Biomedical subjects
Publications and source records attributed to W D Engber.
A case of meningococcemia with a persisting peripheral neuropathy and gangrene of the fingers is presented. These unusual complications are thought to be related to the diffuse intravascular coagulation syndrome.
Camptodactyly is a nontraumatic flexion deformity of the proximal interphalangeal joint. The literature pertaining to its etiology and treatment is reviewed. An analysis of 66 patients with 110 affected hands is discussed with particular reference to the natural history of this deformity and the results of 24 operative procedures. Improvement was noted in less than 20% of 32 patients treated nonoperatively and followed for an average of 30 months. Corrective types of operative procedures in 20 hands resulted in improvement in only 35%. A treatment plan dependent on the age of the patient, the presence or absence of osteocartilagenous changes at the proximal interphalangeal joint, and associated anatomic abnormalities is presented.
In a review of thirty-six patients with fifty-seven stress fractures of the medial tibial plateau, I found that limitation of activity was universally successful in treatment. Neither displacement of the fracture nor recurrence of symptoms after healing were seen. The main danger in this entity is misdiagnosis and inappropriate treatment.
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Sixty-one sequential patients initially referred because of hand-reduction abnormalities were retrospectively reviewed. Twenty distinct diagnoses were recognized. Particularly noteworthy was the number of instances in which standard classification schemes failed to explain fully the structural or syndromic characteristics in this group of patients. One-fourth (15 of 61) of the diagnoses were of disorders resulting from abnormalities of single genes; more than one-third (21 of 61) had multiple malformation syndromes. The importance of dysmorphologic and genetic investigation of individuals with congenital reduction malformations of the hands is evident from these data and from the cases presented.
Seven cases of painful reactive synovitis following great toe Silastic hemiarthroplasty have been observed. All cases were treated successfully with synovectomy and removal of the implant. Microscopic examination of the synovium uniformly demonstrated a chronic foreign-body giant-cell reaction with intracellular and extracellular silicone elastomer particles. Gross examination of the implants showed varying degrees of erosion of the articulating surface. Abrasion of a Silastic implant creates free-floating silicone elastomer particles that can precipitate a reactive synovitis. The authors believe an irregular, degenerated first metatarsal head is a contraindication to an interpositional Silastic hemiarthroplasty.
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