Treatment of fractures of the humeral capitellum using herbert screws.

Isolated fractures of the capitellum are rare injuries and account for 1% of all elbow injuries. The purpose of this study is to evaluate the clinical outcomes of 11 Type I capitellum fractures treated by open reduction and internal fixation using at least two standard Herbert screws between 1998 and 2003. The average age of the patients was 27.5 years. The mean follow-up time was 23.4 months. The final postoperative assessment was made at the 12th month. The results were evaluated according to the Mayo Elbow Performance Index. We obtained excellent result in eight patients and good result in three patients. We recommend open reduction and fixation with Herbert screws inserted from the posterior surface of the lateral epicondyle and early mobilization in Type I fractures of the capitellum.

Four-point bending strength of transverse osteotomies stabilized with various Kirschner wire and tension wire band configurations.

Four different fixation configurations of K-wires of two different diameters were used to stabilize a transverse osteotomy in chicken humerus bones. Four-point bending was applied to these to assess their apex dorsal bending rigidity. The configurations of K-wires included intramedullary, crossed and two with different tension wire band designs. One of these consisted of two transverse K-wires which did not cross the fracture line, around which the tension wire band was placed. The results showed that there was no statistical significance between the two different tension band wiring techniques and that both were superior to the intramedullary and crossed K-wire fixation techniques.

Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger.

UNLABELLED: We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19-43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes-Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16-2 g) and 0.51 g (range: 0.16-1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3-8 mm) and 4.3 mm (range: 3-7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Microvascular transplantation of physeal allografts.

We compared growth in vascularised allograft transplants, autografts and in non-operated physes in rabbits immunosuppressed with cyclosporin A and in non-immunosuppressed animals. Molecular haplotyping was undertaken before operation to ensure allogenicity. Postoperative bone scans and fluorochrome labelling were used to confirm physeal vascularity. The animals were killed at three or five weeks. Proximal tibial physeal autografts, with or without cyclosporin A, or allografts with cyclosporin A, grew at similar rates to the physes of non-operated rabbits. All the operated physes grew at rates significantly greater than their contralateral controls. 99mTc-MDP bone scans accurately predicted the viability of the epiphyseal plate. Quantitative histomorphological analysis of the heights of the physeal proliferative and hypertrophic zones showed that successful physeal transplants have a normal appearance, but when unsuccessful have thickened hypertrophic zones compatible with physeal ischaemia. We discuss the significance of these results in relation to the transplantation of physes in children.

Effects of stem design and pre-cooling prostheses on the heat generated by bone cement in an in vitro model.

The necrotizing effects of the heat, particularly at more than 50 degrees C, produced by the exothermic polymerization process associated with the acrylic implant cement polymethylmethacrylate (PMMA) are well documented. The temperature changes that occur are dependent on the thickness of the PMMA. The current study investigates the hypothesis that the heat produced by the bone cement may be reduced by the choice of stem design and by pre-cooling the hip prosthesis. The thermal alterations at the bone-cement interface were measured in an in vitro model. The results indicated that a temperature decrease of approximately 7 degrees C could be achieved by pre-cooling the prosthesis, and by changing the shape of the prosthesis stem from flat and wide to round.

Tension band wiring of unstable transverse fractures of the proximal and middle phalanges of the hand.

Twenty-three isolated, unstable and closed transverse middle and proximal phalangeal shaft fractures in 23 patients were treated by tension band wiring. The tension band was applied with two transverse Kirschner wires that did not cross the fracture line. All of the fractures united and achieved satisfactory functional outcomes. No patient required either physiotherapy or tenolysis or capsulotomy surgery.

The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis.

In spite of the increasing evidence that passive smoking increases the incidence of respiratory infections and bronchial hyper-responsiveness, the information about whether exposure to sudden heavy smoke enhances the development of acute respiratory infections in children remains inadequate. In this study, to quantitate the level of exposure to environmental tobacco smoke, in 28 children (age ranging 2-18 months) with respiratory syncytial virus (RSV) bronchiolitis and in 30 children (age ranging between 2-15 months) with non-respiratory symptoms, the serum levels of cotinine, the major metabolite of nicotine, were measured at admission to the emergency department. Parents were asked to fill in a questionnaire about the housing conditions and their smoking habits. Serum samples were taken again from the children with RSV bronchiolitis at their second visit at 1 month after discharge from the hospital. The children with RSV bronchiolitis had higher levels of serum cotinine (mean of 10.8 ng/ml) in the acute stage, compared with post-bronchiolitis stage (mean of 7.4 ng/ml). Moreover, patients admitted with non-respiratory symptoms had significantly lower levels of serum cotinine (mean of 3.9 ng/ ml) than both phases of patients with RSV bronchiolitis. Children with RSV bronchiolitis were found to have higher levels of cotinine when either the mother or both of the parents smoked, than the children with non-smoker parents. In conclusion, children admitted to the hospital with RSV bronchiolitis were shown to be acutely exposed to more cigarette smoke after 1 month and much more than the children admitted for non-respiratory diseases. These findings may imply that sudden heavy cigarette smoke exposure may predispose to an acute respiratory infection.

Report of eight cases of humeral fracture following the throwing of hand grenades.

A series of eight cases is presented in which similar fractures of the shaft of the humerus occurred during the throwing of hand grenades. Transient paresis of the radial nerve accompanied the fracture in one patient. In seven patients, the fracture healed without complication. In the remaining case, non-union developed, and surgical treatment was instituted. The mechanism of the fracture is discussed with reference to the literature.

Late-term reconstruction of lateral ankle ligaments using a split peroneus brevis tendon graft (Colville's technique) in patients with chronic lateral instability of the ankle.

We reviewed 14 patients with chronic lateral instability of the ankle treated by Colville's technique between 1996 and 2001. The mean patient age was 25 (20-35) years and all were men. The mean period between injury and surgery was 25 (18-32) months, and the mean follow-up was 20 (14-32) months. Twelve of the results were excellent and two were good according to the criteria of Chrisman and Snook. All patients returned to normal daily activity levels at an average of 6 months following surgery.

Can quantitative 99mTc-MDP bone scans be used to predict longitudinal growth of epiphyseal plate allografts after microvascular transplantation? An experimental study.

Allograft and autograft microvascular proximal tibial epiphyseal plate transplants were performed in female New Zealand White (NZW) rabbits to quantify the growth rate and total growth potential of immunosuppressed and nonimmunosuppressed rabbits. The purpose of this experiment is to examine whether the 99mTc-MDP radionuclide uptake of the transplanted epiphyseal plate at 1 week postoperatively, done to assess anastomotic patency of the transplant, could also serve as a predictor of eventual longitudinal growth of the transplant or replant. All transplants and replants demonstrating positive 99mTc-MDP uptake in the proximal tibial epiphyseal plate at 1 week showed continued longitudinal growth. The precise amount of 99mTc-MDP uptake, however, did not correlate with the amount of growth at 3 and 5 weeks follow-up.