Carpal instability after fractures of the distal end of the radius]

Evaluation of the scapho-lunate angle (SLA) was made on the lateral X-rays of 335 cases after Colles' fracture. Value of SLA over 65 degrees was accepted as the sign of the dorsal intercaleted segmental instability of the wrist (DISI). In the material was stated 84 cases (25%) of the DISI. Frequency of the incidence of the DISI was analysed according to fracture type and the age of the patient. More frequent incidence of the DISI was discovered in the intraarticular fractures (44%) than in the extraarticular (20%). The difference between fractures with or without dislocation was not so great (27% tp 21%). Increasing percent of the DISI was stated in the older age-groups (the greatest--49%--in the group after 70-years old).     

Service Intensity and Organizational Attributes: A Preliminary Inquiry

Service intensity can vary dramatically across the clients who are served within a psychosocial intervention. But studies of the determinants of intensity are disappointing, and examinations of its impacts on key client behaviors tend to be biased by unaccounted for reciprocal relations. The author argues that it may be useful to take into account organizational attributes. Service intensity may be more fully explained by attributes such as program life-cycles and learning routines, administrative reforms, worker attention spans, worker dispositions, and caseloads. Data from an intervention for adults with homeless experience and substance abuse problems (n=136) support the author's argument. Results suggest that intervention leaders must become aware of and capable of manipulating the organizational context of treatment.     

Provocation tests for clinical diagnosis of carpal instability--part II]

Basing on a review of available literature the author presents 9 provocative tests used in clinical examination of carpal instabilities, their methodology and principles of clinical interpretation. Tests used to diagnose instabilities of the following joints are discussed: distal radio-ulnar, triquetro-hamate and luno-capitate.     

Clinical and radiographic evaluation of mechanical sufficiency of the operative treatment of pathological fractures in bone metastases

Background. Aims: Retrospective evaluation of mechanical sufficiency of applied surgical methods of bone metastases treatment according to authors' own scoring system.
Material and methods. 60 patients with bone metastases treated operatively in our Ward during 1989-2002. Mean age of patients was 62,5 years old. There were 39 women and 21 men. In 48 cases (80%) there were possible to diagnose primary localization of the tumor. We could not reveal primary focus of the tumor in 10 cases (20%). Localizations of bone metastases are as follow: femur - 49 cases, humerus - 10 cases, tibia - 1 case.
After local excision of metastatic tumor had been done the internal osteosynthesis and bone cement application was made in 45 cases, the internal osteosynthesis only was made in 7 cases, hip arthroplasty was made in 8 cases. Mean time of follow-up since surgical procedure was 8 months. Scoring system for radiographic and clinical evaluation of mechanical efficacy of operative fixation of pathologic fractures: grade I - good mechanical fixation, grade II - minimal loss of fixation, grade III - poor mechanical fixation, grade IV - relapse of pathological fracture.
Results. We had poor results in 5%, because of the death of 3 patients. In 58 cases (97%) we had very good or good results - no pain, good function and independence in daily activities (grade I and II in scoring system of mechanical efficacy of pathologic fracture fixation). In remaining 2 patients (3%) there was loss of mechanically stabile fixation of pathological fracture.
Conclusions. 1. Mechanical efficacy of the fixation of pathological fractures is good and lasting in 97% of cases. 2. Local complications rate was 2% and was due to mechanical unstabile fixation of pathological fracture.