Sneddon's syndrome: generalized livedo reticularis and cerebrovascular disease. Importance of hemostatic screening.

We report two cases of Sneddon's syndrome. Both cases had widespread livedo reticularis with repeated cerebrovascular accidents without persistent neurological deficit. In one case, hemostatic examination revealed an imbalance of plasminogen activator-inhibitor values, possibly related to the thrombogenic propensity of the syndrome. Treatment with acetylsalicylic acid led to normalization of hemostatic parameters and resulted in a symptom-free period of more than 10 months. The importance of hemostatic screening in patients with Sneddon's syndrome is discussed.     

Volar dislocation of the proximal interphalangeal joint of the finger: an indication for urgent operative treatment

Two patients are described with persistent acute volar dislocation of the middle phalanx of a finger. Closed reduction was impossible due to intra-articular interposition of the lateral slip of the extensor mechanism, combined with a tear of a collateral ligament. It is important to recognize these injuries at an early stage and an operative treatment is required.     

Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome

Twenty-eight patients were treated by ulnar shortening osteotomy for static or dynamic ulnar impaction syndrome. Ulnar variance was measured on a true anteroposterior radiograph. There were 25 wrists that were too long, two neutral, and one that was short. Bones were shortened by a mean of 3.5 mm. Mean follow-up time was 29 months (range 7–60), all with confirmed consolidation. At final follow-up mean grip strength had improved from 67% to 75%, mean Disabilities of the Arm, Shoulder, and Hand (DASH) score from 40 (range 12–83) to 26 (range 0–61) and mean range of movement from 80% (range 40%–100%) to 88% (range 50%–100%). Smoking, age at operation, type of osteotomy (transverse or oblique), dominance of hand, and sex did not influence consolidation or functionality. Special attention was paid to the anatomy of the distal radioulnar joint and the inclination of the sigmoid notch of the radius. There was no correlation between the anatomy and the functional outcome scores. Mean consolidation time (10 months) (range 2–32) and return to work were longer than in similar studies. Our findings confirm the usefulness of ulnar shortening osteotomy in the relief of ulnocarpal impingement symptoms.     

Proximal row carpectomy in advanced Kienbock's disease

This retrospective study assessed the outcomes of 21 patients (16 male and 5 female, mean age 39 years) with advanced Kienbock's disease treated by resection of the proximal carpal row. They were clinically reviewed. The mean follow-up was 67 months, with all but two patients having had a follow-up of 2 years. No or mild pain was being experienced by 13 patients, moderate pain by 3 and severe pain by 5. Grip strength increased from 19 kg pre-operatively to 26 kg postoperatively (or 65% of the normal contralateral side). There was a slight increase of mobility. The DASH score was 22 points (range 0-78) and the Patient Rated Wrist Score (PRWS) was 30 points (range 0-84). Two patients developed Complex Regional Pain Syndrome which was ongoing at the time of review and one developed a superficial wound infection. Proximal carpal row resection arthroplasty gave satisfactory results in patients with advanced Kienbock's disease.     

Fixation of a periprosthetic humeral fracture with CCG-cable system

We report a case of periprosthetic fracture of the shoulder, treated operatively. A special plate/cable system (ECG) was used with an excellent outcome. This easy technique is recommended for such fractures.     

Contact allergy to petrolatums

46 yellow and while petrolatums were screened for their skin sensitizing properties in 3 subjects with known histories of contact sensitivity to yellow petrolatum.
Patch testing revealed that all the petrolatums examined contain sensitising substances in varying amounts. The results were analyzed with regard to origin, color, purification procedures involved in the production of pharmaceutical grade petrolatum, and pharmacopoeial requirements satisfied. Allergenicity correlated positively with these parameters, but only among petrolatums of the same brand.
Petrolatum sensitivity may sometimes account for false positive patch test reactions to substances diluted in it. A petrolatum which causes no reaction on healthy skin may cause rczematous reactions on damaged skin.     

Debridement arthroplasty for osteoarthritis of the elbow (Outerbridge-Kashiwagi procedure)

The Outerbridge-Kashiwagi (O-K) procedure has been described to treat mild to moderate osteoarthritis of the elbow. We treated a consecutive series of 15 patients (16 elbows) with the O-K procedure. All patients were reviewed after a mean follow-up of twenty months (range 3-64 months). The purpose of this study was to evaluate the results of the O-K procedure. Assessment included evaluation of elbow pain, range of motion and the Mayo elbow Performance Index (MPI). The mean arc of motion improved from 94 degrees (range, 65 degrees-120 degrees) preoperatively to 114 degrees (range 93 degrees-128 degrees) at the time of follow-up (p < 0.01). At the latest follow-up evaluation the total MPI improved from 63 (range, 50-75) to 88 (range, 45-100) (p < 0.01), eight elbows (50%) had no pain, seven (43.8%) mild pain and one (6.2%) moderate pain. The result was excellent for 8 elbows (50%), good for 6 (37.5%), fair for one (6.2%) and poor for one (6.2%). Patients' satisfaction showed that thirteen (86.6%) were much better or better and two (13.3%) were not improved compared with the preoperative situation.