Isolated tuberculosis of a metacarpal bone in a 2 year-old child.
Explore the source record for details and available documents.
Antitubercular Agents↗
Biomedical subjects
J B Jupiter
Publications and source records attributed to J B Jupiter.
Regulation of expression of alpha-smooth muscle actin in cells of Dupuytren's contracture.
Our aims were to describe the distribution of alpha-smooth muscle actin (SMA)-containing cells in Dupuytren's tissue in vivo and to determine the effects of selected agents in regulating the expression of SMA in Dupuytren's cells in vitro. In selected hypercellular zones of Dupuytren's nodules up to 40% of the cells contained SMA, as shown by immunohistochemistry. A lower percentage (20%) of SMA-containing cells was found in regions of lower cellularity. A notable finding was that treatment in vitro of Dupuytren's cells with platelet-derived growth factor significantly reduced the content of SMA. Cells from the same patients showed a significant increase in expression of SMA in response to treatment with transforming growth factor, which confirmed recent findings. In addition, interferon-gamma, which has been previously used as a treatment for Dupuytren's disease in a clinical study, had no reproducible effect on the expression of this actin isoform. Our findings are of significance for the conservative management of contractures.
Actins↗
Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result?
Two cohort populations consisting of 13 patients with an un-united fracture of the distal radius in whom the distal fragment had more than 5 mm of subchondral bone supporting the articular surface distal to the site of the nonunion and ten patients with an un-united fracture of the distal radius with a smaller distal fragment were compared. There were no preoperative differences with respect to age, gender, interval between injury and index procedure, preoperative amount of radius tilt, ulnar inclination and ulnar variance, or the preoperative function. Independent of the size of the distal fragment in all patients the distal radius was restored to gain bony union and realignment with preservation of some wrist motion. The length of the follow-up period averaged 30 months for the small fragment group compared with 22 months for the large fragment group. Bony union was achieved in 22 patients. One patient out of the large fragment group failed to heal the fracture and had wrist fusion. At the follow-up examination there were no significant differences in the radiological and clinical outcome between the two groups. No differences were seen on total range of motion of forearm supination and pronation with an average of 135 degrees in the large fragment group and 145 degrees in the small fragment group. Wrist motion revealed no significant differences in the flexion-extension arc, averaging 90 degrees in the large fragment group and 83 degrees in the small fragment group. Total range of motion of radial and ulnar deviation of the wrist was similar, averaging 39 degrees in the large fragment group and 43 degrees in the small fragment group. Grip strength averaged 59% compared with the opposite limb for the large fragment group and 67% for the small fragment group. We believe that the results of reconstruction of un-united fractures of the distal end of the radius for patients in whom the distal fragment had less than 5 mm of subchondral bone supporting the articular surface distal to the site of the nonunion are comparable to the results for patients with a larger distal fragment. Therefore, we believe that surgeons should try to preserve even a small amount of wrist motion and reserve wrist fusion as a final resort.
Adult↗
Instability after total elbow arthroplasty.
Resurfacing total elbow arthroplasty is occasionally unstable. Instability may be related to insufficiency of the ligaments or improper tensioning and implant positioning at the time of surgery. Ligament reconstruction has produced mixed results; however, attempts to reconstruct the ligaments are probably worthwhile because conversion of a freshly cemented resurfacing implant to a semiconstrained hinge is very challenging.
Arthroplasty, Replacement↗
Surgical management of delayed union and nonunion of distal radius fractures.
Ten patients with malaligned fractures of the distal radius that demonstrated either delayed healing or the development of an atrophic or synovial nonunion on standard radiographs were treated with surgical realignment, stable internal fixation, and autogenous iliac crest bone grafting. All 10 fractures healed with acceptable radiologic alignment within 3 months of the index procedure. After an average follow-up period of 3 years 6 months (range, 2 years to 8 years 6 months) patients had an average of 105 degrees wrist flexion and extension, 145 degrees forearm rotation, and 73% grip strength compared with the opposite limb. In the treatment of malaligned, ununited fractures of the distal radius, specific techniques and implants must be tailored to the deformity of the distal radius and the shape of the distal fragment. A stable, well-aligned wrist with preservation of at least 50 degrees mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 3 patients.
Adult↗
Mechanical testing of bioresorbable implants for use in metacarpal fracture fixation.
The purpose of this study was to evaluate the mechanical properties of a bioresorbable plate and screw system that was developed for the treatment of unstable metacarpal fractures and to compare the strength and stiffness of this system with those of conventional titanium plates and screws. Using a 4-point bending test, we measured the strength and stiffness of these implants over a 12-week period of in vitro degradation. Our data suggest that these implants provide stable bending strength and stiffness for 8 weeks and gradually lose their strength over a period of 12 weeks. Further research is necessary to determine whether this level of fixation is adequate to stabilize unstable metacarpal fractures.
Absorbable Implants↗
Secondary ulnar nerve palsy in adults after elbow trauma: a report of two cases.
Secondary ulnar nerve palsy, an unusual condition in which the onset of ulnar nerve dysfunction occurs 1 to 3 months after elbow trauma, can be the cause of sudden deterioration of elbow function. Initially recognized in 1899, this condition has not been reported often. We describe 2 patients who had no subjective or objective evidence of ulnar nerve dysfunction after elbow trauma but had a sudden loss of motion, pain, and clinical and electrophysiologic evidence of ulnar nerve compression at the elbow 4 to 5 weeks after trauma. Marked improvement occurred after ulnar nerve subcutaneous transposition and contracture release.
Adult↗
Neuropathic arthropathy of the elbow. A report of five cases.
BACKGROUND: Neuropathic arthropathy of the elbow is rare and characterized by a painless but unstable articulation. The functional capacity of patients with this condition has not been reviewed in detail. METHODS: Five male patients, with an average age of fifty-one years, were treated for neuropathic arthropathy of the elbow. The underlying conditions associated with the arthropathy included syringomyelia, insulin-dependent diabetes mellitus, end-stage renal failure, and two cases of polyneuropathy of unknown cause. Four patients sought medical attention after a specific traumatic event. Peripheral sensory and motor dysfunction was present in each patient. Radiographs of the elbow revealed dislocation, fracture fragmentation, and heterotopic ossification. Our management of the neuropathic elbows centered on maintenance of a functional arc of motion through physical therapy aimed at regaining muscle strength and the use of orthoses for support. Operative treatment was performed for an associated ulnar or radial nerve compression syndrome in three patients, and an open reduction and internal fixation of an unstable proximal ulnar nonunion associated with loose implants was performed in one. RESULTS: The patients were followed for an average of nineteen months, with a range of twelve to thirty-six months. All patients had a pain-free elbow with a functional range of motion at the most recent follow-up examination, and none wished to have further treatment. The operatively treated ulnar nonunion united successfully. All three patients treated surgically for an associated nerve compression syndrome had recovery of nerve function. CONCLUSION: In the face of instability and gross distortion of the joint, the patients in this series demonstrated remarkably good function.
Adult↗
Traumatic and reconstructive problems of the scaphoid.
The management of acute scaphoid fractures should be oriented on the concept of fracture stability, ease of reduction, associated ligamentous injury, and risk of impaired blood supply, rather than the direction of the fracture line or location of the fracture within the scaphoid. The lack of predictability of successful fracture union and prognostic discrepancies of historic and contemporary classifications may be related to subtle differences of the internal vascular architecture of each scaphoid. Because the possibility of impaired vascularity is greater with fractures located in the proximal third, stable internal fixation is indicated to provide mechanical stability and fracture surface contact to enhance revascularization. Improved healing rates in a shorter time and earlier rehabilitation with percutaneous techniques of internal fixation have produced a clear shift from classic conservative treatment to internal skeletal fixation. Although the rates of union of well-vascularized nonunions have not been dramatically improved with the use of internal fixation as compared with inlay bone grafting, the restoration of scaphoid anatomy and prevention of malunion and associated carpal collapse with interpositional bone grafting techniques will reduce the risk of osteoarthritis.
Bone Transplantation↗
The unstable elbow.
Explore the source record for details and available documents.
Biomechanical Phenomena↗
Fractures of the distal humerus.
The quality of elbow function after fracture of the distal humerus is related to the degree to which normal anatomic relationships are restored. This article addresses the issues related to fractures of the distal humerus, including challenges, controversies, surgical exposure, postoperative management, and complications.
Adult↗
Reconstruction of posttraumatic elbow instability.
Successful reconstruction of posttraumatic elbow instability depends on restoration of the anatomic contributors to stability. The osseous and articular structures are paramount. The radial head and coronoid should be repaired or reconstructed and the olecranon (proximal ulna) should be repaired in anatomic alignment so that the contour and dimensions of the trochlear notch are restored and the radiocapitellar joint is aligned appropriately. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. Patients with longstanding subluxation or dislocation may require temporary hinged external fixation or reconstruction of the collateral ligaments with tendon grafts.
Adult↗
Percutaneous and limited open fixation of fractures of the distal radius.
Percutaneous and limited open fixation of fractures of the distal radius is an important method of treatment for many unstable fractures such as unstable dorsal bending fractures, shearing fractures of the radial styloid and lunate facet, and simple articular fractures. The quality of the reduction is monitored with image intensification and the tactic of the reduction is based on manipulation of the fracture fragments by longitudinal traction, percutaneous manipulation, and in some instances by direct manipulation through small incisions. The role of arthroscopy remains uncertain and may represent an alternative to open exposure of the articular surface in some patients although bone grafting may be necessary in patients with fractures with significant metaphyseal defects.
Arthroscopy↗
Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis.
We treated 15 patients with atrophic nonunion of a diaphyseal fracture of the humerus with an associated bony defect using an autogenous cancellous bone graft and a plate to bridge the defect. There were nine men and six women with a mean age of 48 years. The mean length of the bony defect was 3 cm. At a mean follow-up of 30 months only one fracture failed to unite. This suggests that, in the presence of a well-vascularised envelope of muscle, the application of an autogenous cancellous bone graft in conjunction with a bridging plate represents a good alternative to more demanding surgical techniques.
Adult↗
Unrecognized dislocation of the medial portion of the triceps: another cause of failed ulnar nerve transposition.
OBJECT: Failed surgical treatment for ulnar neuropathy or neuritis due to dislocation of the ulnar nerve presents diagnostic and therapeutic challenges. The authors of this paper will establish unrecognized dislocation (snapping) of the medial portion of the triceps as a preventable cause of failed ulnar nerve transposition. METHODS: Fifteen patients had persistent, painful snapping at the medial elbow after ulnar nerve transposition, which had been performed for documented ulnar nerve dislocation with or without ulnar neuropathy. The snapping was caused by a previously unrecognized dislocation of the medial portion of triceps over the medial epicondyle. Seven of the 15 patients also had persistent ulnar nerve symptoms. The correct diagnosis of snapping triceps was delayed for an average of 22 months after the initial ulnar nerve transposition. An additional surgical procedure was performed in nine of the 15 cases and, in part, consisted of lateral transposition or excision of the offending snapping medial portion of the triceps. Of the four patients in this group who had persistent neurological symptoms, submuscular transposition was performed in the two with more severe symptoms and treatment of the triceps alone was performed in the two with milder neurological symptoms. Excellent results were achieved in all surgically treated patients. Six patients declined additional surgery and experienced persistent snapping and/or ulnar nerve symptoms. CONCLUSIONS: Failure to recognize that dislocation of both the medial portion of the triceps and the ulnar nerve can exist concurrently may result in persistent snapping, elbow pain, and even ulnar nerve symptoms after a technically successful ulnar nerve transposition.
Adolescent↗
Enchondroma versus chondrosarcoma of the phalanx.
Explore the source record for details and available documents.
Aged↗
Phalangeal and metacarpal fractures of the hand.
This article addresses the types of metacarpal and phalangeal fractures seen in a variety of sports. Treatment options are discussed in depth based on the location, configuration, and associated soft-tissue injuries. This article provides a greater understanding of the treatment algorithm to minimize the possibility of long-term functional consequences for the athlete.
Athletic Injuries↗
Mangling upper limb injuries in industry.
The salvage of upper limbs mangled by industrial machinery became possible with the development of predictable techniques of vascular and microvascular anastamosis. Unfortunately, many of these salvaged limbs are associated with fair and poor functional outcomes. The quality of the skeletal fixation can have a substantial effect on the functional outcome and should be a major focus of the limb repair process. Internal plate fixation facilitates wound care and limb mobilization without tethering muscle-tendon units and is safe in the majority of severe upper limb injuries provided that all devitalized tissue is debrided and, if necessary, reconstructed using microvascular tissue transfers. Injury patterns, especially those which involve associated injury of the elbow or forearm ligaments, must be identified and treated appropriately. Internal fixation should restore anatomical alignment and provide sufficient stability to allow immediate active mobilization of the limb without contributing to devascularization of the soft tissues or skeleton.
Accidents, Occupational↗