Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study.

In a prospective study, 43 patients with 47 metacarpal or phalangeal fractures with significant displacement, rotation, angulation and/or instability were treated with internal fixation using AO minifragment screws and plates. In all fractures an anatomical reduction was achieved. Postoperatively all metacarpal fractures were protected by means of a plaster, in which motion was allowed, whereas all phalangeal fractures were treated by means of a soft bandage. At a review after a mean period of 28 months, 31 patients with 35 fractures out of 34 patients with 38 fractures had regained excellent recovery of total active flexion (92 per cent). Three patients had a poor recovery of total active flexion; one had an infection, the other two were operated on 6 and 14 days after their injury, whereas the mean delay between injury and operation was 3 days. All patients not reviewed had regained good or 100 per cent function.

Acute hernia of Bochdalek during pregnancy. Hyperemesis for the first time in a third pregnancy?

A rare case of a patient with right-sided diaphragmatic hernia during pregnancy is described. Knowledge of this disorder offers the possibility of early diagnosis on clinical, ultrasound, and radiographic criteria before serious complications develop. Operative correction must be performed, with timing dependent on clinical presentation and period of gestation.

Operative treatment of median cervical cysts.

Median cervical cysts are congenital anomalies arising from remaining thyroglossal duct epithelium. A major problem in the surgical treatment of these cysts is the high frequency of recurrence. Embryonic considerations indicate an important causal role for the hyoid bone in these recurrences. We studied the relationship between operative techniques and the number of recurrences in 36 patients treated in our hospital. Fourteen patients sent from other hospitals had a recurrent fistula; in thirteen cases the hyoid bone was still in place. All patients who had the central part of the hyoid bone excised were cured. In 14 patients without adequate excisions of the hyoid bone we found four recurrences. To prevent recurrence a total excision of thyroglossal duct epithelium is necessary.

The influence of preoperative jaundice, biliary drainage and age on postoperative morbidity and mortality after pancreatoduodenectomy and total pancreatectomy.

Details are given of the postoperative course of 56 patients after pancreatoduodenectomy, and 11 after total pancreatectomy. The main indication was adenocarcinoma (56 cases). The most serious complication was leakage from the pancreatojejunostomy, which occurred in nine patients and was fatal in seven of these (10%). This was the only cause of death in the group. The observed mortality was appreciably higher (38%) in the 13 patients aged over 70 years. Contrary to recent reports, jaundice was not found to influence postoperative mortality adversely, nor was preoperative biliary drainage found to reduce mortality.

The use of a straight tube graft decreases blood loss and operation time in patients with an abdominal aortic aneurysm.

A retrospective study was carried out on 386 consecutive patients admitted during the period 1975 to 1981 with an abdominal aortic aneurysm; 110 patients (39%) were treated by means of a straight tube graft instead of the more commonly employed bifurcation prosthesis. Its use reduced the operation time by 26 to 31% (p less than 0.001) in both non-ruptured and ruptured aneurysms. Operative blood loss was significantly reduced in ruptured aneurysms only (29%, p less than 0.05). Secondary operations for iliac aneurysm repair were not required in any patient with a straight tube graft during the follow-up period (6 to 60 months). Our experience suggests that, in the absence of significant iliac artery disease, the use of a straight tube graft is the procedure of choice in the treatment of an abdominal aortic aneurysm.