- Email: [email protected]
Subcapital fractures of the fifth metacarpal bone
ABSTRACTS
study, the authors studied the effect of antibiotics on the first 18 to 24 hours of the clinical course of suspected GABHS pharyngitis. Two-hundred sixty patients were cultured, evaluated for the presence of predetermined signs and symptoms, and randomized into groups receiving either penicillin V, cefadroxil, or syrup placebo for 3 doses. Patients were reevaluated by the same physician 18 to 24 hours later. No differences in symptoms or clinical findings were found between control and treatment groups in patients with nonGABHS pharyngitis. Of the total study population, 60% were bonafide streptococcal infections (positive GABHS culture and serologic response at 4 weeks). Of the GABHSpositive patients, significantly fewer patients treated with penicillin or cefadroxil had persistence of signs or symptoms when compared to the placebo group. The authors suggest that institution of therapy prior to receiving culture results may be appropriate in selected patients, given the dramatic early clinical improvement seen with antibiotic treatment in streptococcal pharyngitis. Ethan B Wilson, MD
FRACTURE, METACARPAL
Subcapital f r a c t u r e s of the fifth m e t a c a r p a l bone Abdon P, Muhlow A, Stigsson L, et al Arch Orthop Trauma Surg 103:231-234 Nov/Dec 1984
In this two-part study, the authors retrospectively studied the incidence of various metacarpal fractures as well as the final outcome of 29 randomly selected patients with subcapital fractures of the fifth metacarpal bone that had been treated conservatively. Of all patients treated for upper extremity fractures at two Swedish hospitals, 5% had fractures in the subcapital region of the fifth metacarpal, which accounted for 54% of all single fifth metacarpal fractures. The ratio of dominant to nondominant hands was 9:1. The final outcome of these patients was classified by various cosmetic and functional criteria by the patient and by an examiner. These criteria were functional disability, cosmetic complaints, visible displacement, extensor deficit, flexion deficit, and rotational deformity. The residual volar angulation was determined by roentgenographs with the hand in a special Plexiglas holder. The contralaterat hand was used as the control. Comparing the volar angulation measurements of patients with and without functional disability, the authors suggest that fractures that increase the volar angulation of the head to the diaphysis by more than 15° (which corresponds to 30 ° of total angulation) need reduction, and those with less than 15° of increased angulation do not warrant surgical reduction. Functional disability was minimal In almost all cases and grip strength likewise was not altered. Douglas J Butzier, MD
146/1237
FLANK PAIN, DIAGNOSIS
Sonography vs e x c r e t o r y urography in a c u t e flank pain Hill MC, Rich JI, Mardiat JG, et al AJR 144:1235-1238 Jun 1985
Sonography and excretory urography are compared prospectively in the diagnosis of acute flank pain. Sixty-one patients underwent both studies, which then were assessed independently. Final diagnosis was made on the basis of clinical correlates and outcome. Forty-one patients had urinary tract stones, Urography correctly diagnosed 85%; sonography diagnosed 66% (when ureteral dilation was interpreted as suggesting stone disease). When the stone was at the ureterovesical junction, sonography was more sensitive (79%) than urography (68%) in detection. All stones missed by sonography were evident on plain radiographs (which were not available to the sonographer). There were no false positive diagnoses of stone disease or pyelonephritis by either method. Neither method was sensitive in diagnosing acute pyelonephritis. The authors suggest that although sonography is slightly less sensitive than urography in diagnosing acute flank pain, it can be a useful alternative in patients with relative contraindications to urography (pregnancy, iodine allergy, dehydration, or multiple recurrences of renal colic). [Editor's note: Statistical analysis and comparison of the stone versus non-stone accuracies would make the correlation much more meaningful.] Sally Coates, MD
ISCHEMIA, BOWEL, DIAGNOSIS
Serum phosphate levels in a c u t e bowel ischemia: An aid to early diagnosis Feretis CB, Koborozos BA, Vyssoulis GP, et al
Am Surg 51:242-244 Apr 1985
The high mortality of bowel ischemia has been believed to be related to delay in diagnosis. Recent animal studies have noted increased serum phosphate levels following ischemic episodes. This study investigated the levels of serum phosphate in 18 patients with acute intestinal infarction. Preoperative samples were drawn 4 to 12 hours following the onset of symptoms. The levels were found to be significantly elevated in 17 patients [6.12 _+ 0.75 mg/dLI when compared to both normal laboratory values (3 to 5 grn/dL) and to 24 patients in the control group (3.80 _ 0.49 mg/dLJ found to have other causes for their acute abdominal presentation at laparotomy. Phosphate levels for the intestinal ischemic group fell postoperatively to 4.35 +_ 1.01 mg/dL. It also was noted that the length of time from symptom onset was related directly to the serum phosphate lev-
Annals of EmergencyMedicine
14:12 December 1985
study, the authors studied the effect of antibiotics on the first 18 to 24 hours of the clinical course of suspected GABHS pharyngitis. Two-hundred sixty patients were cultured, evaluated for the presence of predetermined signs and symptoms, and randomized into groups receiving either penicillin V, cefadroxil, or syrup placebo for 3 doses. Patients were reevaluated by the same physician 18 to 24 hours later. No differences in symptoms or clinical findings were found between control and treatment groups in patients with nonGABHS pharyngitis. Of the total study population, 60% were bonafide streptococcal infections (positive GABHS culture and serologic response at 4 weeks). Of the GABHSpositive patients, significantly fewer patients treated with penicillin or cefadroxil had persistence of signs or symptoms when compared to the placebo group. The authors suggest that institution of therapy prior to receiving culture results may be appropriate in selected patients, given the dramatic early clinical improvement seen with antibiotic treatment in streptococcal pharyngitis. Ethan B Wilson, MD
FRACTURE, METACARPAL
Subcapital f r a c t u r e s of the fifth m e t a c a r p a l bone Abdon P, Muhlow A, Stigsson L, et al Arch Orthop Trauma Surg 103:231-234 Nov/Dec 1984
In this two-part study, the authors retrospectively studied the incidence of various metacarpal fractures as well as the final outcome of 29 randomly selected patients with subcapital fractures of the fifth metacarpal bone that had been treated conservatively. Of all patients treated for upper extremity fractures at two Swedish hospitals, 5% had fractures in the subcapital region of the fifth metacarpal, which accounted for 54% of all single fifth metacarpal fractures. The ratio of dominant to nondominant hands was 9:1. The final outcome of these patients was classified by various cosmetic and functional criteria by the patient and by an examiner. These criteria were functional disability, cosmetic complaints, visible displacement, extensor deficit, flexion deficit, and rotational deformity. The residual volar angulation was determined by roentgenographs with the hand in a special Plexiglas holder. The contralaterat hand was used as the control. Comparing the volar angulation measurements of patients with and without functional disability, the authors suggest that fractures that increase the volar angulation of the head to the diaphysis by more than 15° (which corresponds to 30 ° of total angulation) need reduction, and those with less than 15° of increased angulation do not warrant surgical reduction. Functional disability was minimal In almost all cases and grip strength likewise was not altered. Douglas J Butzier, MD
146/1237
FLANK PAIN, DIAGNOSIS
Sonography vs e x c r e t o r y urography in a c u t e flank pain Hill MC, Rich JI, Mardiat JG, et al AJR 144:1235-1238 Jun 1985
Sonography and excretory urography are compared prospectively in the diagnosis of acute flank pain. Sixty-one patients underwent both studies, which then were assessed independently. Final diagnosis was made on the basis of clinical correlates and outcome. Forty-one patients had urinary tract stones, Urography correctly diagnosed 85%; sonography diagnosed 66% (when ureteral dilation was interpreted as suggesting stone disease). When the stone was at the ureterovesical junction, sonography was more sensitive (79%) than urography (68%) in detection. All stones missed by sonography were evident on plain radiographs (which were not available to the sonographer). There were no false positive diagnoses of stone disease or pyelonephritis by either method. Neither method was sensitive in diagnosing acute pyelonephritis. The authors suggest that although sonography is slightly less sensitive than urography in diagnosing acute flank pain, it can be a useful alternative in patients with relative contraindications to urography (pregnancy, iodine allergy, dehydration, or multiple recurrences of renal colic). [Editor's note: Statistical analysis and comparison of the stone versus non-stone accuracies would make the correlation much more meaningful.] Sally Coates, MD
ISCHEMIA, BOWEL, DIAGNOSIS
Serum phosphate levels in a c u t e bowel ischemia: An aid to early diagnosis Feretis CB, Koborozos BA, Vyssoulis GP, et al
Am Surg 51:242-244 Apr 1985
The high mortality of bowel ischemia has been believed to be related to delay in diagnosis. Recent animal studies have noted increased serum phosphate levels following ischemic episodes. This study investigated the levels of serum phosphate in 18 patients with acute intestinal infarction. Preoperative samples were drawn 4 to 12 hours following the onset of symptoms. The levels were found to be significantly elevated in 17 patients [6.12 _+ 0.75 mg/dLI when compared to both normal laboratory values (3 to 5 grn/dL) and to 24 patients in the control group (3.80 _ 0.49 mg/dLJ found to have other causes for their acute abdominal presentation at laparotomy. Phosphate levels for the intestinal ischemic group fell postoperatively to 4.35 +_ 1.01 mg/dL. It also was noted that the length of time from symptom onset was related directly to the serum phosphate lev-
Annals of EmergencyMedicine
14:12 December 1985