Biomedical subjects
Publications and source records attributed to G Fabry.
Six cases, all females with a mean age of 35 years are reviewed. The clinical expression was suggestive, despite atypical radiological pictures. Surgical resection cured all of them.
We treated 12 patients with a posttraumatic or congenital deformity of the distal radius. A radial osteotomy and a Sauvé-Kapandji procedure were carried out. In 9 patients the deformity was caused by a malunited fracture; the other 3 patients were referred to us with a Madelung deformity. We performed 6 open wedge osteotomies and 6 closing wedge osteotomies. All but one patient rated the result of the operation as good or excellent. The reason for the only failure could be carpal instability.
We describe a technique of femoral derotation osteotomy performed according to the Ilizarov principles of percutaneous corticotomy and fixation with a frame. We performed 24 femoral osteotomies in 16 patients, four with cerebral palsy and 12 with idiopathic femoral anteversion. All had rapid union and there were few complications. The advantages of the method include early ambulation, good control of rotation and axial alignment, and minimal scarring.
The value of five provocative tests for the diagnosis of carpal tunnel syndrome (CTS) was assessed in four groups: 54 hands with confirmed CTS, 12 with typical symptoms but normal electrophysiological studies, 16 hands in persons with diabetes and 81 hands in normal controls. Compared to normal controls the Tinel sign and the closed first test are highly specific; Durkan's compression test is not useful to discriminate between symptomatic patients with and without EMG disturbances. The closed fist test is specific in these situations.
The long-term evaluation (mean 4.5 years) of radial shortening in 17 patients with Kienböck's disease demonstrated an improvement in pain, but no patients are painfree, and mobility and force are restricted respectively to 69.5% and 72% of the contralateral side. Radiographically, further evolution of the lunatomalacia could not be prevented. The possibility of creating distal radioulnar joint dysfunction and/or ulnar impaction requires in our view a reconsideration of these leveling techniques in the treatment of Kienböck's disease.
PURPOSE OF THE STUDY: CD instrumentation has been presented as a system which is able to achieve a 3-dimensional correction of idiopathic scoliose. We performed a prospective study about the apex derotation following CD instrumentation. MATERIALS AND METHODS: 24 consecutive patients with idiopathic scoliosis were included in this study. On pre- and postoperative CT scans the rotation angle relative to the sagittal plane according to Aaro and Dahiborn (RA sag) were measured the pre- and postoperative changes were evaluated with paired T-tests together with the significance. Kruskal Wallis tests were performed to correlate the mean values of those calculated changes with the number of instrumented levels and with the different King types of scoliosis. RESULTS: There was no statistical significant increase or decrease of the rotation if we consider the sag without taking into account the type of curve. DISCUSSION: The different ways to measure rotation in scoliosis are presented. The limits of the method we used (RA sag) are also discussed. We reviewed the literature concerning derotation with CD instrumentation to compare it with our results. CONCLUSION: The evaluation of rotation in scoliosis is not easy. The CT scan seems to be the best method. Nevertheless, the postoperative changes of the morphology of the patient can be a factor of error in rotational measurement.
The authors report 3 cases of subacute osteomyelitis of the distal radius and ulna, simulating a malignant bone tumor. The literature on this particular condition is reviewed.
In the recent literature a controversy exists about the tension in the distal radioulnar ligaments during pronation and supination. A mathematical model supports the theory of Schuind and coworkers and indicates that the palmar distal radioulnar ligament is taut in supination.
Salmonella infections in man can be divided in five clinical groups: enteric fever, septicaemia without localization, focal disease, gastroenteritis and the carrier state. Salmonella typhi is mostly associated with enteric fever and the carrier state. Bone infections due to S. typhi have been reported relatively seldom. They usually occur as the result of metastatic spread during septicaemia or, more rarely, after direct inoculation. Two patients with S. typhi osteomyelitis of the forearm without evidence of a primary infection or direct inoculation are presented here.
Artificial anterior ligament reconstruction was very popular between 1975 and 1990. Recently, disappointing results have been published. We reviewed 68 patients who had received an artificial anterior cruciate ligament reconstruction 1 year and 5 years after their operation. The Leeds-Keio device was used as a scaffold. The ligament failed in 32 knees. This was arthroscopically confirmed in 20 cases. The other 12 knees were grossly unstable, with a reappearance of pivot shift, anterior drawer sign and high KT 1000. Generally, we found a marked increase in laxity over the period of investigation. Several biopsies were taken during arthroscopic examination of suspected ruptures. They showed lack of collagenisation and ingrowth.
We retrospectively compared two similar groups of patients who underwent either endoscopic decompression of the carpal tunnel (single portal technique, 44 patients) or open decompression (58 patients) during 1 year in our department. To find out whether there was any subjective difference between the results of the two techniques, we sent each patient a questionnaire and received a 95% response. No major complications occurred. Three endoscopic decompressions had to be abandoned, and open release was performed. We could not demonstrate any significant difference in relief of symptoms and return to work between the two groups. Patient satisfaction at 6 to 18 months follow-up was high with both techniques.
In patients with chronic wrist pain of more than 6 months duration, arthroscopy may reveal fraying of the ulno-triquetral and ulno-lunate ligaments. This can be a sign of longstanding triquetrolunate dissociation. We present a prospective study in which frayed ulno-triquetral (UT) and ulno-lunate (UL) ligaments were sought on wrist arthroscopy and correlated with longstanding triquetro-lunate (TL) rupture.
51 wrists of 30 embalmed cadavers have been used to perform an anatomical and radiological study relating cartilaginous and ligamentous lesions of the wrist with sex, age, ulnar variance (UV) and the state of the triangular fibrocartilage complex (TFCC) in an elderly population (mean 76.6 years). Two-thirds of all wrists (66%) showed cartilaginous lesions, mainly on the lunate (22, or 44%). The TFCC was perforated in 23 wrists (46%), and most were central degenerative perforations. Correlations were found between ulnar variance and TFCC thickness (P < 0.05) and ulnar variance and TFCC perforations (P < 0.05). A significant relation was observed between age and proximal row intercarpal ligamentous ruptures (P < 0.05) and between age and ulnar variance (P < 0.05). No statistical correlation was seen between ulnar variance and cartilaginous lesions on the lunate (P < 0.05) in this slightly ulnar negative population (mean-0.37 mm).
Ulnar variance was measured in standardized conditions in 125 normal wrists and in 52 patients with Kienböck's disease. No significant difference in ulnar variance between a sex/age-matched control group and a group of patients affected with Kienböck's disease was found. A positive correlation was found between age and ulnar variance. No significant difference was found between men and women. Based on these results, negative ulnar variance does not seem to be an important factor in the etiology of Kienböck's disease.
Forty-nine patients with chronic wrist pain were examined by radiocarpal arthrography, followed by radiocarpal arthroscopy. One patient had bilateral involvement. None of these patients showed deformities or lesions on standard and dynamic radiographs. Not all patients who underwent arthrography underwent radiocarpal arthroscopy. Sensitivity of arthrography was 52%, specificity 50%, positive predictive value 92%, and negative predictive value 8% compared with arthroscopy. In this patient group, a very low negative predictive value was found: in 92% of the negative arthrographic examinations an arthroscopic lesion was found. Arthrography of the radiocarpal joint is a good examination for confirming a clinical suspected lesion, but is of limited value when negative.
The growing precision of diagnostic techniques (MRI, arthrography, arthroscopy) and the consequent increase of the diagnosis of cartilaginous and ligamentous lesions of the wrist led us to undertake a detailed anatomical study of the carpus and to extend this study to the search for correlations between these lesions and the radio-ulnar index. Fifty one cadaveric wrists were dissected from an elderly population (mean age of 76 years). Cartilaginous lesions were found in two-thirds of radioulnar joints of the wrist with a marked predominance for the lunate bone (43%). The triangular cartilage of the fibrocartilaginous complex (TFCC) was perforated in 23 wrists (46%). We established a correlation between the radio-ulnar index and perforations of the TFCC (p < 0.05), as well as the thickness of this structure (p < 0.05). The relationship between age and rupture of intrinsic ligaments (p < 0.05), and the radio-ulnar index (p < 0.05) and age was also established. We present our figures, discuss the clinical implications, and draw the following conclusions from this study. 1) The carpus is a complex joint which is subject to age-related degeneration. 2) The large number of cartilaginous lesions observed in this study must be taken into account in the interpretation of MRI and the "over" precise results of arthroscopy.
Thirty-three feet in 29 patients with metatarsalgia were reviewed after Jones transfer to the lesser rays to evaluate the long-term results and the indications for these procedures. Transfer of the long extensor tendons to their respective metatarsal necks and fusion of the interphalangeal joints with shortening of the toe were performed. The procedures were performed in patients with symptoms of metatarsalgia, secondary to anterior pes cavus deformity (clawfeet, 16 patients), and in patients with mild or severe spreadfoot deformity with fall of the central metatarsals (12 patients). In all of our patients, the striking clinical sign was the long toes. Rating of the results was based on (1) the presence of pain or calluses and (2) residual deformity of the forefoot and toes. Symptoms of metatarsalgia were relieved in 25 feet, occasionally present in 6 feet, and unchanged in 2 patients. Complete correction of the deformity was achieved in 26 patients, 6 patients had slight residual deformities, and in the 1 poor result, overcorrection was present after the procedure. This operation is believed to be an excellent choice for patients with metatarsalgia due to (simple) pes cavus deformity and in patients with clawing and metatarsalgia secondary to excessively long toes.
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