Pigmented villonodular synovitis: a study of the clinical and pathological features

Chronic arthritis presents characteristic clinical, laboratory and radiological features in diagnosis but occasionally, it may prove difficult to differentiate this from pigmented villonodular synovitis [PVNS] and other similar diseases. In equivocal cases, the diagnosis will rest with detailed histological examination of biopsied synovial tissue. This study correlates clinical and laboratory findings with those of histopathology in 13 such cases

Early internal fixation of unstable ankle fractures

A series of 127 patients with displaced ankle fractures, treated by rigid internal fixation and early joint exercises over a period of 54 months formed the material of this study. Thirteen patients were fixed by an intramedullary k. wire to the fibula and a malleolar screw for the medial malleolus; thirty nine fixed by bimalleolar screws; fibular plate in seventy five of which tension band wiring to the medial malleolus was done in twenty three. A syndesmosis screw was done in forty three/127 patients. The results were evaluated according to the scoring system of Roberts [1983] showing good results in 71.7%; fair in 22.8%; and poor in 5.5% according to the objective rating. It is deduced from this study that the modified Lange-Hansen classification should always be followed; fixation of the lateral malleolus is better done by a plate and screws and done first. The malleolar screw is sufficient to fix the medial malleolus and tension band wiring; though proved to be more secure; is better recommended in cases of delayed union. The treatment of ankle fractures is comprehensive, however recent publications generally favour internal fixation especially in unstable fractures[1, 2, 3]. Accurate reduction and rigid internal fixation are essential if late osteoarthritic changes are to be avoided, and to eliminate the need for plaster immobilization. This permits, better treatment of the soft tissues immediately after operation, and early mobilization achieving a quick functional recovery[4, 1] The aim of this work is to study the validity of internal fixation in unstable ankle fractures, followed by early mobilization and to determine the incidence of early degenerative arthritis

Treatment of deep wound infection with closed irrigation and suction technique in orthopedics

Twenty six cases of deep wound infection were managed with closed irrigation and suction technique using appropriate antibiotics in Ringers solution. 69% were controlled and were asymptomatic during the whole period of follow-up, with the implants in position. Advantages of the technique are also discussed

Internal fixation of transverse fractures of the patella using two Kirschner wires and tension band wiring

Various techniques of internal fixation have been recommended in treating transverse fractures of the patella. Modified tension band wiring using two kirschner wires was the aim of this study, which was adopted in nineteen transverse fractures with complete loss of their extensor power and displacement of their fractures. All patients were followed up for 16 months. Excellent results were found in 68.5%; good in 26% and fair in 5%. It was concluded that this technique is reliable, simple, and patients resumed their activities early. Moreover it provided rigid fixation with a contact articular surface especially during flexion and extension, rendering the fracture more stable and avoiding plaster complications

Giant cell tumour involving the fifth metatarsal

Although giant cell tumour most frequently involves the bones around the knee, in very rare instances it is apt to affect the cylindrical bones of the hands and feet. A case is described' of an adult male who presented with a swelling of his fifth metatarsal bone and which proved to be a Grade 2 giant cell tumour

Finger tip injuries

Eighty-eight patients with ninety finger tip injuries were treated: free grafts 48 and pedicle flaps 19. The simplest and fastest methods of repair were full thickness and split thickness grafts. The most satisfactory donor area for full thickness grafts was the inner aspect of the arm. In children and women the inguinal region was a more appropriate donor area. The hypothenar area was a very good donor site for split thickness and full thickness grafts. Skin flaps gave the best sensory and cosmetic results. The disadvantages of free grafts were the delay and the deficiency of the sensory return, and those of cross finger flaps were the disfigurement and liability of injury to the extensor tendon of the donor finger. The awkward position of the finger in thenar flaps was a source of discomfort. lnframammary flaps were bulky and disfiguring. Proximal amputation was reserved for manual labourers, especially in the little and ring fingers