Effects of intra-articular distal radius depression on wrist joint contact characteristics.

Twelve cadaver extremities were used to study the effect of scaphoid and lunate facet depressions on the contact characteristics of the radiocarpal joint. Pressure-sensitive film was inserted into radiocarpal joints with varying degrees of depression, and the specimens were loaded statically in neutral position, radial deviation, and ulnar deviation. The film was removed and analyzed for contact area and pressure. The only statistically significant effect of a lunate fossa depression was an increase in scaphoid fossa pressure with a 3-mm step-off and the hand in neutral position. Scaphoid fossa depression had more significant effects. With a 1-mm scaphoid fossa depression, lunate fossa pressures increased in neutral position and in radial deviation. Lunate fossa contact area increased, compared to intact joints, in ulnar and radial deviation with 1-mm scaphoid fossa depressions and in all loading positions with 3-mm scaphoid fossa depression. Therefore, it appears that the most significant effect on radiocarpal joint contact characteristics occurs with a depression of the scaphoid side of the joint. Even with depressions as small as 1 mm, significant changes on the lunate side of the joint were observed.

A biomechanical comparison of techniques of flexor tendon repair.

Achieving satisfactory digital motion after suturing severed flexor tendons remains a challenge. Although a suture technique proposed by Savage is stronger in vitro than a true Kessler repair, the Savage technique has not been previously tested in vivo. We repaired 96 severed canine tendons using either of two modifications of the Kessler technique or the Savage technique. The tensile strength of these repairs were compared at 0, 1, 3, and 6 weeks after suturing. The Savage technique provided a significantly stronger repair than the "suture locking" method in vitro and at 1 and 3 weeks after repair. We found no significant differences between the tensile strengths of the Kessler-Tajima and suture-locking methods at any time.

Late repair of coarctation of the descending thoracic aorta in 190 patients. Results up to 30 years after operation.

Over a 30-year period, 190 consecutive patients had repair of coarctation of the descending thoracic aorta at a mean age of 25 years (range, 1 to 60 years); 130 were male. Median preoperative blood pressure (BP) was as follows: systolic, 160 mm Hg (range, 94 to 300 mm Hg) and diastolic, 90 mm Hg (range, 50 to 160 mm Hg). Dacron grafts were used in 64.7% of patients. Follow-up was obtained at a mean interval of 84.9 months, range, one to 360 months. Survival status was established for 86.1% (163/190) of patients. Postoperatively, the median BP was 133 mm Hg systolic (range, 90 to 195 mm Hg) and 80 mm Hg diastolic (range, 50 to 120 mm Hg). Overall, 80% of patients were either normotensive or had mild hypertension after operation. The best BP response and late survival were in patients operated on under 13 years of age. This study further confirms that early operation (below 5 years of age) is desirable. However, contrary to some previous reports, patients operated on as adolescents, despite some mild residual hypertension, had an excellent long-term prognosis. Patients over 21 years of age at operation had a high rate of persistent hypertension and experienced other serious cardiovascular complications.

Morbidity associated with extraoral open reduction of mandibular fractures.

One hundred consecutive extraoral open reductions of mandibular fractures were analyzed in an attempt to quantitate the morbidity of this technique and demonstrate possible predisposing factors. A complication rate of 13% was found in this series. Age of the patient, coexisting systemic disease, operative delay and operative and postoperative misadventures could not be correlated with morbidity. An obvious relationship was found between the area of the fracture and the presence and disposition of teeth in the fracture line, and the incidence of complications. Open reductions of the mandibular angle associated with teeth removed from the fracture line produced the greatest incidence of complications both quantitatively and qualitatively.

Morbidity associated with teeth in the line of mandibular fractures.

Complications related to teeth in the lines of mandibular fractures were studied in a retrospective review of 207 fractures; 32.3% resulted in some form of morbidity. Statiistical comparison of fractures in which teeth were removed and fractures in which teeth retained suggests that removal of teeth in fracture lines does not minimize morbidity.

Acute frontal sinusitis as a late complication after midfacial trauma.

The anatomical relationships of the frontal and nasoethmoid region are reviewed, with particular emphasis on the nasofrontal drainage system. A case report is presented in which obstruction of the nasofrontal duct created a delayed frontal sinusitis in a patient with severe midfacial trauma. A brief review of the different conditions that can appear as periorbital inflammation in the posttraumatic period is given, followed by a brief discussion of the various therapeutic alternatives available to the surgeon when presented with this situation.