Treatment of isolated distal ulnar shaft fractures with below-elbow plaster cast. A prospective study

In a prospective study 52 patients with an isolated fracture of the distal ulna were treated with a below-elbow plaster cast. The histories of 46 patients were reviewed after a mean follow-up of 3.5 years (ranging from 10 months to 7 years). Forty-three fractures united. There were two non-unions. One fracture displaced while in the plaster, so that there was no longer any bone contact between the fragments. The fracture was consequently treated by open reduction and internal fixation. The type of fracture, the initial displacement (all fractures had bone contact) or the initial angulation (maximum 10 deg) was not found to influence the final clinical results. Below-elbow plaster cast appeared to produce satisfactory results in 89% of the patients.     

Subcapital fractures of the four ulnar metacarpal bones

A strain of Chromobacterium violaceum isolated from a fatally infected patient was found to produce a beta-lactamase. When the organism was grown in drug-free medium, beta-lactamase activity was barely detectable, but when it was grown in the presence of penicillin G, a much larger amount of activity was produced. The beta lactamase was active primarily against cephalosporins; it was sensitive to inhibition by cloxacillin but resistant to p-chloromercuribenzoate. Thus this enzyme closely resembled the common type of beta-lactamase found in Pseudomonas aeruginosa. The organism was relatively susceptible to ticarcillin, carbenicillin, and cefoxitin, which resected hydrolysis by its beta-lactamase, but was quite resistant to 11 other beta-lactam antibiotics. Production of the beta-lactamase appeared to be mediated by chromosomal genes.     

Outcome of femoral shaft fractures in the elderly

Published literature on fractures of the femoral shaft has reported results of treatment stratified by fracture type or treatment type. The current study analyzes the outcome of fractures of the femoral shaft in elderly patients. One hundred thirty-eight patients older than the age of 65 years sustained femoral shaft fractures. Ten percent of the patients had associated injuries. The majority of the patients had significant prefracture medical problems. Nonsurgical treatment was used in 29 cases. Surgical treatment in 109 patients consisted of cerclage wires in 13 cases, plates and screws in 58 cases, intramedullary nails in 26 cases, and long stem prostheses in 12 cases. Complications of treatment occurred in 46% of patients. The type of treatment did not influence the frequency of complications. Twenty percent of patients died within 6 months of the fracture. There was a significant difference in the age of the patients who survived compared with those who did not survive. The mental status of the patient was also a major determinant of survival. Alert and oriented patients had a much better chance of survival. The outcome of fractures of the femoral shafts cited in the literature is different from the results seen in this population of elderly patients. The observed complication rate of 46% and mortality rate of 20% in this series is similar to those reported for intertrochanteric fractures and femoral neck fractures. Age and mental status are important determinants in the survival of the patient regardless of the treatment administered.     

Results of bypasses to the anterior tibial artery through the interosseous membrane

Two month-old Wistar male albino rats were exposed during a 30-day period to a daily oral intake ad libitum of either 200 microg/mL Cd (as CdCl2), 0.1 microg/mL Se (as Na-selenite), or the same dosages of Cd + Se in drinking water. The daily intake from the water was calculated to be 15 mg Cd/kg and 7 microg Se/kg. Cadmium (Cd) accumulates in the heart (p < 0.005) and, in rats, decreases both body mass growth (p < 0.005) and heart mass (p < 0.02). Selenium (Se) significantly decreases the negative effect of Cd on body mass growth. In the hearts of Cd-treated rats, cadmium caused the decrease (p < 0.05) of selenium-dependent glutathione peroxidase (GSH-Px, EC 1.11.1.9) activity. At the same time, the activities of total superoxide dismutase (total SOD, EC 1.15.1.1), manganese-containing superoxide dismutase (Mn SOD), and copper-zinc-containing superoxide dismutase (CuZn SOD) were increased (p < 0.005). The activities of total SOD, CuZn SOD (p < 0.005), GSH-Px (p < 0.02), and glutathione-S-transferase (GST, p < 0.005) were increased in the hearts of Se-treated rats. However, by concomitant administration of Cd and Se, these changes were diminished (total SOD, GST) or were completely eliminated (Mn SOD, GSH-Px). These results indicate that Se only partly diminishes the effects of Cd cardiotoxicity.     

The cast-brace treatment of femoral shaft fractures

Ninety-eight fractures of the shaft of the femur were seen in one unit over the two years 1974 and 1975, and the results have been assessed in sixty-nine. Of these, thirty-eight were treated by skeletal traction in a Thomas's splint followed by skin traction, and thirty-one by skeletal traction followed by a cast-brace. The technique of application is described in some detail. The average time for application of the cast-brace was six weeks after the injury, the time in hospital eight weeks and the time till removal fifteen weeks. The patients selected for a cast-brace were in hospital for just over half the time of the others and their fractures on average united more quickly, though with some trouble from angulation of fractures of the uppermost third of the shaft. It is concluded that when used with all the judgment and skill it demands, the cast-brace method is a great advance in conservative treatment.     

Structural integrity of implanted WMT infinity hip and Osteonics Omnifit hip in fresh cadaveric femurs

OBJECTIVES: To evaluate the role of proton MR spectroscopy (1H-MRS) in detecting metabolic changes in diffuse or focal lesions in the brain of patients infected with HIV. METHODS: Sixty HIV seropositive patients (25 with HIV related encephalopathies, 20 with toxoplasmosis, eight with progressive multifocal leukoencephalopathies (PMLs), and seven with lymphomas) and 22 HIV seronegative neurological controls were examined with a combined MRI and 1H-MRS technique using a Siemens 1.5 Tesla Magnetom. Spectra (Spin Echo sequence, TE 135 ms) were acquired by single voxel, localised on focal lesions in toxoplasmosis, PML, lymphomas, and HIV encephalopathies and on the centrum semiovale of neurological controls. Choline (Cho), creatine (Cr), N-acetyl aspartate (NAA), lactate, and lipids were evaluated in each spectrum and NAA/Cr, NAA/Cho, and Cho/Cr ratios were calculated. RESULTS: A significant decrease in NAA/Cr and NAA/Cho ratios were found in all HIV diagnostic groups in comparison with neurological controls (p<0.003), suggesting neuronal or axonal damage independent of brain lesion aetiology. However, the NAA/Cr ratio was significantly lower in PML and lymphomas than in HIV encephalopathies (p<0.02) and toxoplasmosis (p<0.05). HIV encephalopathies, lymphomas, and toxoplasmosis showed a significant increase in the Cho/Cr ratio in comparison with neurological controls (p<0.03) without between group differences. The presence of a lipid signal was more frequent in lymphomas (71%) than in other HIV groups (Fisher's test, p=0.00003). The presence of mobile lipid resonance together with a high Cho/Cr ratio in lymphomas may be related to an increased membrane synthesis and turnover in tumour cells. A lactate signal (marker of inflammatory reaction), was found in all but one patient with PML lesions (75%), but had a lower incidence in the other HIV diagnostic groups (Fisher's test, p=0.00024). CONCLUSION: 1H-MRS shows a high sensitivity in detecting brain involvement in HIV related diseases, but a poor specificity in differential diagnosis of HIV brain lesions. Nevertheless, the homogeneous metabolic pattern that characterises PML suggests the usefulness of 1H-MRS as an adjunct to MRI in differentiating CNS white matter lesions, such as HIV encephalopathies, from PML.     

Home traction of femoral shaft fractures in younger children

Radiation doses of occupational personnel exposed from diagnostic x rays, therapeutic installations, and patients were measured using thermoluminescent dosimeters. The monthly occupational doses from diagnostic x ray ranged from 0.1076 mSv to 0.5774 mSv, and those from therapeutic treatment ranged from 0.365 mSv to 0.657 mSv, which is within the dose limit recommended by ICRP 60. The patient organ doses were evaluated and found to range from 0.0615 mSv s(-1) to 2.8823 mSv s(-1) for gonad, 0.3676 mSv s(-1) to 2.1088 mSv s(-1) for thyroid, and 0.00972 mSv s(-1) to 4.01 mSv s(-1) for eyes.     

Ender nailing of acute humeral shaft fractures in multiple injuries

From January 1987 to April 1993, 25 multiply injured patients were treated with closed intramedullary Ender nail fixation of the humeral shaft. Criteria for the procedure were humeral diaphyseal fractures with associated multiple injuries. Seventeen distal and mid-shaft fractures were treated via a modified anterograde approach in which the rotator cuff is not violated. Eight proximal third fractures were treated via the standard retrograde approach. Postoperative follow-up averaged 36 months. Full range of motion was attained 17 of the 25 patients. Of the eight remaining patients, three with a slightly limited range of motion achieved full range of motion following nail removal; three had preoperative radial nerve palsy which resolved within 1 year, and two patients required follow-on plating. In 92 per cent (23 of 25) there were no incidences of infection or non-union. Flexible nails avoid complications of reaming. The modified anterograde approach allows excellent shoulder motion since it does not violate the rotator cuff. Ender nails provide excellent fixation and clinical outcome in the multiply injured patient and are cost effective compared with interlocking nails.     

The conservative and surgical therapy of traumatic humeral shaft fractures

Sixty-three patients with humeral shaft fractures were evaluated clinically and radiographically 18 months after injury; 27 patients were treated surgically (group A) and 36 patients conservatively (group B). Analysis of the results according to a score by Kwasny revealed 6.2 points in group A and 2.2 points in group B (P < 0.0001; F = 46.9). The results of these two comparable groups suggest that conservative treatment of humeral shaft fractures is superior regarding mobility of the shoulder and elbow, strength, the incidence of neurological complications, pain, subjective rating and cosmesis. There were no differences on roentgenograms between the two groups (P = 0.48).     

Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus

In previous experiments using the fat substitute sucrose polyester (SPE, or olestra), no compensatory response was observed on day 2 after experimental manipulations, which reduced the percentage of energy from fat to approximately equal to 30% from 40% on day 1. In the present study a more severe manipulation was made; the amount of energy from fat was reduced from 32% to 20% to determine whether such a reduction would provoke any physiologic or behavioral response. Subjects came to the unit for two, 2-d test sessions. Intake on day 1 was fixed: subjects were given meals containing either control fat (11319 kJ, 32% of energy as fat) or SPE (9561 kJ, 20% of energy as fat). On day 2, intake was ad libitum. On day 1 subjects rated themselves as more hungry while consuming the fat-substituted meals than when consuming the control meals and they disclosed greater hunger in the end-of-day questionnaires. The effect of the manipulation was carried over into day 2. By the end of day 2, subjects had compensated for 74% of the energy (fat) deficit caused by the previous day's manipulation. These results differ from those obtained when fat was reduced from 40% to 30% of energy; this more severe reduction reveals that a reduction in fat of this size can lead to a biobehavioral response. Together, these data suggest that people could change their diet to meet dietary guidelines; however, if a more severe reduction is attempted, adherence may be made more difficult by the strength of the compensatory response.     

Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures

PURPOSE: This report describes the early clinical experience with use of a transluminally placed endovascular graft (TPEG) covered with pre-expanded polytetrafluoroethylene (PTFE) to treat iliac artery aneurysms and fistulas. MATERIALS AND METHODS: Eight patients with iliac artery aneurysms (n = 7) and common iliac artery to common iliac vein fistula (n = 1) were treated with TPEGs. The iliac artery aneurysms were either common iliac (n = 6) or hypogastric (n = 1). All of the patients had significant comorbid diseases. The TPEG devices were made with pre-expanded PTFE sutured to Palmaz stents and delivered through 10- or 12-F sheaths. RESULTS: The aneurysms were successfully excluded in six of seven patients and the one iliac artery-to-vein fistula was successfully occluded. There were no immediate procedural complications related to the TPEG devices. Follow-up was limited (mean, 12 months), but no stenoses or occlusions of the TPEG devices were detected. The one failure was probably due to the marked tortuousity of the iliac artery, which prevented an adequate seal. CONCLUSION: In the authors' early clinical experience, the use of TPEG devices with pre-expanded PTFE successfully treated iliac artery aneurysms and an iliac artery-to-vein fistula. Although the results are encouraging, longer follow-up is necessary to better evaluate this type of treatment.     

Treatment of humeral shaft fractures by retrograde locked nailing

From 1992 to 1994, 29 middle and 19 distal humeral shaft fractures (39 acute fractures, six nonunions, and three pathologic fractures) in 48 patients were treated by retrograde locked nailing. The first eight acute fractures were treated with Seidel nails, the other 40 fractures with specially designed humeral locked nails. Nails were inserted from the supracondylar (6) or the olecranon fossa (42) entry portal. With a single operation, all acute fractures and nonunions achieved osseous union without serious complications. The average time to union was 8.2 weeks for acute fractures and 14.2 weeks for nonunions. Recovery of shoulder function was complete. Elbow motion was excellent in all but one nonunion that resulted from a Type IIIB open fracture. Two patients with supracondylar entry had apex to posterior angular malunion. One patient with a distal comminuted fracture had varus malunion. Three patients had an iatrogenic bony split, but healing was unaffected. Patients with pathologic fractures maintained satisfactory arm function postoperatively. Given the few complications and good functional recovery seen in this study, retrograde locked nailing appears to be a good alternative treatment in middle and distal humeral shaft fractures. The olecranon fossa approach, with more linearity to the humerus, is preferred. In the authors' experience, humeral locked nails are inserted more easily and are associated with fewer complications than are Seidel nails.     

Late instability in cervical spine fractures secondary to laminectomy

Of 256 patients with a major spinal cord injury as a result of fracture of the cervical spine, 38 per cent had a laminectomy. Three months after injury, 33 per cent of the patients with laminectomy required fusion for instability compared to 22 per cent of the nonlaminectomy group. There were no cases of late instability in pure flexion or extension fracture groups. Ninety per cent of the late instability cases were in the groups with hyperflexion and flexion compression fractures. Laminectomy should be avoided for these fractures, but early fusion may be necessary to prevent progressive deformity.     

Bull sperm motility and membrane integrity in media varying in osmolality

Studies were designed to evaluate bull sperm motility and membrane integrity following exposure to Tyrode's solution varying in osmolality from 100 to 1537 mOsm. Congo red and bisbenzimide (HOECHST 33258) stains were used to distinguish between sperm with intact versus disrupted plasma membranes. Sperm motility was subjectively evaluated. No significant differences were found between motile and unstained sperm (sperm with intact membranes) in solutions with nearly physiologic osmolalities between 200 and 300 mOsm. However, in 100- and 150-mOsm solutions, the percentage of motile sperm (5 and 19%), respectively) was lower than the percentage of sperm unstained with Congo red (18 and 35%). With HOECHST 33258 stain, the corresponding values were 7 and 14% versus 26 and 31%. The percentage of motile sperm declined greatly in the 500-mOsm medium, but the proportion of unstained sperm was affected little until the osmotic pressure exceeded 732 mOsm. Partial recovery of motility occurred when sperm were returned to the isotonic medium. This study indicated that the sperm plasma membrane was more resistant to osmotic damage than were the mechanisms responsible for sperm motility. Lack of motility in hypertonic media was not an absolute indicator of cell death, and unstained sperm overestimated sperm viability, which are factors to consider when sperm are being evaluated, especially relative to cryopreservation.