ABSTRACT
Herpetic whitlow can be a vector for spread of infection, especially among health care professionals. Until now, treatment has been inadequate. In two patients with documented herpetic infections of the finger, the antiviral drug idoxuridine was applied to the lesions by cathodal iontophoresis. Results were characterized by rapid relief of discomfort and swelling, rapid appearance and coalescence of vesicles, and rapid healing, with reduced pain and little or no paresthesia. No recurrences have been noted in the two patients after 42 and 38 months. The positive beneficial results indicate that aggressive iontophoretic treatment for herpetic whitlow is useful and justified.
Subject(s)
Dermatitis, Occupational/drug therapy , Herpes Simplex/drug therapy , Idoxuridine/administration & dosage , Iontophoresis , Paronychia/drug therapy , Adult , Biochemical Phenomena , Biochemistry , Dentists , Fingers , Humans , Male , Paronychia/etiology , Paronychia/pathologyABSTRACT
Forty-nine patients (52 knees) with untreated anterior cruciate ligament (ACL) ruptures were evaluated an average of 14 years after injury. The results were compared with those of a ten-year follow-up study on the same patients. Eighty-six percent of the knees had one or both menisci removed. There had been little change in symptoms, except that the incidence of giving way had decreased. The incidence of anterior laxity and rotary instability continued to be high. Seventy-five percent of the patients continued to participate in strenuous sports. The incidence of degenerative changes on roentgenograms had increased, with one-third of the knees demonstrating joint space narrowing or unequivocal evidence of osteoarthritis. Development of degenerative changes was associated with varus deformity, meniscectomy, and relatively heavy body weight.
Subject(s)
Knee Injuries/therapy , Ligaments, Articular/injuries , Adolescent , Adult , Aged , Arthroscopy , Female , Follow-Up Studies , Humans , Knee Injuries/diagnosis , Knee Injuries/diagnostic imaging , Knee Joint/diagnostic imaging , Male , Middle Aged , RadiographyABSTRACT
Fifty patients (fifty-three knees) with surgically verified ruptures of the anterior cruciate ligament were evaluated at an average of ten years after injury. There was a high incidence of anterior laxity, rotatory instability, and meniscal tears at follow-up. The roentgenographic incidence of osteoarthritis at follow-up was low. Patients who had regained normal thigh circumference had better results than those with thigh atrophy. Although few of the patients felt that the knee was completely normal, 72 per cent of the patients returned to strenuous sports and 47 per cent felt that they had no restrictions because of the knee. This study of untreated ruptures may provide a baseline for evaluation of procedures to repair or reconstruct the anterior cruciate ligament.
Subject(s)
Knee Injuries/physiopathology , Ligaments, Articular/injuries , Adolescent , Adult , Athletic Injuries/physiopathology , Atrophy , Child , Female , Follow-Up Studies , Humans , Hypertrophy , Knee Injuries/complications , Knee Injuries/surgery , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis/etiology , Rupture , Sports , Thigh/pathologyABSTRACT
Fifty-one trimalleolar ankle fractures in 50 patients were evaluated subjectively, objectively, and roentgenographically at an average of 42 months following injury. Anatomic reduction of the posterior marginal fragment was achieved in 6 of 7 ankles treated by open reduction and internal fixation of the fragment. Anatomic reduction of the posterior marginal fragment was achieved in three of 44 ankles treated by closed reduction and in none of the eight with large fragments. End results rated as fair or poor occurred more frequently among those patients with large posterior lip fragments and those with residual subluxation of the talus. The incidence of moderate or marked post-traumatic arthritis was greatly increased in those patients with residual subluxation of the talus. Post-traumatic arthritis was present in 11 of 12 patients with moderate or severe pain and in 11 of 17 with moderate or marked restriction of motion. Failure to reduce a posterior lip fracture involving less than 25 per cent of the tibial articular surface did not affect the overall end result significantly. In ankles with a posterior marginal fragment involving 25 per cent or more of the articular surface, open treatment was associated with better subjective, objective, and roentgenographic end results than closed treatment.
Subject(s)
Ankle Injuries , Fractures, Bone/therapy , Adult , Aged , Ankle/diagnostic imaging , Female , Follow-Up Studies , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Male , Middle Aged , Postoperative Complications , RadiographyABSTRACT
Isolated partial tear of the anterior cruciate ligament should be suspected in the patient with effusion, flexion contracture and poorly localized pain and tenderness following a knee injury. The diagnosis is difficult to make from physical findings or even arthrography. Arthroscopy is helpful in making the diagnosis and in ruling out associated meniscus lesions. A normal meniscus should not be removed if this seemingly trivial lesion is the only abnormal finding at arthrotomy. Surgical treatment is not necessary if the diagnosis can be made by other means. This injury responds well to immobilization in extension followed by rehabilitation.
