Surgical treatment of varus malunion of the proximal humerus with valgus osteotomy.

Among the complications of 2-part fractures of the upper end of the humerus, little attention has been paid to the treatment of the varus malunion. However, this deformity frequently causes pain and disability of the shoulder. To improve this condition, we treated this malunion with a valgus wedge osteotomy. From August 1995 to January 1999, 5 patients with this deformity, all complaining about pain or unsatisfactory function of the shoulder (University of California, Los Angeles score <13), underwent osteotomy and internal fixation with a plate and screws. The mean age was 53 years (range, 25-73 years), there were 4 male patients, and the left side was involved in 4 cases. The mean follow-up was 34 months (range, 22-63 months). Union occurred in all cases by 6 weeks. Three of the results were excellent, and two were good (University of California, Los Angeles score >30). All patients were satisfied with the treatment.

Effect of allopurinol, superoxide-dismutase, and hyperbaric oxygen on flap survival.

The effect of allopurinol, superoxide-dismutase, and hyperbaric oxygen was compared on axial pattern skin flap survival. An abdominal flap based on the inferior epigastric pedicle was raised in rats for this purpose. Three experimental groups were studied. In the first group, adult male Wistar rats received 50 mg/kg I.P. of allopurinol. The second received 20,000 I.U./kg of superoxide-dismutase. The third group was submitted to hyperbaric oxygen therapy. The flaps were exposed to 8-h warm ischemia. Flap survival was evaluated on postoperative day 7. All flaps survived, and the mean survival areas were 63.53%, 83.03%, and 55.98%, respectively, in the allopurinol, superoxide-dismutase, and hyperbaric groups. The percentage of flap necrosis was significantly smaller in all experimental groups when compared to controls (P < 0.05). It was clear that the superoxide-dismutase group had better results on axial pattern ischemic skin flap survival, under the tested conditions. The tested methods improved flap survival to ischemic injury, and the flap designed is a reliable model for further investigations.

Tratamento da osteoartrose da base do polegar com artroplastia de interposicao tendinosa e reconstrucao ligamentar / Treatment of the osteoarthritis of carpometacarpal joint of the thumb by ligamentar reconstruction and tendon interposition arthroplasty

Os autores relatam os resultados do tratamento cirurgico de 21 pacientes portadores de osteoartrose da articulacao trapeziometacarpica (23 polegares operados). Todos os pacientes eram do sexo feminino, com a idade variando de 42 a 73 anos com a media de 58 anos. A tecnica cirurgica consistiu da retirada completa do trapezio, com o emprego do flexor radial do carpo para a estabilizacao do polegar e para a interposicao tendinosa (tecnica de Burton). Baseados em criterios clinicos e radiograficos os resultados foram considerados bons em 21 dos polegares operados. Nesses casos houve desaparecimento da dor, a media da abducao ativa foi de 40 graus e na flexao ativa a polpa do polegar tocava a base do V metacarpiano. As medidas das forcas de pinca polegar-indicador e de preensao elevaram-se de 20 por cento e 15 por cento, respectivamente, quando comparadas com as do pre-operatorio. A reducao do "espaco articular" foi em media de 10 por cento