Flexor Tendon Rupture After Distal Radius Malunion Associated With Electromyographic Abnormalities: A Case Report.

CASE: A 63-year-old woman with a history of a malunited distal radius fracture presented with left hand pain and inability to flex her thumb, index, and middle fingers. Anterior interosseous neuropathy was suggested because of abnormal electromyography findings. However, magnetic resonance imaging later revealed flexor tendon ruptures. A distal radius corrective osteotomy with autograft and volar fixation was performed with tendon transfers and carpal tunnel release. CONCLUSIONS: Attritional flexor tendon rupture after a nonoperatively managed distal radius fracture is rare but remains an important differential diagnosis in patients with signs and symptoms of anterior interosseous nerve paralysis.

The Reliability of a Grading System for Digital Subtraction Imaging Quality During Cervical Transforaminal Epidural Steroid Injection.

OBJECTIVE: Digital subtraction imaging (DSI) decreases the risk of intravascular injection during cervical transforaminal epidural steroid injection (CTFESI); however, sequence acquisition and interpretation are operator-dependent skills. This study tests the reliability of a grading system to determine adequate DSI during CTFESI. SETTING: Academic tertiary medical center. METHODS: A grading scheme for adequate DSI quality during CTFESI was created by the study authors based on patient positioning, mask image, and volume of contrast injected. The inter-rater and intrarater reliability values of this grading scheme were tested using 50 DSI images evaluated by three raters during two distinct sessions separated by four weeks. Based on a power analysis, a sample of 50 scans was sufficient to detect significant correlations. Inter-rater reliability was determined by percent agreement between graders for dichotomized categories of "quality of DSI is adequate for safe C-TFESI" vs "quality of DSI is inadequate for safe C-TFESI." The percentage of agreement was reported, along with Gwet's agreement coefficient (AC). The intrarater (pre/post) correlation was assessed using Yule's Q statistics. RESULTS: Correlation coefficients were interpreted as follows: 0.00-0.19 "very weak," 0.20-0.39 "weak," 0.40-0.59 "moderate," 0.60-0.79 "strong," and 0.80-1.00 "very strong." Inter-rater reliability analyses demonstrated that the patient position category had "very strong" agreement, contrast volume had "strong" agreement, and mask image had "moderate" agreement. The overall inter-rater reliability was "moderate." All of the raters demonstrated "very strong" intrarater reliability. CONCLUSIONS: The proposed grading system for adequate-quality DSI during CTFESI showed overall "moderate" and "very strong" inter- and intrarater reliability, respectively. This scheme provides an objective measure of DSI quality for CTFESI. Refinement is needed to improve the reliability of this scheme.

Stereoselective synthesis of cis- and trans-oligo(phenylenevinylene)s via palladium-catalyzed cross-coupling reactions.

cis-Oligo(phenylenevinylene)s (OPVs) are synthesized by Suzuki-Miyaura coupling of arylboronic acids with (Z)-bromoalkenes in over 96% geometrical purity. On the other hand, trans-oligo(phenylenevinylene)s can be synthesized by Hiyama coupling of aryl iodide with (E)-alkenylsilanes in almost perfect purities. Effect of pi-conjugation chain length on photoisomerization behavior of OPVs is described.

Highly (Z)-selective hydrosilylation of terminal alkynes catalyzed by a diphosphinidenecyclobutene-coordinated ruthenium complex: application to the synthesis of (Z,Z)-bis(2-bromoethenyl)arenes.

[reaction: see text] Complex 1 bearing a diphosphinidenecyclobutene ligand (DPCB-OMe) catalyzes highly stereoselective hydrosilylation of diethynylarenes with HSiMe2Ph to afford (Z,Z)-bis(2-silylethenyl)arenes. Treatment of the hydrosilylation products with N-bromosuccinimide causes bromodesilylation in a stereospecific manner, giving (Z,Z)-bis(2-bromoethenyl)arenes in high geometrical purity (>98%).

Inpatient rehabilitation of patients requiring hemodialysis: improving efficiency of care.

OBJECTIVE: To determine if reducing missed therapy sessions by patients requiring hemodialysis will reduce the length of stay (LOS) and improve the efficiency of care in an inpatient rehabilitation unit. DESIGN: Retrospective study. SETTING: Inpatient rehabilitation unit at a university medical center. PARTICIPANTS: All patients discharged from the Albany Medical Center rehabilitation unit between January 1, 2003, and June 30, 2004. The total number of patients was 955, 40 of whom required hemodialysis. INTERVENTION: On January 1, 2003, Albany Medical Center began providing hemodialysis in the late afternoon, allowing patients to complete a full 3-hour program without missing therapy sessions to attend dialysis. We compared the outcomes of 915 patients who did not require hemodialysis with the outcomes of 40 patients who required hemodialysis. We also compared the outcomes of patients treated on the rehabilitation unit in 2003-2004 to the outcomes of patients treated on the rehabilitation unit before dialysis was available at times that did not conflict with therapy (calendar year 2001). MAIN OUTCOME MEASURES: LOS, improvement on the FIM instrument, and FIM efficiency score. RESULTS: The LOS of the hemodialysis patients changed from 16.0 in 2001 to 12.1 in 2003-2004 (P<.05), and the FIM efficiency score of the hemodialysis patients improved from 1.8 in 2001 to 2.9 in 2003-2004 (P<.05). The FIM efficiency score of the nondialysis group in 2003-2004 was 4.0. This was significantly greater (P<.05) than that of dialysis patients in 2003-2004. CONCLUSIONS: A program to reduce conflicts between medical treatments such as hemodialysis and therapy sessions may result in reduced LOS and improved efficiency on an inpatient rehabilitation unit.

The effect of multidrug chemotherapy on bone graft augmented prosthesis fixation.

Use of combination adjuvant chemotherapies have improved the disease free survival rate of tumor patients significantly. However, studies have shown that chemotherapeutic agents have negative effects on bone graft incorporation and fixation of porous-coated prostheses needed for reconstruction of bone defects after wide resection of malignant tumors. Unilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous-coated segmental prosthesis was performed in eight mixed-breed dogs under perioperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. Eight strips of autogenous cortical bone were evenly placed around the junctions between the femur and the prosthetic surface. Autogenous cancellous bone was placed under and between the strips of cortical bone. Two cycles of the chemotherapy were given preoperatively, and three cycles postoperatively. The animals were followed for 12 weeks, with sequential assessments of weight-bearing and radiographic evaluation. Biomechanical, histological, and microradiographic analyses of the retrieved specimens were performed. Doxorubicin, cisplatin, and ifosfamide combination chemotherapy showed a significant effect on new bone formation as seen in reduced callus size and lower ultimate strength of extracortical fixation. However, the onlay corticocancellous grafting method provided better biologic fixation of the prosthesis compared with fixation without any bone grafting under non-chemotherapy condition in a previous study. Extracortical bone grafting is an effective modality for implant fixation even under intensive chemotherapy.

Stereocontrolled synthesis and optical properties of all-cis poly(phenylene vinylenes) (PPVs): a method for direct patterning of PPVs.

Geometrically pure, all-cis poly(phenylene vinylenes) (PPVs) are synthesized by Suzuki-Miyaura-type polycondensation of 2,5-dioctyloxy-1,4-benzenediboronic acid with (Z,Z)-bis(2-bromoethenyl)benzenes, which are prepared by ruthenium-catalyzed (Z)-selective double hydrosilylation of diethynylbenzenes, followed by bromodesilylation of the resulting (Z,Z)-bis(2-silylethenyl)benzenes with N-bromosuccinimide. The all-cis PPVs thus obtained undergo one-way photoisomerization to the corresponding trans-PPVs both in solution and in the solid. This phenomenon is applied to direct microscale patterning of PPVs onto a quartz substrate.

Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis.

We retrospectively reviewed 11 hip arthroplasties in 7 patients receiving long-term (15 years) hemodialysis for chronic renal failure. Osteonecrosis of the femoral head, osteoarthritis, and amyloid arthropathies were treated by total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) using cementless anatomic medullary locking stem. The average follow-up period was 8 years and 3 months (range, 3-13 years). The D'Aubigne and Postel hip score was restored to 14.5 postoperatively from 7.7 preoperatively. All femoral cementless components achieved bone-ingrown fixation. Although 1 BHA resulted in central migration, there was no loosening of the cementless acetabular component. We are encouraged by the predictable long-term stability of the bone-implant interface achieved by cementless fixation with an extensively coated implant. Cementless THA remains a useful treatment option for patients on long-term hemodialysis.

Predictive factors for vascularized iliac bone graft for nontraumatic osteonecrosis of the femoral head.

We reviewed the results of 35 operations performed on 29 patients with osteonecrosis of the femoral head in which a pedicle iliac bone was utilized. The average age was 35 years (17-62). There were 28 patients of stage 2 and 7 of stage 3; there were 17 type C-1 hips and 18 type C-2 hips. The pedicle bone was inserted in the anterolateral direction of the femoral head. The average follow-up period was 8 years and 7 months. Collapse of the femoral head occurred in 19 hip joints. Although 16 of 28 stage 2 hips showed collapse, all 7 stage 3 hips resulted in collapse. Thirteen of 17 hips did not show collapse in patients with type C-1 necrosis, whereas 15 of 18 hips developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral direction of the femoral head, incidence of collapse was reduced. These results indicate that deep circumflex iliac pedicle bone graft may be indicated for stage 2 type C-1 necrosis, and that the penetration of the graft into the anterolateral aspect of the lesion is essential for the procedure to succeed.

The effect of a doxorubicin, cisplatin and ifosfamide combination chemotherapy on bone turnover.

BACKGROUND: Use of combination adjuvant chemotherapies have improved the disease-free survival rate of tumor patients significantly. Previous experimental studies have shown that chemotherapeutic agents have negative effects on fixation of porous coated prosthesis, but the effects on normal bone turnover rate and mechanicalproperties have been reported to be minimal. MATERIALS AND METHODS: Fourteen dogs were used to study the effect of a doxorubicin, cisplatin and ifosfamide combination in normal bone turnover. We developed a safe and clinically-relevant canine model for multidrug perioperative chemotherapy that simulates current cancer treatment. The bone specimens were analyzed using microradiography, bone histomorphometry and torsional testing. The results were compared with canines that underwent a similar surgical protocol without chemotherapy. RESULTS: The results showed no differences in mechanical properties after 22 weeks of chemotherapy. The porosity, osteonal activity and mineral apposition rate of the cortical bone were unaffected. The results also showed no difference in porosity of perimeter in cancellous bone, but the mineral apposition rate was significantly reduced. CONCLUSION: The difference in mineral appostion rate of cancellous bone shows that, although the effect of temporary chemotherapy on bone may have minor effects on normal turnover and that the effect may be reversible, it causes disturbance in bone mass accumulation. This may later raise the risk for fragility fractures and osteoporosis.