Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Surgical techniques and a review of 70 patients.

We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 11 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability. Pinch grip strength was normal in 48. About one-third of the patients had some loss of flexion/extension; this was seldom noticed by the patients and caused no significant disability. Free tendon graft reconstruction is indicated for severe fresh lesions, for old lesions with chronic disability and for lesions which have not responded to conservative management.

Reproducibility of flow cytometric assessment of follicular tumours of the thyroid.

The reproducibility of the DNA index of paraffin wax sections from 44 follicular tumours of the thyroid (18 follicular adenomas and 26 follicular carcinomas), which had been assessed by flow cytometry was analysed in two laboratories, using consecutive sections of the same specimens and two different commercially available flow cytometers. Two slightly different cell preparation and staining techniques were used in the two laboratories. Using strictly defined criteria the histograms were classified blind as diploid, peritetraploid, aneuploid, or inadequate and insufficient by two independent investigators. Both the concordance between the two different flow cytometers and the agreement of duplicate assessments within the same flow cytometers were assessed. The mean coefficient of variation of the G0/G1 peak of the diploid tumours in the PARTEC flow cytometer was 5.5 (range 2.3-9.8) and in the FACS flow cytometer 5.2 (range 3.7-8.3); this difference was not significant. There was concordance of classification between the two laboratories in 35 of 36 cases. In 25 cases (18 diploid, seven aneuploid) the intralaboratory variation showed a 100% concordance in histogram classification. It is concluded that flow cytometer DNA index assessment of follicular tumours of the thyroid is reproducible and can be used to evaluate the discriminating and prognostic value of this feature.

Early functional treatment of supination-eversion stage-II ankle fractures: preliminary results.

The preliminary results of early functional treatment of 30 patients with a grade-II supination-eversion fracture of the ankle according to Lauge-Hansen are discussed. The treatment of all patients consisted of splint immobilization for one week, followed by the application of a functional brace (Push Brace Medium) and immediate full weight bearing and functional training. All fractures healed without complications. Ankle function, radiographic findings and anamnestic complaints were monitored. The loss of ankle function diminished to 3.2 degrees +/- 4.9 degrees plantar flexion and to 1.7 degrees +/- 5.3 degrees dorsal flexion after one year follow up, none of the patients had significant complaints of pain or swelling. Radiography showed consolidation with callus formation in all cases. The grade-II supination-eversion fracture is a stable fracture which allows early functional treatment with the support of a Push Brace Medium. This results in an inexpensive, simple and comfortable therapy. A prospective randomized clinical trial is necessary to show the advantages of functional treatment over cast immobilization. Long-term follow-up will have to ascertain the theoretic risk of posttraumatic osteo-arthritis.