Biomedical subjects
Publications and source records attributed to U Mennen.
A new method to restore flexion of fingers is described whereby the plantaris tendon (or part of the tendo Achillis), with its bony insertion, is transferred to the finger. Strong bony anchorage is achieved in the distal phalanx, while a sound interweaving suture technique proximally in the palm will ensure enough strength to allow immediate mobilisation.
100 consecutive patients whose finger had been bitten by another person, or who had cut it on a tooth in a fight, have been studied. 82 healed completely but 18 eventually needed amputation. Early and thorough debridement is required, plus a suitable mixture of antibiotics. Once infection is established in bone or tendon sheath, amputation is often needed, but most infected joints can be saved.
It has been stated, but not reported, that compartment syndrome can occur in a transferred muscle (Bostwick, 1979). We report this unusual complication in two consecutive cases in which a latissimus dorsi muscle transfer had been done.
An improved technique to motorise the triceps is described whereby the bony insertion of the deltoid into the humerus is detached. Similarly the bony insertion of the triceps into the olecranon is detached and a 10 mm. width of this central section of the triceps tendon and aponeurosis reflected with its bony insertion. The two bony blocks are sutured together by stainless steel wire. This technique allows for early active mobilisation of the elbow which allows the patient early rehabilitation, prevents adhesions and eliminates the disadvantage of transferred tendons elongating. These complications were seen with earlier versions of motorisation of the triceps. Careful patient selection and pre-operative evaluation is of the utmost importance to achieve a successful motorised elbow extension procedure.
A newborn baby with a severe congenital constriction band associated with pseudarthrosis and impending gangrene of the foot is described. Early one-stage circumferential excision of the band with immediate wound closure by multiple Z-plasties salvaged the compromised foot. The pseudarthrosis indicated the severely compressive nature of the fibrous band. The uneventful healing of the pseudarthrosis and the full recovery of neurovascular function points to essential normal tissue underlying the constricting band.
Since internal fixation of metacarpal fractures has a high complication rate, most fractures should be managed conservatively, with the emphasis on early mobilisation. However, some fractures do need internal stabilisation. We propose the use of the clamp-on plate, which is simple to use, has a very low complication rate and allows immediate mobilisation.
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A clamp-on plate has been developed to stabilize long-bone diaphyseal fractures. Its design is entirely different from conventional screw-secured plates. Minimal soft tissue, especially periosteal, dissection is required for application. Since there is no intramedullary encroachment, no further damage is done to the endosteal blood supply. One hundred seventy-one fractures of the radius and/or ulna were followed for at least 6 months. There were no nonunions. The average time to union was 12.3 weeks, compared to 21.4 weeks for similarly selected fractures of the radius and/or ulna treated during the same time framework by conventional screw-secured plating methods. The fact that union is reliable and can be achieved earlier than with conventional screw-secured plates supports the author's contention that sparing of the blood supply to the fracture and thus, the biological integrity of fracture healing play a parallel role along with biomechanical stability in achieving fracture union.
The technique and measurement of the bone strength of the radius and ulna in the non-human primate are presented. The aim of this study was to find a relationship between the mechanical strength of an intact radius and ulna forearm and its collateral isolated radius and isolated ulna which would be of assistance in the studies on mechanical bone strength and bone healing. The findings include: (1) bone strength is significantly influenced by factors such as age, sex, and body weight; (2) wide variation in normal bone-tissue strength exists among similar individuals; (3) there are differences in bone strength in the same individual if contralateral sides are compared; (4) growing bones are very elastic and are able to bend to an angle of up to 90 degrees before a fracture occurs; (5) soft tissue structures (such as muscle, interosseous membrane, and tendons) do not contribute to the strength of a diaphysis in low velocity injuries; and (6) the midshaft area of the radius is approximately 10% stronger than that of the ulna in the adult.
When dealing with injury from high-voltage electricity, it must be realised that a crush injury is a more appropriate term than a burn injury. The eventual usefulness of the arm and/or hand should be weighed against the necessarily very intensive surgical treatment of the limb. This evaluation should be done during the initial stages, since it will influence early management. The treatment should therefore be aggressive and should be focused on a high renal output as well as an extensive debridement, which may include amputation at an early stage. Six recent cases, demonstrating this approach, are reported.
A desmoplastic fibroma occurring in the distal forearm of a 14-year-old black boy is described and the historical background of the tumour together with an outline of the disease emphasizes the differential diagnosis between this condition and other fibrous lesions of soft tissue and bone. The clinical and radiological features as well as the treatment of desmoplastic fibroma are discussed. It is believed that this is the first such patient reported in Africa.
In a case of traumatic loss of the whole of the distal third of the quadriceps mechanism as well as the overlying skin, knee extension was restored by anterior transfer of the lateral and medial hamstring muscles into the patella.
In 1979 the first Negro patient with Dupuytren's Contracture who had no evidence of Caucasoid Admixture in his genetic make-up was reported on. Another five such cases are presented.
Two cases of spontaneous septic osteitis of the pubis in patients who had not previously undergone intrapelvic or abdominal surgery are presented. Early diagnosis and evaluation of the immunological system are discussed. Drainage of the pus and thorough debridement of the affected bone are the hallmarks of correct treatment. The administration of suitable antibiotics with simultaneous correction of immunological deficiencies will result in eventual cure.
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Infections of the hand are always very serious conditions and should therefore be treated aggressively. Early diagnosis, adequate anaesthesia, a bloodless field and thorough drainage including debridement, elevation and early active mobilization are the cornerstones of treatment. Antibiotics need not be given routinely, but under certain circumstances (for example in the case of human bites) combination antibiotic treatment is imperative. Management of hand infections along these lines is most rewarding and should prevent a chronic infection or a disastrous osteitis which would result in a permanent lesion and disablement. The management of specific hand infections is discussed.
A paraskeletal clamp-on plate has been developed which maintains the operatively reduced position of a fractured long bone during the healing phase while having a minimal effect on the healing process. The plate consists of a central ridge with paired finger-like projections on each side, constructed in such a manner that on head-on projection the ridge and two projections form just more than a semicircle. The points of the projections, which are wedge-shaped and bent at right -angles towards the centre, are squeezed into the bone with a crimping tool. The technique is simple, the operating time significantly shortened and the healing time notably reduced; fracture union is sound without signs of disuse osteopenia, stress protection or damage to the bony architecture due to drill holes. A second removal operation is not needed and the complication incidence is remarkably low, as is the financial outlay.