Joel Engel

The Fate of Injected Trigger Fingers

Patients who were scheduled for surgical release of their trigger fingers underwent an injection of the involved tendon sheath prior to surgery. In thirty-six patients the injection of methylene blue was undertaken in a proximal-distal direction and in forty-three the direction of the injection was reversed. The success rate of the injections was 61 per cent, in the proximal distal group and 37 per cent in the second group. There was no significant statistical difference with regard to age, but duration of the disorder and mode of injection regarding the different fingers did have statistical significance.

Minimal Tourniquet Pressure to Maintain Arterial Closure in Upper Limb Surgery

Complications of the pneumatic tourniquet used during limb surgery result from excessive direct pressure. Traditional recommendations suggests parameters for maximum pressure and time limits rather than the minimal effective pressure to achieve a bloodless field. A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate haemostasis in the upper limb. The correlations between several possible influencing parameters (age, sex, arm fat thickness, extremity length, systolic, diastolic, and mean blood pressures) and the minimal pneumatic tourniquet pressure at which the peripheral pulse reappeared were studied in 50 patients undergoing surgery, using a Doppler stethoscope. The average Doppler Opening Pressure was 168.5 ± 42.7 mmHg and the only significant clinical variable was the mean blood pressure. From these results an equation was derived to predict the minimal effective tourniquet pressure. The mean calculated tourniquet pressure was 202.3 ± 34.2 mmHg, well below the 250 to 300 mmHg previously recommended. The technique consisted of inflating the tourniquet to a pressure of 300 mmHg, then reducing it to the calculated value. A bloodless field was maintained in all patients.

A comparison between K-wire and compression screw fixation after arthodesis of the distal interphalangeal joint.

Thirty patients underwent arthrodesis of the distal interphalangeal (DIP) joint for various injuries. Fixation with K-wires was compared to fixation by compression screws. The screw method came to be preferred by us, principally because the immobilization time was significantly less and the patients returned to work more quickly. The success rate of fusion and the time required for it were about the same.

Aneurysmal bone cyst of the hamate bone

An aneurysmal bone cyst (ABC) is an uncommon benign bone lesion that principally occurs in long bones and in the vertebral column. The appearance of ABC in carpal bones is very rare. We report a case of ABC that occurred in the hamate bone.

Late Complications of Neonatal Volkmann’s Ischaemia

A child was born with ischaemic damage to the skin and muscles of the left upper limb. Repeated surgery of the soft tissues resulted in a functional limb. Recent röentgenograms show extensive metaphyseal and epiphyseal damage. This case is reported for its uniqueness and to stress the necessity of long term follow-up.

Wrist arthrodesis: modified Gill's technique.

Twenty-five wrist arthrodesis procedures were performed on 24 patients, applying a modification of Gill’s technique, which used a corticocancellous strut graft from the distal radius. Patients were followed up until solid bony fusion was established. Union was achieved in 21 of 25 wrists and was subsequently achieved with a further procedure in the remaining four wrists. We have found that the modified Gill’s technique is a reliable, simple procedure with a low complication rate which does not require the harvest of a distant bone graft.

The role of three dimension computerized imaging in hand surgery

Three-dimensional computerized imaging is a new modality of radiological imaging. This new technique transforms the two-dimensional slices of bi-plane CT into a three-dimensional picture by a computers monitor adjusted to the system. This system enables the physician to rotate the angle of viewing of the desired region to any desired angle. Moreover, this system can delete certain features of different densities from the picture, such as silicone implants, thus improving visualization. Our preliminary results using this technique are presented. The advantages, pitfalls, and suggested future applications of this new technique in hand surgery are discussed.

Carpal tunnel syndrome due to carpal osteophyte

An unusual case of carpal tunnel syndrome is presented in which the excessive pressure in the tunnel was caused by an osteophyte. The importance of axial x-ray views of the tunnel in diagnosing such cases is stressed.

Persistent dislocation of the shoulder in elderly patients.

Four elderly patients with longstanding unrecognized dislocation of the shoulder were treated by physiotherapy only. Good functional results, associated with a greatly increased range of pain‐free motion, demonstrate the usefulness of conservative treatment in cases of persistent dislocation of the shoulder in the elderly.

Diagnosis of Osteoid Osteoma Using Computerized Tomography

A thirty-seven-year-old male with Osteoid Osteoma of the proximal ulna is described. He had suffered from pain in his elbow for two and a half years prior to diagnosis. Computer Tomography demonstrated and localised the nidus which was surgically removed.