Late presentation of triceps rupture. A case report and review of the literature.

Rupture of the triceps tendon is a rare injury. The treatment protocol for acute injuries is well described and predictably successful. However, if the diagnosis is missed, the surgeon is presented with a more difficult management problem. We report the case of a 19-year-old woman who presented 8 months following a triceps tendon rupture. The diagnosis and technique for repair and postoperative rehabilitation are described. A review of the literature is also presented. Although our patient regained excellent motion and function, we feel the injury is best managed by avoiding misdiagnosis via a high index of suspicion and a careful examination at the time of injury.

The effects of anabolic steroids on rat tendon. An ultrastructural, biomechanical, and biochemical analysis.

Forty-eight male rats were randomly separated into four groups: a control group, a group treated with anabolic steroids, a group treated with daily exercise, and a group treated with both steroids and exercise. At 6 weeks, biomechanical, ultrastructural, and biochemical testing was performed on the Achilles tendons of half of the rats in each group. The remaining rats continued in the experimental protocol, but steroid administration was discontinued. Similar testing was then performed on the remaining rats at 12 weeks. Testing showed anabolic steroids produced a stiffer tendon that absorbs less energy and fails with less elongation; tendon strength was unaffected. Effects were entirely reversible on discontinuation of the steroids. Light microscopic analysis revealed no changes in the appearance of the fibrils. No change in fibril diameter or shape was noted on electron microscopic analysis. Biochemical testing revealed no change in qualitative immunofluorescence staining with Type III collagen or fibronectin. Abuse of anabolic steroids is a widespread problem among competitive athletes; consequently, complications after their use are seen with increasing frequency. Knowledge of the effects of these drugs on tendon and the musculotendinous unit may prove helpful in counseling athletes who use anabolic steroids.

Reflex sympathetic dystrophy. A review of the literature and a long-term outcome study.

According to the literature, approximately half of all patients diagnosed with reflex sympathetic dystrophy respond to nonoperative treatment. Because no long-term studies exist, however, the relapse rate and outcome of this condition are not known. In this paper, a historical review and a brief discussion of the theories of pathogenesis of the disease are presented. The results of treatment, as documented in the literature, are also presented. This paper also reports on 10 patients with reflex sympathetic dystrophy who were treated nonoperatively and for whom a follow-up of at least 1 year was documented. The patient population and short-term results are consistent with those found in the literature. Nine of the 10 patients were contacted for long-term follow-up at an average of more than 5 years after diagnosis. A significant number of patients experienced worsening of symptoms (56%) and reported that their condition negatively affected their activities of daily living (78%). Of those who were employed prior to diagnosis, 67% reported a job change or unemployment directly related to the disease. Therefore, the long-term results of nonoperative treatment are not as encouraging as is indicated in the literature.

The treatment of olecranon fractures by excision or fragments and repair of the extensor mechanism: historical review and report of 12 fractures.

The operative treatment of olecranon fractures is controversial. Proponents of open reduction and internal fixation cite restoration of anatomy and rigid fixation, while proponents of excision of fracture fragments with repair of the extensor mechanism cite few complications and a rapid return of motion and function. An extensive review of the literature is presented, outlining the arguments in favor of each procedure. A series of cases is also presented. We report the results after excision of fragments and repair of the extensor mechanism for all 17 patients who underwent this procedure during the past 10 years at our hospitals. Evaluation included subjective, clinical, and radiographic assessment to provide a clinical score. Among the 12 patients with sufficient follow up to be rated, there were 7 excellent results, 4 good results, and 1 poor result. There were no complications. Our patients had a rapid return of motion and function with a rapid return to the preinjury level of activity. We believe the indications for this procedure may be even broader than suggested in the literature.

Biomechanical considerations in intramedullary fixation of lower-extremity fracture.

Since Gerhard Kuntscher's first cloverleaf design was introduced in the early 1940s, intramedullary nail geometry has become increasingly complex. Many design changes have been introduced, and these have had profound effects upon the mechanical performance of intramedullary devices, making them more versatile. The subset of long-bone fractures amenable to intramedullary fixation is expanding, largely because of these advancements in nail design. Selection of the appropriate nail and bone-nail construct for each fracture configuration requires a knowledge of basic biomechanical principles behind nail design and the implant-host interface. Appropriate clinical application of this knowledge not only ensures the best possible intramedullary fixation of long-bone fractures, but it also aids in avoiding some of the complications that may occur.

A mechanical study of six digital pulley reconstruction techniques: Part I. Mechanical effectiveness.

A laboratory study on fresh-frozen human cadaver limbs compared six types of flexor tendon pulley reconstruction in the fingers. The reconstructions used were those described by (1) Bunnell, (2) Karev, (3) Weilby, and (4) Lister, and two types developed by us that have not been previously described. The pulleys were studied in specific configurations to determine their effectiveness in transforming tendon excursion into finger flexion. In each finger, comparison was made between the amount of tendon excursion required for full flexion with an intact pulley system versus the various types of reconstructed pulleys. The ratio of these two values was defined as the mechanical effectiveness of the pulley reconstruction. The Karve reconstruction was most effective at 108.2%, which was significantly different from the other five reconstructions (p less than 0.01). The remaining reconstructions ranged in effectiveness from 80.0% to 88.5%.