Segmental nerve conduction velocity in vibration-exposed shipyard workers.

OBJECTIVES: Segmental sensory nerve conduction velocity (SNCV) was measured from the wrists to the hands and digits of a population of vibration-exposed shipyard workers. This study was designed to investigate whether SNCV was selectively slowed in the fingers and whether a laboratory approach could be adapted for robust field use. METHODS: Wrist-palm, palm-proximal digit, and digital segments were determined from stimulation at the wrist with recording electrodes placed distally and adjusted to individual anatomy. The cohort was selected on the basis of current use of vibratory tools. RESULTS: Wrist-palm and digital segments were slower than palm-proximal digit segments for dominant and non-dominant hands and for both ulnar and median nerves. In the dominant-hand median nerve of participants with current exposure, the SNCV was 41.4 m/s (SD 8.0) for the wrist-palm segment, 50.8 (SD 9.5) for the palm segment, and 42.1 m/s (SD 9.3) for the digital segment. Temperature had an important effect on nerve conduction velocity but not equally across segments. Other explanatory variables had modest effect on SNCV. CONCLUSIONS: Reduced SNCV in the digits may be a consequence of industrial exposure to vibration. Each sensory nerve segment appeared to have a different characteristic velocity and different pattern of association with skin temperature. There are differences between median and ulnar nerve segments, with potentially important consequences when standard distances are used to assess wrist-digit velocity.

Injuries of the distal tibial epiphysis: systematic radiographic evaluation.

The site of injury to the distal tibial epiphysis in the younger individual depends on the relation of the ligaments to the epiphysis, the type of injury, and the maturity and degree of closure of the growth plate. A characteristic radiographic pattern of injury occurs as a result of each particular injuring force, which in turn requires a specific mode of fracture reduction. One hundred and ninety-four cases of epiphyseal injuries were reviewed, and the incidence and diagnostic characteristics of the various types are presented. The Salter-Harris classification of lesions reveal the type II is the most common (46.4%), followed by type III (25.2%), type IV (10.3%), and type I (5.7%). The triplane fracture constituted 9.8%, and miscellaneous injuries, which could not be classified, were 2.6%.