1/12. Operative stabilization of a flail chest six years after injury.We report a case of operative stabilization of an incompetent upper chest wall 6 years following flail chest. The indications for stabilization were chronic pain and dyspnea associated with rib malunion and loss of hemithorax volume. At operation, multiple pseudoarthroses were encountered and partial resection of ribs three and four was required. Malleable plates were used to bridge the gaps created by the resection and were secured in place with sternal wire. The patient reported a dramatic relief of symptoms and, at 18 months postoperatively, continues to work full-time on his cattle ranch essentially pain-free.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/12. Free vascularized thin corticoperiosteal graft.This paper describes a new thin corticoperiosteal graft harvested from the medial condylar and supracondylar areas of the femur. It is based on the articular branch of the descending genicular artery and vein and consists of periosteum with a thin (0.5 to 1.0 mm) layer of outer cortical bone. By retaining the cortex, the cambium layer is preserved, and this is thought to have a better osteogenic capacity than vascularized periosteal grafts. This graft was used to treat six patients with fracture nonunion of the upper extremity in which conventional treatment had failed. Uneventful bony union was achieved in all patients within 10 weeks.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/12. Arteriovenous shunts in free vascularized tissue transfer for extremity reconstruction.Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself. We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1). There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
4/12. The effect of mandibular osteotomy in three patients with hypersomnia sleep apnea.Hypersomnia sleep apnea (HSA) is characterized by apneic episodes during sleep and daytime hypersomnolence. patients afflicted as a result of upper airway obstruction have been treated traditionally with permanent tracheostomy. Three patients with HSA and mandibular retrognathism are presented. Each patient had a retrognathic mandible that stemmed from a different cause. Surgical advancement of their underdeveloped mandibles corrected the symptoms of HSA rapidly. The literature concerning HSA is reviewed and the advantages of mandibular surgery in selected cases are discussed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/12. sarcoidosis of the upper extremity: case presentation and literature review.sarcoidosis of the skeletal system is not rare but problems related to it are unusual. Two cases of sarcoidosis, with involvement of the upper extremity, are presented to point out problems that may occur in its treatment. Osteolytic sarcoid involvement of the phalanges leads to resorption and collapse, with a poor response to bone grafting or splinting. The phalangeal collapse could be treated with intramedullary cement or Kirschner wire fixation. Sarcoid involvement of fractures can lead to a nonunion and they should be treated with excision when appropriate, rather than attempting osteosynthesis. Arteriograms of sarcoid lesions show them to have a very poor blood supply. A bone scan can be used to demonstrate areas of sarcoid involvement before the characteristic lesion becomes evident on a radiography.- - - - - - - - - - ranking = 5keywords = upper (Clic here for more details about this article) |
6/12. Delayed fracture healing following jejunoileal bypass surgery for obesity.A 38-year-old woman, who 5 years earlier had undergone a jejunoileal bypass for gross obesity, fractured the distal forearm by a minor trauma. Circulating 25-hydroxycholecalciferol was undetectable without vitamin D3 supplement but increased to the lower normal range on a daily dose of 1200 units of vitamin D3. serum 1,25-dihydroxycholecalciferol was, however, in the upper normal range, both without and with vitamin d supplement. After intestinal reanastomosis the fracture healed and the biochemical changes normalized. Malabsorption due to reduced amount of functioning intestine may cause severe metabolic bone disease, which may not always be reverted by a high-calcium diet and vitamin d supplementation.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
7/12. Selection, evaluation and indications for electrical stimulation of ununited fractures.Management of nonunions requires careful and critical assessment of the true biologic status of the fracture. The mere radiographic persistence of a fracture line does not invariably indicate nonunion. Ten percent of fractures considered initially to be ununited in this series healed spontaneously without further treatment. The patient who has no pain with weight-bearing and no demonstrable motion on careful stress studies does not usually require further treatment, except for protection against reinjury. Intraosseous venography may be useful to distinguish the delayed from the nonunion in order to institute appropriate and early treatment. Percutaneous direct-current electrostimulation is proving to be a reliable and effective method of managing the most common nonunion of the tibia or distal femur. It appears less satisfactory for the more proximal femoral fractures and for fractures of the humerus. Electrical stimulation does not eliminate the need to stabilize the nonunion of either the femur or the upper limb. Electrical stimulation also does not eliminate the need for bone grafting in approximately 15% to 20% of nonunions. The fractures' biologic inability to respond may be identifiable by 99MTc diphosphonate bone scan. The implantable direct-current electrical stimulatory device proved ineffective in this series. Hopefully, further development of this technology may produce more consistent results in the future. The electromagnetic noninvasive stimulator appears to be a useful alternative method to the semi-invasive system. This, of course, should depend on the individual needs of the patient and the nature and location of the fracture. Continued technologic improvement in all electrical stimulatory methods should broaden their usefulness and applicability. However, the healing status of the fracture and the processes by which each fracture responds must be carefully assessed to appreciate what is being effected by electrical stimulation. Critical evaluation and clarification of indications are essential if the patient is to be offered the most effective therapy available.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
8/12. Application of Kuntscher Y nailing for fractures involving upper end of femur.Kuntscher Y nail is biomechanically a stable assembly and is useful in the management of unstable intertrochanteric, subtrochanteric and pathological fractures involving the upper end of the femur. In addition, it was ideal in special situations with fracture of the upper end of the femur; in a mentally ill patient with an unstable trochanteric fracture, for non-union of a trochanteric fracture and for a fracture of the upper end of the femur associated with a fracture further distally of the femoral shaft. Although it proved to be a very stable fixation, the control of external rotation of the distal femoral shaft was a significant problem in two cases. In all six cases stable fixation was achieved which progressed to sound union, including the case with ununited fracture. No technical difficulty was encountered at the time of operation although this could pose a significant problem. The main danger is the splintering of the lateral subtrochanteric femoral cortex during insertion of the neck piece and inability to negotiate the Kuntscher nail through the fenestration in the neck piece.- - - - - - - - - - ranking = 7keywords = upper (Clic here for more details about this article) |
9/12. One-stage random-pattern de-epithelialised "turn over" flaps in the leg.One-stage random-pattern de-epithelialised "turn over" flaps in the lower third of the leg appear to be as useful and successful as in the upper third of the leg. The blood supply to these flaps and their advantages are briefly discussed. The clinical details of 20 "turn over" flaps done over a period of 18 months are listed and two typical examples are presented.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/12. Vascularized periosteal bone graft from the supracondylar region of the femur.Free, vascularized thin corticoperiosteal grafts and small periosteal bone grafts harvested from the supracondylar region of the femur are described. These grafts are nourished from the articular branch of the descending genicular artery and vein. Thin corticoperiosteal grafts consist of periosteum with a thin layer of outer cortical bone and include the cambium layer, which has a better osteogenic capacity. This graft is elastic and readily conforms to the recipient bed configuration. Thin corticoperiosteal grafts were used to treat 11 patients with fracture non-union of an upper extremity that had no massive bone defects. Early, rapid union occurred in all patients except three: one in which the anastomosed vessel became obstructed and two in which the internal fixation of the fracture was unsecured. The small bone grafts consist of periosteum, full thickness cortex, and the underlying cancellous bone. This graft can be successfully harvested without disturbing the vascularity, unlike the currently used vascularized bone grafts. This graft was used to treat three patients with avascular necrosis of the body of the talus and could prevent the necrotic talus body from progressive collapse in patients in early stages of the disease. One patient with an infectious bone defect of the first metatarsal bone was successfully treated by vascularized bone graft with an accompanying skin flap.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
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