Intrathoracic Glenohumeral Dislocation without Fracture of the Humerus: A Case Report and Review of the Literature.

Case: A fifty-three-year-old man presented with an intrathoracic glenohumeral dislocation (ITGHD) and associated hemothorax, rib fracture, massive rotator cuff tear, and axillary nerve palsy following an ice hockey injury. Treatment consisted of closed reduction and staged open rotator cuff repair. Despite a substantial injury, the patient recovered nearly normal use of the arm two years postoperatively.

Exposures of the elbow.

This article describes the basic bony, ligamentous, and neurologic anatomy of the structures about the elbow. The surgical exposures of the elbow joint are described, providing details of the various posterior, lateral, and medial approaches to the articular segments. Clinical applications describing the potential benefits of each surgical exposure are provided as examples.

Traumatic injuries of the distal radioulnar joint.

Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius.

Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes.

Proximal row carpectomy (PRC) and scaphoid excision with four-corner fusion (4CF) are common motion-preserving, salvage procedures for the treatment of wrists with scaphoid nonunion (SNAC) or scapholunate advanced collapse (SLAC). A systematic review was undertaken to clarify controversies regarding which of these procedures has the better outcome. We collated 52 articles that examine outcomes for SNAC or SLAC patients undergoing PRC or 4CF.

Mycobacterium chelonae infection following silicone arthroplasty of the metacarpophalangeal joints: a case report.

We present a case of infection caused by an uncommon pathogen, Mycobacterium chelonae, in a patient that underwent Swanson silicone arthroplasty of the metacarpophalangeal joints for rheumatoid arthritis. This is the first report of an infection caused by nontuberculous Mycobacteria in flexible silicone implants in the hand. The patient was successfully treated with implant removal, debridement, and antimicrobials tailored to the results of in vitro susceptibility testing.

Traumatic injuries of the distal radioulnar joint.

Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius.

Intra-articular fractures of the upper extremity: new concepts in surgical treatment.

New techniques of internal fixation, postoperative rehabilitation, and emphasis on functional as well as radiographic outcome have refined the surgical treatment of complex fractures of the glenoid, humeral head, supracondylar and intracondylar humerus, olecranon, radial head, distal radius, and distal radioulnar joint over the past decade. Early stabilization and rehabilitation of these injuries leads to soft-tissue stabilization and facilitates the patient's ability to place the hand in three-dimensional space.

Direct detection of a microlens in the Milky Way.

The nature of dark matter remains mysterious, with luminous material accounting for at most approximately 25 per cent of the baryons in the Universe. We accordingly undertook a survey looking for the microlensing of stars in the Large Magellanic Cloud (LMC) to determine the fraction of Galactic dark matter contained in massive compact halo objects (MACHOs). The presence of the dark matter would be revealed by gravitational lensing of the light from an LMC star as the foreground dark matter moves across the line of sight.

Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius.

Scaphoid nonunion with avascular necrosis of the proximal pole remains a difficult problem. We have endeavoured to heal the fracture, restore scaphoid height and revascularize the proximal pole of the scaphoid by means of a vascularized dorsal interposition graft from the distal radius. The procedure has resulted in union of six of ten fractures.

Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report.

Two patients are reported who had tendon rupture and plate breakage following internal fixation with the newly designed AO/ASIF titanium distal radius plate system (pi plate). The incidence of complications with this system warrants further evaluation.

Management of complex dislocations of the distal radioulnar joint.

The authors reviewed their experience in the treatment of complex dislocations of the distal radioulnar joint. Six cases of complex dislocations were treated between 1990 and 1993. An algorithm for the treatment of these injuries has been developed.

Atrophic nonunion of the clavicle: treatment by compression plate, lag-screw fixation and bone graft.

We describe a new surgical treatment of atrophic nonunion of the clavicle. The nonunion is excised by cuts at 45 degrees to the long axis and repair uses 3.5 mm pelvic reconstruction or dynamic compression plates, with a lag screw to provide interfragmentary compression.

Intraarticular osteotomy of distal radial malunions.

Failure to reduce intraarticular fractures of the distal radius to less than 2 mm of residual articular incongruity often will lead to posttraumatic arthrosis. Intraarticular osteotomy of the distal radius was performed for intraarticular malunions with a step greater than 2 mm in the distal radial articular surface, in the absence of arthrosis. The technique involves careful recreation of the fracture into the joint and rigid internal fixation of the osteotomy site.

Synovial osteochondromatosis of the distal radio-ulnar joint.

Synovial osteochondromatosis is an uncommon lesion characterized by cartilagenous and osseous metaplasia of joint synovium. It is typically monarticular, affecting large joints such as the knee and hip, although it has also been described in the ankle, elbow and shoulder. It is exceptionally rare in the hand, but has been reported involving the tenosynovium of the digits and the wrist.

"Splint-top" fracture of the forearm: a description of an in-line skating injury associated with the use of protective wrist splints.

Upper extremity injuries are commonly seen in the sport of in-line skating. The use of protective equipment, including wrist splints, has been advocated as a means to decrease both the incidence and severity of upper extremity injuries in this sport. We report on four cases of open forearm fractures in the in-line skaters that occurred adjacent to the proximal border of the wrist splints.

Wrist arthrodesis using a dynamic compression plate.

We performed 45 wrist arthrodeses in 43 patients by a modification of the AO technique using the dynamic compression plate. Radiological follow-up was obtained in 41 wrists; all had united at a mean of ten weeks. Clinical follow-up was obtained in 32 wrists.

Severe complex injuries to the upper extremity: revascularization and replantation.

Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result.

Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius.

Comminuted intraarticular fractures of the distal radius present a difficult problem in management. It is well established that unreduced significant articular incongruency will result in early degenerative osteoarthritis. The technical demands of, and the results to be expected from, formal open reduction and internal fixation of these comminuted articular fractures have not been addressed in the current literature.

Radiographic definition of the dorsal and palmar edges of the distal radius.

The dorsal and palmar edges of the distal radius, as well as the concavity of the articular surface were labeled with wire and radiographs taken from neutral to 30 degrees of added dorsal tilt. The dorsal edge was identified as the structure that protrudes distally in neutral. The palmar edge was found to overlap with the sclerotic subchondral bone of the radius in neutral.

Granulocyte precursors are the principal cells in bone marrow that stimulate allospecific cytolytic T-lymphocyte responses.

Mouse bone marrow cells were fractionated and enriched for functional activity as stimulators of allospecific cytolytic T-lymphocyte (CTL) responses in vitro. The relevant stimulator cells were enriched sequentially in the low-density fraction of bone marrow, its 2-hr adherent and 18-hr non-adherent fractions and in the FcR-negative fraction of 18-hr non-adherent cells. The functionally enriched cell population contained over 90% granulocyte precursors by ultrastructural analysis.