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Biomedical subjects

A I Froimson

Publications and source records attributed to A I Froimson.

At least 19 recordsLinked to original sources
PubMed1992

Reversible vasospasm in association with the use of heparin and dihydroergotamine.

A case of reversible vasospasm is reported in a 54-year-old man with a closed bimalleolar ankle fracture. On admission the patient had normal distal pulses and laboratory studies. He was a heavy smoker who continued to smoke in the hospital. Deep venous thrombosis (DVT) prophylaxis included dihydroergotamine and heparin (DHE-H). In the early postoperative period, marked spasm of all three arteries developed on the operative side. Smoking privileges and DHE-H were discontinued. The vasospasm resolved after intraarterial nitroglycerin. This case suggests an infrequent but potentially limb-threatening complication of DHE-H.

Ankle Injuries↗
PubMed1992

Long-term follow-up of a total articular resurfacing arthroplasty and a cup arthroplasty in Gaucher's disease.

Patients with Gaucher's disease, a well-described lipid storage disorder with many systemic manifestations, often present to the orthopaedic surgeon with osteonecrosis of the femoral head. This can be a difficult orthopaedic problem because of the patient's young age at presentation and abnormal bone stock. Review of the literature leaves uncertainty as to the ideal treatment of femoral-head avascular necrosis in this disease. This article reports the long-term results of a cup arthroplasty and a total articular resurfacing arthroplasty procedure for bilateral hip involvement. In light of the less-than-satisfactory results of total hip arthroplasty for young patients with Gaucher's disease, resurfacing arthroplasty may warrant more serious consideration. For the older patient with Gaucher's disease, total hip arthroplasty may be preferable.

Child↗
PubMed1992

Autogenous bone marrow and allograft replacement of bone defects in the hand and upper extremities.

The posterior iliac crest has been shown to be an area extremely rich in red active marrow and it therefore provides a source of cells with osteoinductive and osteogenic potential. Concentration of these cells in the presence of routine bone graft enhances local healing of osseous defects and remodeling of graft into healthy bone, even in conditions where bone healing has been noted to be delayed and/or difficult. In a group of 29 patients there were no cases of adverse reactions to bone marrow aspiration or autogenous transplantation. Twenty-five of the 29 patients (86%) showed osseous union by 3 months postsurgery, while 28 of the 29 patients (96%) had complete incorporation at 6 months.

Adolescent↗
PubMed1992

The figure-of-eight splint for proximal interphalangeal joint volar plate injuries.

Volar plate disruption of the proximal interphalangeal (PIP) joint is a common hand injury. Management of this injury must provide stability and motion to avoid disabling instability or stiffness. In this study, 40 patients with closed PIP joint volar plate injuries were treated with the figure-of-eight splint, a custom made, thermoplastic splint that allows protected joint motion. At two-year follow-up, 95% of these patients experienced good or excellent results. The figure-of-eight splint offers a simple and effective method of treatment for volar plate injuries of the PIP joint.

Equipment Design↗
PubMed1991

External fixator pin insertion techniques: biomechanical analysis and clinical relevance.

A series of identically matched pairs of fresh-frozen canine femora (approximating human radii in size and dimension) were used to mechanically compare pull-out strength between 4 mm predrilled, self-tapping, half-pins and 4 mm self-drilling, self-tapping half-pins with drill bit-like cutting flutes. A second biomechanical and videotape analysis was done comparing the differences of pin insertion by power versus hand drilling. Results indicated a mean 22% reduction in bone purchase of self-drilling, self-tapping pins compared with that of predrilled pins and a marked increase in depth of insertion required of the self-drilling pins for comparable pin purchase (10 mm). It was also observed that a visible "wobble factor" exists, which tends to weaken the pin-bone interface when hand drilling is performed.

Animals↗
PubMed1991

Augmented external fixation of unstable distal radius fractures.

The technique of "augmentation" of external fixation employs the use of percutaneous Kirschner wires to secure the radial styloid fragment as a lateral buttress, elevate and fix in place the depressed lunate fossa fragment, and, when necessary, add support to the elevated articular surface by means of subarticular bone grafting. A series of 51 cases of comminuted, unstable intraarticular distal radius fractures has been managed using this technique. Detailed evaluation has demonstrated precise articular reconstitution with an overall satisfactory result rate of 92%.

Adolescent↗
PubMed1991

Callotasis lengthening in the upper extremity: indications, techniques, and pitfalls.

Bone lengthening through callotasis has been performed in 12 bones of the upper extremity in eight patients. Diagnoses included congenital amputations, phocomelia, radial agenesis, traumatic amputations, and infected fracture with bone loss. Nine of the 12 procedures resulted in complete consolidation of the transport gap with new bone without need for bone graft. One patient died of unrelated illness before completion of treatment but demonstrated early consolidation of the gap. In two cases bone graft was required. Complications included one superficial pin tract infection and one case of premature cessation of lengthening because of hand deviation. Early experience with this technique indicates that it is effective in the management of bone defects in the upper extremity. It appears that in most cases a half-frame lengthening device, rather than a more complex circular frame, can be used in the non-weight-bearing upper extremity. Adequate control of the distal segment, appropriate choice of location for corticotomy, and gentle handling of the bone and periosteum can improve results and minimize complications.

Adult↗
PubMed1991

Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow.

Ulnar nerve decompression with medial epicondylectomy was performed in 66 elbows between 1966 and 1986 for compressive ulnar neuropathy at the elbow. This study is an updated review that adds 36 cases to a previously published report on 30 cases. These elbows were graded preoperatively and postoperatively using McGowan's grading system. Eighty-three percent improved one or two grades, and 11% improved subjectively although they showed no objective improvement, 3% noted no change, and 3% were subjectively worse. One early case sustained damage to the ulnar collateral ligament with resultant instability. No other complications occurred. The best results were seen in the Grade I and II lesions, whereas those with Grade III lesions were the least predictable. The procedure is technically uncomplicated with minimal morbidity and reliable results.

Adolescent↗
PubMed1991

Reduction of treatment-related complications in the external fixation of complex distal radius fractures.

Treatment-related complications in the external fixation of complex distal radius fractures may be diminished by the insertion of 4-mm, self-tapping half-pins after predrilling. The pins are placed proximally in the radius and distally through six cortices of the second and third metacarpals. An adaptable fixation device that allows reduction after pin insertion and assembly is recommended. It must allow enough mobility to completely reduce a very unstable fracture after its application. A limited open surgical approach allows direct visualization of the bone where the fixator pins will be placed, as well as central insertion of the pins. It avoids eccentric drill placement, open section defects, redrilling, and damage to soft-tissue structures.

Biomechanical Phenomena↗
PubMed1990

Biomechanical analysis of pin placement and pin size for external fixation of distal radius fractures.

A series of biomechanical analyses were performed to explain the recent reduction in treatment-related complications of external fixation of distal radius fractures using a limited open approach for pin placement and larger 4-mm self-tapping half pins. A comparison of pull-out strength, stress concentration effect, and inherent bending strength of 3- and 4-mm half pins was performed. The effect of proximal pin placement in the radius or in the ulna and the effect of distal pin placement in four, six, or eight metacarpal cortices were determined. These analyses demonstrate that the 4-mm self-tapping half pins result in a significantly higher pull-out strength and only a small decrease in torsional load strength of the bone. They also demonstrate that proximal pin fixation in the radius produces the most stable fixation and that distal pin fixation into six metacarpal cortices produces a strong configuration that does not violate the interosseous muscles of the second intrinsic compartment. The rate of treatment-related complications in the external fixation of distal radius fractures (specifically, pin loosening, bending and breakage, fracture through pin sites, collapse at the fracture site, and intrinsic contracture) are addressed in this study. Such complications can be minimized by using 4-mm pins after central predrilling, with proximal placement in the radius and distal placement through six cortices of the bases of the second and third metacarpals.

Animals↗
PubMed1989

Arthroscopy update #3. Chronic impingement syndrome. The role of ultrasonography and arthroscopic anterior acromioplasty.

Diagnosis of advanced rotator cuff impingement syndrome has been difficult due to dependence on plain radiographs and arthrography, which in the absence of complete tears are frequently inconclusive. Advances in ultrasonography have enabled accurate diagnosis of the more enigmatic partial thickness tears of the rotator cuff. Until recently, advanced impingement syndrome resistant to conservative therapy has been managed by open anterior acromioplasty as described by Neer. This has required a prolonged postoperative rehabilitation program before return to normal activities of daily living and athletic participation. Precise diagnosis with ultrasonography and refined arthroscopic techniques have enabled us to identify 50 patients with resistant impingement syndrome and partial thickness tears of the rotator cuff, and surgically decompress the subacromial space via arthroscopic resection of the coracoacromial ligament and anterior-inferior leading edge of the acromion. Postoperatively there has been minimal pain. Return of nearly full passive range of motion has been achieved in all but two patients within the first week. Active range of motion exercises are begun on the first postoperative day and resistive exercises commence two weeks after surgery. Mean return of normal functioning in activities of daily living has been two months, while return to prior level of athletic activity has averaged five months.

Acromion↗
PubMed1989

Arthroplasty of the hand and wrist.

The historical perspectives of the wrist and its pathologies are discussed in light of developments made by the pioneers of hand surgery.

Arthroplasty↗
PubMed1989

Multifaceted pediatric congenital hand reconstruction.

The management of a variety of complex congenital hand deformities is presented. The importance of early parental education by the surgeon and the rehabilitation team is stressed so that staged reconstruction can be planned and executed. New surgical techniques are demonstrated that provide the patient with the ability to perform normal bimanual activities at an early age.

Blood Vessels↗
PubMed1988

Total articular replacement arthroplasty.

Surface replacement, popularized in the early 1970s has fallen into disfavor by much of the orthopedic community. To date, the authors' experience with 29 cemented total articular replacement arthroplasties (TARAs) in 25 patients has been quite favorable. Factors associated with these favorable results include: a physiologic age less than 60, good bone quality, viability of the remaining femoral head, and preservation of the acetabular subchondral plate. The mean age of cases in this study was 52 years, with patient follow up ranging between 3.5 and 7 years; there were two failures. Today, although conventional cementless total hip arthroplasty seems to be in vogue, real and potential problems exist. These concerns, in conjunction with the good results reported in this series, should encourage the orthopedic surgeon to take a second look at resurfacing arthroplasty, especially in the select group of patients defined in this article. Pending the long-term results of non-cemented prostheses the surgeon may even consider using cementless TARA components.

Adult↗
PubMed1988

Angiomyoma in the hand.

Angiomyoma of the upper extremities is not commonly encountered by the orthopedic surgeon. A case of a vascular leiomyoma developing in a 79-year-old woman is discussed along with a review of the literature.

Aged↗
PubMed1988

Management of malunited fractures of the metacarpal and phalangeal shafts.

Malunions of the tubular bones of the hand should be carefully studied to understand the original deforming forces at the time of injury. Once a three-dimensional concept of the deformity is embraced, a careful plan for osteotomy can be developed and executed. Surgical approach must afford adequate access with the least possible injury to soft tissues. Technique of osteotomy must be tailored to the configuration, location, and biomechanical requirements for proper realignment of the malunited fracture. Important principles in the management of metacarpal and phalangeal malunions are: 1. Rotatory deformities are most disabling yet frequently not appreciated. A 10-degree rotational malalignment in the metacarpal results in a 2-cm overlap at the finger tip. Alignment should always be checked with the fingers flexed into the palm. 2. Adherence to biomechanical principles of fracture repair is mandatory. 3. The appropriate form of osteotomy and subsequent fixation must be carefully chosen and applied to each individual deformity. Familiarity with the osteotomy techniques and alternative forms of fixation affords flexibility in managing complex deformities. 4. The presence of malunion suggests the presence of fracture disease in the soft tissues. They must be delicately handled and carefully inspected for the presence of scarring, adhesions, and contractures. Careful protection of delicate structures should be complemented by judicious tenolysis and arthrolysis at the time of osteotomy. 5. Appropriate, functional postoperative rehabilitation is mandatory. Without adequate therapy the best surgery will produce suboptimal results. Adherence to these principles can avoid further complications and problems and provide a successful ultimate outcome.

Biomechanical Phenomena↗