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Management of Arterial injuries in blunt trauma of the extremity
ABSTRACTS
steroids. They have developed a hydrocephalic antenatal vent for intrauterine placement (HAVIT) consisting of a stainless steel bolt with an adjustable spring loaded ball valve inside. This is placed through the cranium into the ventricular cavity and allows drainage of the spinal fluid into the amniotic cavity when the pressure exceeds the preset limit. In "Clinical Perspectives," p. 1079 of the same issue, Dr. Hodgen illustrates his work with photographs of monkeys showing severe hydrocephalus with proptosis untreated, and with normal looking facies after treatment with the HAVIT. No human cases are reported although the authors said they feel the method has clinical application.--David L. Collins
"'Cold" Bone Scans in Acute Osteomyalitis. D. C. Jones, R. B. Cady. J Bone Joint Surg 63B:376-378, August 1981.
Bone scanning has been established as a useful method of detecting osteomyelitis before radiographic changes appear, the usual findings being an increased uptake of the radioactive material. Three cases of osteomyelitis in children are presented in which surgical and bacteriological proof of diagnosis was obtained, in which the bone scan showed a decrease uptake of technetium. It is suggested that such a negative result is explained by local pressure on the nutrient artery reducing the blood flow to the bone. "Cold" bone scans are therefore not inconsistent with the presence of acute osteomyelitis.--M. G. H. Smith.
Management of Arterial Injuries in Blunt Trauma of the Extremity. K. J. Ransom, C. H. Shatney, C. A. Soderstrom,
and R. A. Cowley. Surg Gyn Obstet 153:241-246, (August), 1981.
This report from the Maryland Institute for Emergency Medical Services Systems in Baltimore is a retrospective review of all patients treated for peripheral arterial injuries from blunt trauma between January 1972 and August 1980. During that time 58 patients were seen with 69 arterial injuries. The ages of this group of patients ranged from 15 to 74 yr with 60 percent of them being less than 30 years of age at the time of injury. Sex ratio was 8:1 males to females. Seventy eight percent of all accidents were the result of motor vehicle accidents. Early fasciotomies were performed, particularly in lower extremity injuries with associated ischemic changes. The authors advocate strongly decompressing fasciotomies and document several complications which may have been prevented by an early fasciotomy. Eighteen of the 58 patients recovered completely from their arterial injuries. A large group survived with no morbidity from vascular trauma but with various degrees of neurological impairment. Fifteen of the patients subsequently had amputations, one of an arm and 14 of a leg. Six other amputations were due to nonvascular causes and one amputation was done because of hemodynamic instability and shock shortly after the time of the injury. Seven patients died of postoperative complications.Robert M. Arensman
217
Surgical Correction of Postburn Flexion Contracturas of the Fingers in Children. J. W. Alexander, B. G. MacMillan, L.
Martel and R. Krummel. Plas Recon Surg 68:218-225, (August), 1981.
The article details the authors' considerable experience with the correction of postburn flexion contractures in fingers of children. Several points are made in the operation (1) Wide release of the scar is recommended by multiple incisions rather than excisions. (2) All joint contractures should be straightened, even forcefully, at the time of surgery to improve the positional results. (3) Tie on dressings utilized to hold thick split thickness or full thickness grafts have been more effective when left on for 1 wk and the finger splinted an additional 2 wk thereafter. (4) The use of intramedullary K-wires for temporary immobilization has not improved the results.--A. B. Sokol Inadequate Reduction of Congenital Dislocation of the Hips.
Renshaw. J Bone Joint Surg 63A:1114-1121, (September), 1981.
Eleven patients were studied who had failure of previously closed reductions of hip dislocations. They had been left with a persistent lateralization of the femoral head and neck despite conservative care. All patients were studied arthrographically. Persistent soft tissue interposition was documented despite prolonged maintenance of conservative techniques. The authors conclude that persistent lateralization at the time of closed reduction should be studied arthrographically to forestall the few cases that require open r e d u c t i o n . Anthony H. Alter Radionuclide Scanning in the Early Diagnosis of Perthes" Disease. R. Calver, V. Venugopal, J. Dorgan, G. Bentley, T.
Gimlette. J Bone Joint Surg 63B:379-382, (August), 1981.
In a prospective survey of 50 children presenting with irritable hip radionuclide scanning was performed. Of these 50 hips, 45 were normal and remained so in followup. The other five hips had evidence of ischemia on scanning and all five developed radiological evidence of Perthes' disease within 6 me. This technique demonstrates the possibility of reliably diagnosing Perthes' disease at an early stage.-M. G. H. Smith. Determination of the Catterall Classification in Logg-CalvePerthas Disease. B. E. Van D a m , R. J. Crider, J. D. Noyes,
and L. J. Larsen. J Bone Joint Surg 63A:906-914, (July), 1981.
Fifty four hips in forty four children with Legg-Calve'Perthes disease were studied. The average followup was 6 yr and 11 me. The authors showed that, prior to fragmentation of the capital femoral epiphyses, the Catterall Classification changed so that its effectiveness is only valid after the fragmentation stage has been reached.--Anthony H. Alter Epiphyseal Extrusion as a Prognostic Index in Lagg-Calve'Perthes Disease. N. E. Green, R. D. Beauchamp, and P. P.
Griffin. J Bone Joint Surg 63A:900-905, (July), 1981.
Two hundred children with Legg-Calve-Perthes disease were studied. Followup ranged from 5 to 26 yr after diagno-
steroids. They have developed a hydrocephalic antenatal vent for intrauterine placement (HAVIT) consisting of a stainless steel bolt with an adjustable spring loaded ball valve inside. This is placed through the cranium into the ventricular cavity and allows drainage of the spinal fluid into the amniotic cavity when the pressure exceeds the preset limit. In "Clinical Perspectives," p. 1079 of the same issue, Dr. Hodgen illustrates his work with photographs of monkeys showing severe hydrocephalus with proptosis untreated, and with normal looking facies after treatment with the HAVIT. No human cases are reported although the authors said they feel the method has clinical application.--David L. Collins
"'Cold" Bone Scans in Acute Osteomyalitis. D. C. Jones, R. B. Cady. J Bone Joint Surg 63B:376-378, August 1981.
Bone scanning has been established as a useful method of detecting osteomyelitis before radiographic changes appear, the usual findings being an increased uptake of the radioactive material. Three cases of osteomyelitis in children are presented in which surgical and bacteriological proof of diagnosis was obtained, in which the bone scan showed a decrease uptake of technetium. It is suggested that such a negative result is explained by local pressure on the nutrient artery reducing the blood flow to the bone. "Cold" bone scans are therefore not inconsistent with the presence of acute osteomyelitis.--M. G. H. Smith.
Management of Arterial Injuries in Blunt Trauma of the Extremity. K. J. Ransom, C. H. Shatney, C. A. Soderstrom,
and R. A. Cowley. Surg Gyn Obstet 153:241-246, (August), 1981.
This report from the Maryland Institute for Emergency Medical Services Systems in Baltimore is a retrospective review of all patients treated for peripheral arterial injuries from blunt trauma between January 1972 and August 1980. During that time 58 patients were seen with 69 arterial injuries. The ages of this group of patients ranged from 15 to 74 yr with 60 percent of them being less than 30 years of age at the time of injury. Sex ratio was 8:1 males to females. Seventy eight percent of all accidents were the result of motor vehicle accidents. Early fasciotomies were performed, particularly in lower extremity injuries with associated ischemic changes. The authors advocate strongly decompressing fasciotomies and document several complications which may have been prevented by an early fasciotomy. Eighteen of the 58 patients recovered completely from their arterial injuries. A large group survived with no morbidity from vascular trauma but with various degrees of neurological impairment. Fifteen of the patients subsequently had amputations, one of an arm and 14 of a leg. Six other amputations were due to nonvascular causes and one amputation was done because of hemodynamic instability and shock shortly after the time of the injury. Seven patients died of postoperative complications.Robert M. Arensman
217
Surgical Correction of Postburn Flexion Contracturas of the Fingers in Children. J. W. Alexander, B. G. MacMillan, L.
Martel and R. Krummel. Plas Recon Surg 68:218-225, (August), 1981.
The article details the authors' considerable experience with the correction of postburn flexion contractures in fingers of children. Several points are made in the operation (1) Wide release of the scar is recommended by multiple incisions rather than excisions. (2) All joint contractures should be straightened, even forcefully, at the time of surgery to improve the positional results. (3) Tie on dressings utilized to hold thick split thickness or full thickness grafts have been more effective when left on for 1 wk and the finger splinted an additional 2 wk thereafter. (4) The use of intramedullary K-wires for temporary immobilization has not improved the results.--A. B. Sokol Inadequate Reduction of Congenital Dislocation of the Hips.
Renshaw. J Bone Joint Surg 63A:1114-1121, (September), 1981.
Eleven patients were studied who had failure of previously closed reductions of hip dislocations. They had been left with a persistent lateralization of the femoral head and neck despite conservative care. All patients were studied arthrographically. Persistent soft tissue interposition was documented despite prolonged maintenance of conservative techniques. The authors conclude that persistent lateralization at the time of closed reduction should be studied arthrographically to forestall the few cases that require open r e d u c t i o n . Anthony H. Alter Radionuclide Scanning in the Early Diagnosis of Perthes" Disease. R. Calver, V. Venugopal, J. Dorgan, G. Bentley, T.
Gimlette. J Bone Joint Surg 63B:379-382, (August), 1981.
In a prospective survey of 50 children presenting with irritable hip radionuclide scanning was performed. Of these 50 hips, 45 were normal and remained so in followup. The other five hips had evidence of ischemia on scanning and all five developed radiological evidence of Perthes' disease within 6 me. This technique demonstrates the possibility of reliably diagnosing Perthes' disease at an early stage.-M. G. H. Smith. Determination of the Catterall Classification in Logg-CalvePerthas Disease. B. E. Van D a m , R. J. Crider, J. D. Noyes,
and L. J. Larsen. J Bone Joint Surg 63A:906-914, (July), 1981.
Fifty four hips in forty four children with Legg-Calve'Perthes disease were studied. The average followup was 6 yr and 11 me. The authors showed that, prior to fragmentation of the capital femoral epiphyses, the Catterall Classification changed so that its effectiveness is only valid after the fragmentation stage has been reached.--Anthony H. Alter Epiphyseal Extrusion as a Prognostic Index in Lagg-Calve'Perthes Disease. N. E. Green, R. D. Beauchamp, and P. P.
Griffin. J Bone Joint Surg 63A:900-905, (July), 1981.
Two hundred children with Legg-Calve-Perthes disease were studied. Followup ranged from 5 to 26 yr after diagno-