Positioning techniques for the augmented breast.

Mammography of the augmented breast can be difficult due to problems associated with the presence of an implant. Modified positioning techniques can greatly increase the amount of breast tissue visualized and improve image detail.

Algorithms for the segmental motor innervation of the extremities.

The pattern of the segmental motor innervation to the extremities is reflected in the kinematics of their joint linkages. More proximally located joints have more complex movements and are controlled by more spinal cord levels than more distal joints with simpler movements. More proximally located joints are also controlled by more cranially located groups of spinal cord levels while more distal ones are innervated by more caudally located groups. Algorithms are presented that summarize these principles in the form of two simple, concise charts and a stick figure. The cord levels given by the algorithms for the innervation of any particular muscle are in good general agreement with recognized authorities. In addition, these algorithms are easily learned and readily applied to clinical problems by placing the patient in the position assumed when playing the piano or operating an automobile. In this posture, the most cranial two spinal cord levels of a group controlling a joint are responsible for "upward" motion of that joint and the most caudal two or three control "downward" motion thereof.

Scapulectomy for the treatment of malignant tumors of the scapula.

Two cases of Tikhor-Linberg resection for rhabdomyosarcoma and malignant chondromyxoid fibroma and two cases of scapulectomy for metastatic disease of the shoulder girdle are reviewed. After resection of the scapula, active motion of the shoulder will be severely restricted, but normal function of elbow, wrist, and hand permit use of the extremity in many activities of daily living. Surgical treatment for metastatic bone disease in the upper extremity and the role of radiation therapy for metastatic bone disease are discussed.

The Jones fracture revisited.

Twenty-two patients with twenty-three fractures of the proximal part of the diaphysis of the fifth metatarsal, an injury originally described by Jones, are reported. The average follow-up was 3.5 years. Delayed union occurred in twelve (66.7 per cent) of eighteen patients treated conservatively. Four patients were operated on within two weeks of injury. The clinical picture in nine of the twenty-two patients suggested that the injury was a stress fracture. Force-platform analysis in eleven cases confirmed that the injury results from vertical and mediolateral forces concentrated over the fifth metatarsal and that it is not caused by inversion. Thirteen of the twenty-three fractures were in young athletes, often occurring during training and causing significant disability. In this group of patients, and in a select number of recreational athletes and non-athletes with delayed union, intramedullary screw fixation of the fracture is advised.

Malignant chondromyxoid fibroma of the scapula.

A rare case of malignant chondromyxoid fibroma developed in the scapula of a woman who was treated with interscapulothoracic resection. When a biopsy specimen was submitted for study, difficulty was encountered in establishing the histologic diagnosis. A large dose of radiation was given before surgery, based on an original biopsy diagnosis of osteosarcoma; in retrospect, preoperative irradiation probably was contraindicated. Two years and four months after surgery, the patient was working with no evidence of recurrence or metastasis.

Results of posterior iliopsoas transfer for hip instability caused by cerebral palsy.

The incidence of subluxation or dislocation of the hip in 185 cerebral palsied patients was 25.4%. Posterior iliopsoas transfer will decrease hip deformities but complications such as weakness of hip flexion or abduction contracture are to be expected in some cases. Posterior iliopsoas transfer did not give uniformly satisfactory results; 9 out of 17 patients were fair to poor even combined with innominate osteotomy and/or versus derotation osteotomy of the femur. Early prophylactic surgery of lesser extent such as adductor release is desirable since treatment of established subluxation or dislocation is often unsatisfactory.

Thrombocytopenia and its management in the surgical patient needing multiple reconstructive procedures.

Thrombocytopenic patients with surgically correctable lesions such as radial clubhands are too often repeatedly transfused with randomly pooled platelets. This is followed by a clinical rejection of the foreign protein and rapid destruction of the platelets. There may be excessive bleeding episodes. Tissue typing technics now available can provide antigenically compatible platelet concentrates which elicit few of these reactions. Therefore, multiple reconstructive procedures can be achieved with a greater safety margin than previously possible.

Pyogenic arthritis of the sacro-iliac joint. Long-term follow-up.

Nine cases of sacro-iliac pyarthrosis are presented. The difficulty in localizing the infection is attributable mostly to failure to appreciate the posteriorly situated physical findings. This, and the difficulty with early roentgenographic demonstration of the lesion, may lead to unnecessary abdominal exploration (as in two of our patients) or to prolonged delay in diagnosis and hence spread of the infection. Awareness of the usual physical findings and prompt use of radioisotope scanning to localize the infection led to earlier diagnosis and avoidance of surgery in three patients seen recently. Antibiotic therapy, with or without surgery, led to cure in all patients, with minimum sequelae.

Post-traumatic osteolysis of the distal clavicle.

Five cases of painful bone resorption from the distal clavicle following shoulder trauma are reported to demonstrate that the lesion is generally benign. Surgical excision is curative. The multiplicity of circumstances leading to clavicular osteolysis suggest that the balance between bone accretion and resorption is precarious in this region of the skeleton.