Alexander P. Aitken

Volar Transnavicular Perilunar Dislocation of the Carpus

A case history of an extremely rare volar perilunar dislocation of the carpus with fracture of the navicular has been presented. The mechanism of injury in this patient was a force directed to the dorsum of the partially flexed hand. This fracture-dislocation presents the reverse picture of the more common dorsal perilunar dislocation. Our explanation of the mechanism of the production of lunar and perilunar dislocation is presented.

Fractures of the Proximal Tibial Epiphyseal Cartilage

Fracture of the proximal tibial epiphyseal cartilage is one of the most uncommon fractures of childhood. The immunity of this cartilage plate to injury is due to the absence of powerful ligamentous attachments to the periphery of the epiphysis. Most reported cases have resulted from hyperextension injuries and show posterior displacement of the tibial shaft with a high incidence of damage to the popliteal vessels. Two unusual cases are presented, both of which show an apparent anterior displacement of the shaft in relation to the epiphysis. In Case 1, the type of fracture has been reported only twice previously, while the medical displacement found in Case 2 has never been reported.

End results of ruptured intervertebral discs in industry

Abstract We are well aware of the fact that the average compensation case is not the best possible material for a favorable end result study. The desire for financial reimbursement for injuries received is of paramount importance to many individuals. That this fact has definitely influenced the end result cannot be denied. However, the period from 1940 to 1944 was one of intense industrial activity brought on by the war. High wages were to be had even by patients who had partial disability. As a result, the results during this period are probably better than they would be in normal times. Nevertheless, the end results of operation for rupture of the intervertebral disc in compensation cases as performed throughout the country from 1940 to 1944 leave much to be desired. Only 13 per cent are symptom-free and capable of performing heavy laborious work. Seventeen per cent have some persistent symptoms but are capable of doing all but the heaviest type of work. Twenty-five per cent have pain and are able to perform only light work. Classed as bad results, 42 per cent continue to have pain and have never returned to any type of work. There was a 3 per cent mortality. The comparison of the 42 per cent bad results against the 30 per cent good results is striking. The percentage of error in diagnosis with present diagnostic criteria is about 40 per cent. Secondary operations were required in 24 per cent of all cases.

Rupture of the intervertebral disc in industry; further observations on the end results.

Abstract A resume is given of the end results of 200 patients operated upon for rupture of the intervertebral disc as a result of industrial accidents between the years 1947 and 1949. The results of this operation in industrial cases are poor and show little if any improvement over a comparable series covering the years from 1940 to 1947. The diagnostic error in this series was 17.5 per cent indicating that the diagnosis of a ruptured disc in the average case cannot be made easily. A review of the diagnostic criteria is given including distribution of pain, effect of coughing and sneezing upon pain, total protein determination, myelogram and neurologic findings, and the fallibility of any or all symptoms, tests or findings are pointed out. The importance of adequate conservative treatment not only as such but also as a diagnostic aid is emphasized. Some of the more common errors in the handling of such cases are discussed. The need for more effectual cooperation between the neurosurgeon and the orthopedist is stressed. The facts pointed out in this paper are not to be construed as a condemnation of the operation for rupture of the intervertebral disc. This condition is a true pathologic entity which requires definitive treatment. The breezy attitude of many surgeons in approaching this problem, the lack of adequate study, the failure to appreciate psychologic effects of injury, the facility with which surgery is recommended and the inadequacy of its performance are to be condemned. In time it is hoped these deficiencies will be corrected; then we will see a decrease in the volume of surgery with a vast improvement in our end results.

Calcareous Tendinitis of the Flexor Carpi Ulnaris

THE relation between amorphous calcium deposits lying in close proximity to joints and acute attacks of pain in these joints has been recognized in recent years. Such deposits are most commonly fou...

Bone abscess due to Salmonella B. (Bredeney)

Abstract Attention is called to the relative frequency of the salmonella group acting as pyogenic organisms. Soft tissue abscesses, osteomyelitis or pyarthrosis may be produced. The more common strains which involve the skeletal system are the Salmonella typhimurium B which affects chiefly bone and the Salmonella choleraesuis C which has a predilection for joints. In either case the clinical picture is one of acute infection. An unusual case is presented. This case differs from those previously reported in that the lesion was a chronic bone abscess and the infecting organism, Salmonella Bredeney B. has not, to our knowledge, been previously described as being a cause of osteomyelitis. The portal of entry in this case is unknown. Whether the attack of diarrhea which occurred four years previously was due to paratyphoid fever and the source of the bone abscess is conjectural.