Fresh Injury Research Articles

Postoperative Management Early Active Mobilization of Extensor Tendon Repair at Zone (V-VII)

Background: The extensor tendons are particularly vulnerable to trauma because their superficial location in a clenched fist, the thin mobile subcutaneous tissue offers little protection, and lacerations of the extensor tendons are common over joints that are easily exposed to contamination. Objective: To assess the evaluation of the postoperative early active mobilization protocol of extensor tendon repair at zone (V-VII). Methods: In this prospective study was carried out at Orthopedic Dept., 250 Bed General Hospital, Kishoreganj, Bangladesh from January to June 2023. Total 40 cases of fresh injury of extensor tendon at zone V to VII were treated. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Routine history taking with details of the injury, the object causing the injury, the dominant hand and the position during the injury, Physical examination, included the zone, and the possible tendons involved together with any associated injury. Results: Forty patients of fresh extensor tendon injuries were included in this study, their ages ranged from 20 to 55 years. There were 33 males (82.5%) and 7 females (17.5%). The dominant hand was involved in 29 of patients (72.5%). The nature of injuries was sharp cut in 34 patients (85%), with crush injuries in 6 patients (15%). The most common site of injuries was zone VI, VII and zone V respectively, and the most common tendon injured was EDC, EI, and EDM. Only 7 patients (17.5%) had single tendon injury, While 33 patients (82.5%) had multiple tendon injuries. At the end of the 6th weeks post operatively, the overall outcome result are summarized. Conclusion: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient. It will give fairly acceptable results.

Mothers and Authority

Mothers and Authority

Evaluation of the result of early repair of open tendo achilles injury

Introduction: Toilet pan injury or accidental cut injury which causes open tendo achilles injury is very much common in our country. The Achilles tendon injury is very difficult to treat, sometimes it creates a disabling condition due to calf muscle contracture, wound infection or skin necrosis. Therefore even in immediate repair of fresh injury will need reconstruction. So early repair of Tendo-Achilles injury after meticulous surgical toileting give best result. Objective: Assessments of result in primary repair of open Tendo-Achilles injury and evaluate the outcomes. To calculate the percentage of results of early repair of open TendoAchilles injury. Assess the rate of infections, skin necrosis, and failure of healing in primary repair. Material & methods: Thirty patients who had acute open Tendo-Achilles injury were studied. Variable level of open acute Tendo-Achilles injury were treated at Sher-E-Bangla Medical College Hospital, Barishl in the period from July 2018 to June 2020. After thorough surgical toileting cut tendon was repaired end to end by modified Kessler method. Plaster cast was given for immobilization & broad spectrum antibiotic given for two to three weeks. Result: Final outcome measured according to Juhana Leppilahti modified scoring scale. Thirty patients with Tendo-Achilles injury were studied. Fifteen cases result were excellent, eleven cases good, two case fair and two cases poor. Conclusion: In early repair of open Tendo-Achilles injury need short period of post operative inactivity. It will help to return a Tendo-Achilles injured patient to his normal work early as well as reduce burden of hospital cost and his family. Early repair of open Tendo-Achilles injury within 12 hours is effective procedure for patients as for surgeon

Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space

To investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space. Twelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C 3, 4, 5 cases of C 4, 5, 3 cases of C 5, 6, and 2 cases of C 6, 7. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation. The average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one ( P<0.05). The effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.

Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases

PurposeDistal tibia fractures comprise about 7%–10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing. MethodsThis is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome. ResultsThere were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23–65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16–22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score. ConclusionIntramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.

Masculinity, Injury, and Death: Implications for Anti-Knife-Carrying Messages.

Although knives are the most common homicide instrument in Britain, factors that influence knife-carrying tolerance (i.e., the extent to which it is seen as acceptable and justified) and perceptions of anti-knife messages (i.e., slogans and posters aimed at reducing knife crime) have not been examined, which the current article will cover by featuring progressively related studies. In Study 1, 227 men took part in a study on factors associated with knife-carrying. In Study 2, 200 participants took part in an experimental study on anti-knife slogans. In Study 3, 169 men took part in a study on existing anti-knife injury posters. In Study 4, 151 men took part in a study on anti-knife CGI posters featuring an avatar with different types of knife injury. Study 1 proposes a structural equation model that shows the intercorrelations between physical defense ability, limited trust in authority, limited control over one's status and the need for respect, and how they predict aggressive masculinity (i.e., macho culture), which, in turn, predicts knife-carrying tolerance. The model also reveals two significant latent factors: saving face inter-male competition (i.e., honor) and perceived social ecological constraints (i.e., socioeconomic limitations). Study 2 shows that the injury slogan was rated as most persuasive. Study 3 shows that the fresh injury poster was rated as most persuasive, emotional, and believable. Study 4 shows that it was the eye injury that was rated as most persuasive, emotional, and believable. The article supports protection motivation theory and offers practical insights into tackling knife crime.

CCD-Based Skinning Injury Recognition on Potato Tubers (Solanum tuberosum L.): A Comparison between Visible and Biospeckle Imaging.

Skinning injury on potato tubers is a kind of superficial wound that is generally inflicted by mechanical forces during harvest and postharvest handling operations. Though skinning injury is pervasive and obstructive, its detection is very limited. This study attempted to identify injured skin using two CCD (Charge Coupled Device) sensor-based machine vision technologies, i.e., visible imaging and biospeckle imaging. The identification of skinning injury was realized via exploiting features extracted from varied ROIs (Region of Interests). The features extracted from visible images were pixel-wise color and texture features, while region-wise BA (Biospeckle Activity) was calculated from biospeckle imaging. In addition, the calculation of BA using varied numbers of speckle patterns were compared. Finally, extracted features were implemented into classifiers of LS-SVM (Least Square Support Vector Machine) and BLR (Binary Logistic Regression), respectively. Results showed that color features performed better than texture features in classifying sound skin and injured skin, especially for injured skin stored no less than 1 day, with the average classification accuracy of 90%. Image capturing and processing efficiency can be speeded up in biospeckle imaging, with captured 512 frames reduced to 125 frames. Classification results obtained based on the feature of BA were acceptable for early skinning injury stored within 1 day, with the accuracy of 88.10%. It is concluded that skinning injury can be recognized by visible and biospeckle imaging during different stages. Visible imaging has the aptitude in recognizing stale skinning injury, while fresh injury can be discriminated by biospeckle imaging.

Results of restoration of complex injuries in ligamentous apparatus of the knee joint

Injuries of multiple ligaments of the knee joint usually occur as a result of high energy trauma. The greatest difficulties one has in choice of tactics in treatment of patients with combined injuries of capsular and ligamentous apparatus of the knee joint. Objective : To determine the most appropriate treatment strategy for patients with complex injuries of the ligaments of the knee joint. Methods : We studied 37 patients (31 men, and 6 women aged 24 to 44 years) with two or more ligaments injuries of the knee joint of varying severity as a result of sport (12) and road traffic (25) injuries. We discovered combined injuries of ligaments: anterior crucial ligament (ACL) and medial collateral — 12; posterior crucial ligament (PCL) and medial collateral — 3; ACL, PCL and both collateral — 15; PCL and lateral collateral — 7. All patients were treated surgically. The outcomes were evaluated in 4 and 6 months after the operation according to scale IKDC and MRI parameters. Results : The most severe injuries are luxations of the shin accompanied by injuries of two crucial ligaments and one or two collateral ligaments. In this case restorative surgical treatment of all damaged structures can be made in the first day after trauma. But due to technical difficulties conservative waiting tactics with staged restoration of ligaments is justified. In the case of fresh or inveterate injury of ACL and PCL it is possible to perform their simultaneous and staged recovery when firstly they restore PCL, and after 3–4 months — ACL. The best results of PCL reconstruction are obtained in case surgical treat­ment immediately after the injury. Along with the reconstruction of PCL it is necessary to restore posterolateral capsular-ligamentous complex. The combined damages of the medial collateral ligament and one of the crucial ligaments rarely need to restore medial capsular-ligamentous structures. Under condition of restoration of fresh ACL injury almost always they eliminate instability caused by medial collateral ligament injury. In another case after fresh injury it is necessary to perform suturing of disruption place and after inveterate — plasthy of medial part of the knee joint.

Application of arthroscopy in treatment of sports traumatic ankle arthritis

To introduce the methods and experience of arthroscopy treating different types of sports traumatic ankle arthritis.Methods The study involved 25 patents with spots traumatic ankle arthritis treated under ankle arthroscopy from January 2008 to October 2010.American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system was applied to make functional evaluation before and after operation.Also,anterior drawer stress radiographs were used to assess the stability of joint.All patients had arthroscopic examination and received corresponding treatments,including synovial scar tissue resection,cartilage surface trimming,and microfracture management.Five patients underwent stage Ⅰ extramalleolus ligament repair.Results Arthroscopy showed simple synovitis in four patients,impingement syndrome developed from synovitis with fibrous scar tissue formation in 10,tibial or talus cartilage lesions in 11 and congestion of fresh injury of fibular end in four.A total of 23 cases were followed up for average 13.5 months (range,6-24 months).The ankle-hindfoot score was increased from preoperative (54.3 ± 6.2) points to (81.5 ± 7.9) points at 1 month,(82.9 ± 2.5) points at 3 months,( 83.1 + 2.1 ) points at 6 months and ( 83.5 ± 3.9 ) points at 12 months,with statistical differences ( t =13.01,20.58,21.10,19.11 respectively,P＜0.05).The anterior drawer stress radiographs showed that the anterior translation of talus improved from preoperative ( 15.2 ± 2.5 ) mm to postoperative (3.5 ± 0.2 ) mm,with statistical difference ( t =9.33,P ＜ 0.05 ).The anterior drawer test and talus tilt test were both negative for all patients.Concluslons Ankle arthroscopy is characterized by micro trauma and fast recovery.Symptomatic treatment under arthroscopy can obviously relieve the uncomfortable symptoms following sports traumatic ankle arthritis. Key words: Ankle joint; Arthroscopy; Sports traumatic ankle arthritis

Nerve Grafting for Spinal Cord Injury in Cats: Are We Close to Translational Research?

Nerve Grafting for Spinal Cord Injury in Cats: Are We Close to Translational Research?

The multifunctional LigB adhesin binds homeostatic proteins with potential roles in cutaneous infection by pathogenic Leptospira interrogans.

Leptospirosis is a potentially fatal zoonotic disease in humans and animals caused by pathogenic spirochetes, such as Leptospira interrogans. The mode of transmission is commonly limited to the exposure of mucous membrane or damaged skin to water contaminated by leptospires shed in the urine of carriers, such as rats. Infection occurs during seasonal flooding of impoverished tropical urban habitats with large rat populations, but also during recreational activity in open water, suggesting it is very efficient. LigA and LigB are surface localized proteins in pathogenic Leptospira strains with properties that could facilitate the infection of damaged skin. Their expression is rapidly induced by the increase in osmolarity encountered by leptospires upon transition from water to host. In addition, the immunoglobulin-like repeats of the Lig proteins bind proteins that mediate attachment to host tissue, such as fibronectin, fibrinogen, collagens, laminin, and elastin, some of which are important in cutaneous wound healing and repair. Hemostasis is critical in a fresh injury, where fibrinogen from damaged vasculature mediates coagulation. We show that fibrinogen binding by recombinant LigB inhibits fibrin formation, which could aid leptospiral entry into the circulation, dissemination, and further infection by impairing healing. LigB also binds fibroblast fibronectin and type III collagen, two proteins prevalent in wound repair, thus potentially enhancing leptospiral adhesion to skin openings. LigA or LigB expression by transformation of a nonpathogenic saprophyte, L. biflexa, enhances bacterial adhesion to fibrinogen. Our results suggest that by binding homeostatic proteins found in cutaneous wounds, LigB could facilitate leptospirosis transmission. Both fibronectin and fibrinogen binding have been mapped to an overlapping domain in LigB comprising repeats 9–11, with repeat 11 possibly enhancing binding by a conformational effect. Leptospirosis patient antibodies react with the LigB domain, suggesting applications in diagnosis and vaccines that are currently limited by the strain-specific leptospiral lipopolysaccharide coats.

Treatment of lateral ankle ligament injuries and ankle instability with semitendinosus tendon graft

Objective To explore the effectiveness of ipsilateral autologous semitendinosus ten don graft in treatment of lateral ankle ligament injuries and ankle instability. Methods Two patients including one male (25 years old) and one female (17 years old) with chronic lateral instability of the ankle were enrolled in the study. Both patients had the history of repeated ankle sprain in supination position and had grade Ⅲ injury of the lateral ankle ligament according to the American College of Foot and Ankle Surgeons Grading System. Anterior drawer test and talar tilt test were all positive. The stress-inversion radiograph demonstrated the average inclination of the talus for 21 ° and the lateral radiograph demonstrated anterior dislocation of the talus. The chronic ankle instabilities in two patients were treated by using the ipsilateral autologous semitendinosus tendon graft to reconstruct the lateral ankle ligament. Results The two patients were followed up for mean eight months, which revealed that the active and passive range of motion was good, with no pain or swelling. The anterior drawer test and talar tilt test were all negative. The stress-inversion radiograph demonstrated that the average inclination of the talus was less than 5°, with no anterior dislocation of the talus. According to the Mazur grading system, the clinical outcome was excellent in one patient and good in one. The two patients were satisfied with the stability of the ankle. Conclusions ( 1 ) Lateral ankle ligament injury is a common cause of chronic ankle instability,even the ankle osteoarthritis. ( 2 ) Brostr(o)m method can attain satisfactory result for fresh lateral injury of the ankle, but not for the old injuries. ( 3 ) Ipsilateral autologous semitendinosus tendon graft is simpleand effective for treatment of lateral ankle ligament injuries and chronic ankle instability and may play an important role in the treatment of lateral ankle instability and prevention of the occurrence of ankle osteoarthritis. Key words: Ankle joint; Sprains and strains; Lateral ligament,ankle

Chronically CNS-Injured Adult Sensory Neurons Gain Regenerative Competence upon a Lesion of Their Peripheral Axon

Several experimental manipulations result in axonal regeneration in the central nervous system (CNS) when applied before or at the time of injury but not when initiated after a delay, which would be clinically more relevant. As centrally injured neurons show signs of atrophy and degeneration, it raises the question whether chronically injured neurons are able to regenerate. To address this question, we used adult rodent primary sensory neurons that regenerate their central axon when their peripheral axon is cut (called conditioning) beforehand but not afterwards. We found that primary sensory neurons express regeneration-associated genes and efficiently regrow their axon in cell culture two months after a central lesion upon conditioning. Moreover, conditioning enables central axons to regenerate through a fresh lesion independent of a previous central lesion. Using in vivo imaging we demonstrated that conditioned neurons rapidly regrow their axons through a fresh central lesion. Finally, when single sensory axons were cut with a two-photon laser, they robustly regenerate within days after attaining growth competence through conditioning. We conclude that sensory neurons can acquire the intrinsic potential to regenerate their axons months after a CNS lesion, which they implement in the absence of traumatic tissue.

Korrekturosteotomie der fehlverheilten Monteggia-Verletzung mit einem Fixateur externe

Definite reduction of the dislocated radial head to prevent further damage and loss of function in case of a neglected radial head dislocation following Monteggia lesion. Three different operation methods are demonstrated.A correction must be striven for in any fresh injury. The indication has to be made according to the complaints in chronic dislocations. A correction is very difficult and not always successful.In principle, none.In principle, the surgical technique depends on the underlying disease and the kind of deformity, as well as on the instruments and implants available. There are different techniques: exclusive angulation osteotomy of the ulna (short interval after injury < 3 months), angulation osteotomy and additional lengthening of the ulna (mostly > 3 months after injury); an open procedure is seldom necessary and should be avoided.Depending of the child's age, the technique used and the implant chosen (external fixator, plate), a cast-free treatment should be striven for (better function).The results depend on the surgeon's experience, the accuracy of planning, and the technique chosen. An intensive postoperative physiotherapy is mandatory, frequently with initial application of CPM (continuous passive motion). Loss of correction and residual malalignments are well known and not rare. They occur mostly in instances of insufficient stability and centralization of the radial head, respectively. There are no evident numbers but this is confirmed by clinical experience.

Spermatic cord injury associated with blunt trauma

Spermatic cord injury due to blunt trauma is an entity rarely encountered in clinical practice, and it may be mainly characterized by the onset of severe pain, swelling, or hematoma in the groin area. We present a case of a fresh spermatic cord injury caused by blunt trauma, which was correctly diagnosed after a surgical exploration. A 53-year-old healthy man had a strong blow from a handlebar on the right groin region in a motorcycle accident. He was transferred to our hospital from a rural hospital 3 hours after the accident because a hematoma was suddenly expanding in the right groin. On presentation, a 12 cm diameter painful subcutaneous hematoma of the right groin extending into the right hemiscrotum was found (Fig. 1). There was no medical history of blood dyscrasias, anticoagulant therapy, inguinal hernia, or urinary symptoms. His vital signs were normal. Contrast-enhanced computed tomographic (CT) images showed a large subcutaneous hematoma with contrast medium extravasation at the groin level and the edematous spermatic cord at the pudendal level (Fig. 2). There was no evidence of either any external iliac or femoral artery injuries. The preoperative diagnosis was a large subcutaneous hematoma bleeding from disrupted subcutaneous vessels. He was taken to the operating room for the removal of the hematoma and hemostasis 5 hours after the accident. Under satisfactory spiral anesthesia, an 8-cm diagonal incision was made over the hematoma of the right groin. A large subcutaneous hematoma as well as the contused spermatic cord was found. The cord was severely damaged at a level approximately 4 cm distal from the internal inguinal ring, and it was bleeding modestly from the internal or external cremasteric vessels. A large hematoma was contained along the distal length of spermatic cord. The vas deferens was intact. A rupture of external oblique aponeurosis and transverse fascia was found after removing the 300-g subcutaneous hematoma. A search for these layers resulted in the discovery of preperitoneal fat without any active bleeding. Based on these findings, a right orchiectomy was performed, and then, the floor of the inguinal canal was repaired by joining the edge of the internal muscle and aponeurosis of the transverse oblique muscle to the Poupart ligament. The external oblique aponeurosis was

Augmented repair as therapy of fresh injury of the posterior cruciate ligament

The discussion about the therapy of the posterior cruciate ligament persists. Conservative treatment, augmented repair, and reconstruction with autografts are discussed. From 1993 to 1997, 49 patients with posterior cruciate ligament rupture had repair Trevira ligament augmentation of 3 mm. There were 21 isolated and 28 combined ruptures. In 5 cases bony avulsions were refixed by screw or additional hook plate. Investigation of 36 patients, in 15 cases with isolated ligamentous ruptures was made. Osseous avulsion had good results in all cases. Isolated posterior cruciate ligament rupture showed good stability in 7 of 15 cases and instability of 2 + in 8 cases. The medial range Lysholm score was 76.8 (+/- 21.6), the OAK score showed 2 very good and 5 good results, 3 fair and 5 bad results. Using the IKDC score led to 3 very good and 4 good results, 2 fair and 6 bad results. Using subjective criteria, 10 patients described results as very good or good, 2 fair and 3 bad. Posterior cruciate ligament rupture with additional knee injury or fracture of the leg showed bad results in 60 % of cases, and good or fair results in only 40 %. We think augmented repair of fresh injury of the posterior cruciate ligament can be used as an alternative therapy to reconstruction with autograft.

Laparoscopic bile duct injuries: a single-institution experience spanning 8 years

Abstract Background This audit represents the authors' experience in the management of 42 bile duct injuries following laparoscopic cholecystectomy and is the largest series reported so far in the UK. Methods Between November 1990 and May 1998, 42 patients were referred for management of bile duct injury following laparoscopic cholecystectomy. The case notes of all patients were reviewed and follow-up information was obtained to provide a 100 per cent follow-up rate. Aspects of the cholecystectomy, presentation, investigation, definitive treatment and follow-up are discussed. Results The referral source was 25 surgeons from 17 different hospitals. The incidence peaked in 1992 (ten cases) and has been stable at four referrals per year over the past 4 years. The median age was 56 years and the M: F ratio 10: 32. Thirty-five laparoscopic operations were performed by consultants and seven by trainees. Intraoperative cholangiography was performed in three. Seventeen operations were converted to an open procedure because of intraoperative difficulty. Injury was noted at operation in nine and an immediate restorative procedure was attempted. Twelve patients had had a reconstructive procedure before referral to this unit and the remainder were referred with a fresh injury. Patients in whom the bile duct was transected (n = 34) presented mostly with jaundice; those with minor injuries not involving the common duct (n = 8) presented with peritonitis. Thirty patients required operation; 25 underwent hepaticojejunostomy reconstruction, two needed revision of a previous biliary–enteric anastomosis, two had primary bile duct repair over a T tube and one required relaparoscopy to clip a leaking cystic duct. At a median of 12 months four patients who had had a reconstruction were symptomatic for cholangitis. Percutaneous transhepatic dilatation was successful in two and a further two required revision of the anastomosis. Another four patients had asymptomatic stenosis and were treated successfully by a single episode of dilatation. Follow-up showed all patients to be asymptomatic at a median follow-up of 42 months; however, six had a raised level of alkaline phosphatase. The remaining patients were managed successfully by therapeutic endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. The overall median hospital stay was 18 days. Perioperative complications were seen in nine patients with no procedure-related deaths. Conclusion Although the initial learning curve seems to have been overcome, a steady state of problems now exists and seems likely to continue. Best results were obtained by hepaticojejunostomy. Most postrepair strictures were dealt with without operation.

MEDIAL ANKLE PAIN AFTER LATERAL LIGAMENT RUPTURE

After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the articular cartilage in 20 ankles, in 19 at the tip and/or anterior distal part of the medial malleolus as well as on the opposite medial facet of the talus. In six patients, a loose piece of articular cartilage was found. We conclude that in patients with a rupture of one or more of the lateral ankle ligaments after an inversion injury, an impingement occurs between the medial malleolus and the medial facet of the talus. Patients with a lesion of the lateral ankle ligament caused by a high-velocity injury (a faulty landing during jumping or running) had a higher incidence of macroscopic cartilage damage (p < 0.01), medially-located pressure pain (p = 0.06) and medially-located complaints at one-year follow-up (p = 0.02) than those with low-velocity injury (a stumble).

Green June Beetle Control in a Bermudagrass Pasture, 1995

Abstract The study was located on a poultry farm in Snead, AL Test was a RCB design (four replications), with two blocks in each of two adjacent bermudagrass paddocks. Bermudagrass was 4-6 inches tall a treatment. The paddocks were on sandy loam soil, and had a history of being fertilized with poultry manure. Insecticide treated plots were 60 ft by 30( ft, untreated plots were 30 ft by 300 ft. Insecticides were applied 15 Sep with a tractor drawn sprayer in 25 gpa (40 psi, flat fan nozzles). Plots wen evaluated 20 Sep by excavating five, 0.4 ft2 samples located randomly along the center line of each plot. Samples were dug to a depth of 8 inches Number of live green June beetle grubs was counted per sample. Number of dead grubs on the surface in each of five, randomly located 4 ft2 quadrat-was counted on each treated plot on 16 Sep. Fresh tunnelling injury was rated on a 0-9 scale, using a 4ft2 sampling frame divided into nine sections Tunnelling in any given section was given a rating of 1, and summed over all sections. Five random estimates of tunnelling injury were made per plo on 20 Sep. Counts and ratings were averaged for each plot before data analysis.

Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study.

To investigate intraarticular lesions producing persistent postoperative pain, we arthroscopically examined 31 ankles in 31 patients (15 women and 16 men) with lateral ligament injury. The patients ranged in age from 15 to 33 years, with a mean of 20 years. Nine patients were freshly injured, and 22 patients had chronic injuries. All of the patients underwent arthroscopic examination immediately before the ligament operation. Chondral lesions were found in 89% of the freshly injured ankles and 95% of the ankles with chronic injuries. Most of these lesions were in the medial half of the ankle joint, especially in the anteromedial edge of the tibial plafond. After followup for 1 year postoperatively, persistent pain was noted in 4 patients who had chondral lesions of greater than one-half the thickness of the articular cartilage. Pain and tenderness were localized at the anteromedial joint line, corresponding to the location of the chondral lesions. Chondral lesions of greater than one-half the thickness of the articular cartilage were found in 8 ankles in the chronic injury group, but there were none in the fresh injury group. Thus, in lateral ligament injuries of the ankle, the longer the time elapsed from the initial injury, the more severe the associated chondral lesions became. These chondral lesions appear to cause persistent pain.