F. William Bora

The Treatment of Injuries to the Carpometacarpal Joint of the Little Finger

A roentgenogram of the hand with the forearm pronated 30 degrees from the routine anteroposterior position shows the degree of displacement in an intra-articular fracture through the base of the little finger metacarpal. Fracture of the base of the little finger metacarpal without displacement or with minimum ulnar displacement was satisfactorily treated with a molded cast. Power grip is improved if fractures of the carpometacarpal joint of the little finger with ulnar and proximal displacement are corrected. All fractures which resulted in displacement requiring open reduction and pin fixation had a delay of three days or more in treatment, so early treatment is recommended.

Peripheral Nerve Repair in Cats: The Fascicular Stitch

This experimental study was designed to compare the functional return after epineurial suture and perineurial suture of the surgically divided sciatic nerve of cats. In this study muscles distal to the nerve lacerations were reinnervated more rapidly and more completely after the perineurial suture. Sensory return following both types of repair was the same. Neuromas at the repair site were smaller when the perineurial stitch was used. Accurate fascicular alignment and contact was observed more consistently when the fascicular stitch was used.

A study of nerve regeneration and neuroma formation after nerve suture by various techniques.

The effectiveness of epineurial, perineurial, and a combined epiperineurial methods of nerve suture in the severed sciatic nerve of rabbits was studied by biochemical assay of the collagen just distal to the neuroma and the collagen and myelin of the posterior tibial nerve. Repairs were done both immediately after severance and in a separate group 3 weeks later. More collagen was found near the neuroma in the immediate epineurial group, but 60 per cent of the normal myelin was found in the posterior tibial nerve after the immediate epineural suture compared to 28.3 per cent in the immediate perineurial group.

Inhibitors of Collagen Biosynthesis as a Means of Controlling Scar Formation in Tendon Injury

After tendon injury, the formation of peritendinous adhesions restricts the gliding of the healed tendon. In this study, attempts have been made to reduce the amount of adhesions with four drugs. Four agents which are known to alter collagen biosynthesis were tested for their ability to inhibit scar formation in the repair of an incision in a tendon. α, α-dipyridyl, beta-aminopropionitrile, D-penicillamine and cis-hydroxyproline were all found to decrease the amount of scan formed around the flexor tendon. α, ά-dipyridyl showed significant toxic side effects. Rats treated with beta-am inopropionitnile showed moderate toxicity. D-penicillamine-treated rats showed minimum toxicity, but with the dose employed, this drug was slightly less effective than the others. Cis-hydroxyproline showed no toxic side effects in our experiments. The inhibition of collagen biosynthesis by proline analogues is a new approach to the problem of reducing scar formation. Further study is needed before considering its use in clinical situations.

The treatment of ruptures of multiple extensor tendons at wrist level by a free tendon graft in the rheumatoid patient

We report the results of the treatment of multiple ruptures of extensor tendons to the fingers at wrist level in the rheumatoid patient by free tendon grafts. Twenty-three patients averaged 65 degrees of active motion at the metacarpophalangeal joints when seen at an average follow-up of 43 months.

Regeneration after nerve transection: Effect of inhibition of collagen synthesis

Abstract Dense collagen scar forms at the cut ends of transected nerves, and impedes nerve regeneration. To minimize scarring, we treated rats with the proline analog, cis -hydroxyproline, from day 4 to 21 after sciatic nerve transection and reanastomosis. Twenty-eight days after surgery, there was 47% less collagen in the distal nerve stump of treated rats than of controls. Seventy days after surgery, posterior tibial nerve content of the myelin lipids, sulfatide, and unesterified cholesterol, was 40% higher in treated rats than in controls.

The biomechanical responses to tension in a peripheral nerve.

The biomechanical adjustments rat sciatic nerves make to tension were studied 7 weeks after experimental nerve repair. Nerve tissue adjusts to tension by increasing its compliance if stretched within its physiological limits. Anatomical changes observed in the nerve tissue 7 weeks after stretching apparently accounts for the nerves extensibility, a biomechanical adjustment that helps preserve nerve continuity during the joint extension phase of extremity rehabilitation.

Prosthetic nerve grafts: A resorbable tube as an alternative to autogenous nerve grafting

The use of a prosthetic nerve graft, composed of a resorbable polyorthoester tube, as an alternative to free autogenous nerve grafting for the treatment of a gap in a peripheral nerve was studied, with a cat sciatic nerve as the model. The results demonstrate that regeneration will occur through a resorbable tube spanning a 1.5 cm gap and reinnervate end organ muscle. In those muscles showing evidence of reinnervation, nerve regeneration through the tubes as assayed by electrophysiologic examination demonstrated no difference compared with autogenous nerve grafts, with the exception that the initial rate of regeneration was delayed by 4 to 6 weeks.

Osteoid osteoma of the carpal bones

Three cases of osteoid osteoma of the carpal bones are described, with a review of the literature. The scaphoid is the carpal bone involved most frequently. Typically the lesions are painful and respond to aspirin. Roentgenologic finding of the central area of lucency surrounded by sclerotic bone often is diagnostic. Block excision with bone grafting is an acceptable method of treatment.

Lipofibromatous hamartomas of the median nerve.

Five cases of lipofibromatous hamartoma of the median nerve are reported. The initial onset of symptoms and recognition of a mass occurred in adults in four cases. The fifth patient was an infant when the mass was first noticed, and she also had macrodactyly. Treatment included carpal tunnel release in three patients, one of whom required a second procedure for excision of the mass and sural nerve grafting. Nerve ablation without grafting was performed in the other two patients; one of these patients noticed no sensory or motor deficit after surgery. From this small series we cannot recommend a preferred treatment for these patients; each case must be approached on an individual basis. The diagnosis is best confirmed by biopsy.