Magnetic resonance imaging to assess vascularity of scaphoid nonunions.

The unreliability of current methods of assessing of bone vascularity is well documented, precluding any prospective analysis of its influence on bone healing. In hopes of accurately predicting scaphoid vascularity, magnetic resonance imaging was used prospectively in patients with radiographic evidence of nonunion. Magnetic resonance imaging scans were compared to plain radiographs, tomograms, and the operative impressions of the surgeon. The diagnostic accuracy of each test was determined by a pathologist's interpretation of histological sections. Ten of thirteen surgical specimens were available for analysis. The magnetic resonance imaging scan accurately predicted scaphoid viability in all ten cases (three viable, seven avascular). This compared with diagnostic errors in six of ten plain radiographs, one of seven tomographs, and two of ten surgical assessments. Magnetic resonance imaging can accurately predict the vascularity of the ununited scaphoid. With further follow-up of these patients, the capability of the avascular scaphoid to heal will become evident. Definitive preoperative determination of the healing potential of scaphoid nonunions may then be possible, thereby aiding the surgeon's choice of the appropriate surgical procedure.

Proteus syndrome.

The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartomatous, and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous." Clinical features of this new syndrome are currently being defined. Including the case reported herein, we have found 34 patients with Proteus syndrome described in the English literature. Major clinical findings, defined as those findings seen in more than half of the cases, include hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses, and scoliosis. Histologic examination of subcutaneous masses has identified a variety of lipomatous, hamartomatous, and angiomatous tumors.

A partially biodegradable material device for repair and reconstruction of injured tendons. Experimental studies.

We assessed the applicability of a partially biodegradable synthetic material composed of polyglycolic acid (PGA) and dacron to repair or replace severely injured tendons. Adult rabbits underwent complete laceration and repair of one Achilles tendon. Group 1 (N = 8) had end to end tenorrhaphy with size 0 braided polyester suture, and Group 2 (N = 16) tendons were similarly repaired with the bicomposite designed PGA-dacron device. Group 3 (N = 16) received laceration and removal of 1 cm of tissue, and the defect was bridged with the same PGA-dacron material. No postoperative immobilization was applied. Evaluation, consisting of biomechanical testing or histologic inspection, was done at 4 and 8 weeks after tenorrhaphy. All tendons healed, and at 8 weeks the mean maximum load at failure of the repaired tendons was 32.2 +/- 3.4 kgf, 40.3 +/- 2.4 kgf, and 31.8 +/- 3.2kgf for Groups 1, 2, and 3, respectively. Values between groups were not significantly different, but all were significantly less (P less than or equal to 0.05) than the strength of the unoperated control tendons (55.8 +/- 7.2 kgf). The most noteworthy finding was the lengthening of the repaired tendons, due to scar elongation at the tenorrhaphy site, that occurred during healing as determined by a landmark placed a fixed distance proximal to the repair site. Group 1 tendons lengthened 22 mm, while Group 2 and 3 tendons increased by 12.5 mm. Histologically, fibrous tissue ingrowth into the residual dacron scaffold occurred, but it was inconsistent and inadequate in quality and quantity to be satisfactory as neotendon. The fibrous tissue did not mature or align in response to load. We concluded that the PGA-dacron material had adequate strength and physical properties to use both for primary tenorrhaphy and to bridge the tendon defect. However, in our experience this material lacks any significant advantage over other materials available or known to be under evaluation to support neotendon formation when an actual soft tissue defect exists.

A combination pelvic osteotomy for acetabular dysplasia in children.

Several surgical procedures have been devised to increase acetabular coverage of the femoral head in children with dysplasia of the hip. In this report we describe an acetabuloplasty that combines the key aspects of the Pemberton and Salter osteotomies. It has been used at the Los Angeles Unit of the Shriners Hospital for Crippled Children since the late 1960's. To assess the results of this combination procedure, fifty hips in forty-four children were evaluated at an average of six years postoperatively. The average age at operation was 7.3 years, and 62 per cent of the patients had had prior surgery. Clinically, thirty-two hips in which there had been no or slight symptoms preoperatively remained unchanged, twelve that had had preoperative limitations improved, and six showed some deterioration in terms of slight loss of motion, mild pain, and a limp. Roentgenographically, acetabular dysplasia (as measured by the acetabular index and by the center-edge angle of Wiberg) improved in more than 90 per cent of the hips. The roentgenographic results were comparable with those obtained by innominate or pericapsular osteotomy. The combination osteotomy has the advantages of both the Pemberton procedure and the Salter operation and proved to be an excellent surgical procedure for older children whose acetabular development did not progress as well as was expected.