Mark B. Stern

Comminuted intertrochanteric fractures treated with a Leinbach prosthesis.

A series of 105 Type III and IV comminuted intertrochanteric fractures were treated by the insertion of a Leinbach prosthesis and followed for an average of 8.1 months. Based upon the results, the insertion of a Leinbach prosthesis is recommended for the elderly patient with a comminuted intertrochanteric fracture. Function is restored within a short period of time and allows unrestricted weight-bearing almost immediately. The hospital stay is shortened. The incidence of secondary operations, thrombophlebitis, pulmonary embolism, decubiti, and pneumonia is relatively low.

Femoral neuropathy as a complication of heparin anticoagulation therapy.

Femoral nerve compression by retroperitoneal hematoma is an uncommon but significant complication of Heparin anticoagulation. The orthopedic surgeon today, utilizing anticoagulation more frequently than ever, must be ever mindful of the early warning signs and symptoms of this syndrome.

Early Experience with Percutaneous Lateral Discectomy

Seventeen patients were treated by percutaneous lumbar discectomy for a herniated disc and sciatica. The criteria for inclusion in this series included: (1) a protruding disc in the lumbar area causing neural compression; (2) persistent sciatica; (3) failure of conservative treatment; (4) magnetic resonance imaging, computer tomographic, or myelographic confirmation of the protrusion; and (5) chronic low-back pain with definite evidence of a protruding disc at the appropriate level. The only contraindication to the procedure is the presence of an extruded fragment. There were ten male and seven female patients, with an average age of 40 years. The operation was performed under local anesthesia and by the method of Hijikata. Six cases were at L5-S1, nine at L4-L5, four at L3-L4, and one at L2-L3. Fourteen of 16 patients were relieved of their symptoms. One operation was aborted due to the inability to pass the cannula beneath arthritic facet joints. One complication occurred early while using general anesthetic. An L5 nerve root was injured, causing a permanent drop foot. Major possible complications include infection, nerve root injury, and vascular injury. The success rate with an average follow-up period of six and one-half months was 87.5%.

The anterior interosseous nerve syndrome (the Kiloh-Nevin syndrome). Report and follow-up study of three cases.

Three surgically treated cases demonstrate that this syndrome is a compressive neuropathy of the anterior interosseous branch of the median nerve rather than a neuritis, as originally believed. All symptoms were in the dominant hand and included deterioration of handwriting, pain, weakness of the flexor policis longus, the flexor digitorum longus to the index finger, and the pronator quadratus. Electromyograms were abnormal in two of the three cases. All forms of conservative treatment failed over a three- to five-month period. All lesions were demonstrable at surgery, and recovery was complete in all cases within five months of surgery. At an average follow-up evaluation of seven years there was no recurrence in any case. The loss of ability to write was characteristic of all three cases and is being reported for the first time.

Eosinophilic granuloma of the proximal tibial epiphysis.

This is a 3-year follow-up report of an eosinophilic granuloma of bone occurring in a growing epiphysis. The lesion occurred in a 6-year-old boy and is only the third such case reported in the literature. Eosinophilic granuloma should be considered in the differential diagnosis of lytic lesions of the epiphysis in childhood.