Over-distraction of the radio-carpal and mid-carpal joints following external fixation of comminuted distal radial fractures

Seven patients with Frykman type 7 and 8 distal radial fractures, who had been treated with external fixation, were noted to have significant over-distraction of 5-8 mm in the radio-carpal and mid-carpal joints. One patient, who also had abnormal negative ulnar variance of 2 mm, had a fair result using modified Gartland and Werly (1951) criteria. The remaining six patients had good results, indicating that over-distraction does not significantly alter the final outcome, so long as a normal distal radio-ulnar relationship is maintained.     

Bilateral scapholunate dissociations with distal radial fractures and post-traumatic intercarpal fusion

A patient with bilateral intraarticular distal radial fractures associated with scapholunate dissociation and post-traumatic lunotriquetral fusion on one side is described.     

Changes in carpal alignment following radial osteotomy for Kienb?ck''s disease

In 87 femoral neck fractures, operated on with 2 von Bahr screws and followed for up to 2 years, the positions of the fixating screws were determined with a new mensuration technique which compensates for the variations in hip rotation in routine radiographs. The union rate of the fractures was related to the position of the screws. A posterior placement of the proximal screw and an inferior placement of the distal screw in both the femoral head and neck improved the outcome substantially.     

The management of acute fractures involving the distal radio-ulnar joint and distal ulna

The acute management of fractures involving the distal radio-ulnar joint and distal ulna is controversial. The primary goal is recognition and differentiation between stable and unstable fracture patterns. Although an operative approach is adopted in the treatment of these injuries, the optimal management protocol awaits good prospective randomized studies.     

Significance of distal motor latency after carpal tunnel operation

Many microorganisms from the deep-sea display high-pressure-adapted--also described as barophilic or piezophilic--growth characteristics. Phylogenetic studies have revealed that a large proportion of the barophilic bacteria currently in culture collections belong to a distinct subgroup of the genus Shewanella, referred to as the "barophile branch." Many of the basic properties of barophiles that enable their survival at extremes of pressure remain to be elucidated. However, several genes whose expression is regulated by pressure, or which appear to be critical to baroadaptation, have been uncovered. One such operon, whose presence appears to be restricted to the "barophile branch," has been identified in DNA samples obtained from sediments recovered in the deepest ocean trench. In the case of another set of pressure-regulated genes, regulatory elements required for pressure signaling have been uncovered. The nature and regulation of these genes is discussed.     

Pilon fractures of the distal tibia

Pilon fractures are relatively rare fractures of the distal metaphysis of the tibia resulting from axial and/or rotational forces. They involve varying degrees of metaphyseal disruption, articular damage, and malleolar displacement. When severe, these injuries represent a tremendous challenge to the orthopaedic trauma surgeon. Traditional treatment of high-grade pilon fractures by closed means has led to unsatisfactory results. Open reduction and internal fixation in accordance with AO/ASIF principles has greatly improved the outcome in these often disabling fractures. Surgical technique involves anatomic restoration of fibular length, reconstruction of the plafond, bond grafting of the metaphyseal defect, and buttress plating of the medial tibia. Thorough preoperative planning and meticulous surgical technique produce predictably good results in the majority of cases.     

Arthroscopic-assisted reduction of distal radius fractures

The outcomes of seven patients with severe comminuted intraarticular fractures of the distal radius treated by arthroscopic reduction and percutaneous external fixation (ARPEF) were retrospectively reviewed. All of the fractures were classified as C3 types using the AO classification scheme. Outcomes were evaluated using the Gartland and Werley functional criteria, an objective wrist examination, a radiographic analysis, and a self-assessment outcome form at an average follow-up of 27 months (range, 12 to 45 months). All patients were free of pain and had returned to their prior occupations. No patient had articular incongruency of greater than 1 mm, and there was no evidence of radiocarpal degenerative change. Active range of motion and maximal grip strength averaged 92% and 98%, respectively, of the uninjured wrist. The technique of arthroscope-assisted reduction and percutaneous external fixation yielded excellent results in a small group of patients, with minimal complications.     

Mandibular fractures following third molar extraction. A retrospective clinical and radiological study

Health care workers (HCW) are at risk of occupationally acquiring Mycobacterium tuberculosis (TB) infection. The Centers for Disease Control and Prevention has published guidelines for health care facilities to protect HCW. One of the recommended elements is TB infection surveillance among HCW using purified protein derivative (PPD) skin testing and analysis of the data by occupational group and work location to determine areas of increased risk of infection. At the military medical center (MMC) we studied, occupational groups with statistically significant (p < 0.05) above-average PPD conversion risk (> 1.1%/year) included respiratory therapists (15.6%/year), nursing technicians (2.3%/year), and military personnel (1.6%/year). Maintenance and engineering workers (2.6%/year), food service workers (2.5%/year), laboratory workers (2.0%/year), custodial workers (1.8%/year), and practical nurses (1.7%/year) had above-average, but not statistically significant, risk. The fourth floor of the MMC had 39% (21/54) of the converters. The surveillance program also uncovered 235 individuals who had not completed adequate prophylactic therapy, and a case of active TB in a laboratory worker.     

Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography

This study evaluated the reliability of plain radiography versus computed tomography (CT) for the measurement of small (< 5 mm) intra-articular displacements of distal radius fracture fragments. The plain radiographs and CT scans of 19 acute intra-articular distal radius fractures were used by 5 independent observers, using 2 standardized techniques, to quantify incongruity of the articular surface in a blinded and randomized fashion. Repeat measurements were performed by the same observers 2-4 weeks later, allowing determination of intraclass correlation coefficients (ICC) as a measure of intraobserver and interobserver agreement. The average maximum gap displacement on plain radiographs was 2.1 mm (range, 0.0-15.0 mm, lateral view) and on CT images was 4.9 mm (range, 0.7-17.3 mm, axial view). The average maximum step displacement on plain radiographs was 0.9 mm (range, 0.0-6.4 mm, lateral view) and on CT images was 1.2 mm (range, 0.0-6.0 mm, sagittal view). More reproducible values determining step and gap displacement were obtained when the arc method of measurement was used on CT scans (ICC values, .69-.97) as compared to the longitudinal axis method for plain radiographs (ICC values, .30-.50). For measured displacements of 2 mm or more, our data demonstrated poor correlation between measurements made on CT images and those made on plain radiographs (gap or step displacement > 2 mm, K = 0.21; step displacement > 2 mm, K = 0.21). Thirty percent of measurements from plain radiographs significantly underestimated or overestimated displacement compared to CT scan measurements. From these data, we conclude that CT scanning data, using the arc method of measurement, are more reliable for quantifying articular surface incongruities of the distal radius than are plain radiography measurements.     

Long-term results of the external fixation of distal radius fractures

OBJECTIVES: Prostate cancer (PCa) has a familial predisposition imparting an increased risk of developing the disease in those with a family history. The pathologic characteristics are similar to sporadic cases; however, the disease-free survival rates of hereditary PCa have recently been disputed, with one major study suggesting that familial cases have higher recurrence rates. Our study seeks to support or refute this association and to evaluate the genetic biomarkers p53, bcl-2, Ki-67, and neovascularity between familial and sporadic disease. METHODS: We retrospectively reviewed data of 573 patients who underwent radical prostatectomy over an 11-year period. Of these, 474 patients had known family history data. Univariable statistical analysis using the Pearson chi-square test and Kaplan-Meier disease-free survival analysis was performed to identify any correlation between the tested variables and family history. Smaller subsets of this cohort that had available archival material for immunohistochemical staining and family history data were analyzed in a similar manner. RESULTS: The preoperative variables (prostate-specific antigen, prostatic acid phosphatase, clinical stage, highest biopsy Gleason sum, and glandular differentiation) and postoperative variables (stage, highest Gleason sum, and glandular differentiation) did not correlate with family history. Kaplan-Meier disease-free survival analysis revealed no differences between sporadic and familial cases. The analysis of p53, bcl-2, Ki-67, and angiogenesis revealed that only increasing p53 expression and positive family history of PCa approached significance (P = 0.057). CONCLUSIONS: Prognostic variables routinely used in PCa and selected genetic biomarker immunostaining abnormalities are not significantly different in men with and without a family history of PCa. Disease-free survival after radical prostatectomy is also unaffected by family history.     

The importance of the correct restoration of the transverse dimension in midfacial fractures]

The final goal, in reconstructing the facial skeleton of trauma patients, is to obtain good aesthetic and functional outcomes. The surgical technique shown, consists in the reduction and contention of the midfacial fractures. It is based on right placing of the zygomatic arch. In fact, the key to repair midfacial fractures, is the correct placing of the zygomatic arch in relation to the cranial base and the midface. In this way the transversal, vertical and sagittal diameters are regained in their correct space relationships.     

Densitometric evaluation of the distal radial epiphysis in patients after Colles fracture

The results of bone mineral density measurements in both forearms of 50 patients aged from 51 to 83 yrs (av. 62.4) who sustained unilateral Colles fracture, were analysed. Time elapsed from fracture was from 0.5 to 6 yrs. The aim of this study was to assess the effect of previous Colles fracture on bone mineral density. It was found that after the preliminary increase of bone mineral density, there was a gradual decrease towards normal values as compared with the unbroken arm. The bone mineral density in the evaluated group with fracture was significantly lower than the control groups without fracture.     

Comminuted fractures of the radial head. Arthroplasty versus internal fixation

Fractures of the radial head continue to challenge orthopaedic surgeons. Fortunately, most simple uncomplicated fractures treated non-operatively with emphasis on early motion achieve good results. Treatment of more complex fractures remains controversial, however. When simple radial head excision is contraindicated, choosing between open reduction and internal fixation and radial head replacement remains difficult. A review of the literature does not provide definite guidelines, but suggest that fracture complexity and technique are critical for success. This paper is not intended to review the treatment of radial head fractures, but rather to focus on choosing between replacement versus internal fixation when preservation of radial head mechanics is indicated.