at 5 years postoperatively. Functional criteria, namely pain, mobility and grip proved satisfactory in 66% of cases. Radiological examination revealed 23% radial implant fractures, 50% dislocated or fractured ulnar implants and 29% foreign body synovitis. This high rate of complication is disappointing given the encouraging initial results, and leads us to reconsider the appropriateness of such surgery in severe cases of rheumatoid wrist.
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Seventy-five surgically soft-tissue lesions of the hand were examined prospectively by real-time ultrasound and correlated with surgical and pathological findings. The normal ultrasonic anatomy of the hand is described. The use of real time sonography allowed a reliable diagnosis of the cystic or solid nature of soft-tissue tumors, an accurate estimation of their volume and their precise three-dimensional localization. Sonography facilitates the location of foreign bodies, and appears as a new promising technique for the evaluation of tendons.
Fractures of the scaphoid bone are nowadays better known and treated. However, the types of fractures and fragment dislocations are not well described. The authors analysed 325 fresh and old scaphoid fractures and describe six basic types, clearly defined by location and direction of the fracture line. In fresh cases, the dislocation is mainly rotational. In older cases there is an additional bone resorption. The six basic types of fracture lines are demonstrated radiologically and the course of untreated cases is shown.
An original pattern of nail flap is described. It consists of a longitudinal band of lateral nail matrix and bed associated with its lateral wall. A vascular anatomic study with latex neopren infusion has been performed. The dorsal branch of the medial phalangeal artery could be shown to be the arterial pedicle of the flap. The venous system was shown to be concomitant. Eight nail autoplasties have been performed in eight cases, proving the reliability of the flap. It provides an interesting way of reconstruction of the nail in tumors, black longitudinal nail bands, posttraumatic and also post-infectious lesions of the nail.
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Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.
Carpal instability is a difficult problem and a static as well as a dynamic radioanatomical study of the wrist is indispensable for correct diagnosis. This study is based on the description of the variations of the aspects of the bones of the proximal carpal row. An analysis of the projection of each individual bone was made, and thus, the author was able to describe the radioanatomical features of the wrist in three positions: neutral, radial and ulnar deviation. Secondly, the author points out the modifications produced on a normal wrist by active and passive loading. On the posteroanterior views, the most important stresses seem to be rotational (pronosupination) and translational. On the lateral views, the anterior and posterior "drawer" movements are particularly interesting. The author emphasizes the features of normal, lax and pathological wrist patterns.
The author reports his personal experience of eleven cases of midcarpal instability. Diagnosis was essentially based on dynamic radiological investigations of the wrist with distraction and posterior "drawer" movements. Damage to the anterior capsuloligamentous complex is the underlying cause. According to the predominance on the ulnar or radial side, one may speak of anteromedial or anterolateral midcarpal instability. Management differs in the case of recent injuries which should be treated on a nonoperative basis as compared to the case of longstanding lesions whose treatment is difficult. It seems as though only intercarpal arthrodesis is the solution to adequate stabilization of the lesions. To avoid loss of motion, the author suggests the possibility of palliative treatment by arthroplastic resection of the proximal row of the carpus, which, in this type of indication, seems to be a last resort.
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The authors report their first evaluation of 40 arthroplasties of the wrist with the Swanson implant. The indication for this procedure was principally severe damage to the wrist joint. The radiologic findings have been summarized. In regard to operative technic, there have been no major problems. In 20 cases also arthroplasty of the head of the ulnar was done. There were no significant early complications. The clinical results after 14 months, with a range of 6 to 45 months, was always satisfactory in regard to pain and the preservation useful flexion and extension. So far, tolerance to the implant seems to be satisfactory. The joint narrowing, regularily found in the new articulation, does not detract from the long-term results. Thus the authors retain a favorable impression of this arthroplasty which should find a place in the treatment of badly damaged rheumatoid wrists. In addition to relieving the pain, it preserves mobility that would be sacrificed with an arthrodesis. Among the associated procedures, the authors have been disappointed with arthroplasty of the head of the ulna and have given it up.
The authors report seven cases of isolated dorsal dislocations of the distal radio-ulnar joint. Four were recent dislocations and three were old, chronic dislocations. Acute dislocations were treated surgically. An anatomic study on human cadavers enabled us to define the injuries responsible for radio-ulnar dislocations. An electromyographic study of the extensor carpi ulnaris confirmed its role as a dynamic stabilizer of the ulnar head. Two of the three old dislocations were revised after an attempt at ligamentous reconstruction. These patients benefitted from a resection of the ulnar head. The third patient one underwent a Sauve-Kapandji procedure. Cadaver studies underline the fact that ligamentous reconstruction procedures are actually tenodeses.