Carlo Scuderi

Ruptures of the quadriceps tendon: Study of twenty tendon ruptures

tendon or produce a supraor dicondyIar fracture of the femur. The tendon defect may not be readiIy detected due to the hematoma formation about the knee which is associated with this injury. In addition, x-rays taken revea1 no fracture. With the patient supine and the knee in the extended position there is no appreciabIe drop of the patelIar IeveI. For this reason, some ruptured quadriceps tendons are not recognized for several weeks foIlowing the accident unti1 the sweIIing subsides and the patient is found to have lost active voIuntary extension of the knee. I treated the foIlowing group of cases from September, 1938 to August, 1935. These have a11 been treated in private or charity practice, exclusive of mihtary service. Not one case was seen during my miIitary experience when I was in charge of orthopedic surgery in one of the large genera1 hospitaIs in the zone of the interior, for approximateIy two years. Eighteen patients with twenty ruptures of the quadriceps tendon were treated. (Table I.) Two patients had biIatera1 ruptures; one was a woman of seventy and the other a man of sixty-eight years of age. In both cases onIy one Ieg required surgica1 repair, the other side having an incompIete tear. The power of voIuntary extension of the knee was very weak, but present. In time aImost compIete return of the quadriceps strength was attained in the unoperated Ieg. Three patients were seen Iate, one at six weeks who refused surgery in spite of the fact that he was unabIe to go up or down stairs without hoIding on to the banister. Another was seen at seven and one-haIf weeks with about 60 per cent tear of the quadriceps, but with good range of voluntary knee extension, although weak in quadriceps power. The third case was a priest who had injured his knee ten weeks previousIy and went eIsewhere for the surgery. The end result of this case is unknown to me. Two of the patients had been operated upon in neighboring states and were referred to me for foIIow-up care because they lived in Chicago. I operated upon thirteen patients and observed them from eight months to two years thereafter. Two cases were the resuIt of direct cutting injuries, one the resuIt of a knife wound and the other the resuIt of a windshieId cut caused by a head-on coIIision. Eighteen ruptures were the resuIt of indirect GioIence. The patient either tripped or feI1, the knee or knees buckIed, and apparentIy one, two or a11 three of the foIIowing prerequisites were present: (I) vioIent contracture of the quadriceps muscle in an attempt to break the faI1, with the knee partiaIIy bent; (2) an ex-

Compound fractures of the elbow joint in adults

T HE increasing frequency of automobiIe accidents has produced a great number of bad compound comminuted fractures of the eIbow joint. A large percentage of these are of the Ieft elbow, due to the custom of driving with the elbow protruding from the car window. As the bodies of the cars are wider, when an accident occurs the arm is exposed to terrific vioIence. A discussion of compound fractures of the eIbow must be opened primariIy with a ful1 discussion of a method of treatment of compound fractures that has proved satisfactory, not onIy in the eIbow, but in other regions. This method we have used successfuIIy with 91 per cent cIean cases, irrespective of the muItiplicity of the injuries or the extent of the compounding. Where there is no great destruction of tissue or lacerated or incised wounds, we have nearly IOO per cent cIean wounds. The method is as folfows: I. Cover the wound with steriIe gauze. 2. CIeanse surrounding area and shave any hair present. 3. Wash and cleanse wound and edges of wound with soap, water and norma salt soIution. 4. Debride aI avascuIar tissues. Cut away dirty edges of wound with scissors or knife. If separate spicuIes of bone are dirty and detached they must be removed. If dirt is ground Into one of the bone fragments the dirt may be removed from this bone: fragment with a chise1 or a rongeur. Irrigate freely with norma saIt soIution. 5. The wounds are sutured IooseIy, the sutures being stitches from I ” to I! 4” apart. Clry dressings are applied and changed every six hours during the first two days in order to obtain the maximum capillary drainage and to prevent any fermentat ion. When the marked extravasation of scum decreases, the dressings may be left in pIace unti1 the remova of the stitches. This method, in our hands, has been far more satisfactory than the use of Dakin’s cr any other group of antiseptics. The reasons why wounds treated in this manner rc:main cIean are: I. The skin edges are Ioosely coapted and this permits the subsequent oozing of blood to carry away froeign bodies that have escaped the observation of the surgeon. 2. The serum that is thrown out later by every wound tends to dissoIve and force out any excess bIood cIot, nourish the injured tissues, and carry away foreign bodies, as we11 as destroy dead tissues. 3. The dry dressings afford a maximum capiharit:,, so that al1 serum and blood that has been extruded may be rapidIS absorbed; and the six-hour change of these dressings is sufhcient to prevent fermentation or growth of bacteria in the extruded secretions.

Backache; diagnosis and treatment from an orthopedic standpoint.

The procedure and salient points in the history, physical examination and x-ray studies are presented so as to facilitate the diagnosis. Once the diagnosis is established, the recommended therapy is proposed. Myelography in the diagnosis of herniated disk is discussed and therapy for this condition outlined.

Supracondylar fractures of the femur; a recommended treatment for non-unions and fresh fractures.

S UPRACONDYLAR fractures of the femur are a real chahenge to everyone who treats them because of the frequent diffrculty one has in attaining adequate reduction and immobilization and because of the additional fact that considerabIe knee motion is permanently lost due to the required period of immobiIization. A method which permits accurate reduction and firm fixation of the fracture shortens the period of disability because of faster callus formation and also permits earlier mobilization of the knee, minimizing the ultimate loss of knee motion. The authors believe that the use of the blade plate in fresh cases offers these definite advantages. Only when a supracondylar fracture is in exceIIent position shouId conservative treatment such as traction or cast immobiIization be used. Once displacement of some degree is present it is beIieved that a definite surgica1 indication exists. Non-union of supracondyIar fractures of the femur in recent years has been found to be common. In this series are three patients who were operated upon for non-union of the fracture within a period of three months. Up to March 28, 1950, when the first patient was operated upon for a non-union (C. K.) using a massive bone graft and blade plate, innumerable other methods had been tried with indifferent resuIts. The reduction was often inadequate, the period of immobilization long and the Ioss of knee motion great. The gamut of skeIetaI traction, Roger Anderson pins with externa1 bar fixation, bent knee in a spica cast, Russel traction, intermedulIary autogenous bone grafts and intramedullary beef bone grafts were found to be successful in some cases, but the end results Ieft one with much to be desired. Perforation of the popIitea1 artery, although frequentIy referred to in textbooks, was found to occur onIy once in twenty-one years. The number of supracondylar fractures seen during this period could we11 be in dozens rather than in singIe digits.

AN UNUSUAL CARPAL FRACTURE DISLOCATION: REPORT OF CASE

In reviewing the literature of the past ten years on carpal injuries we have been unable to find a reference to any case in which a fragment of the navicular bone and the entire lunate were dislocated into the volar surface of the lower third of the forearm. In order to permit such a displacement between the flexor tendons, the annular ligament of the wrist must have been torn. This case is being reported because the bones were dislocated so far from their normal position and because the end result of carpalectomy was excellent. W. L., a Negro girl, aged 17 years, admitted to the Cook County Hospital, March 12, 1933, was in a condition of serious shock. While washing windows, she fell out of a fourth story window, landing in a cement courtyard. The injuries are enumerated as follows: Basal skull fracture with bilateral ecchymosis of the orbits