Fracture of the hook of the hamate. A case report.
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Biomedical subjects
Publications and source records attributed to H U Cameron.
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The method of fabrication and properties of a dual structured implant system consisting of a metallic porous surface layer is described. The ingrowth of bone tissue into the outer porous surface layer results in part fixation, while the solid inner core region provides the necessary mechanical strength for a device used for the replacement of heavy load bearing joint regions such as the hip and knee. Additionally, novel implant systems are suggested using the porous coating concept.
Pull-out testing of screws inserted into cement and bone under various conditions showed that the cement-screw complex was significantly stronger when the screw was placed in soft cement and the cement was allowed to polymerize without further manipulation. When screw fixation in osteoporotic bone was reinforced with cement, the bone was the weakest component in the system. Fixation under these conditions should be enhanced by increasing the area of contact between the cement and bone. By cooling the cement to prolong its working time, it could be injected with a syringe in such a way that maximum endosteal and periosteal contact was provided.
A recently recognized complication of intertrochanteric fracture is a subcapital fracture occurring at the tip of the blade of an intertrochanteric fracture fixation blade plate. Histological examination reveals that this is not a fatigue fracture but is the result of stress concentration effects of a stiff metalic device. This fracture may be prevented by using a blade plate with a long blade which is well seated in the head, and by removing the metallic device as soon as it is safe to do so. Ultimate prevention lies in using a more compatible material for the internal fixation of fractures.
In a review of subcapital fractures due to metastases in the femoral neck it was found that in the majority of cases pain in the region of the hip developed a few days prior to fracture. While the majority of subcapital fractures are sustained as the result of a single incident of trauma, in cases with metastases trabecular stress fractures occur in increasing numbers until finally femoral neck fracture occurs. It would seem that once a critical number of trabecular stress fractures has been reached the patient develops pain. Immediate radiologic examination should be performed, and if there is evidence of bone destruction approaching 50% of the cortex, prophylactic hip pinning is strongly indicated.
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The material from a case of Tietze's disease has been examined histologically. A review of the literature on the pathology of this lesion correlated with the findings from this case indicates that there is a pathological lesion in the costal cartilage in this disease. This consists of an increased vascularity and degenerative changes with patchy loss of ground substance leading to a fibrillar appearance. Cleft formation may occur with mucoid debris which may undergo calcification. Hypertrophic changes may be present at the periphery. The aetiology still remains obscure.
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Eburnated bone in osteoarthritic joints has been examined with the Scanning Electron Microscope to investigate the cause of the bone loss which occurs at the joint surface in this condition. In eburnated bone the lamellae surrounding the Haversian canals can readily be seen. After artificial abrasion the surface is flat and featureless. After treatment with agents which leach out some of the ground substance the lamellae can again be seen. These observations indicate both corrosive wear and abrasive wear play a part in producing eburnation.
In an attempt to determine failure or reoperation rates for common forefoot procedures, the records of 706 patients who had 1003 forefoot operations were studied. The revision rate for the Keller procedure was 2.26% when no interposition implant was used. The revision rate for metatarsal osteotomies, mainly due to nonunion, was 2.7%. The revision rate for proximal phalangectomies was 3.3%, being 1.9% when the distal end of the phalanx was removed and 4.4% when the proximal end was removed. The failure rate for proximal interphalangeal joint fusion was 17.8%. These results demonstrate that the antiquity of a procedure is not necessarily a recommendation.