Biomedical subjects
Publications and source records attributed to P Dimakopoulos.
Trigger wrist is a relatively rare phenomenon. The pathological entities to which the term trigger wrist is applied are not well defined in the literature. We present three cases of trigger wrist as a result of flexor tendon pathology, review the literature and discuss the use of the term "trigger wrist".
We treated 16 patients (11 women and five men, average age 45 years), all having four-part valgus impacted fractures of the proximal humerus, with transosseous suturing. All had preoperative angiography performed 6-12 h after admission. The average impaction angle was 43 degrees , and the mean lateral displacement of the humeral head was 1.4 mm. Postoperative angiography was performed 8-10 weeks after the operation followed by digital image processing using the segmentation technique. No statistically important reduction in the length and area of large (>0.5 mm) vessels was seen. Union was confirmed by the reduction in the length and area of small vessels (<0.5 mm). At a mean follow-up of 40 months, avascular necrosis was only found in one patient. The average Constant-Murley score was 87 (67-100) points, whereas the functional score in comparison with the unaffected shoulder was 94% (89-100%). Despite the small number of patients, transosseous fixation seems to preserve the remaining blood supply of the humeral head.
Thirty-eight patients with four-part proximal humerus fractures and fracture dislocations were treated with humeral head replacement between 1989 and 1995. At followup (mean, 37 months; range, 12-48 months) the patients were evaluated for postoperative pain, active range of motion, muscular strength, overall function in every day activities, and patient satisfaction. Complications developed in five patients and consisted of humeral component malposition (one shoulder), rotator cuff insufficiency (two shoulders), and heterotopic ossification (two shoulders). According to the Neer criteria, the overall results were: 32 (84%) patients had no pain and improved motion (active forward elevation averaged 130 degrees, external rotation 45 degrees, and average internal rotation to the first lumbar vertebra); in this group strength and function 6 months postoperatively was 80% of the normal side and reached 90% of the normal side at 1 year postoperatively under continuous stretching and strengthening exercises; and 34 patients (90%) were satisfied with their treatment. The results of the study indicate that humeral head replacement is a dependable method to restore comfort and function to patients with acute or old four-part fractures of the proximal humerus. However, recovery of function and range of motion are much less predictable in patients with an old injury.
Over a 20-year period, 59 children with spasticity mainly due to cerebral palsy underwent surgery for correction of a thumb-in-palm deformity. A classification of the deformity based on the functional anatomy of the thumb divided the problem into four different types. A retrospective analysis of the results has shown the classification to be helpful in selecting a surgical option for treatment. In addition, the classification helps to keep accurate records, predict patient progress, and coordinate postoperative treatment.
We report our experience in conservative treatment of 30 patients with trigger digits followed up for an average of 22.3 months. In 26 patients (86.6%) the pain disappeared and the others experienced a remarkable improvement. Locking resolved in 23 patients (76.6%): in 19 patients immediately after the injection and in the other four gradually thereafter. Only three patients needed a second injection. All were satisfied and none required any other form of treatment.
10 patients underwent arthroscopic removal of the central and torn portions of the lateral discoid meniscus, leaving a semilunar-shaped peripheral portion. All but one of the knees were asymptomatic at follow-up.
A case of a rare, large discoid medial meniscus with a bucket-handle tear is described. The radiogram was normal and the clinical impression was torn medial meniscus. A diagnostic arthroscopy revealed an unusually large medial discoid meniscus with a bucket-handle tear. Open partial excision was performed following the arthroscopy.
Thirty-seven patients with osteochondrosis dissecans involving the femoral condyles of the knee were treated with arthroscopic removal of all partially or completely detached osteochondral fragments and with curettage of the crater to bleeding bone. Ten patients underwent a repeat arthroscopy five to 15 months later. All defects had filled with fibrocartilage.