Alan A. Halpern

Sit-up exercises: an electromyographic study.

The effect of 5 different sit-up regimens on the abdominal muscle activity were investigated by electromyography as well as the degree of lumbar flexion required with each type of sit-up. In the long-lying position the rectus abdominus muscles were only active an average of 34% of the sit-up cycle. The greatest duration of activity (90%) was found in the shoulder lift hook-lying (knees flexed) sit-up in which the subject elevates the trunk to the point where the scapula is lifted from the mat. In addition, this sit-up requires minimal flexion of the lumbar spine (3 degrees versus 38 degrees) and is less likely to result in increased forces across the lumbar disk. The evidence is that this sit-up is the most effective in terms of abdominal muscle activity and the safest in terms of causing lumbar spinal flexion.

Anterior compartment pressures in patients with tibial fractures.

Twenty patients with tibial fractures had measurements of tissue pressure in the anterior compartment acutely and for the first 72 hours following injury. Measurements were made using a mercury monometric indicator similar to that described by Whitesides. Patients with fractures of the proximal third of the tibia, those with displacement of the fracture fragments greater than 50%, and those whose injury was the result of high-energy trauma developed higher compartment pressures and we conclude that such patients should be observed closely for the development of a compartment syndrome. In normotensive patients in this series fasciotomy was not necessary for tissue pressures less than 50 mm Hg in the absence of any sensory or motor compromise.

Does persistent fetal femoral anteversion contribute to osteoarthritis?: a preliminary report.

Persistence of femoral anteversion into adulthood is a developmental abnormality which Somerville has postulated may predispose to the later development of osteoarthritis of the hip. To test this hypothesis, the femoral anteversion was measured in 20 adult patients with idiopathic osteoarthritis of the hip. The average anteversion in painful hips was found to be 24 degrees compared with 12.11 degrees in the uninvolved hip. None of the pain-free hips had an anteversion of greater than 22 degrees while 54% of those with pain had anteversion greater than this value. While these results are preliminary, they suggest that increased femoral anteversion may definitely contribute to the later development of osteoarthritis of hip.

Allescheria boydii osteomyelitis following multiple steroid injections and surgery.

This is a report of a 46-year-old male who developed an Allescheria boydii infection secondary to excision of an interdigital neuroma. Previously reported cases of infection occurred in an immunosuppressed patient and in patients on systemic corticosteroid therapy, but not associated with a surgical wound. This patient received multiple local corticosteroid injections which may have produced local as well as systemic immunosuppression. Fungal cultures were not taken for many months and thus the true etiology of the infection was not discovered until late. The importance of obtaining fungal cultures particularly in patients receiving corticosteroid therapy, either local infiltration or systemic, cannot be overemphasized.

Compartment syndromes of the forearm: early recognition using tissue pressure measurements.

A compartment syndrome of the forearm can be a devastating injury if not relieved promptly by early fasciotomy. Of five patients who developed compartment syndromes, compartment pressures were measured in four and found to average 69 mm Hg. Tissue pressure measurements provided early objective evidence of the presence of the compartment syndrome and contributed significantly to the ultimate functional recovery. We would advise repeating the measurement for pressures in excess of 30 mm Hg in the upper extremity, and fasciotomy for pressures in excess of 40 mm Hg when accompanied by any neurovascular compromise.

Painful medial bipartite patellae: a case report.

Bipartite patellae, though not unusual as an incidental roentgenographic finding, are rarely painful. This is a report of bilateral medial bipartite patella in a 20-year-old woman, which seems not to have been previously described in the literature. The symptoms were significantly relieved by an excision of the accessory ossification center.

Total hip arthroplasty in the cardiac transplant patient.

Osteonecrosis of the femoral head following cardiac transplantation has led to bilateral total hip arthroplasties in 2 patients. The clinical course and rejections of these patients are outlined. The pathological changes in the femoral heads suggested that the process leading to osteonecrosis in the cardiac transplant patient is the same as that following renal transplantation, both being due to immunosuppression probably related to steroid dosage. Successful joint replacement can be carried out in the cardiac transplant with careful monitoring of anesthesia. Both patients have done well, being followed for 14 and 6 months respectively.

Coccidioidomycosis of the spine: unusual roentgenographic presentation.

Vertebral osteomyelitis is a frequent consequence of disseminated coccidioidomycosis. In a 25-year-old man, the sequela was a single level unilateral osseous bridge between the second and third lumbar vertebra. A review of previous cases has disclosed one case with a similar roentgenographic picture. The occurrence of a single level unilateral reactive process should arouse suspicion of a localized chronic bone infection.

Subclavian artery injury and fracture of the scapula.

A fracture of the scapula is frequently associated with other significant injuries. In the case described, a motorcycle accident victim sustained multiple injuries, including a scapular fracture associated with a tear of the subclavian artery, demonstrated by angiography and confirmed at operation. A literature review revealed no similar case.

Massive synovial cyst of the shoulder causing vascular compromise. A case report.

A 47-year-old paraplegic patient is described who developed a massive synovial cyst of the upper extremity. The cyst developed in combination with a tear of the rotator cuff and the long head of the biceps tendon and involved the fasica surrounding the long head of the biceps. The increased pressure in the cyst resulted in a compartment syndrome of a portion of the long head of the biceps muscle. A review of the literature revealed no similar case.