Lawrence M. Lubbers

Treatment of subtrochanteric fractures with a sliding screw-plate device.

In a series of 45 subtrochanteric fractures treated with a sliding screw-plate device, union was achieved in 43 patients (95.3%). Most were Seinsheimer Type II C (9), Type IIIA (12), and Type V (18). Fractures were stabilized in a valgus position (average, 140 degrees), with primary medial displacement of the femoral shaft (25 patients). Radiographic analysis of the degree of postoperative impaction of the fragments correlated with the fracture pattern. Fractures with medial cortical comminution such as Type IIIA and Type V were the most unstable, with an average of 10.8 and 8.0 mm axial impaction, respectively, and were at the greatest risk of complication. The sliding screw-plate device is a reliable method of achieving union in subtrochanteric fractures.

A standardized measurement of ulnar carpal translocation

45 seconds without severe pain recurring and pinch strength falling again to 10 pounds (Fig. 1). Diagnosis of a chronic, exercise-induced, compartment syndrome in the first dorsal interosseous muscle was made. The patient had a release of the fascia of the first dorsal interosseous muscle and of the adductor pollicis through a 1% cm, V-shaped incision made in the first dorsal web space under local anesthesia. By 2 weeks after surgery, he could pinch repetitively without the aching discomfort (Fig. 1). He was placed on gentle pinching exercises in the immediate postoperative period to permit stretching of the fascial compartments. By 1 month after surgery, he was able to work without problems. Two months later, the opposite hand had a similar procedure.

Long-term results of the minimal resection Darrach procedure

Eighteen patients had a minimal resection Darrach procedure at the distal radial-ulnar joint for treatment of posttraumatic arthritis. The follow-up averaged 8 years (range, 2 to 18 years). Fourteen patients were completely satisfied with the result achieved with the procedure and four were mostly satisfied. No patient had either subjective or objective evidence of distal ulnar instability. Grip strength for patients without radiocarpal arthritis was 84% of the uninvolved side. Preoperative ulnar variance was plus 4 mm and at follow-up minus 4 mm. At follow-up examination, four patients had ulnar carpal translocation. The average radial inclination angle of the patients with ulnar carpal translocation was 24 degrees, compared with 18 degrees for patients without ulnar carpal translocation. The minimal resection Darrach procedure gives excellent relief of pain without the instability attributed to the Darrach procedure. It must be used judiciously in patients who have a radial inclination angle above 23 degrees.

Madelung Deformity in Skeletally Immature Patients: Morphologic Assessment Using Radiography, Ct, and Mri

PURPOSE The purpose of this study was to define the pathoanatomy of the distal radius and surrounding soft tissues, identify the factors that may contribute to diminished forearm rotation, and relate these findings to alterations in wrist motion in skeletally immature patients with the Madelung deformity. METHOD Four skeletally immature female patients with bilateral Madelung deformities (eight wrists) underwent evaluation of each wrist with radiography, CT, and MRI to assess the morphology of the deformity. Two patients (four wrists) had isolated idiopathic Madelung deformities, and two patients (four wrists) had Madelung deformities secondary to dyschondrosteosis. RESULTS Radiographically, all wrists demonstrated dorsal bowing of the radius, marked ulnar tilting of the radius and radial tilting of the ulna, volar tilting of the distal articular surface of the radius, and triangulation of the epiphysis. On CT, patients with the idiopathic deformity demonstrated dorsal ulnar subluxation and relative supination of the carpus with respect to the distal radius. Patients with dyschondrosteosis demonstrated no ulnar subluxation and relative pronation of the carpus. All wrists demonstrated a fixed pronated deformity of the distal radius. On MRI, a physeal bar that bridged the distal metaphysis of the radius to the epiphysis was identified in all eight wrists, located on the volar aspect of the radius at the lunate facet. An anomalous volar ligament, a volar radiotriquetral ligament, and the short radiolunate ligament were hypertrophied in seven wrists. CONCLUSION Based on its location, it is likely that a physeal bar impedes the normal development of the distal radius ulnarly. Hypertrophy of the short radiolunate ligament may be an important contributing factor to carpal pyramidalization owing to tethering on the volar pole of the lunate. Diminished forearm rotation is likely related to carpal malalignment, a fixed pronated deformity of the distal radius, and dorsal bowing of the radius.

Doppler mapping in hypothenar syndrome: An alternative to angiography☆

Four patients with hypothenar hammer syndrome were evaluated preoperatively with Doppler mapping and angiography. Both tests documented ulnar artery occlusion. In one patient, the proximal extent of thrombosis could not be identified by angiography. In all cases Doppler mapping accurately documented the extent of occlusion as confirmed by surgical exploration. Doppler mapping is a noninvasive alternative to angiography in the evaluation of hypothenar hammer syndrome.

Connective tissue nevus and osteopoikilosis in the hand: The Buschke-Ollendorff syndrome

The Buschke-Ollendorff syndrome is a rare disorder of uncertain etiology characterized by osteopoikilosis and connective tissue nevi. An unusual presentation of this syndrome is described that involves both the cutaneous and skeletal manifestations affecting the hand. The bones of the hand and carpus are a common site for osteopoikilosis. Connective tissue nevi of the hand may require excision for diagnosis or mechanical impingement. Special elastin stains must be done on these cutaneous lesions to confirm the diagnosis. Routine hematoxylin-eosin stains may fail to show any pathologic change in mild cases.