ABSTRACT
In our unit a high failure rate of the RM finger prosthesis joint replacement system was noted, prompting a review of cases. A series of patients underwent implantation under the care of one surgeon and the results were monitored. Twenty-one devices were implanted of which 16 were inserted for rheumatoid disease. Patients were reviewed regularly and the implant performance was assessed critically along with survival of the implant to revision, infection or death of the patient. The mean follow-up was 32 months. Unacceptable failure rates at early and medium term stages were identified, with 15 of the implants revised by 2 years. Loosening was the commonest mode of failure. The authors do not recommend the use of this implant, especially in cases of rheumatoid arthritis.
Subject(s)
Arthritis, Rheumatoid/surgery , Arthroplasty, Replacement/instrumentation , Finger Joint/surgery , Joint Prosthesis , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis Failure , ReoperationABSTRACT
Over 10 years in our unit, 127 patients underwent surgical repair of an acute thumb ulnar collateral ligament (UCL) rupture for clinically unstable injuries or displaced avulsion fractures. Ultrasound was used when clinical diagnosis was uncertain. The male/female ratio was 3:2, with a mean age of 40 years (range: 12-81 years). Most of them (> or =66%) were hyper-extension/abduction injuries. The most common cause was a fall (49%), followed by sports injuries; skiing accounted for only 2.4%. Ultrasound was 92% sensitive for UCL ruptures (positive predictive value (PPV) 99%). Over 99% of patients had a UCL rupture confirmed at surgery. Other findings included avulsion fractures (21%), dorsal capsular tears (57%) and dorsal capsule infolding (29%). The most common surgical complication was neurapraxia (6.5%). In our population, thumb UCL injuries are rarely caused by skiing. Ultrasound is a useful, sensitive adjunct in acute diagnosis. Dorsal capsular tears and joint interposition are common. Surgery provides excellent results with few long-term complications.
Subject(s)
Athletic Injuries/surgery , Collateral Ligaments/injuries , Hand Injuries/surgery , Metacarpophalangeal Joint/injuries , Thumb/injuries , Accidental Falls/statistics & numerical data , Adult , Aged , Aged, 80 and over , Athletic Injuries/diagnostic imaging , Athletic Injuries/epidemiology , Child , Collateral Ligaments/diagnostic imaging , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Fractures, Bone/surgery , Hand Injuries/diagnostic imaging , Hand Injuries/rehabilitation , Humans , Male , Metacarpophalangeal Joint/diagnostic imaging , Metacarpophalangeal Joint/surgery , Middle Aged , Retrospective Studies , Rupture/diagnostic imaging , Rupture/therapy , Sensitivity and Specificity , Thumb/diagnostic imaging , Thumb/surgery , Treatment Outcome , Ulna , Ultrasonography , Young AdultABSTRACT
Pectoralis major rupture is a well-recognised but uncommon injury that rarely leads to complications. We present an unusual case where the resultant haematoma following a partial rupture became infected and caused problems with diagnosis. We are only aware of one previous report of this.
Subject(s)
Abscess/surgery , Hematoma/surgery , Pectoralis Muscles/injuries , Abscess/diagnosis , Adolescent , Diagnosis, Differential , Hematoma/diagnosis , Humans , Magnetic Resonance Imaging , Male , Pectoralis Muscles/pathology , Pectoralis Muscles/surgery , RuptureABSTRACT
Rapidly progressive cases of primary idiopathic hip osteoarthrosis are well known and recognized. Their prevalence and significance are, however, often poorly appreciated. This article aims to assess the prevalence of the condition in a United Kingdom district general hospital. Several points arise: 1) Patients suffering rapid deterioration do not always alert their surgeon to the worsening symptoms; 2) Waiting lists need regular administration and the patients regular review while on such lists; 3) Decisions about surgery and case selection should be made purely on clinical grounds with financial, political, and administrative considerations accorded little or no relevance.
Subject(s)
Osteoarthritis, Hip/diagnostic imaging , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/statistics & numerical data , Cross-Sectional Studies , Equipment Failure Analysis , Female , Follow-Up Studies , Health Services Accessibility/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Osteoarthritis, Hip/epidemiology , Osteoarthritis, Hip/surgery , Radiography , Reoperation , Retrospective Studies , United Kingdom/epidemiology , Waiting ListsABSTRACT
Recurrent dislocation of the patella is a disorder with a complex aetiology. Several surgical procedures have been recommended for its correction, but there are few clinical or radiological guidelines to facilitate the selection of a particular procedure. The results of treating a series of 29 knees are presented with a follow-up of at least 2 years. A significant correlation has been found between the horizontal movement of the centre of the patella on quadriceps contraction (quadriceps pull test) and surgical outcome when lateral release alone is selected for the correction of recurrent patellar dislocation.
Subject(s)
Joint Dislocations/surgery , Muscle Contraction/physiology , Muscle, Skeletal/physiology , Patella/injuries , Adolescent , Adult , Female , Follow-Up Studies , Humans , Joint Dislocations/physiopathology , Knee Injuries/physiopathology , Knee Injuries/surgery , Male , Recurrence , Time Factors , Treatment OutcomeABSTRACT
We present a case of a Galeazzi-type of fracture dislocation with an irreducible distal radioulnar joint. This is illustrated by intraoperative pictures which may assist others who find themselves faced with this injury.
Subject(s)
Fracture Fixation, Internal , Fractures, Comminuted/surgery , Radius Fractures/surgery , Ulna Fractures/surgery , Adult , Fractures, Comminuted/diagnostic imaging , Humans , Male , Radiography , Radius Fractures/diagnostic imaging , Ulna Fractures/diagnostic imagingABSTRACT
Strips of tissue from knuckle pads contract in response to the myofibroblast stimulant mepyramine in a reversible, repeatable and dose-dependent manner. The significance of this finding is discussed.
Subject(s)
Dupuytren Contracture/physiopathology , Finger Joint/physiopathology , Muscle Contraction/physiology , Adult , Biomechanical Phenomena , Dupuytren Contracture/surgery , Female , Finger Joint/surgery , Humans , Male , Middle AgedABSTRACT
This prospective trial collected all cases where injuries had resulted from the hand passing through or striking glass and had been referred to a hand injury service during 1 year. Eighty-seven cases were referred and the factors relating to these injuries were examined. A record was made of the structures damaged, the surgery performed and prevailing socioeconomic factors. These injuries were very costly in terms of morbidity, surgical effort and time, with significant resource implications. The study appears to confirm other reports that current legislation on glazing safety was too long delayed and is inadequate now that it is in place.
Subject(s)
Glass , Hand Injuries/surgery , Wounds, Penetrating/surgery , Adolescent , Adult , Aged , Building Codes/legislation & jurisprudence , Child , Female , Hand Injuries/classification , Hand Injuries/prevention & control , Humans , Male , Middle Aged , Safety/legislation & jurisprudence , Wounds, Penetrating/classification , Wounds, Penetrating/prevention & controlABSTRACT
We studied the medium- to long-term results of steroid injection into the carpal tunnel of women with the carpal tunnel syndrome (CTS). Of 45 hands, only 11 had lasting relief of symptoms and 22 had no relief whatsoever. There was no correlation of the typical signs and symptoms of CTS with outcome. Other series have offered various predictive factors for the outcome of injection but we found little or no correlation between these factors and outcome.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Carpal Tunnel Syndrome/drug therapy , Hydrocortisone/therapeutic use , Adult , Aged , Aged, 80 and over , Anesthetics, Local/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Female , Follow-Up Studies , Forecasting , Humans , Hydrocortisone/administration & dosage , Injections, Intra-Articular , Lidocaine/administration & dosage , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
We present an unusual case of carpal dislocation which to our knowledge has not previously been described in any of the current classifications of such injuries. Despite the extensive damage sustained, the case was managed without difficulty and outcome has been very satisfactory.
Subject(s)
Carpal Bones/injuries , Fractures, Bone/physiopathology , Joint Dislocations/physiopathology , Wrist Joint/physiopathology , Carpal Bones/diagnostic imaging , Fracture Fixation/methods , Fracture Fixation/rehabilitation , Fracture Healing , Fractures, Bone/diagnostic imaging , Fractures, Bone/therapy , Humans , Joint Dislocations/diagnosis , Joint Dislocations/therapy , Male , Middle Aged , Radiography , Range of Motion, Articular , Wrist Injuries/diagnostic imaging , Wrist Injuries/physiopathology , Wrist Injuries/therapy , Wrist Joint/diagnostic imagingABSTRACT
Two cases of loss of function of the flexor pollicis longus tendon are presented. Initial assumptions that these were cases of primary tendon rupture proved to be wrong when unexpected intraoperative findings suggestive of previous long standing tendon rupture were later matched with a history of previous trauma. Spontaneous subcutaneous rupture is rare in otherwise healthy tendons.
Subject(s)
Finger Injuries/diagnosis , Tendon Injuries/diagnosis , Adolescent , Adult , Casts, Surgical , Diagnosis, Differential , Finger Injuries/complications , Finger Injuries/therapy , Humans , Intraoperative Period , Male , Rupture , Rupture, Spontaneous , Tendon Injuries/complications , Tendon Injuries/therapy , Tendons/transplantation , Thumb/injuries , Thumb/surgery , Time FactorsABSTRACT
This retrospective study looks at the severe head injury patients admitted to one unit in a year. Within this group, those with significant gastrointestinal bleeding were further studied to assess medical prophylaxis against this complication. A preliminary attempt is made to gauge whether such medication is appropriate, particularly with reference to H-2 antagonists. No firm conclusions can be drawn, but sufficient doubt remains to justify a prospective trial which is planned.
Subject(s)
Craniocerebral Trauma/complications , Gastrointestinal Hemorrhage/prevention & control , Histamine H2 Antagonists/therapeutic use , Adolescent , Adult , Aged , Dexamethasone/therapeutic use , Drug Therapy, Combination , Female , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/etiology , Humans , Intensive Care Units , Male , Medical Audit , Middle Aged , Retrospective StudiesABSTRACT
It is often said that casualty officers are unable to assess burns accurately. This prospective study examines this, proving the point and offering basic suggestions for improvements.
Subject(s)
Burns/pathology , Emergency Medicine , Triage/methods , Child, Preschool , Clinical Competence , Female , Hospital Units , Humans , Injury Severity Score , Male , Prospective StudiesABSTRACT
A case of rupture of the flexor carpi radialis tendon in association with scapho-trapezial osteoarthritis is reported. The symptoms of pain and swelling contrast with the loss of function which characterizes rupture of other tendons in the hand and wrist.
Subject(s)
Osteoarthritis/complications , Tendons/pathology , Wrist , Carpal Bones/diagnostic imaging , Humans , Male , Middle Aged , Osteoarthritis/diagnostic imaging , Radiography , Rupture, SpontaneousABSTRACT
Dermal eccrine cylindroma, or turban tumour, is a rare benign tumour of the eccrine sweat glands. Despite its histologically benign behaviour, the disease process is distressing for the patients. We present our experience of this condition, with a review of the literature, and recommend a treatment protocol for the disease.