Closed intramedullary nailing of tibial fractures in elderly patients.
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Biomedical subjects
Publications and source records attributed to H Horoszowski.
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Excessive elongation of both femora in a 12-year-old achondroplastic dwarf resulted in fixed extension and contracture of both knees. An attempt to shorten these overly elongated femora surgically was complicated by the unanticipated release of massive fat emboli, which resulted in the patient's death.
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Recurrent dislocation of the shoulder has long been recognized, and more than 100 techniques for repair of the injury are described. This survey describes 113 patients who suffered from recurrent anterior dislocation of the shoulder and were operated upon in accordance with the Putti Platt technique. The most significant preoperative finding was inadequate immobilization after the primary dislocation (62% of the patients). Postoperative recurrence was uncommon (1%) and a relative increased limitation of motion in the postoperative period improved gradually to almost a full range of movement.
Parachuting injuries commonly result from inaccurately performed landing. Alteration of the vertical force absorption pattern to a rotational one is suggested as their major cause. Special attention to the flexed body position and adduction of the lower limbs while gliding and landing can prevent those injuries.
A 24-year-old man with persistent low back pain and right sciatica, was found to have an osteoid osteoma of the right pedicle of the second lumbar vertebra. 99mTc-MDP bone scan and CAT scan produced an early diagnosis of the lesion. Intraoperative 99mTc-MDP in vitro combined with imaging and quantitative activity measurements were useful for accurate localization and complete removal. The method is simple and can be performed in every nuclear medicine department, with no need for special operating room facilities.
Pain around the hip joint and femoral neuropathy in a patient with a bleeding coagulopathy should alert the physician to the possibility of an iliopsoas haematoma. Unfortunately this diagnosis is often missed. Clinically, reduced hip motion, a mass in the iliac fossa and alteration in the motor and sensory function of the femoral nerve may be noted. If the pain is on the right side, appendicitis must be excluded. Ultrasound is the diagnostic aid of choice, being more sensitive than computerized tomography or radioisotope investigations. Treatment should be gradual, gentle and protracted to avoid recurrent bleeding episodes.
The total absence of literature regarding the affects of haemophilia on the hand prompted this three year study at the Israel National Haemophilia Centre. The hands of all haemophiliacs were examined and X-rayed at the time of their annual check-up. Apart from a number of established Volkmann's contractures in elderly patients and multiple bone cysts of the carpus, surprisingly little pathology was found. When considering the extensive damage done to the musculoskeletal system by this haemarthritic pathogenesis it is astounding how the hand, with its multiple small joints, constant movement and trauma, escapes significant damage.
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Extreme diastasis of the pubis and malalignment of both ilium and hip joints are always associated with the absence of infraumbilical structures and with the failure of the anterior bladder wall to close. Therefore, for a successful cure of extrophy, the pelvic ring has to be repaired, at the time of or a few days prior to the surgical cure of the bladder. The repair of the pelvis, when executed in poor aseptic conditions, results in difficult nursing problems, and fails due to the lack of convenient fixation. For these reasons, we transformed Bartons tongues into an external fixator which enhanced and improved the controlled contention of the "vertical bilateral posterior osteotomy" of the pelvis. When a two stage procedure is decided on, the modified Bartons tongues do not interfere with the urologic surgery, and in addition, the nursing problems are alleviated. Although we have used our modified Bartons tongues in only three cases, our methodology is of low enough risk for it to be reported at this time.
One reason for failure of nerve recovery after suture or nerve grafting is the inappropriate matching of motor and sensory fibers. Methods used in attempting to solve this problem have either been unprecise, too time consuming, or unpleasant to the patient. Both experimentally and on cadaver samples, the level of choline acetylase activity is eight times higher in motor nerve fascicles than in sensory fascicles. In experimentally cut nerves, the ChAC activity remained high even after a period of 45 days. Thus it was possible to identify both ends of the motor and sensory fascicles in fresh injuries, and the proximal parts in old injuries. We have since used this method of intraoperative nerve identification in three patients. It has proved to be a rapid (70-80 minutes), viable technique for the immediate differentiation between proximal parts of motor and sensory nerve fascicles in cases of old nerve injuries. In contrast to our animal studies we found that the ChAC activity in the distal segment was still different for the various fascicles five months after transection. Presumably the present need for distal exploration to identify the "target organ" can be avoided.
Metatarsalgia is a symptom and not a disease. Three cases, as examples, are presented to highlight the need for axial roentgenograms of the forefoot in order to elicit the pathology missed by regular posterior-anterior and lateral roentgenograms.
Factor XI (PTA) deficiency, a coagulopathy, has been found to be relatively common in Ashkenazi Jews. Clinically it may manifest itself by varying forms of hemorrhage including postoperative bleeding. It is recommended that all Ashkenazi Jews have a partial thromboplastin time (PTT) coagulation test before surgery in order to rule out this coagulopathy, and if the PTT is abnormal a Factor XI assay should be done to confirm the diagnosis and ensure that proper therapy can be provided. A surgical case is presented with its ensuing complications resulting form lack of such information.
A 65-year-old woman with spontaneous osteonecrosis of the medial femoral condyle of the left knee was treated by a fresh cadaveric osteochondral bone graft. The latest follow-up examination at 2.5 years demonstrated good functional results, as well as radiographic evidence of satisfactory consolidation with no aseptic necrosis or osteoarthritis.
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