Proximal interphalangeal joint arthrodesis using powered staple fixation. Observations on autopsy specimens

A new method for internal fixation using power-driven staples was recently developed. In theory, this new technique should be ideal in performing small joint arthrodesis. In autopsy specimens, the biomechanical properties were observed in simulated proximal interphalangeal joint arthrodesis (PIP). The tension-band technique, acting as a control, was significantly superior. The two techniques had similar biomechanical properties. The three 7- x 7-mm staples is recommended. The tension-band technique remains the technique of choice in small joint arthrodesis.     

Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty

Chronic ulcerations of the hallux may result in amputation if infection becomes uncontrolled. Salvage of the hallux often requires surgical intervention when conservative measures fail. Many authors have described various procedures to prevent recurrent ulceration and the potential for loss of the great toe. The authors have reviewed their experience with the hallux interphalangeal joint arthroplasty for chronic neuropathic ulcers of the great toe. Between August 1988 and July 1991, the authors performed 46 hallux interphalangeal joint arthroplasties on 40 patients (22 males, 18 females). Of the 40 original patients, one patient was lost to follow-up in the immediate postoperative period, leaving 45 procedures on 39 patients. Thirty-six feet were noted to heal both the procedure and ulceration uneventfully (80%). There were five minor complications (11%). Four cases were deemed failures (9%). Overall, 41 feet (91%) healed and had no evidence of recurrence in the follow-up period. Follow-up was an average of 23.6 months (range 4-44 months). The hallux interphalangeal joint arthroplasty has been a valuable procedure for chronic ulcerations of the hallux. By allowing these ulcers to heal, loss of the great toe has been avoided. Function and structure of the foot has been maintained.     

High implant fracture incidence with Sutter silicone metacarpophalangeal joint arthroplasty

We performed a retrospective review of Sutter silicone metacarpophalangeal (MP) joint arthroplasties in 34 patients (42 hands, 168 implants) with rheumatoid arthritis. Patients were evaluated at an average of 27 months (minimum follow-up period, 12 months). Twenty percent of the implants were shown to be definitely fractured on final follow-up examination, and 45% followed for more than 3 years were definitely fractured. At the final follow-up examination, the average ulnar drift in intact implants was 11 degrees and in the fractured implants, 23 degrees. However, there was no correlation between implant fracture and patient satisfaction. Eighty percent of patients said they would undergo the procedure again. Because of a significantly higher implant fracture incidence at a relatively shorter follow-up period than that of most studies of silicone MP implants of the Swanson design, we have abandoned the use of the Sutter implant.     

Clinico-anatomic basis for anterior approach to the shoulder joint

A study of the causes and conditions of formation of meningeal adhesions, as well as of the possibilities of their prevention by replacement of the meningeal defects with cold-preserved homografts of fresh auto- and homografts, and synthetic film "Fluoroplast-4", as practised in 50 experiments in 46 dogs, has demonstrated that the adhesive process depends on the presence and intensity of brain and meningeal injuries. The possibility of preventing the formation of adhesions was shown to be independent of the type of the plastic material used. The adhesive processes are equally manifest in all methods of plastic repair. Neither do they depend on the method of connecting the transplant with the edges of the meningeal defect. The employment of the "Cyacrine" tissue adhesive causes grosser adhesions. Alloplastic repair is inferior to homoplastic with suturing the margin of the meningeal defect to the transplant, since it does not permit a tight closure of the subdural space.     

Further studies into proximal interphalangeal joint dimensions for the design of a surface replacement prosthesis: medullary cavities and transverse plane shapes

The proximal and middle phalanges from 83 proximal interphalangeal joints (PIPJs) were set in clear plastic and sectioned in the transverse plane leaving the heads whole. The sections were cleaned, shadowgraphed and measured. The medullary canals were marked on sagittal and frontal plane shadowgraphs of the intact bones and analysed. The information was then used in the design of a surface replacement prosthesis for the PIPJs. The main dorsal surface of the proximal phalanx (PP) was found to be angled to the longitudinal baseline of the bone by a mean of 5.19 degrees. This angle increased just proximal to the phalangeal head to a mean of 11.84 degrees. The mean ratio between these angles was 2.71. The phalangeal shaft bone was thicker laterally than dorsally and palmarly, and thicker dorsally than palmarly for the proximal and middle phalanges throughout the length of the bone. The shape and size of the transverse cross-section of the medullary canal changed throughout the length of the shaft. The centreline of the PP medullary canal coincided with the midline of the bone in the frontal plane and was approximately a straight line along the length of the canal. In the sagittal plane the centreline was slightly palmar to the midline and the angle between it and the longitudinal baseline of the bone changed along the length of the canal. In the region of the shaft just proximal to the PP head (where the stem of a surface replacement prosthesis would fit) the mean angle was 10.63 degrees. The centreline was offset dorsally from the centre of rotation of the PIPJ by a mean of 0.83 mm, 0.83 mm, 0.80 mm and 0.57 mm for the index, middle, ring and little fingers respectively, with an overall mean of 0.76 mm. The mean PP head heights (transverse plane) were 9.17 mm, 9.33 mm, 8.73 mm and 7.40 mm and the mean PP widths (transverse plane) were 12.86 mm, 13.25 mm, 12.75 mm and 10.54 mm for the index, middle, ring and little fingers respectively. The mean angle between the lateral sides of the condyles to the transverse baseline was 78.35 degrees and the mean distance from the centreline of the PP head (transverse plane) to the bases of the two condyles was 4.69 mm. The mean maximum depth of the PP head intercondylar sulcus in the frontal plane was 0.72 mm and in the transverse plane, the mean maximum depth of the intercondylar sulcus on the anterior face was 0.82 mm.     

A new approach to the brachial plexus: clinical results

Chlamydia pneumoniae was isolated from the pharyngeal swab of a 15-year-old patient with acute bronchitis. The serum IgM antibody against C.pneumoniae was elevated up to 160-fold in the acute phase and decreased to 20-fold in the convalescent phase using the microimmunofluorescence (MIF) test. IgG antibody titers in the acute phase and the convalescent phase were 40-fold and 160-fold respectively using the MIF test. The patient recovered from the bronchitis without any effective treatment, indicating spontaneous cure of the disease.     

Structure-odour relationships: results of an applied electron-topological approach

Relationships between odour and chemical structure of compounds are studied by means of the electron-topological method developed for structure/activity research especially. A brief explanation is given for distinguished features of the method. Application examples are demonstrated for sandalwood, ambergris odour, garlic aroma and meat keynotes in food additives. The structural fragments affecting the odour appearance are revealed and discussed with respect to their electronic and topological peculiarities. The latter are formulated as rules for activity prediction of new compounds with special properties.     

Giant sacral schwannoma: removal by an anterior, transabdominal approach

We report a case of a giant intrasacral schwannoma expanding into the presacral space. 'En bloc' resection was accomplished by an anterior, transabdominal approach. The advantages of such a procedure are discussed.     

Dislocation after total hip arthroplasty using the anterolateral abductor split approach

The three basic surgical approaches used most commonly in total hip arthroplasty are transtrochanteric, posterior, and anterolateral. Complications related to each of these surgical approaches have been reported including dislocation, trochanteric nonunion, heterotopic ossification, neurovascular damage, postoperative limp, and implant malalignment. The anterolateral abductor split approach previously has been reported to allow ease of access into the hip joint, optimum joint visualization, protection of neurovascular structures of the hip, and predictable results for postoperative hip function restoration. Reviewing a large consecutive series of primary total hip arthroplasty cases (1518), the authors report an overall dislocation rate less than 1% (12:1518; 0.79%). Stratified by preoperative diagnosis, patients undergoing total hip arthroplasty after trauma, or presenting with congenital dysplastic hip are at the highest risk for postoperative dislocation. Primary total hip arthroplasty using the anterolateral, abductor split approach can minimize the rate of postoperative dislocation in the prevailing preoperative diagnostic categories.     

An experimental study on the replacement of the anterior cruciate ligament of the rabbit''s knee using an augmented substitute

This study was designed to test the putative role of plasma cholecystokinin (CCK) in eating behaviour by examining the relationships between bioassayed plasma CCK concentrations and rated sensations of satiety and hunger following the ingestion of an appetizing nutrient-dense meal and between plasma profiles of CCK and scintigraphically determined gastric emptying in nine healthy male volunteers. Mean plasma CCK levels from the whole group showed a significant negative correlation with mean hunger ratings (r = -0.64) and a positive correlation with fullness (r = +0.68). However, there was considerable interindividual variation and negative correlations with hunger were only seen in three out of nine subjects and positive correlations with fullness in four out of nine subjects. In contrast, there was a strong relationship between the plasma CCK produced over the first 2 h after the meal and the half time for gastric emptying of the meal (r = -0.81). These data do not support a direct role for circulating levels of CCK in the control of hunger and satiety following a meal. Instead, the strong correlation with gastric emptying is compatible with release of CCK in response to nutrient delivery into the small intestine.     

Evaluating cognitive theory: A joint modeling approach using responses and response times.

In current psychological research, the analysis of data from computer-based assessments or experiments is often confined to accuracy scores. Response times, although being an important source of additional information, are either neglected or analyzed separately. In this article, a new model is developed that allows the simultaneous analysis of accuracy scores and response times of cognitive tests with a rule-based design. The model is capable of simultaneously estimating ability and speed on the person side as well as difficulty and time intensity on the task side, thus dissociating information that is often confounded in current analysis procedures. Further, by integrating design matrices on the task side, it becomes possible to assess the effects of design parameters (e.g., cognitive processes) on both task difficulty and time intensity, offering deeper insights into the task structure. A Bayesian approach, using Markov Chain Monte Carlo methods, has been developed to estimate the model. An application of the model in the context of educational assessment is illustrated using a large-scale investigation of figural reasoning ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional distal interphalangeal joint splinting for trigger finger in laborers: a review and cadaver investigation

This two-part study evaluates the efficacy of functional distal interphalangeal joint (DIP) splinting for the treatment of trigger finger. Thirty-one fingers from 21 meat packing plant workers were treated with DIP splinting. A single corticosteroid injection was offered if triggering was stage 4 or greater. All workers returned to work immediately. Eighty-one percent of the digits were treated successfully (mean follow-up: 1 year). Treatment failure correlated with duration of symptoms and stage of triggering but did not correlate with age, race, sex, disease in multiple digits, or prior treatment. For the second part of the study, the effect of DIP splinting on flexor digitorum profundus (FDP) tendon excursion was studied in 16 fingers from 4 fresh cadavers. Excursion decreased 4.8 mm for the Stax splint and 4.2 mm for the dorsal Alumafoam splint. We conclude that DIP splinting provides a reliable and functional means of treating work-related trigger finger without lost time from work. Our cadaver investigation supports our theory that DIP splinting significantly decreases FDP excursion.     

Distal interphalangeal joint arthrodesis comparing tension-band wire and Herbert screw: a biomechanical and dimensional analysis

Thirty cadaveric distal interphalangeal joints (15 male and 15 female joints) were prepared with either a Herbert screw or a tension-band wire technique to simulate an arthrodesis. To elucidate mechanical differences between these constructs, the strength of the specimens was determined for three-point anteroposterior and lateral bending and for axial torsion. The Herbert screw demonstrated significantly greater anteroposterior bending strength and greater torsional rigidity when compared to the tension-band wire technique. For dimensional analysis, the height and width of each distal phalanx was measured prior to fixation, 4 mm from the distal tip of the bone (the region that must accommodate the large-diameter threads of the Herbert screw). Results indicated that the mean height of the distal phalanx (3.55 mm) is smaller than the diameter of the screw (3.90 mm). Fracture or thread penetration at the tip of the distal phalanx during screw placement occurred in 25 of the specimens overall and in all the female phalanges, often resulting in stretching or violation of the nail bed. Despite fracture or screw penetration, the Herbert screw appears to offer additional strength that may be clinically important for joint arthrodesis.     

Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach

Anterior cruciate ligament reconstruction by free patellar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecutive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B) a transpatellar tendon approach was used. Postoperative pain was managed by analgesics and, in patients who had epidural anesthesia, by administration of bupivacaine in indwelling catheters. Generally, the analgesics and bupivacaine were given immediately on request to establish comfort at rest and to permit range of motion exercises without severe pain. Compared with those in Group A, the patients of Group B had a significantly longer period from the first dose of analgesic or bupivacaine to the second, and the total number of doses of analgesic or bupivacaine was significantly lower. In the subgroup of patients with epidural anesthesia (21 in Group A and 32 in Group B), the Group B patients required significantly less analgesics, as doses equivalent to 10 mg of morphine, compared with that of Group A.     

Aortic valve replacement in the elderly. Encouraging postoperative clinical and hemodynamic results

Seventy-three patients aged 60 and over and 277 patients under 60 years of age underwent isolated aortic valve replacement (AVR) for aortic stenosis, regurgitation, and mixed disease from 1966 through 1975. Cardiac catheterization was performed five to nine months following operation in 77% of these patients. Follow-up averaged 55 months per patient. The hospital mortality in the elderly group was 2.7%, compared to 5.8% in the younger group. The late cardiac mortality was 21% and 19%, respectively. There was significant improvement (P less than .001) in the left ventricular end-diastolic pressure, cardiac index, and functional class in each of the three disease groups in the younger as well as the elderly patients. More important, the magnitude of improvement in each of these variables in patients over and under 60 years of age was not significantly different. Increasing longevity will make cardiac operations more common in the older population. These findings indicate that AVR carries the same low risk and brings about a similar improvement in left ventricular pump function in patients older and younger than 60.     

Image-guided endoscopic surgery: results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system

Image-guided surgery has recently been described in the literature as a useful technology for improved functional endoscopic sinus surgery localization. Image-guided surgery yields accurate knowledge of the surgical field boundaries, allowing safer and more thorough sinus surgery. We have previously reviewed our initial experience with The InstaTrak System. This article presents a multicenter clinical study (n=55) that assesses the system's capability for localizing structures in critical surgical sites. The purpose of this paper is to present quantitative data on accuracy and performance. We describe several new advances including an automated registration technique that eliminates the redundant computed tomography scan, compensation for head movement, and the ability to use interchangeable instruments.