A consecutive group of ninety-three patients with ninety-six affected joints, have been reviewed retrospectively to provide information regarding the incidence and longer term effects of injuries to the proximal interphalangeal joint of the fingers. The patients have been grouped according to the severity of the injury, judged clinically and radiologically. From this review it would appear that these injuries are somewhat less common than is suggested in the literature. The severity of the trauma would seem to influence the result in that some thirty per cent with dislocation or fracture-dislocation did badly and of these forty-three per cent had open injuries. Some experimental work on fresh cadavers, to investigate the damage to the ligaments in the more common dorsal dislocation, has been included. From our findings, suggestions have been made regarding the treatment of these injuries.
Six patients with nonunion of long bones, one with delayed bone formation during distraction osteogenesis, and one with nonunion of the neck of the femur were enrolled in a clinical trial. Duration of nonunion was from 8 to 94 months (mean 29,4 months). Recombinant human OP-1 (BMP-7) was purchased from the manufacturer. One unit (3,5 mg of active substance mixed with 1 gram of type I bovine bone-derived collagen) was used in each patient. In four patients OP-1 implant was delivered by standard open operative procedure, in 3 percutaneously. In one patient with femoral neck nonunion OP-1 implant was placed intramedullary. No patient had serious adverse reactions related to the implant. At 5 to 8 weeks following the operative procedure five out of 6 patients with nonunion of long bones and one patient with delayed bone formation in distraction osteogenesis were judged by clinical and radiological criteria to have been treated successfully. In one patient with femoral neck nonunion bone union was achieved after 22 weeks. To determine whether the local stimulation with OP-1 might induce prolonged changes in systemic levels of growth and angiogenic factors, the serum levels of the angiogenin (ANG), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and insulin-like growth factor-1 (IGF-1) were assessed prior, and 1, 2, 6 and 12 weeks after operative treatment with OP-1 device. There is no evidence for a potentially harmful systemic rise in growth and angiogenesis factors after local administration of the amount of BMP-7 used in our study.Keywords
This case illustrates the serious disability which may occur in a young person following a Colles' fracture. In this case, over correction occurred and it was necessary to carry out a corrective osteotomy of the distal radius. The operation is described and attention is drawn to a further complication of this procedure as it emphasizes the care required when placing screws through the distal end of the radius.
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