Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw.

BACKGROUND: Avulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children. METHODS: Between January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6 weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations. RESULTS: On the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week. CONCLUSIONS: Our results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term.

Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia.

BACKGROUND: Neglected and repeated ruptures of the patellar tendon are fortunately an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by contractures of the quadriceps muscle and extensive scar tissue formation, and clinical findings are similar regardless of whether the rupture occurred during or after total knee arthroplasty. In both cases, reconstruction is the treatment. METHODS: Here, we present data on reconstruction of the patellar tendon using our own method, which is performed in the following manner: the fascia flap shafted in the distal direction is separated from the vastus lateralis fascia of the quadriceps muscle, then folded back and fixed to the tibial tuberosity enclosing the patella in a Y shape. We used this new method in sixteen cases. All of the patients were examined clinically for an average of twenty-eight months. The Knee Society score was determined prior to surgery and on follow up. RESULTS: Both the physical and ultrasound monitoring showed that all sixteen tendons healed properly, indicating that there was no need for any further surgical interventions. The mean Knee Society pain and function scores as well as the average range of motion of the knee increased significantly after the operations. CONCLUSION: We believe that the presented method is an acceptable option for functional and biomechanical repair of the patellar tendon for the following reasons: the static balance of the knee joint remains unaltered, the quadriceps muscle is not damaged, and the central pulling direction remains steady.

Anatomy of the chicken foot for the experimental investigation in flexor tendon surgery.

A chicken model for research in flexor tendon surgery is used despite the considerable differences between avian foot and human hand anatomy. In order to properly correlate and interpret the data collected from such experiments, a reexamination of chicken anatomy and terminology was undertaken. Thirty chicken feet were studied anatomically for tendon-tendon sheath structures including vascularization, flexor systems, and histologic specimens. The data collected show, besides striking similarities between human and avian anatomy, differences critical enough to warrant a reevaluation of previous descriptions of the avian structure.

[Writing difficulty syndrome--a rare symptom complex involving the median nerve and the carpal tunnel]. / Mogigraphia-syndroma--a nervus medianus ritka alagút tünetegyüttese.

Authors describe the cases of two patients, suffering from the rare, however frequently not diagnosed real writing spasm. In these patients surgery brought healing or significant improvement. After a review of the literature the symptoms, the possibilities of diagnosis and therapy are described. With their paper they want to call attention to this not well known disease.

[Submicroscopic study of degeneration and regeneration following experimental nerve transplantation]. / A degeneráció és regeneráció szubmikroszkópos vizsgálata kísérletes idegtranszplantáció után.

Authors, as a continuation of a former series of experiments, examined the fate of free autologous nerve grafts. It was found that the transitory state without circulation does not influence the start of regeneration and its temporal process in the graft. They call attention to the important role of the Schwann cells in the regeneration. 8-10 weeks postoperatively a complete remyelinization was observed even in the distal stump.

[Questions about the two-stage reconstruction of flexor tendon injuries. IV. Clinical experience]. / A hajlítóín-sérülések kétszakaszos helyreállításának kérdései. IV. Klinikai tapasztalatok.

Authors report on clinical experiences gained with the two stage flexor tendon transplantation described by Hunter. Their modifications are described and the results given in details. They touch also upon the indications of the procedure considering the preoperative evaluation. Other procedures are also offered for injuries with bad prognosis and the future trends of investigation, held to be important, are mentioned.

[Questions concerning two-stage reconstruction of injured flexor tendons. III. Ultrastructure of the tenosynovium in the pseudo-tendon sheath created by using a silicone rod]. / A hajlítóínsérülések kétszakaszos helyreállításának kérdései. III. A tenosynovium ultrastruktúrája a szilikonrúddal kialakított pseudoínhüvelyben.

Authors have investigated the ultrastructure of the pseudo tendon sheath, formed with silicon rod and man. They have observed a superficial structure, resembling the normal tendon sheath in scanning electron microscopic examination. With transmission electron microscopy phagocyte "A" type and secretion "B" type synovial cells were found. Authors state that the newly formed tenosynovium has an important role in the nutrition of the tendon graft and the prevention of adhesions.

[Use of a distally pedicled radial artery as an island flap for covering traumatic skin losses]. / Disztálisan nyelezett artéria radiális szigetlebeny alkalmazása akut traumás börhiányok fedésére.

Authors performed plastic operation using lower arm insulated flap with distal pedicle in 2 cases for covering traumatic skin defects on the dorsal side of the hand. Attention is called to the advantages of this method. Beside the shorter time of treatment in many cases a series of operations can be avoided by the primary covering with an insulated flap.

[Surgical treatment of inveterate Monteggia injury in childhood]. / A gyermekkori, nem friss Monteggia-sérülés mütéti kezelése.

Authors, based on the experience gained from the operative therapy of a 9 year old child with inveterated Monteggia injury, discuss the types, the diagnosis and the principles of treatment of this injury. They take the part of urgent treatment following early diagnosis as the results of the treatment of the non-fresh cases are generally less favourable.

[Results of surgical management of Bennett fractures]. / Eredményeink a Bennett-törések mütéti kezelése után.

Authors examined in a 15-year material of the Department of Traumatology, Clinic of Surgery of the Pécs University of Medicine the late results of Bennett's fracture, treated surgically. In the treatment of 51 patients they came to the conclusion that the reduction of the fracture with anatomical exactness and the early functional treatment improved the results considerably.

[The role of an external mini-fixator in the management of infected injuries of the hand]. / A mini külsö rögzítö szerepe a kéz fertözött sérüléseinek kezelésében.

Authors use since 1982 the mini fixateur externe in the treatment of the severe infected injuries of the hand. The stable, external fixation resulted in all the 31 patients, treated unsuccessfully with other methods, in healing.

Preserved tendon grafts in reconstructive hand surgery: a review.

The authors discuss the use of tendon grafts, primarily in flexor tendon repair, a problem not yet satisfactorily resolved. Criteria for successful non-autogenous tendon grafts are presented, with interest focussing on the immunologic antigenicity of the grafts and the physiologic properties and processes of tendon regeneration. Methods for preserving tendon grafts, including freeze-drying and the use of various chemical agents, are compared and recommended, as well as methods for managing tendon grafting procedures. Questions remaining to be answered in the area of preserved tendon grafts are raised, with suggestions for some answers and avenues for future research. Possibilities for wider clinical applications of the procedure are supported and discussed as well.

[Girlestone's arthroplasty with resection of the femur head in the management of infection as a complication of hip prosthesis]. / Girdlestone szerinti combfej-resectios arthroplastica a csípöprotézisek infekt szövödményeinek gyógyításában.

From the endoprosthesis material with early and late complication and treated with Girdlestone's method (resection arthroplasty of the femoral head) n 36 cases, 27 were available for follow-up after 1-11 years (in average 5 years). The assessment was made with an own point-system. 3 categories were differentiated on the base of these points. From the 27 patients 7 were satisfied, 14 "reconciled", 6 dissatisfied. It could be stated that Girdlestone's operation does not mean a catastrophe, as the major part of the patients has no pain and sinus, is able to walk and to make the domestic work and is not reduced to the care of others.

[Biological and functional factors in 2-stage flexor tendon reconstruction]. / Biologische und funktionelle Faktoren bei der zweizeitigen Beugesehnenrekonstruktion.

After a review of the morphological and biological relationship of the intact human flexor tendon-sheath unit, the authors discuss injuries of the flexor tendon. They summarize research to date, including their own results. In their opinion, the success of two-stage tendon grafting used in the treatment of such injuries, apart from the known clinical factors, also depends on biological and functional factors.

[Problems of the two-stage restoration of flexor tendon injuries. I. Current results. Biological and functional factors affecting healing]. / A hajlítóín sérülések kétszakaszos helyreállításának kérdései. I. Az eddigi vizsgálatok eredményei. A gyógyulást befolyásoló biológiai és funkcionális tényezök.

After describing the morphological and biological relations in the intact human flexor tendon and tendon sheat unit authors deal in details with the severe injuries of the flexor tendons inside the tendon sheat, having a bad prognosis. The results of the previous experimental investigations, and among them their own results, are reviewed. The success of the two-phase tendon transplantations in this kind of injury is determined, according to their opinion, beside the known clinically related factors, by biological and functional factors. Further examination of the complicated reparative processes with the use of modern methods of investigation is planned. The present work is ment for introduction of these experiments.

[Problems of the two-stage restoration of flexor tendon injuries. II. Light- and scanning electron microscopy studies of flexor tendon sheaths from hens and from humans]. / A hajlítóínsérülések kétszakaszos helyreállításának kérdései. II. Fény és scanning elektronmikroszkópos vizsgálatok normál tyúk és emberi ujj hajlító-ínhüvelyeken.

Authors examined the normal flexor tendon/tendon sheat unit of the toes of the hen and in the zone Verdan 2 of the human hand with light and scanning electron microscope. The fine structure of the synovial membrane was studied with special care. It was found, in accordance with some previous literary data, that the morphology of the hen's and human tenosynovium resemble to each other. The structures of the parietal visceral synovial membranes are described and compared, and the mechanism of the secretion of the synovial fluid is discussed. The results of the present investigations may serve, over the description of the normal anatomical relations, as a comparison to other experiments of two-phase tendon transplantations with the formation of pseudo tendon sheats and also for clinical practice.

[Results of replantation of limbs]. / Végtag-replantációink eredményei.

Authors describe 7 cases of limb replantation in their material. The field of indication is reviewed, the early postoperative complications and the possibilities of their treatment are discussed. The means of reaching the possible best results are examined. The ways of performing the possible optimal limb replantation are scheduled on the basis of their own experiences.

[Possibilities of using preserved tendon in hand surgery. Review of the literature]. / Konzervált ín felhasználásának lehetöségei a kézsebészetben. Irodalmi áttekintés.

Authors review the possibilities of the use of conserved tendon, especially on the field of flexor tendon reconstruction--a problem that can not be considered to be solved entirely. The requirements of the conserved tendon are reviewed, the question of the antigenicity is emphasized and the process of tendon regeneration, using conserved tendon, is described. The various procedures of conservation e.g. freeze drying and different chemical methods are compared and the criteria of the use of conserved tendon are discussed. The possibilities of the use of conserved tendon are mentioned, several questions, requiring further investigations, are posed. A wider use of conserved tendon in the future is recommended.

[Experimental 2-stage tendon and tendon sheath reconstruction in tendon sheath injuries]. / Experimentelle Sehnen- und Sehnenscheidenrekonstruktion von Beugesehnenverletzungen in zwei Sitzungen.

The whole tendon sheath of hens were cannulated by a silicone rubber stick in a first stage and only the injured part of the tendon sheath was substituted by a autologous venous or fascial transplant. The tendon was reconstructed by a free tendon transplant in a second stage. The venous respectively the fascial patches revitalize within 2 weeks. Smooth slide faces originated on their inner surface. The adhesions between the reconstructed tendon sheath and the tendon were small in general. The healing of the tendon ran down without any disturbance.