Patients older than 80 years of age are the most rapidly increasing group among surgical admissions and patients visiting emergency rooms. Epidemiological data of this group are of enormous medical and economic relevance. The principle aim of this study was to determine factors predictive of operative mortality in octagenarians, their clinical profiles, and length of stay compared to younger patients in similar diagnostic categories. A computer-based registry of geriatric surgery was used to record and analyze all relevant clinical and epidemiological data. The rate of admissions in octogenarians increased during the 18-year period (1973-1989) from 0.7% to 7.5% of all admissions. The number of patients undergoing surgery was 700. Three hundred and seventy-one of the procedures were elective and 329 were emergencies. Operations in octagenarians as a percentage of all operative procedures increased during the period considered from 1.1% to 5.1%. The operative mortality in this series was 10.5% prior to 1984 and decreased to 6% during the last 5 years. The average hospital stay of octagenarians was 9.8 days as opposed to 4.9 days in patients less than 70 years of age. The prognostic classification described by the authors proved very helpful in predicting mortality.

Age Factors↗

PubMedDate not supplied

Proximal wrist imaging.

Ligamentous injuries to the triangular fibrocartilage are often difficult to evaluate. The plain film examination along with the physical examination serves as the basis for the initial assessment of most wrist injuries. Ligamentous injuries of the wrist often present at the subacute or chronic state with the physical examination and plain films being insufficient to make a definitive diagnosis in many cases and the plain film radiographic exam being of little additional value. This paper reviews the triangular fibrocartilage complex including the underlying anatomy and biomechanics, along with its radiographic evaluation by modern imaging techniques.

Carpal Bones↗

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Radiologic measurement of superior displacement of the humeral head in the impingement syndrome.

A method for directly measuring the position of the humeral head on the face of the glenoid in different positions of abduction of the arm was developed. We studied three subject groups: 12 patients with normal shoulders (group 1), 15 patients with stage II impingement syndrome (group 2), and 20 patients with rotator cuff tears or stage III impingement (group 3). The study consisted of a series of anteroposterior roentgenograms in the plane of the scapula with the arm in neutral rotation. Roentgenograms were obtained at 20 degrees intervals as the arm was elevated in the plane of the scapula from 0 degree to 120 degrees. Patients held a weight equal to 2 1/2% of body weight in the hand. The parameters measured were excursion of the humeral head on the glenoid face, expressed as the distance that the center of the head lies above or below the center of the glenoid, arm angle, scapulothoracic angle, and glenohumeral angle. For patients with normal shoulders (group 1), there was no significant change in position of the humeral head with arm elevation. In contrast, those with stage II impingement (group 2) had significant (p < 0.05) superior displacement of the center of the humeral head with arm elevation. Patients with rotator cuff tears (group 3) demonstrated a significant rise (p < 0.05) during the first 40 degrees of abduction. The average position of the humeral head in the two pathologic patient groups was superior (p < 0.05) to the average head position in the normal patient group. There was no significant difference in head position between patients with stage II impingement and patients with rotator cuff tear. The ratio of the glenohumeral angle to the scapulothoracic angle during abduction was calculated for our patient groups. In both patient groups, arm abduction had a larger scapulothoracic component than for normal shoulders. The superior migration of the humeral head is a probable result of cuff failure, either partial or complete.

Adult↗

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Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing.

The goals of this study were to define biplanar glenohumeral kinematics and glenohumeral-scapulothoracic motion relationships in normal patients with a two-plane radiograph series and then in patients with anterior shoulder instability or rotator cuff tear both before surgery and after surgical repair and postoperative rehabilitation. A two-plane radiographic series of x-ray films in the scapular and horizontal (axillary) planes was performed. With these films, measurements of the relationship between the centers of the humeral head and glenoid and measurements of the component contributions of glenohumeral and scapulothoracic motion to total arm abduction were made. Six normal adults underwent x-ray evaluation to establish normal control values. Kappa analysis was used to determine reliability of technique. Eighteen patients with confirmed anterior shoulder instability (group A) and 15 with confirmed rotator cuff tears (group B) were studied before surgery. Seven (39%) of 18 of the patients in group A and all 15 (100%) of the patients in group B demonstrated superior translation of the humeral head during scapular plane abduction. In the horizontal plane 14 (78%) of 18 patients in group A (instability) and none in group B (rotator cuff tear) demonstrated abnormal anterior translation of the humeral head on the glenoid. Both groups demonstrated altered glenohumeral-scapulothoracic motion relationships compared with the normal control group. Two years after surgery 12 patients from group A and 14 patients from group B were restudied. All of these patients had demonstrated abnormalities of humeral head translation before surgery. For group A 12 (100%) of 12 patients demonstrated normal glenohumeral kinematics in both planes after open anterior stabilization. For group B 12 (86%) of 14 patients demonstrated normal glenohumeral kinematics in both planes after open rotator cuff repair. In group A the altered glenohumeral-scapulothoracic motion relationships persisted, whereas in group B these relationships became normal.

Adolescent↗

PubMedDate not supplied

Anterior-inferior capsular shift of the shoulder: a biomechanical comparison of glenoid-based versus humeral-based shift strategies.

This study compared the biomechanical effects of an anterior-inferior capsular shift based at the humeral side with one on the glenoid side of the joint on resultant multidirectional glenohumeral translation and rotation. Nine matched pairs of fresh cadaveric shoulders were placed in a testing apparatus that constrained 3 rotations but allowed simultaneous free translation of the humeral head with respect to the glenoid. The right and left shoulders of each of the matched pairs were randomized to undergo either a glenoid-based or humeral-based anterior capsular shift. The shoulders were tested vented and following the capsular shift procedure. Translational testing was performed at 0 degrees, 45 degrees, and 90 degrees of glenohumeral elevation with the humerus in neutral rotation, 30 degrees internal rotation, and 30 degrees external rotation. Sequential loads of 30 N in anterior, posterior, and inferior directions were applied while maintaining a 22-N joint compressive load. The maximum arc of internal and external rotation after application of a 1-newton-meter moment was determined for the vented specimens and then after the capsular shift procedure. Both shift strategies resulted in significant limitation of anterior, posterior, and inferior translation in all of the tested positions. No significant differences were noted between the 2 shift strategies with respect to restriction of translation in the anterior or inferior directions. The glenoid-based shift caused a significantly greater decrease in posterior translation at 45 degrees and 90 degrees of abduction. With respect to rotation, the glenoid-based shift exerted significantly greater restriction on external rotation than the humeral-based shift. This study supports the use of either a humeral-based or glenoid-based shift to control multidirectional glenohumeral instability. Greater reduction in external rotation was demonstrated after the glenoid-based shift. Specific differences demonstrated in translation control for humeral-based versus glenoid-based capsular shift procedures may be useful in tailoring a procedure for specific instability patterns.

Aged↗

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Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment.

The study population consisted of 14 shoulders in 13 consecutive patients with surgically confirmed isolated subscapularis tendon tears. In all but three patients, the mechanism of injury was traumatic hyperextension or external rotation of the abducted arm. All patients reported pain and weakness in the affected shoulder. Physical findings revealed limited passive range of motion at maximal internal and external rotation due to pain, weakness of internal rotation of the shoulder, and tenderness in the region of the intertubercular groove. However, these findings did not conclusively point to the subscapularis tendon as the site of injury. Preoperative interpretation of magnetic resonance imaging studies was used to diagnose tears of the subscapularis tendon in 14 shoulders and biceps tendon subluxation or dislocation in 6 shoulders. On arthroscopic examination, one patient was found to have a partial-thickness tear that was treated with arthroscopic debridement. Six shoulders had full-thickness tears of the subscapularis tendon, and seven shoulders had full-thickness tears associated with concomitant biceps tendon pathologic conditions, including subluxation, dislocation, or rupture. The full-thickness subscapularis tendon tears were repaired via an open anterior approach to the shoulder through the deltopectoral groove. Associated biceps tendon injuries were treated with tenodesis of the tendon to the intertubercular groove. Our early followup results have shown that, with proper diagnoses and surgical treatments, patients have greatly decreased pain and marked improvement in shoulder function.

Adolescent↗

PubMedDate not supplied

Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair.

A two-part study was undertaken to clarify the anatomy of the common peroneal nerve at the level of the lateral joint line and risk factors associated with arthroscopically assisted inside-out lateral meniscus repair. In part I, 70 legs in 35 preserved cadavera were dissected to evaluate the relevant anatomy of the common peroneal nerve; 7 (10%) manifested division of the common peroneal nerve into deep and superficial branches proximal to the knee joint. A cutaneous branch not previously described in the literature emanated from the common peroneal trunk in 21 of the legs (30%). In part II, arthroscopically assisted inside-out lateral meniscus repair was performed on 10 fresh-frozen cadaveric knees. Divergence between suture arms increased as suture position was sequentially posterior. Capture of a nerve branch occurred in 2 knees (20%) when posterior retraction was not used. Nerve involvement was eliminated when a retractor was employed. There was significant anatomic variability in the course and branching pattern of the common peroneal nerve at the level of the lateral joint line. During arthroscopically assisted inside-out lateral meniscus repair, risk of injuring the peroneal nerve was related to suture position because of the proximity of anatomic structures and the tendency for suture divergence with soft tissue tethering.

Arthroscopy↗

PubMedDate not supplied

Nucleic acids in regenerating rabbit bone.

Explore the source record for details and available documents.

Animals↗

PubMedDate not supplied

The sequential pneumatic compression device in surgery for lymphedema of the limbs.

A modified technique for operations for lymphedema of the limbs is presented and illustrated in three cases. The technique consists of using the Lympha-Press, a new sequential pneumatic compression apparatus, which was used before operation for reduction of lymphedema, facilitating the surgical procedure, during operation to enlarge the lymphatic vessels, making creation of the lymphatico-venous anastomosis easier, and after operation to avoid early occlusion of the anastomosis, serous accumulation, pain, wound infection and ugly scars.

Female↗

PubMedDate not supplied

The role of dendritic cells in the motility of melanoma cells in initial lymphatic metastasis.

Malignant melanoma is well known for its aggressive metastatic behavior, following upon the earliest initial stages. It is the purpose of this preliminary paper to add some new ideas, based on electron microscopy, to our understanding of the complex progression of malignant melanoma, using cutaneous melanoma as a model for the subtypes. Special attention is paid to cellular interaction in the progression of melanoma, with emphasis on the subtypes.

Cell Movement↗