Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius.

Five comminuted and displaced fractures of the distal metaphysis of the radius were treated by a technique of minimally invasive plate osteosynthesis (MIPO) with the aim of minimizing soft tissue damage and devascularization of the fracture fragments. This technique used the small AO T-shaped locking compression plate (AO LCP T-plate) and left the pronator quadratus intact. Radial inclination, palmar tilt, and ulnar variance were restored without loss of reduction in all five cases and the fractures healed at an average of 10 weeks, with good to excellent clinical outcomes.

Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach.

Six patients with a displaced coronal shear fracture of the distal end of the humerus were treated surgically with the anterolateral approach to the elbow, in which the capitulum and trochlea could be exposed widely. All underwent open reduction and internal fixation to reduce anatomically and mobilize the joint at an early stage. The mean duration of follow-up was 40 months (range, 24-54 months). All fractures healed with an acceptable functional result. In no case did we observe collapse of the capitulum or trochlea. We recommend open reduction by the anterolateral approach, which provides good exposure of the fracture sites and allows internal fixation to be accomplished with the use of Herbert screws, resulting in good fixation and compression of the bone fragments.

Tardy posterolateral rotatory instability of the elbow due to cubitus varus.

BACKGROUND: Cubitus varus has long been considered merely a cosmetic deformity. The purpose of this paper is to demonstrate a causal relationship between cubitus varus and instability of the elbow. METHODS: In twenty-four patients (twenty-five limbs) with a cubitus varus deformity following a pediatric distal humeral fracture or resulting from a congenital anomaly (three limbs of two patients), tardy posterolateral rotatory instability of the elbow developed approximately two to three decades after the deformity occurred. All patients presented with lateral elbow pain and recurrent instability. The average varus deformity was 15 degrees (range, 0 degrees to 35 degrees ). Surgery was performed in twenty-one patients (twenty-two limbs). Treatment consisted of reconstruction of the lateral collateral ligament and osteotomy in seven limbs, ligament reconstruction alone in ten, osteotomy alone in four, and total elbow arthroplasty in one. RESULTS: In three patients, the triceps muscle was dynamically stimulated intraoperatively to contract while resisting extension of the elbow. This produced posterolateral rotatory subluxation of the elbow, which was reversed by corrective osteotomy and lateral transposition of a portion of the medial head of the triceps that originally had been attached to the elongated, deformed medial aspect of the olecranon. At an average of three years (minimum, one year) after the operation, the result was good or excellent for nineteen of the twenty-two limbs that had undergone an operation; three limbs had persistent instability. CONCLUSIONS: With cubitus varus, the mechanical axis, the olecranon, and the triceps line of pull are all displaced medially. The repetitive external rotation torque on the ulna permitted by these deformities can stretch the lateral collateral ligament complex and lead to posterolateral rotatory instability. Thus, cubitus varus deformity secondary to supracondylar malunion or congenital deformity of the distal part of the humerus may not always be a benign condition and may have important long-term clinical implications. Operative correction can relieve symptoms of instability. The indications for preventive corrective osteotomy remain to be determined.

Anatomic and histologic studies of lateral collateral ligament complex of the elbow joint.

We studied the gross and histologic anatomic characteristics of the lateral collateral ligament complex of the elbow joint from 15 cadavers to demonstrate its cross-sectional anatomy. The lateral ulnar collateral ligament adheres closely to the supinator, the extensor muscles, its intermuscular fascia, and the anconeus muscle and lies posterior to the radial collateral ligament. The lateral ulnar collateral ligament itself was identified with microscopy as a slender, poor structure consisting of the thick area of the posterolateral capsuloligamentous layer and a poorer structure than the anterior bundle of the medial collateral ligament as the primary stabilizer of the elbow joint. We believe that the lateral ulnar collateral ligament contributes to rather than is a major constraint to the posterolateral rotatory instability as part of the lateral collateral ligament complex with the surrounding tissues.

Fractures of the base of the middle phalanx of the finger. Classification, management and long-term results.

We classified fractures of the base of the middle phalanx into five types: 1) single palmar fragment; 2) single dorsal fragment; 3) two main fragments; 4) not involving the articular surface, including epiphyseal separation in children; and 5) all others. Types 1 and 2 were subclassified into avulsion, split and split-depression. Surgery is recommended for unstable type-1 avulsion fractures, type-2 avulsions which may develop buttonhole deformities, and all fractures which displace articular cartilage surfaces. Long-term follow-up showed that surgical treatment which produced good stability and congruity gave good results. These should be the primary aims of treatment.

Acute posterolateral rotatory subluxation of the elbow joint. A case report.

The elbow joint has become increasingly recognized as a very important joint for all sports activities. Players in some sports cannot compete at all with an unstable elbow due to ligament injuries. Thus, professional sports players and heavy laborers, as in our case, should find the excellent results of primary ligament repair preferable. This technique is less invasive than secondary ligament reconstruction and can result primarily in an accurate, stable elbow with full range of motion for mobilizing the joint and muscles at an early stage.

The Galeazzi-equivalent lesion in children revisited.

A fracture at the medial end of the distal third of the radius with an epiphyseal separation of the distal ulna in a 16-year-old boy is described. This injury, known as the Galeazzi-equivalent lesion in children, is characterized by complete distal ulnar epiphyseal separation without rupture of the distal ligamentous stabilizing system between the radius and ulna, which includes the triangular fibrocartilage complex, interosseous ligaments and periosteal tube of the ulnar. The Galeazzi fracture-dislocation and the Galeazzi-equivalent lesion appear to be completely dissimilar in their pathological anatomy. We suggest calling the latter a "pseudo-Galeazzi injury".

Coxa magna after open reduction for developmental dislocation of the hip.

We studied coxa magna after open reduction of developmental hip dislocation, including the etiology, incidence, and influence on the long-term results and acetabular development. Forty-seven hips in 47 patients were radiographically examined for at least 10 years, and another 20 hips in 20 patients were examined arthrographically at an early stage after open reduction. At follow-up, the incidence of coxa magna, which was defined as a femoral head with a size > or = 20% greater than the opposite side, was 34.0%, and that seemed to be one of factors that worsened the long-term results. One of the most important causes of coxa magna is to overwiden the acetabular capacity by excising the limbus; another cause is the surgical invasion and synovitis of the hip joint after operation.

Hemodynamic alterations secondary to an electrical burn in the rat: a pilot study.

Rats subjected to a standard electrical burn of 250 volts for 10 seconds receive a severe injury stimulating a pronounced systemic circulatory response. Initial postinjury hyperemia is replaced by a low perfusion state within 24 hours. Our study demonstrates the difficulty in isolating regional microcirculatory alterations under such circumstances. Modification of the burn model or the method of fluid resuscitation may minimize the influence of this dynamic systemic response.

Potentiation of infection by epinephrine.

A subinfective dose of Staphylococcus aureus (6 X 10(6)) does not produce wound infection in the rat model. Reducing the dosage (concentration) of epinephrine results in decreased numbers of viable bacteria in tissue and a lower incidence of wound infection in this model.