The authors report about 72 cases of epicondylian tenotomy. It is a simple operative technique, which is described in details. This technique allows rapid post-operative course and good results in 97% of the cases.
The authors report about 72 cases of epicondylian tenotomy. It is a simple operative technique, which is described in details. This technique allows rapid post-operative course and good results in 97% of the cases.
Hyperextension of the wrist may induce underestimated intrinsic and extrinsic ligamentous tears. Undetected scaphoid fractures show the importance of accurate primary diagnostic. Evaluation of the anatomic and functional integrity of the ligaments of the wrist remains challenging. It requires great experience, but in any case, radiology remains the basic diagnostic tool used by both the general practitioner and the specialist. Only the use of reproducible imaging techniques will allow for comparison between healthy and pathological side as well as for follow-up. Every one should master and use standardized techniques as described in this paper. The costs bound to appropriate imaging techniques are certainly lower than the consequences of misdiagnosed ligamentous damage or carpal bone fractures. Furthermore, standardized techniques will avoid repeating radiological sessions.
The compartment syndrome of the foot is a rare and unrecognized entity. The most common etiology is post traumatic. Some years ago the diagnostic was suspected when the after-effects appear. Since fifteen years many authors have precised the anatomy, the diagnostic and the treatment of the compartment syndrome of the foot. Consequently the morbidity of this Pathology has diminished. In fact, because of the severity of associated injuries of the foot, after-effects are not rare and responsible for late disability.
Controversies exists about the value of sosgraphy in diagnosis of meniscal injuries. We therefore examined 179 knee joints. In a prospective study of 177 patients with knee problems, ultrasound was utilized to assess its values as a screening tool for meniscal tears. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultra-sound waves. 113 meniscal tears were seen at arthroscopy; 22% of these tears could not be detected by scanning (false negative results) while 10% of intact menisci showed positive echogenic structures analysed as meniscal tears. The results showed a sensitivity of 30.0% and a specificity of 85.3%. We cannot share the opinion of some autors that ultrasound is a reliable means of accurately diagnosing meniscal tears. It seems that ultrasound scanning of the menisci is still a experimental method without any clinical importance.
According to medical statistics over the last two decades, skiing is still associated with a certain risk of accident and injury. A review of studies carried out in Davos on alpine skiing accidents covering two decades aimed at assessing the effect of safety improvements in ski bindings combined with ski shoes and skis in view of injury statistics. Five comprehensive research studies included almost 10,000 injured and non-injured skiers and experience with nearly 29,000 injured skiers treated the Davos hospital. Firstly, the causes and preceptating factors of skiing accidents were determined and the role of binding release tests assessed. Then the effect of the skier on the accident was investigated. The function of ski binding adjustments was also studied. In a fourth step comprehensive data on multicentric research project were obtained. With the growing popularity of safety bindings in the 1970's and the results of research projects, the frequency of skiing accidents seemed to diminish or at least stagnate. The annual statistics from 1974 to 93 show a reduction in the frequency of tibial fractures and simultaneous rapid increase in the frequency of injuries of the knee joint, the upper limbs and the trunk. The situation demonstrate that measurements to control the accident rate cannot be based only on accident statistics and technical developments, but must rely on further studies of the mechanism of the fall and analyses of the long-term consequences of injuries.
Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with a radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter II fracture with open reduction and fixation, 6 avulsion fractures which were treated twice operatively and 4 times conservatively and 3 ruptures of the ligament which needed reconstruction. In contrast to adults, we see a different, age dependent injury pattern in children. The younger had Salter-I- and II-lesions of the proximal phalanx, whereas the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 patients one year after the accident showed in 12 a full recovery, in 4 cases full function with minor complaints and in one case an ancylosis of the MCP-joint following a postoperative infection.
A complete statistical evaluation of epidemiologic data and costs of burn injuries in 1984 with a follow-up for 5 years is presented, considering a collective of 1.77 million workers in Switzerland. The majority of burns are minor injuries; only about 5% of the burn victimes are admitted to a hospital, 0.2% die. Only one fifth of the costs caused by burns are due to medical treatment and rehabilitation. All other expenses result from continuation of payments of salaries and annuities. The few treatments of severely burnt patients in the burn units cause effective costs higher than the tariff paid by the insurance. Even so, the predominant portion of the enormous costs is taken up by wages while off work and annuities. As our conclusion we stress the importance of primary care for all severe burns including all burns of the hands in a specialized centre. Any economic effort for primary burn treatment, however high it may be, is justified if the duration of rehabilitation and invalidity can thus be reduced.
Hand injuries have occurred due to inflation of an air bag security system during a high velocity car accident. A driver and a passenger retained by three-point lap-shoulder belts crashed on the central railing of a motorway during their vehicle lost of control due to aquaplaning. The air bags inflated during the collision. The driver presented a superficial second degree burn with a 12 cm long blister on the radial side of the hand and distal forearm. The passenger suffered an intra-articular palmar avulsion fracture of the middle phalanx (PIP joint) and a mallet finger of the left fifth digit. The driver was treated conservatively and healed without sequelae. The passenger had K-wire fixation, after fracture repositioning, under local anaesthesia. Physiotherapy was started early. K-wires were removed at three weeks and active therapy continued. 6 months later the digit presented PIP joint stiffness and a 20 degrees flexion deformity. To the best of our knowledge this is the first description of upper extremity lesions due to inflation of an air bag device.
In 1991, 762,800 leisure time accidents were recorded in Switzerland. 33% of the accidents occurred in the course of a sporting activity with the majority happening while playing football. Skiing accidents came second. Although the recession reduced the number of accidents, skiing accidents were on the increase. The number of all other leisure time accidents including football accidents (the largest group) declined, as did occupational accidents. In terms of medicine, insurance and the economy, the significance of more than 54,000 skiing accidents each year is enormous. SUVA, the Swiss National Accident Insurance Organization is launching a comprehensive campaign to prevent skiing accidents. Among the many methods of prevention possible, such as physical preparation prior to the skiing season, safe equipment, correct skiing technique, consideration for other slope users and adaptation to the snow conditions, etc., this campaign focuses on the avoidance of a cold start. The campaign, which is planned to last several years and will cover the whole of Switzerland, aims to propagate the warm up before setting off downhill. The concept and development of this large-scale, professionally-run SUVA preventive campaign are described.
The anatomy of the palmar scapho-triquetral ligament was studied: on 15 hand specimens by means of gross anatomical dissections and MR imaging; and on a further 10 foetal wrist specimens, microanatomically. This ligament allows us to present the proximal carpal row as a socket, consisting of an upper part (the triquetrum, distal part of the scaphoid, and the dorsal and palmar scapho-triquetral ligament), and a base (the concave parts of the lunatum and scaphoid, connected by the scapho-lunate ligament). With a hyperextension wrist injury the upper part follows the distal part of the carpus, while the base remains fixed at the radius. The upper part slips away from the base, consequently, injuring the ligamentous structure, or causing a scaphoid fracture. The luno-triquetral and the palmar scapho-triquetral ligaments are also frequently torn. The overall prognosis depends on the grade of ligament damage. The arthroscopy allows us to estimate the state of the ligament structures, therefore, it is indicated before any reconstructive operation.
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