Bernard Jacobs

Malignant Fibrous Histiocytoma and Osteosarcoma in Association with Bone Infarcts

Four patients, two of them former caisson workers, had malignant tumors of bone associated with bone infarcts in the femur. One of the tumors was osteogenic sarcoma and the other three were malignant fibrous histiocytomas. Despite amputation and other treatment, only one patient survived.

Lower Extremity Amputation in Diabetic Patients

One hundred and seventy-eight lower extremity amputations performed on 103 diabetic patients were reviewed. Although the healing rate for the above-the-knee amputation was higher, the probability of prosthetic use and ambulation was greater with the mid-leg amputation, particularly if the patient required bilateral amputation. Late breakdown of the mid-leg stump, once healing had occurred, was not a significant problem. We feel that the proper amputation level is bestdetermined by the skin temperature and appearance at the proposed amputation site rather than rigid reliance on the presence of pulses, oscillometry, or arteriography and that every effort should be directed to retaining a functioning knee.

Acromioclavicular-joint Injury: An End-result Study

From 1933 to 1959 sixty-two partial separations and fifty-four complete separations or dislocations of the acromioclavicular joint in 116 patients were treated on the Combined Fracture Service of The New York Hospital and The Hospital for Special Surgery. Fifty patients were treated non-operatively and sixty-six, surgically. Ninety-four of the 116 patients returned for follow-up evaluation from five to thirty-five years after treatment. Forty-three of fifty patients treated non-operatively were evaluated. At follow-up twenty-one were asymptomatic, thirty-four had normal shoulder motion, and only four had no residual deformity of the acromioclavicular joint. Twenty-nine of the thirty-five patients treated by open reduction and ligament repair were re-examined. At follow-up fourteen were asymptomatic, twenty had normal shoulder abduction, and fifteen had no residual deformity. Of the six patients treated by coracoclavicular screw fixation, two were asymptomatic, two had normal shoulder abduction, and four had no residual deformity at follow-up. Sixteen of the twenty patients treated by partial claviculectomy were reexamined. Seven were asymptomatic, thirteen had normal motion, and ten had no residual deformity at follow-up. Of the patients re-examined, only twelve were dissatisfied because of residual pain. Of these, six had been treated by open reduction and ligament repair, one by a coracoclavicular screw, and five non-operatively. For complete dislocations the results were quite similar with respect to residual pain and function, regardless of the type of treatment or the degree of residual separation. The causes of symptoms are analyzed and recommendations for treatment are presented.

Opposition of the Thumb and Its Restoration

The restoration of opposition is feasible by means of several operative approaches. Among them the Thompson procedure offers a relatively simple yet effective method. If failure occurs it can seldom be attributed to a fault of the particular method employed; it is much more often caused by the selection of an inadequate motor tendon or its insertion under insufficient tension. Residual power and function of the hand and the relationship of the hand to the extremity as a whole must be carefully appraised before attempting to restore opposition of the thumb. If contracture of the thumb has occurred, this deformity should be corrected prior to (or at the time of) tendon transfer. The restoration of opposition of the thumb in children should not be delayed because of age or skeletal immaturity.

Femoral neck fractures complicating gaucher disease in children

In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton [16, 17]. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One childs fracture was preceeded by multiple bone “crises” localized to the proximal femora.

Varix involving the tibia.

A white roan, si.xt ’-six years old, was admitted to the Bronx Veteramis Admnimiistratiomi Hos1)ital complaining of chronic swelling which had been present in the left leg for the past forty years. The patient was well until 1918, when the anterior aspect of the lower portion of his left leg was hit by the hubcap of a passing army truck. The local swelling subsided promptly and the patient’s only complaint ‘as tingling in the left leg and foot. About two years after the imijury, the left leg began to swell, which led the patient to seek medical advice amid hospitalization on mnany occasions. Apparently, the only previous form of treatment had consisted in the various modalities of phiysiotherapy. On one occasion mild phlebitis was diagnosed, and the patient was treated with bedrestand elevation of the left leg. The Patient denied any history of ulceration, dermatitis, or pulnionary emboli.

Varix Involving the Tibia: A CASE REPORT

The second case of a varix involving the tibia is reported. It is theorized that it arised from post-traumatic dilation of pre-existing transcortical veins.