Biomedical subjects
Publications and source records attributed to K Satku.
A case of simultaneous dislocations of the interphalangeal and carpometacarpal joints of the thumb after a fall is described. We believe this is a unique situation not reported before in the literature. The results of operative intervention of the open IP joint and closed CMC joint dislocations resulted in a stable pain-free thumb with a good range of motion.
We describe a new method of reconstruction after resection of tumours of the proximal tibia by grafting and arthrodesis of the knee. Two separate vascularised bone grafts from the ipsilateral limb were used, one a gastrocnemius-pedicled femoral graft and the other a pedicled fibular graft. An anatomical study of the gastrocnemius-pedicled femoral graft was made. The method was shown to be practical and reproducible. One patient with osteosarcoma has a successful result with no recurrence at two-and-a-half years.
Seven patients with segmental defects of both bones of the forearm had reconstruction operations using a vascularised fibular graft to bridge the radius. Reasonable forearm rotation was preserved with full elbow movements and satisfactory hand function.
Four cases of chronic osteomyelitis successfully managed with local muscle flaps after sequestrectomy are reported. The success of this method in controlling chronic osteomyelitis lies in the introduction of a new vasculature, which provides nutrients, sufficient antibiotics, host defence system and osteoprogenitor cells to the post-sequestrectomy bed. The osteoprogenitor cells are responsible for the incorporation of residual avascular bone into the adjacent living bone by creeping substitution.
Three women with osteoarthritis of the knee presented after sudden worsening of their symptoms. In each case this was found to be due to a stress fracture of the tibia. With treatment by rest and reduced activity, the fracture healed uneventfully in all three patients.
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Untreated anterior cruciate ligament injuries in 97 knees of 87 patients were reviewed after a mean interval of six years. After their initial recovery 63% of the patients were able to return to their pre-injury sport, but six years later 27% of them had deteriorated to the extent that they could not cope with the same level of sport. Radiological deterioration was maximal in those that had had a meniscectomy more than five years before review. Knees with intact menisci were often radiologically normal despite continuing instability.
Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.
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We have studied 48 patients with posterior cruciate ligament injury and 14 knees from fresh frozen cadavers. A diagnosis of posterior cruciate ligament injury was made by the sag and posterior drawer signs and stress x-ray films, the latter being useful in the grossly swollen and multiple ligament-injured knee. For avulsion injury, surgical management gave the best results. Other isolated posterior cruciate ligament injuries did well conservatively. When posterior cruciate injury is part of a multiple ligament injury, the nature of the associated ligament injury and that of the posterior cruciate determine the type of treatment; the posterior cruciate ligament is not more important than other knee ligaments.
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Three cases with nonunion of long bones and problems of bone loss or infection, when conventional bone graft would probably not have been successful, were treated successfully by free vascularized bone transplant to provide a vascular bed in the nonunion site and internal splint, the donor bone being the composite rib graft based on posterior intercostal vessels and proximal fibula based on its peroneal vascular pedicle. The operative technique was divided into five stages, and each stage posed different problems at the donor and recipient areas and vessel anastomoses. Despite these disadvantages, all three cases proceeded to solid bony union in less than 4 months after surgery. Thus the patients were able to be rehabilitated early to retain satisfactory limb function within a relatively short period of time.
Closed medullary nailing for fracture of the femoral shaft was carried out in 101 cases. The operation was performed with the patient in the supine position and without reaming the medullary canal, using the conventional instruments and rigid guide pins. The diameter of the medullary canal was gauged from standard radiographs taken at 1 m tobe-to-film distance. To secure alignment and reduction of the fracture, heavy traction before and during the operation was necessary. The traction applied on a fracture table against the restraining perineal bar caused trauma to the perineal structures in 7 cases. There was no case of deep infection. The fixation of the fracture was by no means rigid but was adequate for early walking and partial weight bearing. When nails with diameters of less than 9 mm were used, a number of complications occurred. These included angulation, rotational instability at the fracture site, fracture of the nail and non-union. Union occurred within 3 months in all except 2 cases. Nearly 60 per cent of the patients were in hospital for less than 2 weeks. Closed medullary nailing of the femur is preferable to the open method, which carries a much higher risk of infection.
Sixty-one children with ganglia treated surgically at the Singapore General Hospital were reviewed. At the wrist the predominance of dorsal ganglia over volar ganglia, which is the pattern in adults, was found only in older children. In children less than 10 years old, volar ganglia predominated. A high recurrence rate (36%) following surgery was observed, putting in question the value of surgery. An expectant regimen is therefore advocated at first. A modified technique for excision of volar wrist ganglia without attendant risk to the radial vessels is discussed.