Quantification of error in measurement of radial inclination angle and radial-carpal distance.

Posteroanterior wrist radiographs of eight patients were evaluated by eight orthopedists. Radial inclination angle and radial-carpal distance were measured by use of a standardized technique. The standard deviation for radial inclination angle was 2 degrees. The standard deviation for radial-carpal distance was 1 mm. The measured rotational variation of radial inclination and radial-carpal distance is 1 degree and 1 mm, respectively, through a 10-degree arc of supination and pronation.

Long-term results of the minimal resection Darrach procedure.

Eighteen patients had a minimal resection Darrach procedure at the distal radial-ulnar joint for treatment of posttraumatic arthritis. The follow-up averaged 8 years (range, 2 to 18 years). Fourteen patients were completely satisfied with the result achieved with the procedure and four were mostly satisfied. No patient had either subjective or objective evidence of distal ulnar instability. Grip strength for patients without radiocarpal arthritis was 84% of the uninvolved side. Preoperative ulnar variance was plus 4 mm and at follow-up minus 4 mm. At follow-up examination, four patients had ulnar carpal translocation. The average radial inclination angle of the patients with ulnar carpal translocation was 24 degrees, compared with 18 degrees for patients without ulnar carpal translocation. The minimal resection Darrach procedure gives excellent relief of pain without the instability attributed to the Darrach procedure. It must be used judiciously in patients who have a radial inclination angle above 23 degrees.

Relationship between radial inclination angle and ulnar deviation of the fingers.

Fifty wrists (thirty-two patients) with rheumatoid arthritis and ulnar drift of the fingers were examined radiologically and compared to fifty normal wrists radiographs. Statistically significant differences were found for measurements of radial inclination angle, carpal-radial distance, third metacarpal-phalangeal angle, and carpal height ratio. Third metacarpal-phalangeal angle of ten degrees or greater on standard posteroanterior radiograph appears to accurately represent digital ulnar drift. Elevated radial inclination angle was highly correlated with digital ulnar drift (p much less than 0.001). Radial inclination angle greater than twenty-two degrees is associated with the development of digital ulnar drift through two mechanisms, radial carpal rotation, and ulnar carpal translocation.

Connective tissue nevus and osteopoikilosis in the hand: the Buschke-Ollendorff syndrome.

The Buschke-Ollendorff syndrome is a rare disorder of uncertain etiology characterized by osteopoikilosis and connective tissue nevi. An unusual presentation of this syndrome is described that involves both the cutaneous and skeletal manifestations affecting the hand. The bones of the hand and carpus are a common site for osteopoikilosis. Connective tissue nevi of the hand may require excision for diagnosis or mechanical impingement. Special elastin stains must be done on these cutaneous lesions to confirm the diagnosis. Routine hematoxylin-eosin stains may fail to show any pathologic change in mild cases.

Doppler mapping in hypothenar syndrome: an alternative to angiography.

Four patients with hypothenar hammer syndrome were evaluated preoperatively with Doppler mapping and angiography. Both tests documented ulnar artery occlusion. In one patient, the proximal extent of thrombosis could not be identified by angiography. In all cases Doppler mapping accurately documented the extent of occlusion as confirmed by surgical exploration. Doppler mapping is a noninvasive alternative to angiography in the evaluation of hypothenar hammer syndrome.

Tendons: high-field-strength, surface coil MR imaging.

High-resolution magnetic resonance (MR) images of the tendons of the hands, wrists, feet, and ankles of six healthy volunteers and six cadavers were obtained using receive-only surface coils and reduced-field-of-view imaging. Normal anatomy was identified and compared with gross anatomic sections of the six cadavers. Experimentally produced tears of the calcaneal (Achilles) tendon in domestic swine were identified on MR images. The hands and feet of 11 patients were examined, and a variety of pathologic lesions were identified, including acute posttraumatic rupture, acute tenosynovitis, chronic tendonitis, and postsurgical complications. MR imaging provides inherently greater soft-tissue contrast than any other currently available imaging modality. With the use of surface coils and reduced-field-of-view imaging to enhance spatial resolution, MR imaging has become a valuable tool for imaging tendons. Advantages over other available modalities include excellent depiction of anatomic detail, superior contrast resolution, and the potential for multiplanar imaging.

High-field MR surface-coil imaging of the hand and wrist. Part II. Pathologic correlations and clinical relevance.

High-resolution magnetic resonance (MR) images of the hands and wrists of 12 patients with a variety of suspected pathologic conditions were obtained at 1.5 T using a prototype surface coil. Lesions included ganglions, rheumatoid arthritis, carpal fractures, carpal tunnel syndrome, and arteriovenous malformations. In the selected cases studied, MR images provided potentially relevant information. Surgical, pathologic, and radiographic correlations were obtained. MR imaging affords delineation of soft-tissue structure that is unmatched by other imaging methods, including computed tomography. It is anticipated that MR imaging of the hand and wrist will afford sufficient valuable clinical information in certain conditions to justify its expense outside a research setting. Further clinical testing, however, is warranted.

Composite tissue transfer in burn patients.

The advent of microsurgery has presented many advantages to the reconstructive surgeon in the treatment of burns and their resultant deformities. The skilled microsurgeon has a vast armamentarium from which to choose. The best method of reconstruction requires a thorough knowledge of flap alternatives and careful patient individualization. Five clinical cases are presented.

Treatment of subtrochanteric fractures with a sliding screw-plate device.

In a series of 45 subtrochanteric fractures treated with a sliding screw-plate device, union was achieved in 43 patients (95.3%). Most were Seinsheimer Type II C (9), Type IIIA (12), and Type V (18). Fractures were stabilized in a valgus position (average, 140 degrees), with primary medial displacement of the femoral shaft (25 patients). Radiographic analysis of the degree of postoperative impaction of the fragments correlated with the fracture pattern. Fractures with medial cortical comminution such as Type IIIA and Type V were the most unstable, with an average of 10.8 and 8.0 mm axial impaction, respectively, and were at the greatest risk of complication. The sliding screw-plate device is a reliable method of achieving union in subtrochanteric fractures.

Principles in the application of the hoffmann® apparatus for complex injuries of the upper extremity.

Fifteen patients with 13 closed and 13 open fractures in the upper extremity were treated with either the Hoffmann apparatus alone or a combination of internal and external fixation. Two patients required amputation for unreconstructable defects. Two asymptomatic nonunions of the distal ulna and one malunion of the distal radius occurred. There were no cases of osteomyelitis at the fracture sites or pin sites. Successful fracture healing in severe injuries was achieved by closely following the principles of fixation for primary or secondary bone healing, with early bone grafting for any osseous deficit and open wound treatment of contaminated fractures.

Use of the Hoffmann apparatus in the treatment of unstable tibial fractures.

The Hoffmann apparatus was employed in the treatment of thirty-four complex tibial fractures that we considered to have a poor prognosis with more conventional forms of treatment. Complications were minimum. The time to union for all of the fractures averaged 5.8 months and appeared to be directly related to the accuracy of the reduction. In twenty-five fractures in which it was possible to achieve an anatomical reduction and to apply compression through the apparatus, the time to union averaged 5.1 months. In six fractures that could not be anatomically reduced and compressed, the time to union averaged 8.2 months. Shortening or significant angulation of the fractures did not occur. The accessibility of the wound for serial débridement and the stabilization of the fracture as well as the traumatized soft tissue were thought to be of great value in preventing deep wound infection. A retrospective evaluation of many of the healed fractures revealed roentgenographic evidence of primary bone-healing without visible callus. Knowledgeable application of the principles and biomechanics of primary bone-healing are essential for successful treatment by this method.

A thermostable antigen associated with ovarian cancer.

Ovarian carcinoma contains an antigen (TA) which is stable at 100 degrees. Rabbit antisera to glycoprotein-rich extracts of tumors detect TA in 70 per cent of ovarian malignancies, in some benign ovarian cysts, certain normal lung preparations, normal cervix, and squamous-cell carcinoma of the cervix. Highest levels may be associated with mucin secretion. No detectible antigen was present in normal ovary, plasma, A, B, and O erythrocytes, leukocytes, placenta, brain, heart, liver, corpus uteri, spleen, skeletal muscle, or kidney. Prolonged digestion of boiled tumor extracts with papain, trypsin, chymotrypsin, on Sephadex G-150 corresponding to a globular protein of 27,000 to 36,000 molecular weight. A beta-globulin mobility is seen in immunoelectrophoresis. It appears that TA differs in tissue specificity and molecular size from other known ovarian cancer associated antigens.