Search

Distal radial fractures are common problems for the orthopedic surgeon, and various surgical treatments have been reported. However, each method has its indications, pitfalls, and limitations. It is important to select the appropriate procedure for the fracture pattern. We studied 115 consecutive patients including 45 patients with distal radial fractures treated with percutaneous pinning, 67 patients treated with external fixation, and 32 patients treated with assisted wrist arthroscopy. Percutaneous pinning was useful in extra-articular fractures and minimally comminuted intra-articular fractures, but was inadequate for patients with severe osteopenia and markedly comminuted intra-articular fractures. External fixation was indicated when intra-articular comminution was present. However, the dorsomedial fragment was often not reduced and maintained by this technique; additional pinning was needed to reduce this fragment. A dynamic-type fixator was feasible for younger patients who required early functional recovery. Arthroscopy provided accurate visualization of the wrist joint and the intra-articular fracture.

A new method for reconstruction of an amputated thumb with a free neurovascular flap and an iliac bone graft in one stage is described. The method consists of fbur operative steps: (1) preparation of the recipient hand, (2) elevation of a free dorsalis pedis flap, (3) iliac bone graft, and (4) transfer of the flap with microvascular anastornoses. Four successful results with this operation are presented. The method, which reconstructs the thumb in a single operation, is suitable for patients who refuse other reconstructive methods which sacrifice uninjured digits or toes.

Posterior decompression plus posterior reconstruction (laminoplasty) is a useful surgical method for treatment of cervical compressive myelopathy. There are many laminoplasty procedures. This paper describes the Z-shaped laminoplasty developed by Hattori in 1971, and presents a clinical follow-up of the authors' experience with 130 patients. The procedure involves grinding the laminae down with an air drill and making a Z-shaped cut into the thinned laminae without excising the laminae. This technique enlarges the spinal canal. The purpose of this technique is to decompress the spinal cord and at the same time maintain clinical stability. Postoperative results were satisfactory without any major complication. Follow-up study was conducted in 78 cases with a minimal follow-up period of more than 2 years. Satisfactory clinical results were maintained for long periods postoperatively, and the enlargement of the spinal canal was well maintained as demonstrated on follow up X-ray study.

The clinical effects of cefoxitin (CFX) were evaluated in the prophylaxis of postoperative infections in the field of orthopaedics. The clinical response was good in 46 out of 50 patients; an efficacy rate of 92%. Four patients (8%) who did not respond to CFX were suffering from infections due to Mycobacterium tuberculosis (1), suspected Pseudomonas aeruginosa (1), and infection of unknown organism (2). A review was also made of recent trends among clinically isolated bacterial strains and their susceptibility to antibiotics in the field of orthopaedics. CFX is recommended as an antibiotic of first choice for the prophylaxis of postoperative infections in the field of orthopaedics.