Robert D. Larsen

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.

The Pathogenesis of Dupuytren's Contracture

1. Sixty-nine additional specimens of Dupuytrens contracture have been studied. These specimens were fixed with the fascia under normal tension and sectioned longitudinally. 2. The lesion of Dupuytrens contracture begins as an area of fibrous-tissue proliferation and ends as a band of thick collagen fibers. Hemosiderin deposits in the cellular areas are believed to be evidence of previous hemorrhage into the areas. Abrupt termination of collagen fibers at the edge of the cellular nodules has been observed. 3. Partial rupture of the palmar and plantar fascia was produced in twelve monkeys, together with appropriate control operations. By this method a lesion which resembles the cellular stages of Dupuytrens contracture has been produced. The monkey lesion matures into dense collagenous tissue in the same way that the cellular stages of Dupuytrens contracture mature. Contracture of the finger did not develop in the monkeys in these experiments. 4. One patient has been encountered in whom a nodule developed within the palmar fascia after laceration of the fascia. The nodule had the microscopic characteristics of the cellular stage of Dupuytrens contracture. 5. A similar fibrous-tissue proliferation has been provoked by partial rupture of the anterior rectus sheath of a dog. The response in the dog was less intense than in the monkey and the lesion healed more rapidly. 6. These observations lead us to believe that partial rupture of the palmar aponeurosis is one way in which the type of fibrous-tissue proliferation observed in Dupuytrens contracture can be provoked.

An Experimental Evaluation of the Efficacy of Chymotrypsin in the Reduction of Edema in Crushed Extremities

Because of the scarring and limited motion that occur as the final result of edema of the hand, prevention or decrease of the original edema would be desirable. Clinically, in patients with postoperative edema of the hand, we feel that aqueous chymotrypsin aids in the reduction of the edema. In this work, the drug was used under controlled circumstances at various dosage levels in monkeys with traumatically induced edema of the upper extremities. The studies reveal that, when chymotrypsin was given in large doses, the maximum degree of edema reached was less than that in the control animals and that reduction of edema began sooner and was completed more rapidly in the treated animals. These observations suggest that aqueous chymotrypsin can be used effectively in human patients with traumatically induced edema of the extremities.

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.

Dupuytren??s Contracture

Dupuytrens contracture is a progressive disease which involves the palmar fascia and the digital extensions of the palmar fascia, beginning as a small nodular thickening in the palm. In its most advanced form the disease causes a severe and crippling contracture of the palm and one or more of the digits. Less frequently the condition is encountered in the foot, but contracture of the toes does not occur.