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Biomedical subjects

C A Peimer

Publications and source records attributed to C A Peimer.

At least 37 records · Page 2Linked to original sources
PubMed1993

Severe fractures of the distal radius: effect of amount and duration of external fixator distraction on outcome.

Although severe intra-articular fractures of the distal radius are often treated with external fixation/distraction, little attention has been devoted to the amount and duration of fixator distraction required to maximize outcome. To determine these effects, we conducted a retrospective study of 26 patients whose primary treatment was external fixation/distraction. Patients were evaluated by chart review, questionnaire, x-ray films, and physical examination an average of 104 weeks after injury. The carpal height index was used to quantify distraction. Scores for pain, function, wrist motion, and grip strength and the total score were adversely affected in proportion to the increase in carpal height index by distraction. Outcome was adversely affected as the duration of distraction increased. Motion scores were affected most. Overall, patients recovered at least 75% of motion and grip strength, and 85% attained New York Orthopedic Hospital grades of good or excellent. These are the first data to show that there are potential adverse effects from increasing amounts of distraction and prolonged use of the external fixator.

Adult↗
PubMed1993

Scaphocapitate fusion in the treatment of Kienböck's disease.

The primary treatment goal for Kienböck's disease remains decompression of the lunate. Although a number of treatment options are available, scaphocapitate fusion is our first choice in many cases of Kienböck's disease. Scaphocapitate fusion mechanically decompresses the lunate and prevents progressive carpal instability. When compared with STT fusion, it has been shown to result in equal or relatively less loss of wrist motion and thumb basilar joint motion. For disease in earlier stages and with ulnar-minus variance, joint leveling procedures have been shown effective; but ulnar-neutral and ulnar-positive wrists would cause one to favor scaphocapitate fusion to prevent postoperative ulnocarpal abutment.

Arthrodesis↗
PubMed1992

Reduction osteotomy for triphalangeal thumb: an 11-year review.

Since 1977 we have operated on 13 of 15 triphalangeal thumbs in nine children (five boys, four girls). Follow-up ranged from 22 to 134 months (mean, 65 months). Total active motion averaged 63 degrees at the interphalangeal joint and 79 degrees at the metacarpophalangeal joint. There was no evidence of instability or laxity of ligaments. Reduction osteotomy was insufficient to shorten grossly long thumbs of two patients, and it was necessary to shorten the metacarpal. Premature closure of the phalangeal physis occurred in two thumbs but did not result in inadequate length; one postoperative pin-tract infection resulted in nonunion that required reoperation. This long-term experience supports reduction osteotomy for triphalangeal thumbs because it addresses the deformities and preserves both motion and stability.

Child↗
PubMed1992

Tenosynovial injection for carpal tunnel syndrome.

Although local steroid injection into the tenosynovium is a frequent treatment for carpal tunnel syndrome, it involves some risk and is not always effective. We simulated injection on 16 fresh cadaver forearms, instilling 1 ml (group 1) or 2 ml (group 2) of methylene blue at 1 cm or 3 cm proximal to the most distal wrist crease. Passive flexion and extension were simulated 2 minutes after injection by application of traction to the appropriate digital tendons. Specimens were dissected under loupe magnification from midpalm to midforearm, dye diffusion was quantified and photographed, sections of the carpal tunnel and contents were graded for presence of dye, and average values were determined for each of the four groups. Diffusion of dye was best in group 2B in which 2 ml was injected 3 cm proximal to the distal wrist flexion crease.

Cadaver↗
PubMed1992

Wrist position and extensor tendon amplitude following repair.

After primary repair of severed extensor tendons, various methods are used to limit tendon adhesions and avoid rupture. Early passive digital motion with wrist extension (a "reverse Kleinert" protocol) has been advocated. However, there are no data to support an optimum wrist position or to indicate how much finger motion may safely be permitted. In this study we used eight fresh cadaver limbs to measure extensor tendon gliding in Verdan's zones 3 to 8 when active grip and passive extension were simulated at different wrist positions. We found that if the wrist is extended more than 21 degrees, the extensor tendon glides with little or no tension in zones 5 and 6 throughout full simulated grip to full passive extension, permitting "passive motion" exercises to minimize tendon adhesions without risking rupture. In addition, we found that up to 6.4 mm of tendon can be debrided safely and full grip can still be permitted postoperatively if the wrist is splinted at 45 degrees extension.

Cadaver↗
PubMed1992

Flexor tendon lacerations in zone V.

Twenty-three patients with zone V flexor tendon lacerations rehabilitated by the Kleinert protocol were studied at an average of 46 months after trauma. Hand function was subjectively normal in only eight. Of fourteen patients who were employed at the time of injury, eight returned to their original occupations. Eight others were working at other jobs, and we considered six more capable of employment. Only one had a poor functional result that precluded occupational use of the hand. Pinch/grip strengths recovered to 85%/79% of the uninvolved side. Independent flexor digitorum superficialis/flexor digitorum profundus action was present in only seven patients. Sixteen regained full digital flexion. Extension loss averaged 25% at the wrist and 10% in each digit. As assessed by static two-point discrimination, sensibility was poor after associated median and ulnar nerve transections; this did not preclude good objective functional results. Complications included two tendon ruptures, proximal interphalangeal hyperextension in the presence of an unrepaired flexor digitorum superficialis, and limited motion in two patients after poor compliance in therapy. Tenolysis was needed in 4 of the 23. We now use a modified Duran technique for noncompliant patients and in those who are unable to extend their PIP joints because of weak intrinsic muscles.

Adolescent↗
PubMed1992

Ideal scaphoid angle for intercarpal arthrodesis.

This experimental study was conducted to determine the best scaphoid position, measured as the radioscaphoid (RS) angle for optimum wrist motion after scapho-trapezio-trapezoid (STT) and scaphocapitate (SC) fusion and to assess the implications of radial styloidectomy on motion after STT fusion. STT and SC fusions were simulated in six fresh cadaver hands with the scaphoid in horizontal, neutral, and vertical positions with respect to the long axis of the radius seen on lateral x-rays. RS angle and wrist motion were measured on x-ray films before and after each simulated arthrodesis. Radial deviation and wrist extension increased as the RS angle increased (i.e., increased as the scaphoid became more nearly vertical). Ulnar deviation and flexion decreased as the scaphoid became more nearly horizontal. We found no statistically significant differences in RS angle between SST and SC fusions with respect to ulnar deviation, flexion, or extension. However, radial deviation was more sensitive to RS angle after STT fusion than after SC fusion, but the differences were not statistically significant. The ideal radioscaphoid angle (range) for maximal wrist motion when STT fusion is performed is 41 to 60 degrees; when SC fusion is performed, it is 30 to 57 degrees. Motion is not improved by radial styloidectomy after simulated STT fusion.

Arthrodesis↗
PubMed1992

Endoscopic release of the carpal tunnel: a randomized prospective multicenter study.

A 10-center randomized prospective multicenter study of endoscopic release of the carpal tunnel was carried out. Surgery was performed with a new device for transecting the transverse carpal ligament while control hands were treated with conventional open surgery. There were 122 patients in the study; 25 had carpal tunnel surgery on both hands and 97 had surgery on one hand. Of the surgical procedures, 65 were in the control group and 82 were in the device group. The endoscopic device was coupled to a fiberoptic light and a video camera. A trigger-activated blade was used to incise the transverse carpal ligament. After surgery, the best predictors of return to work and to activities of daily living were strength and tenderness variables. For patients in the device group with one affected hand, the median time for return to work was 21 1/2 days less than that for the control group. Two patients treated with the endoscopic device required reoperation by open surgical decompression; only one of these had incomplete release with the device. Two patients in the device group experienced transient ulnar neurapraxia.

Activities of Daily Living↗
PubMed1992

Reconstruction of traumatic or congenital amputation of the thumb by distraction-lengthening.

Reconstruction of the traumatically or congenitally amputated thumb presents a significant challenge. The individual needs of the patient must be matched with the armamentarium available to the surgeon. Metacarpal elongation via the distraction-lengthening technique, which uses local tissue without sacrificing any adjacent digits or toes, is a reliable means of increasing thumb length by 3 to 3.5 cm. The optimal situation for performing this procedure is the presence of an amputation in the perimetacarpophalangeal joint region. Although neo-osteogenesis has been shown to be useful in pediatric patients, bone grafting is recommended in those individuals aged 25 years and older with gaps of 3 cm or more. The patient must be carefully observed during the distraction period because of the potential problems that may arise from the use of an external fixation device.

Amputation, Traumatic↗
PubMed1991

Scaphocapitate intercarpal arthrodesis.

We reexamined 17 patients at 16 to 57 months (average, 23.4 months) after scaphocapitate arthrodesis. Surgery was performed for treatment of rotary scaphoid instability, isolated arthrosis, resistant scaphoid nonunion, and prevention of carpal collapse in Kienböck's disease. Scaphocapitate fusion with autogenous bone grafting was used to bridge carpal spaces. Two patients had nonunion of the scaphocapitate arthrodesis, which required reoperation. Seven patients experience persistent pain with heavy use; of these, two changed occupations and one remains disabled. Compared with the nonoperated side, scaphocapitate fusion reduced wrist extension an average of 28 degrees, flexion 40 degrees, radial deviation 14 degrees, and ulnar deviation 14 degrees. The greatest loss was of radial deviation. Static grip reached a average of 74% of the nonoperated side. Dynamic power regained 73%, and dynamic endurance measured 105% of the nonoperated side. Motion peaked after six months on average, and then reached a plateau. Static strength peaked at 11 months and then stabilized.

Adult↗
PubMed1991

Pathologic fractures: a complication of microparticulate synovitis.

We report seven cases of pathologic fracture in adult patients that were seen an average of 5 years (range from 33 to 114 months) after silicone wrist (three) and trapezial (four) arthroplasty. All patients had initially done well after their operation. At return, all had radiographic evidence of generalized implant and intramedullary bone destruction, the latter always including endosteal scalloping and widening from cortical resorption. These radiographic changes may be less striking than the discrete osteolytic lesions seen after degeneration of carpal implants. Our patients represent examples of pathologic fracture as the end stage of untreated microparticulate synovitis, a consequence of prosthetic wear. Our experience suggests that careful and continuous follow-up justified after insertion of stemmed silicone implants, and that patients should be informed of the potential late complications of this procedure, including pathologic fracture.

Aged↗
PubMed1991

De Quervain's syndrome: surgical and anatomical studies of the fibroosseous canal.

Anatomical variations of the first dorsal fibroosseous compartment were studied in 70 patients (38 women, 32 men) who underwent surgical release of the tendons. Seventy-one dissected forearms were also studied. De Quervain's tenosynovitis was the only diagnosis for two thirds of the patients. Nonoperative treatment for all of these patients failed. Forty-three patients (61%) had job-related symptoms. Recovery ranged from 3 to 36 months postoperatively (mean: 4.5 months). Multiple subcompartments were recorded in 47% of patients and in 75% of anatomic specimens. In 94% of the specimens, the abductor pollicis longus (APL) tendon had two to four slips, but in only two were there multiple extensor pollicis brevis (EPB) tendons. Surgeons must recognize that multiple APL tendon slips and two subcompartments are the rule, rather than the exception, in normal anatomy.

Adolescent↗
PubMed1990

Brachioradialis transfer for digital palsy.

Although brachioradialis tendon transfer is thought to offer limited tendon excursion and finger motion, we have used it to restore active thumb and digital function in eight patients. Three had Volkmann's contracture, one avulsion of forearm muscles and four had tetraplegia resulting in inability to perform activities of daily living and loss of pinch or grasp and extrinsic extension. The brachioradialis was transferred to the flexor pollicis longus, to the flexor digitorum profundus or to the common digital extensors. Except for one patient who had unremitting pain, all were pleased with their improved motion, pinch, grip, and independence. Function, however, remained abnormal in all but one.

Adolescent↗
PubMed1990

Digital augmentation for ectrodactyly: management and planning.

Selection of the most appropriate operations for a patient is as important as technical expertise in performing the procedures. Web deepening may be performed alone or in addition to tissue augmentation and should be planned in conjunction with bone lengthening. Skeletal augmentation is useful if fingers are missing or inadequate, and it is necessary to add bony tissue. In general, in order to grow, skeletal transfers must be performed on very young children or must include vascularized physes; complex cases may require microvascular composite toe-to-hand transfer. Distraction-lengthening for intercalary skeletal enhancement is indicated for patients with multiple hypoplastic, aplastic, and missing digits, but the cosmetic result is limited. The major procedures should be started by age 2 years and finished by age 4; unfortunately, it is most often not advisable to perform microvascular surgery at such an early age. Modification of functional patterns, even though they are abnormal or the result of incomplete anatomy, should be avoided in the older child or adult because tinkering does not lead to significant benefits. For a cooperative, and often difficult, staged venture to be maximally successful, physicians and parents must share realistic expectations of aesthetic and functional results.

Age Factors↗