Joseph L. Posch

Free Full-Thickness Skin Grafts from the Palm to Cover Defects of the Fingers

: Although nonsurgical treatment of osteoporotic vertebral compression fractures, including medication, exercise, bracing, and bed rest, have been reasonably effective, vertebroplasty and kyphoplasty have evolved as valuable adjunctive treatment options. Over the past decade, vertebroplasty, which involves the percutaneous injection of bone cement directly into the fractured vertebral body, has been used as a treatment for painful osteoporotic vertebral body compression fractures, a leading cause of morbidity in the elderly. Kyphoplasty, another minimally invasive procedure that allows for correction of spinal deformity and for controlled cement filling of the fractured vertebral body, involves the percutaneous cannulation of the vertebral body followed by the placement of an inflatable bone tamp. Reported results for both vertebroplasty and kyphoplasty suggest rapid improvement in pain and physical functioning in patients with osteoporotic vertebral compression fractures. Kyphoplasty allows for low-pressure cement injection and affords the opportunity to correct spinal deformity. Further study is required to define the precise indications, timing, and relative merits of these techniques.

High-pressure injection injuries of the hand.

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.

Thrombosis of the Ulnar Artery Following Blunt Trauma to the Hand

Thrombosis of the distal ulnar artery secondary to a blunt injury to the hand may give characteristic neurological and vascular symptoms, yet is easily confused with other conditions. Recognition of this entity is important so that the proper mode of treatment may be applied. Resection of the thrombosed segment and ligation of the proximal and distal ends is the treatment of choice. Satisfactory results were obtained in our series of ten patients with resection of the thrombosed Segment.

Treatment of intertrochanteric fractures of the femur.

the three main methods of 3. Internal fixation is usuahy the method of choice because it aIIows free motion of the Iegs and frequent change of position in bed and out. At times, however, intertrochanteric fractures are so badIy comminuted and the condition of the patient such that it is impossibIe to use interna fixation. treating these fractures and criticizes each as foIIows : I. ExternaI spIints or casts confine the patient to such a degree that a change of position is difficuIt. This confinement encourages the formation of pressure uIcers, muscuIar wasting, and residua1 joint stiffness that may deIay genera1 recovery. 2. Traction devices hoId the patient in a supine position, and because of this, bedsores and hypostatic pneumonia occur rather frequentIy. “ We11 leg” traction does permit patients to be turned or with assistance to be pIaced in a whee1 chair, A method of treating intertrochanteric fractures by means of a hanging cast was recentIy described by Johnson.2 By this method the mortahty rate in his series of over fifty cases was decreased from 39.3 to 18 per cent and the duration of hospitaIization shortened by twenty-two days. * From the City of Detroit Receiving Hospital and the Department of Surgery of Wayne University ColIege of Medicine, Detroit, Mich.

Secretan's disease: Post-traumatic hard edema of the dorsum of the hand.

Five cases are presented of hard, brawny edema of the dorsum of the hand, typical of Secretans disease. We now believe splinting and active exercise to be the initial treatment of choice. Only after months of such conservative management should one resort to surgery.

Secondary tenorrhaphies and tendon grafts in injuries to the hand

Abstract In a series of twenty-three cases with free tendon grafts in the fingers good functiona results were obtained in all but four patients. Ten tendon grafts were performed in the thumb, with one failure. Secondary tenorrhaphies were performed on ten patients, with improvement being noted in all except one. The tota range of motion obtained was less than that noted in tendon grafts. The fundamental problems regarding flexor tendon grafts in the fingers and thumb have been stressed. Concepts developed during the past ten years have been elaborated upon and postoperative rehabilitation has been emphasized.

Injuries to the hand from homemade rockets

Abstract Injuries to the hand from homemade rockets are becoming much more frequent. In the first six months of 1958 eight severe injuries were encountered in the Detroit area alone. Prevention of these injuries is extremely important. The first procedure is extremely important. One should keep in mind the necessity for secondary procedures, and the ultimate aim is maximum function. The surgeon is aided to a considerable extent in the treatment of these particular injuries by the young age of the patient, with his excellent recuperative powers and remarkable capacity for compensating and adapting to disability.

Injuries to the hand in children

Abstract A series of injuries of the hand in children have been presented. The surgical procedures necessary are shown in Table III. Table III Surgical Procedures Primary tenor- Tendon graft 21 raphy 34 Pedicle graft 9 Primary neuror- Secondary tenor- rhaphy 19 rhaphy 7 Fixation of fractures 25 Secondary neuror- Amputations 13 rhaphy> 2 Lacerations 14 Bone graft 1 Skin graft 46 Tendolysis 1 Ages, sex, etiologic factors, types of injuries and treatment have been discussed. Prevention has been emphasized and follow-up care mentioned.

Acute burns of the hand

Abstract It has been the purpose of this paper to point out the simple and yet effective ways for the evaluation of the arterial circulation to the foot and to emphasize the types of trauma which may lead to serious consequences. Some forms of trauma stem from improper advice given by physicians who have not determined that the foot was inadequately supplied by a normal arterial blood flow. Illustrative cases have been cited which point up the types of trauma and the unfortunate consequences, the majority of which could have been avoided.