Management of simple camptodactyly.

From a review of 57 patients with flexion deformity of the fingers (camptodactyly), 21 patients with 38 digits treated operatively had 18% good or excellent results, whereas 14 patients (41 digits) treated conservatively had 66% good or excellent results. Mild deformities responded well to splints and stretching. Moderate deformities treated operatively gained extension but at the loss of finger flexion. Severe deformities had improvement in extension (averaging 19 degrees in operative cases and 27 degrees in conservative), but there was significant loss of flexion in the operative group. Overall, 16 of 21 patients had loss of flexion after operative treatment. Conservative treatment of camptodactyly is recommended for digits with less than 60 degrees lack of extension. Operative treatment should be reserved for failed conservative treatment. Early joint motion post-operatively appears essential and surgical procedures that immobilize the P.I.P. joints should be avoided.

Blood flow evaluation of vascularized bone transfers in a canine model.

Blood flow in vascularized bone transfers was evaluated in a canine model. Cortical bone blood flow was determined in undisturbed control bone, vascularized heterotopic bone transfers, and nonvascularized cortical bone grafts by means of the radionuclide-labeled microsphere technique. Four animals were studied at 2 days, three at 1 week, eight at 2 weeks, four at 4 weeks, and three at 6 weeks postoperatively. In the 2-day animals, the vascularized bone transfers exhibited intermediate levels of blood flow (1.4 +/- 0.4 ml/100 g of bone/min) compared with undisturbed control bone (2.7 +/- 0.5 ml/100 g of bone/min) and conventional cortical bone grafts (0.0 +/- 0.0 ml/100 g of bone/min). At 1 week postoperatively, the differences in blood flow values of the vascularized transfers (1.7 +/- 0.7 ml/100 g of bone/min) and control bone (1.4 +/- 1.0 ml/100 g of bone/min) and of the nonvascularized grafts (0.2 +/- 0.1 ml/100 g of bone/min) and control bone (1.6 +/- 1.1 ml/100 g of bone/min) were no longer significant. At 2 weeks postoperatively, blood flow had increased in both graft groups. At 4 weeks postoperatively, the bone blood flow values in the vascularized transfers (4.8 +/- 1.4 ml/100 g of bone/min) were significantly greater than the bone blood flow in control specimens (1.6 +/- 0.5 ml/100 g of bone/min) and conventional cortical bone grafts (2.5 +/- 2.0 ml/100 g of bone/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of chronic perilunate dislocations.

Fifteen patients with 16 perilunate dislocations that had been untreated for a minimum of 6 weeks after the injury were evaluated after subsequent treatment at a mean of 6.4 years. The median time from injury to definitive treatment was 17 weeks. Ten wrists had completely ligamentous injuries and six had fracture-dislocations. Treatment consisted of open reduction and internal fixation in six patients, isolated carpal bone excision in four, wrist arthrodesis in two, proximal row carpectomy in two, and bilateral carpal tunnel release in one. In this series the results of excision of the lunate or scaphoid alone were uniformly poor. One of the two patients who had a proximal row carpectomy required secondary radial styloidectomy, and a pseudarthrosis developed in one of the two patients who had a wrist arthrodesis. All six patients treated by open reduction and internal fixation had satisfactory outcomes and none required additional surgery.

Thrombosed vascularized bone graft: viability compared with a conventional bone graft.

Previous reports in the literature have suggested that the viability of a thrombosed vascularized bone transfer is similar to that of a conventional bone graft. Our clinical impression, however, has been that this is not the case. The viability of thrombosed vascularized bone grafts was compared with that of conventional nonvascularized grafts in a canine model. Assessment included quantitating bone blood flow, tetracycline uptake, and osteocyte count. Results suggest that a thrombosed vascularized bone graft is less favorable for vascular invasion and the usual process of bone graft incorporation than a conventional bone graft.