Orthopedics
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In the past two years the closed locked intramedullary nailing system has been used at the Sunnybrook Trauma Unit. This system has equalled the results reported by Hansen in the use of closed intramedullary nailing with conventional indications, and has provided an excellent means of handling complex and difficult shaft fractures of both the tibia and the femur. ⋯ It has a minimal blood loss and can be done with practice in a reasonable period of time. This technique will add greatly to the armamentarium of the trauma surgeon.
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A technique for recording the myoelectric activity of electrically stimulated muscle through its motor nerve without the interference of stimuli artifacts has been developed and tested. The technique consists of a wide band differential amplifier with fine intramuscular wire electrodes. ⋯ A stimulus calibration study shows that low frequency stimuli had negligible effect on the EMG when set below three times suprathreshold. A test procedure shows artifact-free EMG during action potential rate stimulation as well as during superimposed high frequency recruitment stimulation.
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Irreducible palmar dislocation of the proximal interphalangeal joint in which the central slip remains intact is a rare injury. A noose formed by the extensor mechanism traps the condyle of the proximal phalanx. ⋯ Closed reduction was unsuccessful in this case. Open reduction achieved a good result.
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Case Reports
Bacterial meningitis following Pantopaque myelography. A case report and literature review.
A case of acute bacterial meningitis following Pantopaque myelography is reported, and the literature reviewed pertaining to this uncommon but potentially fatal complication. A positive Gram's stain is most helpful in differentiating bacterial from chemical meningitis. Treatment of the meningitis before and after determination of its cause is described. Preventive steps include removal of Pantopaque from the subarachnoid space immediately at the conclusion of fluoroscopy, and observance of strict sterile technique during myelography, including use of face masks.