Timo Raatikainen

Arthrography, clinical examination, and stress radiograph in the diagnosis of acute injury to the lateral ligaments of the ankle

We examined 188 consecutive patients, each of whom had an acute ankle sprain, using clinical stability as sessment, stress radiographs, and arthrography to compare the reliability of these methods used in diag nosing lateral ligament ruptures of the ankle. Sixty-six of the ankles were treated operatively. Arthrography accurately detected ligament damage in all of the pa tients with this injury and revealed the extent of the injury in about 85%, whereas clinical examination and stress radiographs detected only about half of the injuries. The injuries and the results of these two meth ods were often controversial, as our study will show.

Bioabsorbable miniplating versus metallic fixation for metacarpal fractures.

Bioabsorbable implants offer an attractive alternative to metallic implants to stabilize small bone fractures in the hand. Self-reinforced bioabsorbable miniplating for metacarpal fractures was studied in bones from cadavers and compared with standard metallic fixation methods. One hundred twelve fresh-frozen metacarpals from humans had three-point bending and torsional loading after transverse osteotomy followed by fixation using seven methods: (1) dorsal and (2) dorsolateral 2-mm self-reinforced polylactide-polyglycolide 80/20 plating, (3) dorsal and (4) dorsolateral 2-mm self-reinforced poly-L/DL-lactide 70/30 plating, (5) dorsal 1.7-mm titanium plating, (6) dorsal 2.3-mm titanium plating, and (7) crossed 1.25-mm Kirschner wires. In apex dorsal and palmar bending, dorsal self-reinforced polylactide-polyglycolide and poly-L/DL-lactide plates provided stability comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable plates were applied dorsolaterally, apex palmar rigidity was increased and apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher torsional rigidity than 1.7-mm titanium plating and in failure torque comparable with 2.3-mm titanium plating. Low-profile selfreinforced polylactide-polyglycolide and poly-L/DL-lactide miniplates provide satisfactory biomechanical stability for metacarpal fixation. These findings suggest that bioabsorbable miniplating can be used safely in the clinical stabilization of metacarpal and phalangeal fractures.

Composite Implant of Native Bovine Bone Morphogenetic Protein (BMP) and Biocoral in the Treatment of Scaphoid Nonunions — A Preliminary Study

Background and Aims: Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. We report a preliminary study of a composite implant consisting of a biocoral frame, carrier collagen and bovine BMP in the treatment of scaphoid nonunions. Material and Methods: Two proximal and eight waist area scaphoid nonunions were treated using BMP/coral implant combined with either the Matti-Russe procedure (2 cases) or an interpositional bone graft fixed with screws or compression fixation pins (8 cases). In two cases only a one piece BMP/coral implant was used as an interpositional graft and in other cases interpositional autograft was used with granular BMP/coral implant placed between the fragments and the graft. Results and Conclusions: Only two wrists resulted in complete union. These preliminary results suggest that composite implant of BMP, as used in the present study, may not solve the problems encountered in the treatment of scaphoid nonunions. Poor vascular conditions in scaphoid may not provide enough mandatory osteogenic cells for BMP to function properly. In avascular conditions coral does not resorb edequately and implants may also work as a sequester between the bone graft and the scaphoid bone and therefore actually inhibit the healing process.

Microvascular Flaps from the Lateral Arm and Radial Forearm for the Repair of Defects of the Achilles Tendon Region

Two patients presented with loss of skin in the Achilles tendon region, which is difficult to repair satisfactorily. They were both treated with microvascular flaps, one of which was taken from the lateral arm, and the other from the radial forearm. Both methods gave good functional results.

Free tissue coverage of wound complications following Achilles tendon rupture surgery.

The purpose of this study was to examine the long term functional results following free tissue coverage in 4 patients who developed wound complications after surgical treatment of partial or total Achilles tendon rupture. Between 1987 and 1993, 3 radial forearm flaps and 1 lateral arm flap were used. Two Achilles tendons were reinforced, 1 with palmaris longus tendon, and 1 with extensor carpi radialis and palmaris longus tendons. The patients were seen during followup an average of 3.1 years after the reconstruction. All patients were able to return to their preoperative level of activity within a year, and the aesthetic outcome was good in all cases. Isometric and isokinetic calf muscle performance was evaluated with a Lido Multi Joint II dynamometer, which showed the mean of isometric test values in 3 patients to be greater than 90% of that of the normal unaffected side, and probably abnormal (80%) in 1 patient. The mean isometric values obtained in 3 ankle positions, 20 ° plantar flexion, neutral, and 10 ° dorsiflexion, were 114%, 104%, and 94%, respectively. Isokinetic peak torque values were normal in 3 patients at a velocity of 30 ° per second, and in 2 at 90 ° per second. The mean peak torque value was 90% of normal at both angle velocities. The cross sectional area of the calf muscle was greater than 90% of the normal unaffected side. Ultrasonography indicated that the diameters of 2 reinforced tendons were larger than those on the control sides. Posterior peritendinous fibrosis was found in the upper corner of the scar in 2 patients.

Repair of partial quadriceps tendon rupture. Observations in 28 cases.

We operated on 28 patients with partial rupture of the quadriceps tendon. A simple excision of the scar tissue and closure of the tendon gave an excellent or good result in 25 patients. Ultrasonography was useful to confirm the diagnosis.

A novel treatment of grade III acromioclavicular joint dislocations with a C-hook implant

Introduction: This study evaluates the results of the new surgical treatment of complete acromioclavicular (ac) dislocations using coracoclavicular (cc) fixation with a shape memory metal C-hook implant. Materials and methods: Fifteen patients were prospectively analyzed. They all had a Tossy III ac dislocation due to trauma. The ac ligament was reinserted using a surgical bone anchor, and the position of the joint was restored by fixing it with a C-hook. After 3 months the C-hook was removed. Functional status, symptom severity, X-rays and patient satisfaction were analyzed during clinical control visits. The follow-up time was 1 year. Results: At 12 weeks, full shoulder function had been achieved by 93% of the patients. The final control visit showed full recovery of active ROM in all patients. Two patients had mild pain during certain movements. X-rays showed the precise anatomical position of ac joint with no statistically significant differences compared to the healthy side. Patient contentment was excellent in 14 cases and satisfactory in one case. The average sick-leave was 58 days, including the removal operation. Minor osteolysis of the clavicle was noticed in two patients. Conclusion: The new C-hook implant provides accurate anatomical reduction, conserves the articular surfaces and enables fast functional recovery with excellent patient contentment. Technically, the implant is easy to use. Based on this study, the C-hook presents a reliable novel treatment option in surgical ac repair.

Stabilization of acute, complete acromioclavicular joint dislocations with a new C hook implant

Although coracoclavicular fixation is currently popular for type III acromioclavicular (AC) dislocations, a surgical gold standard is lacking. The purpose of this study was to evaluate the preliminary outcome of surgical treatment of complete AC dislocations with a new nitinol C hook implant. When the implant is cooled (<5 degrees C), it softens enough to be easily inserted under the coracoid process with a hole drilled in the clavicle. Cooling is induced with ice water. When the implant reaches body temperature, it hardens and anatomic reduction is achieved. Patients with acute type III AC dislocations were prospectively evaluated. The AC ligament was reinserted with the use of a bone anchor, and the position of the joint was restored by fixing it with a new C hook. Clinical and radiographic control checkups were carried out at 3, 8, and 12 weeks and 2 years postoperatively. Certain patient-related variables, functional status, symptom severity, and patient satisfaction were assessed. By 12 weeks, all patients had achieved full functional status. Radiographs showed accurate anatomic reduction. Overall subjective satisfaction was very good in all cases. No complications or implant failures occurred. On the basis of this pilot study, the new C hook implant provides secure anatomic reduction with very good functional recovery and patient satisfaction. The main benefit of the implant is the ease of insertion. It preserves the articular surfaces and allows slight movement of the AC joint during abduction of the arm. The C hook implant is a new surgical concept with potentially better patient recovery.

EFFECT OF GLYCOSAMINOGLYCAN POLYSULFATE ON CHONDROMALACIA PATELLAE : A PLACEBO-CONTROLLED 1-YEAR STUDY

The effect of glycosaminoglycan polysulfate (GAGPS) on damaged patellar cartilage and clinical symptoms of chondromalacia was studied on 31 patients in a placebo-controlled double-blind trial. The clinical diagnosis was confirmed by arthroscopy. The treatment consisted of 12 intramuscular injections of either GAGPS or placebo, and the patients were followed for 1 year. In 26 patients, rearthroscopy was performed at the 1-year follow-up. Comparison of the two arthroscopies showed improvement in 8/13 patients in the GAGPS group compared with 3/13 in the placebo group. The clinical parameters correlated well with the results of the arthroscopies. The results support the use of GAGPS for chondromalacia patellae.

Recovery of muscle strength after late repair of distal biceps brachii tendon

Background and Aims: Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated. Materials and Methods: Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer. Results: Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work. Conclusion: Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.