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Background and Aims: Ruptures of the distal part of the biceps brachii tendon are rare. the diagnosis is often delayed and only late repair can be considered. in this study,the in this study,the recovery of muscle strength after late repairo ft he distalb iceps brachii tendon was evaluated.Materials and Methods: sixteen patients with aruptured distal biceps brachii tendon were analysed. the mean delay from the primary trauma to the operation was 35 weeks. thetendon wasanatomically re-attachedwith bone anchors.inthreecases atendon graft was needed. the operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 12��weeks by using acomputer-based isoafter an average follow-up time of 12��weeks by using acomputer-based isoby using acomputer-based isokinetic dynamometer.Results: patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side,average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in thecases where atendon graft was used. one patient needed are-operation for are-rupture. there were three cases of transient paresthesia of the cutaneous nerve. all patients resumed their previous work.Conclusion: late anatomical repair of the biceps brachii tendon restores very good ate anatomical repair of the biceps brachii tendon restores very good the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.

We examined 188 consecutive patients, each of whom had an acute ankle sprain, using clinical stability assessment, stress radiographs, and arthrography to compare the reliability of these methods used in diagnosing lateral ligament ruptures of the ankle. Sixty-six of the ankles were treated operatively. Arthrography accurately detected ligament damage in all of the patients with this injury and revealed the extent of the injury in about 85%, whereas clinical examination and stress radiographs detected only about half of the injuries. The injuries and the results of these two methods were often controversial, as our study will show.

Bioabsorbable implants offer an attractive alternative to metallic implants to stabilize small bone fractures in the hand. Self-reinforced bioabsorbable miniplating for metacarpal fractures was studied in bones from cadavers and compared with standard metallic fixation methods. One hundred twelve fresh-frozen metacarpals from humans had three-point bending and torsional loading after transverse osteotomy followed by fixation using seven methods: (1) dorsal and (2) dorsolateral 2-mm self-reinforced polylactide-polyglycolide 80/20 plating, (3) dorsal and (4) dorsolateral 2-mm self-reinforced poly-L/DL-lactide 70/30 plating, (5) dorsal 1.7-mm titanium plating, (6) dorsal 2.3-mm titanium plating, and (7) crossed 1.25-mm Kirschner wires. In apex dorsal and palmar bending, dorsal self-reinforced polylactide-polyglycolide and poly-L/DL-lactide plates provided stability comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable plates were applied dorsolaterally, apex palmar rigidity was increased and apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher torsional rigidity than 1.7-mm titanium plating and in failure torque comparable with 2.3-mm titanium plating. Low-profile selfreinforced polylactide-polyglycolide and poly-L/DL-lactide miniplates provide satisfactory biomechanical stability for metacarpal fixation. These findings suggest that bioabsorbable miniplating can be used safely in the clinical stabilization of metacarpal and phalangeal fractures.

One hundred and thirty eight knees of 124 patients with partial rupture of the patellar ligament were treated surgically after failure to heal them by conservative means. Ultrasonography was used to confirm the diagnosis in 45 knees, and when positive it had a good correlation with the operative findings. During surgery excision of the devitalized tissue in the patellar tendon was performed. Histologic examination of the removed tissue revealed degenerated, fibrotic tissue with neo-vascularization, and slight to moderate inflammation resembling devitalized tissue. The patients were re-examined 18.6 +/- 15.0 months post-operatively. Ninety-seven patients (111 knees = 80.4%) benefitted from the operation with excellent or good results. Thirteen knees had to be re-operated with more radical excision due to renewed symptoms. In conclusion, surgical excision of the devitalized tissues gives a good functional result in most of the cases in which non-operative treatment with rest and physical treatment has failed, helping the athlete to return to his pre-injury activities.

No abstract

Bioabsorbable internal fixation by means of pins, tacks, screws and miniplates offers an alternative to metallic osteofixation for the stabilization of small bone fractures, osteotomies, ligament injuries and fusions in the hand. The advantages of using them include avoidance of metallic-implant-related long-term complications and a secondary removal operation. Currently the most commonly used devices are made of poly L-lactide (PLLA) and copolymers of polylactides (P(L/DL)LA) and polyglycolide (PLGA). In areas of mechanical stress, the use of ultra-high-strength self-reinforced devices is recommended. Biomechanical studies on fresh frozen bones have shown that the fixation rigidity achieved with self-reinforced devices approaches that of metallic osteofixation methods. The reliability of modern implants has been confirmed in several experimental and clinical studies.

Only two wrists resulted in complete union. These preliminary results suggest that composite implant of BMP, as used in the present study, may not solve the problems encountered in the treatment of scaphoid nonunions. Poor vascular conditions in scaphoid may not provide enough mandatory osteogenic cells for BMP to function properly. In avascular conditions coral does not resorb edequately and implants may also work as a sequester between the bone graft and the scaphoid bone and therefore actually inhibit the healing process.