The authors have developed a new skeletal traction system for comminuted intraarticular fractures and fracture-dislocations in the hand. The system consists of two or three Kirschner wires and rubber bands, and is easy to assemble. It is more compact and comfortable than the banjo splint, and equally effective, and it allows early motion of the affected digits. A description of the technique is followed by the clinical results of seven cases of severe articular injuries in the hand. At the time of follow-up, the average range of the affected PIP joint motion was about 80 degrees. The final active motion of the injured DIP joint ranged from 0 to 40 degrees in flexion and that of the affected thumb (trapezial fracture) was not limited. The average follow-up period was 13.1 months.

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Tibial plateau fractures in 17 patients were managed arthroscopically, using interporous hydroxypatite (HA) as a bone graft substitute. Soft-tissue repair and intra-articular lavages were carried out arthroscopically, and depression of the articular surface was done by elevation of the subchondral plate by the bone compactor through a small window under image intensification and filling with HA through the tibial outer rim. Follow-up periods averaged 2 years and 6 months. According to roentgenograms and computed tomograms no development of arthrosis could be found. All of the patients have been followed to fracture union and have returned to their previous activity levels.

A novel drug delivery system for osteomyelitis was developed using porous hydroxyapatite blocks (HA-b) loaded with antibiotics by centrifugation. In the study, 10 mm3 HA-b was placed in a container and mixed with antibiotic solution; the antibiotic was then loaded into the pores of the HA-b by centrifuging at 1500 rpm for 15 min. Slow release of HA-b in both moist form and dried form (by heating at 160 degrees C) was tested after loading with the antibiotic arbekacin sulfate (ABK), 1-N-(S)-4 amino-2-hydroxybutyryl dibekacin. To estimate the concentration of antibiotic, both forms of HA-b were placed in 3 mL of phosphate buffered saline (PBS), which was replaced every 48 h. In both groups, which were loaded with 70 mg ABK per one block of HA (concn 0.5 microgram/mL) which is sufficiently high to control most pathogens, was maintained for 21 exchanges of PBS (after 42 days). Minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus (MRSA), 3.13 micrograms/mL, was maintained until nine exchanges took place (after 18 days). The centrifugation method is simple, and dried ABK produced by heating loaded HA-b is particularly useful in clinical applications for osteomyelitis.

Surface bacterial flora, as well as homogenates, of medical leeches, Hirudo medicinalis and Hirudinaria manillensis, were surveyed and the susceptibility of these isolates to 15 antimicrobial agents was examined. Aeromonas spp. were isolated from all leeches, and Pseudomonas fluorescens and other glucose-non-fermenting gram-negative rods (NF-GNR) were frequent isolates. Isolates were highly resistant to cephalosporins but susceptible to carbapenems, aminoglycosides and ofloxacin. The results indicate that prophylaxis with antimicrobial agents active against Aeromonas spp. and NF-GNR is necessary to avoid opportunist infections caused by indigenous leech flora during medical leech therapy on immunocompromised patients.