Thorough debridement and immediate primary wound closure for animal bite injuries of the upper limbs.

PURPOSE: Animal bite injuries are often encountered in daily practice. In particular, these injuries of the upper limbs can result in severe functional impairment. We have performed early debridement of contaminated tissue and primary closure for these injuries. METHODS: The subjects consisted of 15 patients (6 males and 9 females) aged 1-91 years (mean 53.6 years) who visited our hospital due to animal bite injuries (dog in 9 patients, cat in 6). The bite site was the forearm in 5 patients and the hand in 10. In the operating room, contaminated tissue was removed, and primary wound closure was performed after irrigation. RESULTS: The bite penetrated to the muscle layer in 6 patients, tendon sheath in 5, joint in 1, bone in 1, and involved only the subcutaneous tissue in 3 patients. The mean period until the completion of wound treatment was 19.8 ± 8.4 days. As complications, numbness of finger, metaphalangeal joint contracture and superficial radial nerve injury were observed in each one case. In a patient with bite injury of the palmar and dorsal sides of the thumb reaching the bone, additional debridement was necessary. At the final observation, the visual analog scale was 1.2 ± 1.4, and the Quick Disabilities of the Arm, Shoulder, and Hand score was 9.7 ± 12.2. CONCLUSIONS: Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs. The results of our study suggest that thorough debridement allows primary closure, even for animal bite injuries.

[Delayed radial nerve palsy following a humeral shaft fracture].

We reported a 24-year-old man with right radial nerve palsy. He had suffered from a right humeral shaft fracture approximately three years before. The fracture was treated with intramedullary nailing. Our radiograph of the right upper limb showed callus around the fracture site. A nerve conduction study revealed conduction block of the radial nerve at the lateral side of the callus. Tinel's sign was present in the median nerve at the medial side of the callus. Surgical exploration revealed that the radial nerve trunk was compressed at the callus site. The median nerve trunk was close to the callus. We decompressed radial nerve trunk, and the patient's neurological symptoms improved gradually after the operation. Delayed radial nerve palsy has been reported only rarely, whereas acute compression of the nerve sometimes occurs after humeral shaft fractures. Morever, the median nerve also was vulnerable to compression at the site of callus. These findings underscore the importance of taking into account the possibility of delayed compression neuropathy after humeral shaft fracture.

The relationship between postoperative results and bone dynamics in RA patients who underwent cementless Ortholoc II TKA: histomorphometric study.

Abstract We previously reported a histomorphometric study of iliac bone obtained at the time of cementless total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). In this paper, we further extended our analysis to investigate the postoperative results and radiographs after TKA in association with bone metabolism. All the patients were female, ranging in age from 38 to 68 years (mean, 56.8 years). Histomorphometric results demonstrated that bone volume and trabecular thickness were decreased, whereas bone absorption and bone formation rate (BFR) were increased. The bone in patients with mutilating disease (MUD) showed remarkably increased bone turnover and osteoporosis compared with those of the more erosive subset (MES) patients. Sixteen out of the 20 patients were alive at the time of follow-up (follow-up period between 5 years 10 months and 8 years 11 months). Among them, 10 patients could be further examined. Radiolucent lines (RLL) were assessed by the modified Knee Society evaluation (scoring) system. The number of RLL (N-RLL) were correlated with BFR in morphometric examination. In addition, the weight-bearing zones in the N-RLL were more significantly correlated with BFR. The Japanese Orthopedic Association (JOA) score and pain score negatively correlated with eroded bone surface. The present study indicated that bone dynamics, rather than the bone volume at the time of TKA, were involved in the presence of RLL and in pain after surgery for TKA.

[Histomorphometric study of the iliac bone in rheumatoid arthritis].

In order to investigate the status of osteoporosis associated with rheumatoid arthritis, a histomorphometric study was performed on the specimens taken from the iliac bone of the patients who underwent total knee arthroplasty. All of them had received double tetracycline labeling preoperatively. Twenty consecutive patients admitted to Nakaizu Spa Hospital for the surgery from February to July, 1989 were subjected for the study. All the patients were women with the age ranging from 38 to 68 years (aver. 56.8 years). Seventeen out of the 20 patients were of class 3 or more according to Steinbrocker's staging. There were MUD (multilating disease), 14 MES (more erosive subset) and no LES (least erosive subset) patients according to Ochi's classification. Basically the Frost's method was used for the morphometric examination, and Parfitt's histomorphometric parameters were used for the results evaluation. The results demonstrated that bone volume and trabecular thickness were decreased whereas bone absorption and bone formation rate were increased. Histological findings showed resemblance with that of hyperparathyroidism in view of thin trabecular pattern. The osteoporosis in the present rheumatoid patients were considered to be due to abnormal bone remodeling, secondary to high turn-over of the bone. The bone in the more advanced type (MUD) patients showed much increased bone turn-over and osteoporosis than that of less advanced ones (MES). Hence force, the degree of osteoporosis was in positive relationship with the severity of rheumatoid arthritis. The postoperative clinical results were assessed by the Japanese Orthopaedic Association (JOA) Rheumatoid Knee Scoring System. Sixteen out of the 20 patients survived at the time of the follow-up (follow-up period: 4 years and 4 months to 6 years and 8 months). Among them, 11 patients were directly examined and the remaining five patients answered a questionnaire. The JOA score showed no correlation with bone volume or bone formation rate, but significant negative correlation with bone eroded surface and osteoclast surface in the morphometric examination.