Functional evaluation of the pes anserinus transfer by electromyography and gait analysis.

The effectiveness of the pes anserinus transfer, proposed by Slocum and Larson to control anteromedial rotatory instability of the knee, depends on the pes anserinus muscles contracting at times when the instability threatens the patient's function. To examine the activity of the transferred pes anserinus muscles, quantitated dynamic electromyography, isometric testing of muscle strength, and gait-analysis techniques were employed. Seven normal subjects and nine patients who had undergone pes anserinus transfer for anteromedial rotatory instability were tested. In contrast to the normal subjects, who demonstrated pes anserinus muscle activity primarily during swing phase, the patients displayed conspicuous activity of the semitendinosus, gracilis, and sartorius tendons during stance phase. Quantitated electromyography indicated that the pes anserinus muscles worked harder in the patients than in the normal subjects, and more effort was required from the muscles of patients with poor results than from those of patients with good results. All of the patients also demonstrated reduction of single-limb support time, as well as a shorter stride length and reduced gait velocity. We concluded that the pes anserinus transfer is kinetically sound. Since instability of the knee is a functional defect that is present during stance, the finding of marked activity of the pes anserinus muscles during stance phase in the patients but not in the normal subjects suggests that these muscles were being used to control the instability.

Principles and management of penetrating vascular injuries secondary to shotgun wounds.

The characteristics of shotgun ammunition and ballistics are discussed to give an understanding of how shotgun wounds differ from all other types of civilian penetrating wounds. Five case examples of shotgun injuries to blood vessels involving the neck and extremities are presented to highlight problems encountered and to point out the principles of management. The importance of muzzle-to-victim range, preoperative arteriography and the definite place of conservation treatment are stressed.

Shotgun wounds of the abodomen: revisited.

A review of one hundred and sixty-seven patients with penetrating abdominal injuries caused by firearms showed that 17 patients (11%) had shotgun wounds. Nine patients were treated nonoperatively, whereas eight patients had immediate exploratory laporotomy. An analysis of shotgun wounds of the abdomen is presented to outline the principles in management. Factors influencing conservative versus operative treatment are discussed. Magnitude of the clinical problems have been illustrated by means of 4 cases.

Driver Injuries in Auto Road Racing.

In brief: The author reviewed the incidence and pattern of injuries sustained by drivers over a nine-year period at Mid-Ohio and Waterford Hills (Michigan) road-racing courses. One death occurred at Mid-Ohio, and eight drivers incurred major injuries. No fatalities occurred at Waterford Hills, but three drivers incurred major injuries. The racing stock sedan was the type of car most frequently involved in accidents in the professional group and the open-wheel car in the amateur group. The most common cause of injury was hitting the steel guardrail. Thus, improvements in corner construction and barrier design may improve track safety in auto road racing.

Subtalar Dislocations in Basketball Players.

In brief A US Marine sustained a medial subtalar dislocation while playing basketball in mid-cut tennis shoes. Though such dislocations generally involve high-impact mechanisms, this case supports previous indications of a sports-related mechanism. Generally, conservative treatment involving closed reduction under general anesthesia is adequate, as it was with this patient. Some cases may require surgery. An MRI obtained 8 weeks postinjury revealed possible damage to the articular cartilage of the talus. Preventive strategies may include appropriate shoes, suspended wood floors, and conditioning.

Reappraisal of low-velocity gunshot wounds of the aorta and inferior vena cava in civilian practice.

Eighteen low-velocity gunshot wounds of the abdominal aorta and inferior vena cava were analyzed. Injury to the aorta and inferior vena cava occurred in 9.2% of all penetrating abdominal injuries due to gunshot wounds in our series. The mortality rate was 33% for the suprarenal and 25% for the infrarenal inferior vena cava, 50% for the infrarenal aorta, 100% for the suprarenal aorta and for the combined injuries. Control of active bleeding is more closely related to survival than any other single factor.

Preoperative administration of epoetin alfa to reduce transfusion requirements in elderly patients having primary total hip or knee reconstruction.

Avoidance of allogeneic blood transfusion is challenging in elderly patients with multiple comorbid conditions, who need major elective orthopaedic surgery. We conducted a study comparing the safety and efficacy of preoperative recombinant human erythropoietin (epoetin alfa) in patients having major elective orthopaedic surgery and in matched historical control patients. Patients aged 70 years or more undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) were given two or three doses, respectively, of epoetin alfa (40,000 IU). They also received oral iron for 14 or 21 days. Epoetin alfa increased hemoglobin (Hb) and hematocrit (HCT) levels before surgery; 74% of control patients required blood transfusion, compared with 12.5% of patients receiving epoetin alfa. No serious adverse event was attributed to study treatment. These data indicate that epoetin alfa is safe and effective and reduces the need for allogeneic blood transfusion in elderly patients having elective total joint replacement.

Ninety-eight penetrating vascular injuries: a review of a two and one-half year experience.

In a review of 55 patients with 98 penetrating vascular injuries over more than 2 years (most were gunshot wounds), the mortality rate was 46% in patients with intra-abdominal vascular injuries and 7% in those with extra-abdominal injuries. There were no major amputations. One patient had two fingers amputated.