Firecracker injuries to the hand.

Between September 1999 and April 2000, the Hand Unit at St George Hospital, Sydney, treated three young men with severe injuries caused by holding a lighted firecracker. These cases illustrate the typical injuries seen with this mechanism of injury. They highlight the dangers of these explosive devices and the potential to improve the laws relating to fireworks.

Autograft and Leeds-Keio reconstructions of the ovine anterior cruciate ligament.

This study compared the Leeds-Keio prosthesis with grafting of autogeneic patellar tendon for the reconstruction of the ovine anterior cruciate ligament under controlled conditions. Reconstructed knees from six sheep of each group were evaluated at 12, 26, and 52 weeks postreconstruction with respect to clinical assessment, gross pathology, mechanical properties, and histology. Although no difference in clinical assessment (anteroposterior draw, range of motion, and function) was noted between the prosthesis reconstruction and the autograft reconstruction, the prosthesis provided a higher strength initially, which remained relatively constant over the one-year study. However, prosthesis wear was observed, with up to 50% of Dacron fibers ruptured in some cases. Histologic sections indicated that in the ovine model, the Leeds-Keio prosthesis should be considered an artificial device and not a scaffold or stent that supports aligned collagenous growth. The autograft had low strength at 12 weeks, which increased over the study period. Despite acceptable clinical performance and adequate mechanical properties up to one year postimplantation, neither reconstruction approached the clinical or mechanical performance of the normal anterior cruciate ligament in the ovine model.

Huckstep nail arthrodesis of the knee: a salvage for infected total knee replacement.

Seventeen patients had Huckstep Nail arthrodeses of the knee as a salvage for infected total knee replacements. All patients were followed prospectively for an average of 22.6 months. All patients were satisfied with their results. There was one broken nail secondary to non-union, and three other patients with non-unions (two of whom were asymptomatic). It is believed that this is a reliable method of treatment in selected patients. It has a number of advantages over other techniques. In addition, a two-staged operative method with a number of technical improvements is outlined.

Review of coracoclavicular ligament reconstruction using Dacron graft material.

Operative management of Grade III acromioclavicular dislocations in young, active patients is a controversial issue with regard to operative management. Nine patients with complete dislocation (Allman Grade III) of the acromioclavicular joint who had undergone reconstruction of the coracoclavicular ligament with woven Dacron arterial grafts were reviewed clinically, radiologically and functionally utilizing an isokinetic dynamometer. Average follow-up was 2 years and 7 months. All results were good or excellent in terms of function, range of movement and patient acceptance. One patient developed a transient brachial plexus lesion due to compression caused by exuberant heterotopic calcification in the region of the synthetic ligament. One other exceptional patient continued to get more than occasional discomfort. It is concluded that Dacron loop repair is a relatively simple surgical technique with minimal morbidity and high efficacy in restoring stability and function in high demand patients.