The effect of pisiform excision on wrist function.

PURPOSE: To investigate the effect of pisiform excision on wrist function compared with age- and sex-matched control subjects. METHODS: The authors evaluated the charts of 11 consecutive patients who had undergone pisiform excision. Nine of these patients could be included and clinically examined, and results were compared with 9 matched controls. Measurements included range of motion, strength measurements, neurological examination, and questionnaires. RESULTS: Extension in the operated wrist was reduced in patients compared with controls. The Disabilities of the Arm, Shoulder, and Hand and Michigan Hand Outcomes Questionnaires were significantly different between patients and controls. All other entities were equal between groups. Subjectively, patients experienced impairments in function of the operated wrist, but these could not be identified objectively. CONCLUSIONS: Although great care must be taken in handling the surrounding soft tissue, pisiform excision is a well-tolerated, safe treatment for pain in the pisotriquetral joint resulting from arthrosis and not controlled by nonsurgical means. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Total knee replacement in haemophilic arthropathy.

Eleven total knee replacements were performed in eight patients with severe haemophilia A and the patients were followed up for two to eight years. All the patients had disabling haemophilic arthropathy of one or both knees, which had not responded to conservative treatment. Postoperative complications occurred in 10 knees, including nose bleeding, haemarthrosis, anaphylactic reactions, urinary tract infection with haematuria, recurrent phlebitis at infusion sites, and fever for a few days. There were no wound infections. The outcome, as determined by a standard scoring system, was rated as excellent or good in nine knees, fair in one and poor in one. Nevertheless, all patients were free of pain and all but one returned to full-time or part-time employment. Total knee arthroplasty appears to be a satisfactory procedure in the treatment of disabling haemophilic arthropathy of the knee.

Bacterial arthritis in a district hospital.

Between 1977 and 1988 in the Enschede hospital 72 patients were seen with bacterial arthritis of one or more joints. Staphylococcus aureus was most frequently the causative agent (52%) and the knee was the most frequently infected joint (42%); the mortality rate was 11%. Complete restoration of pre-existent function was seen in 52% of the affected joints. In patients with severe deterioration of joint function after the bacterial infection, the period between the first symptoms and start of treatment (mean 30 days) was significantly longer than in patients with no or moderately deteriorated joint function (mean 10 days). The primary focus was mostly a skin infection, predominantly localized on the lower extremities. Half of all cases of bacterial arthritis occurred in patients with rheumatoid arthritis (RA). We therefore conclude that patients with RA and skin infections, especially if localized on legs or feet, should be treated without delay and that one should not hesitate to prescribe antibiotics. Erythrocyte sedimentation rate (ESR) was less than 20 mm after one hour in 13% and blood leucocyte count less than 10 x 10(9)/liter in 55% of all patients, showing that a normal ESR and/or blood leucocyte count do not exclude bacterial arthritis. In 4 out of 9 patients with infected prosthetic joints the infection resulted in loosening of the joint, before antibiotic treatment was started. In the other 5 patients bacterial arthritis recurred, in one patient resulting in loosening of the joint, only shortly after stopping long-term successful antibiotic treatment (6-24 months). Thus, we feel that lifelong treatment with antibiotics is a reasonable alternative in cases, where the risk of surgery is very high.

Operative correction of posttraumatic and congenital swanneck deformity--a new technique.

Volar plate reconstruction by using a part of the slip of the superficialis tendon is a new technique in the treatment of posttraumatic and congenital swanneck deformity. This small series represents two patients with a posttraumatic swanneck deformity due to volar plate rupture and one patient with a congenital swanneck deformity in six fingers. The results of the operation with a two years follow-up show seven fingers with a normal flexion-extension range without hyperextension. Only one finger has an extension lag of five degrees. All fingers have a normal grip strength and normal fine movements without pain. There were no complications.

[Spondylodiscitis cause by Brucella suis]. / Spondylodiscitis door Brucella suis.

In a 72-year-old Dutchman Brucellae suis spondylodiscitis TXII-LI was diagnosed, complicated by a paraspinal abscess, for which surgical drainage was carried out. The patient failed to recover after the combined antibiotic regimen of doxycycline, rifampicin and trimethoprim-sulfamethoxazole. There was good clinical improvement after a course of doxycycline and streptomycin, however. After a symptom-free period of 9 weeks a relapse occurred. The patient refused treatment and died 6 weeks later at home. The infection had probably been contracted after handling wild boar carcasses from eastern Europe.

Metatarsal head resection in the deformed, symptomatic rheumatic foot. A comparison of two methods.

Metatarsal head resection for the symptomatic, deformed, rheumatic foot was performed in 83 feet of 49 patients via a modified plantar approach with functional after treatment, and in 64 feet of 41 patients via a dorsal approach, followed by placement in a plaster cast for 6 weeks. Both groups were comparable with regard to age, sex, and follow-up. From 1975 to 1985, 147 feet (90 patients) were operated in two different hospitals. Of these, 25 patients (39 feet) were lost to follow-up. The average follow-up was 83.3 mo. (range 33-136 mo.). Data were obtained by studying the medical records and by questionnaires sent to all patients. The results in both groups were quite similar. However a higher rate of wound-healing problems was found with the dorsal approach. The plantar approach resulted in an increase recurrence of metatarsalgia, requiring surgical revision.

Bone grafting for acetabular protrusion in hip arthroplasty. 27 cases of rheumatoid arthritis followed for 2-8 years.

An acetabular bone graft with spongious bone chips was performed in 27 primary total hip arthroplasties in 23 patients with rheumatic disease. There were no major complications. After 5 (2-8) years, the grafts were well incorporated; after 1 year, remodeling had produced a normal cancellous bone structure. Clinical assessment showed overall good results.

Epiphyseal osteoid osteoma. Two case reports.

Two cases of epiphyseal osteoid osteoma presented with a 1-2 year history of monarthritis with swelling and impaired function of the knee and ankle, respectively. In both cases, removal of the lesion resulted in complete recovery.

Treatment of pigmented villonodular synovitis of the knee with yttrium-90 silicate: prospective evaluations by arthroscopy, histology, and 99mTc pertechnetate uptake measurements.

The diffuse form of pigmented villonodular synovitis of eight knee joints of eight patients was treated by intra-articular injection of 185 MBq yttrium-90 silicate (90Y). Six patients had a recurrence of disease after one or two surgical synovectomies. After treatment with 90Y once or twice four knees showed clinical improvement with an accompanying decrease of the inflammatory activity as measured by the technetium-99m pertechnetate (99mTcO4-) uptake ratio and the severity of the diseased synovial tissue. Arthroscopy was performed before and six months after each 90Y treatment. The ratio of 99mTcO4- uptake in the inflamed compared with the normal knee joint correlated well with the macroscopical grading of pigmented villonodular synovitis. In all cases areas of persistent synovitis were found after the 90Y injection and this was confirmed both by histological examination and 99mTcO4- uptake measurements. Biopsy specimens taken from the diseased synovial areas showed histologically mostly less prominent and less numerous villi. The cartilage damage was slightly increased in only two cases. No radiological deterioration was found during follow up (mean 24 months, range 12-41). No complications of the radiosynoviortheses were noted.