Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger.

UNLABELLED: We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19-43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes-Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16-2 g) and 0.51 g (range: 0.16-1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3-8 mm) and 4.3 mm (range: 3-7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Simple calcaneal bone cysts: a pilot study comparing open versus endoscopic curettage and grafting.

This pilot study analysed the outcome of open versus endoscopic curettage and bone grafting for the treatment of simple calcaneal bone cysts. A total of 26 patients were evaluated into two equal groups: group 1 was treated with traditional open curettage and bone grafting and group 2 was treated with endoscopic curettage and percutaneous bone grafting. Cyst size, operating time, length of stay, time to healing, complications, further surgery and radiological healing were recorded and differences were statistically compared. The mean age of the patients was 22.9 years (18 to 28) and the mean follow-up was 28.7 months (24 to 36). There were no statistically significant differences in regard to age of patients, cyst size and the follow-up periods in the two groups. The operating time and mean length of stay of group 2 patients was significantly shorter than group 1 patients (p < 0.001). The time to healing was similar in the two groups. The overall success rates for groups 1 and 2 were 92.3% (12 of 13) and 100% (13 of 13), respectively, and there were no statistically significant differences regarding radiological healing. This pilot study suggests that endoscopic curettage and percutaneous grafting is a simple and safe form of treatment, with similar results to those following open treatment.

Does rofecoxib increase TNF-alpha levels?

OBJECTIVE: Rofecoxib (Vioxx), the first COX-2 selective non-steroidal anti-inflammatory drug (NSAID), was recently withdrawn from the market due to the increased risk of acute myocardial infarction. The precise mechanism responsible for this phenomenon still remains unknown. Tumor necrosis factor alpha (TNF-alpha) is a cytokine, possibly most responsible for mortality in patients with acute myocardial infarction. However, this study was designed to study possible effects of rofecoxib on the level of TNF-alpha by using MSU crystal induced inflammation in the rat subcutaneous air pouch model. METHODS: Rat subcutaneous air pouches were produced and examinations commenced 6 days later. Control groups received only MSU crystals, or no crystals or drugs. To begin with, rofecoxib (30 mg/kg), indomethacin (20 mg/kg) or diclofenac (3 mg/kg) were administered to groups of 5 rats each. Thirty minutes later, MSU crystals were injected into air pouches, except for the negative control group. Twenty-four hours later, the rats were sacrificed for aspiration of fluid and for the dissection of pouch walls to determine leukocyte counts, pouch wall histology, and to assay IL-10 and TNF-alpha. RESULTS: Intra-pouch injection of MSU crystals, compared to non-injected pouches, caused an increase in white blood cell count (WBC) (30 +/- 44.7 versus 4508 +/- 792.3 cells/mm3), in the numbers of pouch wall vessels (vascular index) (4.8 +/- 0.3 versus 11.4 +/- 1.5 vessels/high-power field) and in TNF-alpha (50.0 +/- 13.4 versus 70.34 +/- 20.9 ng/mL), but not in interleukin-10 (IL-10) (60.6 +/- 63.0versus 61.48 +/- 7.1). WBC and vascular index were significantly reduced in all study groups compared to the control group (p < 0.05). Levels of TNF- in fluids were unexpectedly and significantly (p < 0.05) increased in all cases. The highest level of TNF-alpha was found in the rofecoxib group. In contrast to TNF-alpha, IL-10 levels were significantly (p < 0.05) decreased in all three drug groups. Indomethacin tended to suppress inflammation more effectively. However, there was no significant difference between the groups for IL-10 (p > 0.05). CONCLUSION: All three NSAIDs exhibited anti-inflammatory activity against MSU crystal induced inflammation. The difference in anti-inflammatory effects of these three non-steroidal drugs is seen not only in the anti-inflammatory effect on MSU induced inflammation but also in the nature of the effects. Refocoxib tended to increase the TNF-alpha level. Whether increased TNF-alpha levels can help explain the side effect of COX-2 specific inhibitors still requires further studies.

Treatment of fractures of the humeral capitellum using herbert screws.

Isolated fractures of the capitellum are rare injuries and account for 1% of all elbow injuries. The purpose of this study is to evaluate the clinical outcomes of 11 Type I capitellum fractures treated by open reduction and internal fixation using at least two standard Herbert screws between 1998 and 2003. The average age of the patients was 27.5 years. The mean follow-up time was 23.4 months. The final postoperative assessment was made at the 12th month. The results were evaluated according to the Mayo Elbow Performance Index. We obtained excellent result in eight patients and good result in three patients. We recommend open reduction and fixation with Herbert screws inserted from the posterior surface of the lateral epicondyle and early mobilization in Type I fractures of the capitellum.

Tension band wiring of unstable transverse fractures of the proximal and middle phalanges of the hand.

Twenty-three isolated, unstable and closed transverse middle and proximal phalangeal shaft fractures in 23 patients were treated by tension band wiring. The tension band was applied with two transverse Kirschner wires that did not cross the fracture line. All of the fractures united and achieved satisfactory functional outcomes. No patient required either physiotherapy or tenolysis or capsulotomy surgery.

Late-term reconstruction of lateral ankle ligaments using a split peroneus brevis tendon graft (Colville's technique) in patients with chronic lateral instability of the ankle.

We reviewed 14 patients with chronic lateral instability of the ankle treated by Colville's technique between 1996 and 2001. The mean patient age was 25 (20-35) years and all were men. The mean period between injury and surgery was 25 (18-32) months, and the mean follow-up was 20 (14-32) months. Twelve of the results were excellent and two were good according to the criteria of Chrisman and Snook. All patients returned to normal daily activity levels at an average of 6 months following surgery.

Effects of stem design and pre-cooling prostheses on the heat generated by bone cement in an in vitro model.

The necrotizing effects of the heat, particularly at more than 50 degrees C, produced by the exothermic polymerization process associated with the acrylic implant cement polymethylmethacrylate (PMMA) are well documented. The temperature changes that occur are dependent on the thickness of the PMMA. The current study investigates the hypothesis that the heat produced by the bone cement may be reduced by the choice of stem design and by pre-cooling the hip prosthesis. The thermal alterations at the bone-cement interface were measured in an in vitro model. The results indicated that a temperature decrease of approximately 7 degrees C could be achieved by pre-cooling the prosthesis, and by changing the shape of the prosthesis stem from flat and wide to round.

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury.

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.