The use of suture anchors to repair the ruptured quadriceps tendon.

Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.

Outcomes of bilateral cataract surgery in Tanzanian children.

OBJECTIVE: To investigate outcomes of bilateral pediatric cataract surgery in east Africa. DESIGN: Retrospective interventional case series. PARTICIPANTS: Two hundred forty-three children who underwent bilateral cataract surgery at the Comprehensive Community-Based Rehabilitation for Tanzania Disability Hospital between 2001 and 2004. METHODS: Demographic, surgical, preoperative, and postoperative clinical characteristics obtained from patient records were entered into a database (Microsoft Excel; Microsoft, Redmond, WA), and statistical analysis was conducted using SPSS software for Windows (SPSS, Inc., Chicago, IL). MAIN OUTCOME MEASURES: Postoperative visual acuities and factors affecting them and postoperative refraction results. RESULTS: Intraocular lenses were inserted in the first eyes of 232 children (149 Alcon AcrySof [Alcon Laboratories, Fort Worth, TX], 83 polymethyl methacrylate [PMMA]). Fifty-eight (62%) of 94 patients with final follow-up acuities recorded in both eyes achieved 20/60 or better in their better eye and 13 (13%) of 94 patients were blind. Of the various predictors of good visual outcome identified for children or eyes, only absence of preoperative blindness (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.0-18.0; P<0.0005) remained significant in a multivariate logistic regression model. One hundred nine (51%) of 212 refracted first eyes had early postoperative refractive error spherical equivalent magnitudes of 2 diopters (D) or more. Ninety-nine (47%) of 212 eyes had initial postoperative cylinders of 3 D or more, dropping to 30 (18%) of 164 of those who had later follow-up refraction. Presence of biometric data was not associated with smaller postoperative refractive errors. Eyes with AcrySof lenses were less likely (OR, 2.5; 95% CI, 1.04-6.06) to have more than 3 D of astigmatism at latest follow-up. AcrySof lenses also were more likely (OR, 2.1; 95% CI, 1.2-3.7) to be fixated in the bag than PMMA lenses. Acute fibrinous uveitis occurred in 30 cases (12%), and transient corneal haze occurred in 20 cases (8%). Twenty-seven (11%) had chronic complications, 69 (28%) underwent a further general anesthetic procedure, and 9 (4%) underwent yytrium-aluminum-garnet capsulotomy. CONCLUSIONS: Preoperative blindness was the strongest predictor of poor postoperative visual outcome; the use of AcrySof lenses as opposed to PMMA lenses made in-the-bag fixation more likely and also reduced postoperative astigmatism.

Minimally invasive subcutaneous fasciotomy for chronic exertional compartment syndrome of the lower extremity.

Chronic exertional compartment syndrome of the lower extremity can be debilitating in the active population. Open fasciotomy typically provides a cure or significant improvement in up to 90% of patients, provided that the compartments are adequately released. Cosmetic deformity from the surgery may be a major concern, especially in the young female athlete. A technique for minimally invasive subcutaneous fasciotomy is described that allows adequate compartment release and a favorable cosmetic result.

Tendon creep is potentiated by NKISK and relaxin which produce collagen fiber sliding.

The pentapeptide NKISK has been reported to inhibit the binding of decorin, a proteoglycan on the surface of collagen fibrils, to fibronectin, a tissue adhesion molecule. Relaxin has been shown to be effective in relaxing ligaments and other connective tissues. Through collagen staining studies, we have previously demonstrated that collagen fiber sliding is important during changes in ligament length. Because of our interest in fibril-fibril binding as it relates to changes in length of tendon or ligament, we investigated the potential of NKISK, relaxin, or both in combination to potentiate creep. We suspended stained rat tail tendons in test solutions under a constant stress and observed length changes and subsequent collagen fiber sliding. Both NKISK and relaxin potentiated rat tail tendon creep with changes in length most likely occurring as a result of collagen fiber sliding as evidenced by photomicrography.

Late presentation of a displaced subcapital fracture of the hip in transient osteoporosis of pregnancy.

Transient osteoporosis of the hip is rare and has two demographic peaks, one during the third trimester of pregnancy and the other around the fifth to sixth decade of life. During pregnancy, osteoporosis presents with insidious onset of hip pain and antalgic limp with no antecedent infection or trauma. Radiographs show pronounced osteopenia of the femoral head and neck with preservation of the joint space. 1 Bone scan and magnetic resonance imaging are sensitive but not specific for diagnosis, and laboratory studies are typically normal. 2 We present the case of a patient with a displaced, grossly unstable subcapital hip fracture who presented 5 months postpartum and describe successful treatment by open reduction and internal fixation with a muscle-pedicle bone graft.

Cementation for femoral head osteonecrosis: a preliminary clinic study.

Treatment for femoral head osteonecrosis has been less successful in late stages of the disease, after progression to collapse. The current authors treated 21 patients (22 hips) with Stage III osteonecrosis by a technique of open reduction and fixation with methylmethacrylate cement (cementation). The followup ranged from 1 to 3 years (average, 1.7 years). Patient progress was followed using preoperative and postoperative Harris hip scores, Western Ontario and McMaster Universities Osteoarthritis Index, and a health status questionnaire (Short Form-36). Patients were staged preoperatively using the Association Research Circulation Osseous international classification system and radiographic evaluation was done intraoperatively and postoperatively. The Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36 physical health scores improved significantly from 53.5 to 78.0, 66.0 to 48.1, and 27.0 to 40.0, respectively. The outcome was worse for patients with more advanced disease. Six patients, all with severe disease, had total hip arthroplasty. Cementation is technically simple, enables patients' immediate postoperative pain relief and improvement in mobility, and has the potential to restore and maintain the sphericity of the femoral head after collapse. The high failure rate (27%) at short-term followup, although comparable with other reported techniques, does not support generalized use for Stage III disease. Currently the use of this procedure is restricted to symptomatic, young patients (younger than 40 years), preferably with mild to moderate Stage III disease (degree of head involvement < 30% and degree of collapse < 4 mm).

Retinal detachment in East Africa.

PURPOSE: To report the causes of retinal detachment in an African setting and the outcome after surgery. DESIGN: Noncomparative interventional case series. PARTICIPANTS: A total of 361 eyes in 345 patients. METHODS: Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression. MAIN OUTCOME MEASURES: Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation. RESULTS: The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up. CONCLUSIONS: Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.