Oblique ulnar shortening osteotomy by a single saw cut.

Ulnar shortening osteotomy is an effective treatment in patients with ulnar impaction syndrome. Accurate shortening and bony apposition can be obtained for a wide range of shortening lengths with a single-cut osteotomy technique. The saw kef produced by a single saw pass cuts a bony defect with parallel walls. The amount of shortening produced by using standard power bone saws can be increased by stacking as many as three blades together on the saw and by varying the angle at which the cut is made. The amount of shortening is a function of the angle at which the cut is made. The amount of shortening can be increased by a factor of twice the saw kerf if the cut is made at 60 degrees. We tabulated the shortening expected from over 100 combinations of power saw blades and cut angles. Using a series of experimental osteotomies, we demonstrated that the single-cut technique produces a more predictable amount of shortening than the technique of using two parallel cuts to remove a cuff of bone. The single-cut technique is useful for shortening any long bone.

Selective heparinization of venous anastomosis in latissimus dorsi free flaps to cover lower-extremity soft-tissue defects.

Two groups of consecutive patients treated with latissimus dorsi free myocutaneous flaps to cover lower-extremity soft-tissue defects were compared for postoperative vascular occlusion. In the first group of 13 patients (group I), there were five (38%) venous occlusions and no arterial occlusions. The second group of 15 patients (group II) was treated with selective heparinization of each venous anastomosis via a 0.35" catheter sutured into the serratus branch of the donor vein. In this group one patient suffered an arterial occlusion, but no patient suffered a venous occlusion. Statistical analysis using the Fisher exact probabilities test showed a significant decrease in vascular occlusion rate in group II, proving that selective heparinization had a beneficial effect on the venous patency rate.

Forearm fracture plates: to remove or not to remove.

Eighty dynamic compression plates used to fix fractures of the radius and/or ulna were removed from 51 of 98 adult patients. Thirty-seven patients had plates removed electively. Fourteen patients had plates removed for clinical reasons. The average time from insertion to removal was 13.6 months, with a range from 4.4 to 36 months. Only one refracture occurred through the unhealed both bone forearm fracture site in a patient whose plate was taken out 6 months after surgery. One refracture also occurred through the proximal screw hole of a still implanted ulna plate that had been inserted 3 years earlier. Leaving a plate in for the remaining life of a young patient cannot be considered a benign decision considering the persisting chance for refracture and the potential complications from prolonged exposure to metal corrosion complexes and metal ions.

Apparent weakness of median and ulnar motors in radial nerve palsy.

Muscle testing of a patient with radial nerve palsy can incorrectly suggest median and ulnar weakness because of a decreased ability to stabilize the thumb and wrist. Ten adult volunteers had radial nerve blocks and their strengths were quantitatively evaluated before and after blocking for grip, key pinch, isolated thumb adduction (adduction pinch), thumb palmar abduction, finger flexion, and flexor pollicis longus (FPL) function. Data were analyzed by paired t test (p less than 0.05). All composite motions that required stabilization of the wrist or thumb showed marked weakness after the radial nerve block (grip decreased 77%, key pinch decreased 33%, and thumb palmar abduction strength decreased 53%). The strength of adduction pinch, finger flexion, and FPL showed no significant decreases after the radial nerve block. Since adduction pinch and isolated FPL function can be easily tested clinically, they should be examined to prevent confusion with median and ulnar problems.

Ruptured epidermal inclusion cyst of the palm presenting as collar-button abscess.

Two cases of epidermal inclusion cysts that ruptured as a result of trauma and then mimicked pyogenic collar-button abscesses are reported. Rupture of the cyst into the palmar subcutaneous tissue produced an inflammatory response that led to the sterile abscesses drained at surgery. Presentation of a deep space abscess without history of penetrating injury should suggest this diagnosis.

Detection of intraarticular loose osteochondral fragments by double-contrast wrist arthrography. A case report of a basketball injury.

Gravity was used in a case of double-contrast wrist arthrography to demonstrate the intraarticular loose nature of osteochondral fracture fragments. These calcified loose bodies were successfully removed surgically.

Antigen-induced arthritis: an immunohistologic study of articular tissue and synovial fluid using the horseradish peroxidase technique.

Articular tissue and synovial fluid from rabbits with antigen-induced arthritis were stained for localization of immunoglobulin (Ig) and egg albumin (EA) using the immunoperoxidase technique. Discrete granules containing Ig and EA were initially observed within vascular synovial tissue with later occurrence in synovial fluid and dense connective tissue. Homogeneous staining for Ig was not always associated with the presence of antigen and, therefore, cannot be used alone as evidence of the presence of immune complexes. Discrete granules of Ig and EA are formed in dense connective tissue during the period of maximal inflammation and persist for at least 30 days. These granules presumably represent precipitated immune complexes of Ig and EA but can be stained for Ig alone longer than for EA. Insoluble, particulate immune complexes of Ig and EA appeared in synovial fluid within 2 h after injection and remained at least 24 h. These were identical in appearance to the Ig precipitates occurring in synovial fluids from human rheumatoid arthritis.

Temporal and thermal effects on deformation potentials in bone.

There were 44 freshly excised adult rat femora subjected to mechanical deformation in a 4-point bending jig while the load/deformation curves and the electrical potentials generated were recorded simultaneously. Serial testing was repeated after storage of specimens up to 30 days at 25 degrees C and -15 degrees, and after heating for 1 h at 70 degrees, 80 degrees, and 85 degrees C. The amplitude of the potential decreased shortly after the femora had been excised until, by 4-7 days, it reached a plateau which was 10-20% of the initial value. In some cases polarity reversal occurred. These changes were not prevented by freezing or drying nor were they accompanied by increased stiffness. It is presumed that they are related to more subtle changes in the mechanical properties of bone or to alterations in the generating or conducting mechanisms. Heating caused a significant increase in potential without a change in the waveform. A corresponding increase in the deformation occurred due to softening of the bone which could, in itself, be responsible for the increased potential without a basic alteration in the transducer mechanism.