Scaphoid interfragmentary motions due to simulated transverse fracture and volar wedge osteotomy

Background

Our goal was to determine 3-dimensional interfragmentary motions due to simulated transverse fracture and volar wedge osteotomy of the scaphoid during physiologic flexion–extension of a cadaveric wrist model.

Methods

The model consisted of a cadaveric wrist (n = 8) from the metacarpals through the distal radius and ulna with load applied through the major flexor–extensor tendons. Flexibility tests in flexion–extension were performed in the following 3 test conditions: intact and following transverse fracture and wedge osteotomy of the scaphoid. Scaphoid interfragmentary motions were measured using optoelectronic motion tracking markers. Average peak scaphoid interfragmentary motions due to transverse fracture and wedge osteotomy were statistically compared (P < 0.05) to intact.

Findings

The accuracy of our computed interfragmentary motions was ± 0.24 mm for translation and ± 0.54° for rotation. Average peak interfragmentary motions due to fracture ranged between 0.9 mm to 1.9 mm for translation and 5.3° to 10.8° for rotation. Significant increases in interfragmentary motions were observed in volar/dorsal translations and flexion/extension due to transverse fracture and in separation and rotations in all 3 motion planes due to wedge osteotomy.

Interpretation

Comparison of our results with data from previous in vitro and in vivo biomechanical studies indicates a wide range of peak interfragmentary rotations due to scaphoid fracture, from 4.6° up to 30°, with peak interfragmentary translations on the order of several millimeters. Significant interfragmentary motions, indicating clinical instability, likely occur due to physiologic flexion–extension of the wrist in those with transverse scaphoid fracture with or without volar bone loss.     

牡丹江市正常成人尿液红、白细胞定量分析参考值调查

目的尿液沉渣分析红、白细胞由传统的定性报告方式改为定量分析(××/μl).由于使用的检查方法不同,其参考值也不一样,国内目前尚未有统一的参考值,为使牡丹江市有一个统一的判断标准.方法我们对1109名健康成人其中男性591人,女性518人进行尿中红细胞及白细胞的参考值调查.方法采用国内的专用尿沉渣计数板,显微镜下计数.对体检者在统一时间清晨7点钟留取尿液20～30毫升,按统一操作规程进行操作,对不同性别的人群进行参考值的调查.结果男性红细胞x是1.12,S是1.42,95%可信界限0～3.96,参考值范围0～4/μl;男性白细胞x是1.84,是S 2.05,95%可信界限0～5.94,参考值范围0～6/μl.女性红细胞x是2.46,S是3.26,95%可信界限0～8.98,参考值范围0～9/μl;女性白细胞x是2.25,S是3.82,95%可信界限0～9.89,参考值范围0～10/μl.结论通过1109名正常成人尿液红细胞及白细胞含量的调查,建立了牡丹江市的参考值.     

Infected pancreatic fluid collections: percutaneous catheter drainage

Thirty-eight infected pancreatic fluid collections in 23 patients with acute or chronic pancreatitis were drained percutaneously following initial diagnosis with computed tomography and fine-needle aspiration. Fifteen (65.2%) patients were cured completely without surgery. Eight (34.8%) patients required some type of surgery despite successful treatment of the fluid collection, and in two (6.5%) the collection recurred after catheter removal. Complications occurred in three (13%) patients, but only one complication (4%), empyema, was a direct result of catheter drainage. Catheter drainage time averaged 29 days for 16 patients with isolated collections and 96 days and 104 days for patients with collections with pancreatic duct fistulas (nine patients) or gastrointestinal fistulas (14 patients), respectively. This study confirms that infected pancreatic fluid collections can be safely and effectively treated with percutaneous catheter techniques in most patients.     

Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy

Over a 10-year period, 276 pulmonary arteriovenous malformations (PAVMs) were occluded with balloon embolotherapy in 76 patients, 67 (88%) of whom had hereditary hemorrhagic telangiectasia. Eleven patients (14%) were discovered by means of family screening with measurement of arterial blood gases and chest radiography. Epistaxis, dyspnea, hemoptysis, and hemothorax occurred in 79%, 71%, 13%, and 9% of patients, respectively. Clinical histories of strokes and transient ischemic attacks were present in 18% and 37% of patients, respectively. Computed tomographic scans of 59 patients showed stroke in 36%. Sixty-five percent of PAVMs were located in the lower lobes, which correlated with the finding of more pronounced hypoxemia in the upright position. After embolotherapy, symptomatic hypoxemia was corrected, and serial values have remained constant for 5 years. Complications were minimal, and no patient required surgery. Balloon embolotherapy is effective long-term therapy for PAVMs, and family screening should be pursued because of the possibility of a higher frequency of paradoxical embolization (stroke) than previously recognized.