ABSTRACT
A treatment plan for pyogenic arthritis has been devised in which the accessory collateral ligaments are resected through radial and ulnar midaxial incisions. The surgical wound is debrided and copiously irrigated with an antibiotic solution, and intravenous antibiotics are instituted before operation and continued after operation. Physical therapy is begun within 24 hours of surgery and includes active range of motion (ROM) of all joints, dynamic splinting, and hand therapy to ensure both full flexion and extension. Forty patients were treated with this method within a 6-year period. Of five interphalangeal (IP) joints of the thumb, four regained 0 degree to 60 degrees full ROM and one gained 15 degrees to 65 degrees limited ROM. Of the two distal IP joints, one regained full ROM and the other became fused. Among the 33 proximal IP joints, 13 regained full ROM of 110 degrees and 13 regained limited ROM. Good functional results were obtained with this treatment plan in lieu of amputation, which previously was the most likely treatment.
Subject(s)
Arthritis, Infectious/therapy , Finger Joint/surgery , Ligaments, Articular/surgery , Staphylococcal Infections/therapy , Streptococcal Infections/therapy , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Child, Preschool , Debridement , Enterococcus faecalis , Female , Humans , Intraoperative Care , Male , Middle Aged , Physical Therapy Modalities , Splints , Streptococcus pyogenes , Therapeutic IrrigationABSTRACT
A novel technique from the British is described for maintaining the first knot in instrument tying. Other techniques or tricks often used frequently fail. With a little practice, the second knot is no longer a problem.
