Fred M. Hankin

Distal biceps brachii tendon avulsion: A simplified method of operative repair

Rupture of the distal insertion of the biceps brachii may lead to severe functional impairment of the upper ex tremity on the basis of resultant weakness of elbow flexion and supination. When the diagnosis of a post- traumatic distal biceps tendon avulsion is made, a simple method of reattachment is possible and func tionally warranted.

Lipofibromas of the median nerve: Long-term follow-up of four cases

Four cases of lipofibromatous infiltration of the median nerve with long-term follow-up (average 11 years) are reported. Progressive compromise of median nerve function has been noted. Initial treatment considerations should be directed toward biopsy and alleviation of the compression neuropathy. The role of microsurgical debulking procedures remains unclear at this time.

Rupture and displacement of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Preoperative diagnosis.

The evaluation and treatment of injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb remain controversial. In a retrospective study that was done to assess our ability to determine whether displacement of the ligament (a Stener lesion) was present, we reviewed our accumulated experience with patients who had an injury of this ligament who were treated surgically between 1972 and 1984. Since our method of evaluation changed in 1977, we compared the preoperative and operative diagnoses in the twenty patients who were treated surgically from 1972 through 1976 with those in the twenty patients who were so treated from 1977 through 1984. Considering all forty patients who were treated operatively, sixteen (40 per cent) had a typical Stener lesion, and in two others (5 per cent) the ulnar collateral ligament was rolled up on itself and lying beneath the adductor aponeurosis. From 1972 through 1976, stability was tested with the metacarpophalangeal joint in complete extension or in varying amounts of flexion. Of the twenty thumbs that were evaluated by this technique and were treated surgically, 20 per cent had a Stener lesion. From 1977 through 1984, stability was tested with the joint in full flexion because of the findings in anatomical studies that were completed in 1977; the incidence of a Stener lesion in the twenty thumbs that were treated by repair or reattachment of the ligament during this time was 70 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyarthrosis of the knee : treatment considerations

Patients with pyarthrosis of the knee can be effectively managed by several different methods. A retrospective review of patients with the diagnosis of septic arthritis of the knee was undertaken to determine the efficacy of two different treatment programs. Multiple-needle arthrocentesis was contrasted with formal arthrotomy drainage. In this series, patients with a longer than three-day history of a knee pyarthrosis and those with Staphylococcus aureus or enteric gram-negative organisms on culture benefited from open drainage procedures in lieu of repeated aspiration techniques.

Symptomatic relief following carpal tunnel decompression with normal electroneuromyographic studies.

Carpal tunnel syndrome is a frequently encountered clinical entity. A retrospective study of a selected patient population revealed 12% of patients to have normal electrodiagnostic studies. Operative release of the transverse carpal ligament in these patients alleviated median nerve entrapment symptoms. Entrapment neuropathy of the median nerve remains a clinical diagnosis, and absolute reliance on electrodiagnostic studies is unwarranted when making a decision to surgically treat a patient with a suspected carpal tunnel syndrome.

Central carpal instability - Capitate lunate instability pattern: Diagnosis by dynamic displacement

Eleven patients have been diagnosed as having a central carpal instability that has, to our knowledge, not been previously described. The clinical symptom complex is one of pain and clicking in the region of the midcarpus and, at times, frank snapping, usually while lifting heavy objects. Tight grasping, especially in supination, tends to provoke the symptoms. In ten of the patients, the diagnosis of instability was demonstrated by a dynamic traction displacement technique with the aid of fluoroscopy, in one patient the instability pattern was recognized only at the time of surgical exploration of the carpus. One patient has undergone a surgical procedure to reinforce the dorsal ligamentous support at the capitate lunate area. The other ten patients have become asymptomatic as a result of modifying their activities. The capitate lunate instability pattern (CLIP wrist) is a definite and distinct entity, which may be diagnosed with appropriate studies.

A three-phase analysis of the prevention of recreational softball injuries

Recreational sports injuries are expensive to society. Prevention of such injuries must be a major public health goal. In a previous retrospective study, base sliding was found to be responsible for 71 % of recreational softball injuries. Because most injuries occurred during rapid deceleration against stationary bases, quick-release (break-away) bases were evaluated as a means to modify this mechanism of injury. In a prospective study, 633 softball games were played on break-away base fields and 627 games were played on stationary base fields. Forty-five sliding injuries occurred on the station ary base diamonds (1 injury for every 13.9 games) and only two sliding injuries occurred on the break-away fields (1 injury for every 316.5 games). The medical costs for injuries on the stationary base fields was 79 times greater than that on the break-away fields. In a 1035 game follow-up study performed on all fields equipped with break-away bases, two sliding injuries occurred (1 injury for every 517.5 games). Installing break-away bases in fields used by recrea tional leagues would achieve a significant reduction of serious softball injuries (98%) and, therefore, should be mandatory. Based on our findings, the Centers for Disease Con trol has estimated 1.7 million injuries would be pre vented nationally per year, saving

Eosinophilic granuloma : the management of solitary lesions of bone

2.0 billion per year nationally in acute medical care costs.

Hydrogen peroxide as a topical hemostatic agent.

Solitary eosinophilic granuloma (EG) lesions of bone can represent diagnostic and treatment dilemmas for the orthopedic surgeon. A retrospective review of one institutions experience with isolated EG skeletal lesions over a 30-year period was undertaken. Solitary lesions responded well to most treatment modalities (e.g., curettage, excision, and irradiation) and infrequently resulted in functional impairment. While EG involvement in bone can be a manifestation of a systemic histiocytosis, single-focus skeletal involvement appears to be a benign pathophysiologic process.

Arthrodesis of the wrist: Past and present

Many research efforts have been directed toward enhancing the bone-cement interface of total joint arthroplasties. Hemostatic agents have been popularized as effective means of retarding the development of potentially harmful debris interposition adjacent to, and blood lamination patterns within, the methylmethacrylate. The hemostatic effectiveness of hydrogen peroxide was tested on six metaphyseal bone beds in ten mongrel dogs: three sites were treated with hydrogen peroxide and three were saline-treated control sites. The hemostatic effect of the treatments was determined by comparing blood loss per unit area per minute before and after application of the test solutions. The results indicate that hydrogen peroxide is an effective hemostatic agent and reduces the amount of blood and debris trapped within the trabecular bone methylmethacrylate interface.