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Biomedical subjects

C A Peimer

Publications and source records attributed to C A Peimer.

At least 55 records · Page 3Linked to original sources
PubMed1988

Fibrin seal adhesive versus nonabsorbable microsuture in peripheral nerve repair.

Although nonabsorbable microsuture is the material most often used in human peripheral nerve repair, it is capable of eliciting a foreign body reaction, impairing vascularity, and potentially disrupting axonal regeneration. Sutureless methods, including fibrin seal adhesive, may offer an alternative to traditional suture techniques. This study compared the efficacy of fibrin seal with nylon microsuture in tibial microneurorrhaphy on 28 adult New Zealand white rabbits (14 with 10-0 monofilament nylon suture and 14 with fibrin seal). Each rabbit was reexplored at 1, 6, 12, and 18 weeks. The criteria used to compare the two methods were operative time, clinical function, electrophysiologic measures, and histologic findings. Fibrin seal repairs required less time to execute (p less than 0.01) but were inferior in mean conduction amplitude (p less than 0.01) and with respect to histologic criteria. Fibrin seal also appeared less effective in maintaining nerve approximation. We do not believe that fibrin seal provides a superior alternative to nonabsorbable suture in primary nerve repair in this experimental model.

Animals↗
PubMed1987

Closed crush injury of the metacarpophalangeal joint.

Closed crush injuries from direct blows to the dorsum of the hand may produce significant metacarpophalangeal (MCP) joint symptoms or dysfunction. We have treated 11 patients who had chronic pain and swelling, but without extensor tendon subluxation, for an average of 7.4 months. Only two responded to nonoperative treatment. The nine who had exploratory surgery had a consistent anatomic lesion that consisted of a partial, arcuate tear of the sagittal fibers. All the patients improved postoperatively. Cadaver dissections of the dorsal MCP tendon mechanism in 11 fresh specimens (44 MCP joints) demonstrated that neither partial nor complete transection of the ulnar sagittal fibers produces radial dislocation of extensor tendons. Radial sagittal fiber transections frequently produced ulnar tendon dislocation. Patients who have closed impact injuries of the MCP joints and present with longstanding pain, swelling, and limited mobility without extensor tendon migration may have sustained unrecognized partial ulnar sagittal fiber disruption. Repair of the partial sagittal fiber tear and exploration of the MCP joint is indicated.

Adolescent↗
PubMed1987

Long-term complications of trapeziometacarpal silicone arthroplasty.

The trapeziometacarpal joint is often affected by arthritis and treated by surgical methods. The significant forces to which this joint is subjected challenge even the most sturdy prosthetic materials. Short-term complications of arthroplasty are caused by inadequate bony resection and instability. Serious long-term problems results from implant wear and the host tissues' response to the implant. Although silicone elastomer prostheses are generally well tolerated, wear-induced microparticles (15 micron or less) incite an intense inflammatory and destructive synovial response. This "silicone synovitis" typically presents more than two years after arthroplasty and is characterized by pain, swelling, and lytic lesions visible on roentgenogram. The silicone microparticles are generated by cyclic physiologic bearing, shear, and compression forces for which these implants have not been tested. The destructive synovitis is arrested by synovectomy, implant removal, and curettage of the lytic defects. Functional salvage requires conversion to resection arthroplasty or arthrodesis. Patients with silicone implant arthroplasty must be followed indefinitely, at frequent intervals, by clinical examination and roentgenograms. Overall, however, experience indicates that resection arthroplasty is the most predictable and functional procedure for the nonrheumatoid basal thumb joint.

Arthroplasty↗
PubMed1987

Motion of the wrist after simulated limited intercarpal arthrodeses. An experimental study.

Seven different types of intercarpal arthrodeses that are commonly used in clinical practice were simulated in wrists of cadavera by drilling two nonparallel Kirschner wires across the involved joint that was to be fused. The changes in radial deviation, ulnar deviation, dorsiflexion, and palmar flexion, and the arc of motion in two planes (radial plus ulnar deviation and dorsiflexion plus palmar flexion) were compared with control values for each specimen and with each of the other arthrodeses. All of the data were analyzed by calculating the mean and standard error of the changes in these motions of the wrist as compared with the control values for each wrist. The statistical significance of the changes was derived by the t test. For values of t greater than 2.262, the observed mean reductions in the motions were statistically significant (p = 0.05) in all wrists except those that had simulated arthrodesis of the lunate-triquetrum or the capitate-hamate joint. No statistically significant differences were noted between the effects of arthrodesis of the scaphoid-trapezium-trapezoid, scaphoid-capitate, and scaphoid-lunate joints on the motions of the wrist. All arthrodeses except those of the lunate-triquetrum and the capitate-hamate joint produced a statistically significant decrease in the total arc of motion; arthrodesis of the capitate-lunate joint produced the most statistically significant decrease in total arc of motion. In our opinion, the results of the study suggest that there is limited justification for arthrodesis of the capitate-hamate joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Compression neuropathies in the upper extremity.

Electrodiagnostic studies, including electromyography (EMG) and nerve conduction velocity testing (NCV), can be either useful or misleading in the diagnosis of compression neuropathies in the upper extremity. The author contends it depends on whether the clinician knows how to employ these diagnostic techniques in a group of disorders with varying exact etiologies. Making a decision between nonoperative care and surgical release in the management of these patients is also discussed.

Arm↗
PubMed1987

Proximal interphalangeal joint following traumatic arthritis.

The motivated patient with symptomatic post-traumatic PIP joint stiffness and discomfort has the potential for significant functional improvement. The specific treatment will depend on many factors, including residual joint architecture, alignment, and condition of the soft tissues. The careful surgeon will review all physical and roentgenographic data with the patient and involve her/him in the treatment plan. The function achieved eventually will depend as much on the motivated patient in the hands of a skilled therapist as on the surgeon's meticulous technique.

Arthrodesis↗
PubMed1986

Reactive synovitis after silicone arthroplasty.

A number of patients with silicone rubber implants performed by us and other surgeons initially had excellent results; however, they returned with swelling and discomfort. We studied 18 patients ranging in age from 16 years to 57 years who presented 8 to 78 months (average, 31.7 months) after silicone arthroplasty (four scaphoid, six lunate, one scapholunate, four finger, two wrist, one trapezium, and one ulnar head for metacarpal hemiarthroplasty). Erosive osteolysis was seen on x-ray films, with progressive destruction evident in patients followed serially. None of the patients' conditions responded to conservative care. The severity of the proliferative, inflammatory synovitis and the foreign material in the multinucleated giant cells correlated with the interval since arthroplasty. Implant surface analysis by scanning electron microscope and x-ray spectrometer showed that silicone microparticles were the result of implant degeneration and erosion. All joint cultures were negative. Silicone particulate synovitis and destruction were arrested by the removal of the implant, a synovectomy, and curettage of the lytic lesions at salvage (resection arthroplasty or arthrodesis). Patients who have had silicone arthroplasties should be followed indefinitely, at regular intervals, by x-ray films and clinical examination.

Adolescent↗
PubMed1985

Combined reduction osteotomy for triphalangeal thumb.

Triphalangeal thumb is an uncommon congenital deformity. The thumb is long, awkward, frequently angulated, and may have a broad, unsightly nail. When the middle phalanx has an abnormal C-shaped ("delta") epiphysis, the deformity worsens if untreated. Three triphalangeal thumbs in two patients who were 2 1/2 and 8 1/2 years of age were treated with single-stage combined longitudinal and transverse reduction osteotomy, which included narrowing, shortening, and deangulation by ablating the extra joint and abnormal epiphysis. The patients were followed 48 to 59 months after surgery. Realignment, corrected relative length, and interphalangeal motion have been preserved in all thumbs. Neither patient has developed instability or angulation or had a recurrence after surgery.

Bone and Bones↗
PubMed1985

Primary malignant tumors of the upper extremity: retrospective analysis of one hundred twenty-six cases.

We retrospectively evaluated 126 patients with primary sarcomas of bone (45) and soft tissue (61) in the upper extremity principally to evaluate the effectiveness of the Musculoskeletal Tumor Society staging system in predicting treatment outcome and to note differences between bone and soft tissue sarcomas. Patients were followed 2 to 11 years from diagnosis. The mean survival from treatment onset was 49 months (4 to 144 months). A strong statistical relationship (p less than 0.05) between anatomic location (above/below elbow) and surgical stage (stage I/II, A/B) was demonstrated. The type of primary operation and subsequent incidence in local tumor recurrence were found to be statistically different. Seventy percent of soft tissue tumors that metastasized first recurred locally, but such a strong association was not evident for bone. Development of metastases significantly shortened survival. Radical primary excision of soft tissue malignancies sharply reduced local recurrence and thereby diminished metastatic risk; similar findings were not present for bone malignancies. This study suggests that the Musculoskeletal Tumor Society staging system is valid and should be applied to these infrequent malignancies, permitting future statistical comparisons.

Adolescent↗
PubMed1984

Palmar dislocation of the proximal interphalangeal joint.

Fifteen patients with palmar dislocations of the proximal interphalangeal (PIP) joint were reviewed 6 to 49 months after treatment (average 17.8 months). Disruption of the extensor mechanism, palmar plate, and one collateral ligament was found in all patients. The loss of static and dynamic joint support caused palmar subluxation, malrotation, and a boutonnière deformity. Two dislocations were irreducible, and three were associated with dorsal avulsion fractures from the middle phalanx. The serious nature of the injuries from this dislocation was initially unrecognized, and most patients were casually treated; delay from injury to referral averaged more than 11 weeks. Twelve of the 15 required surgery for joint reduction and tendon and ligament repair; three treated earlier were managed by closed reduction and percutaneous pinning. Joint alignment, comfort, and stability were restored, and all returned to full activities including heavy labor. However, a full range of PIP motion was not recovered in any case.

Adolescent↗
PubMed1984

Absorbable versus nonabsorbable suture for microneurorrhaphy.

The results of epineural microneurorrhaphy with use of 10/0 monofilament absorbable (Vicryl and Dexon) and nonabsorbable ( Dermalon , Ethilon, and Prolene) microsuture were compared in 150 isogeneic male Sprague-Dawley rats. After sciatic nerve transection and epineural repair, the animals were observed clinically and reexplored before death at intervals from 2 days to 20 weeks. Half of the animals were randomly selected for electrodiagnostic studies at 6, 12, and 20 weeks before sacrificed. We found no significant clinical, electrodiagnostic, or histologic differences affecting axonal regeneration that were attributable to any of the suture types used. All sutures incited moderate zones of localized inflammation acutely. After dissolution, the absorbable group was essentially free of inflammation, whereas the nonabsorbable sutures persisted in small local granulomas. A possible advantage may be suggested in the use of monofilament absorbable sutures for microneural repairs in certain situations.

Absorption↗
PubMed1982

Microvascular response to angiography.

A controlled laboratory study using matched groups fo pure-bred Sprague-Dawley rats evaluated the histologic microvascular response to contrast angiography. The femoral vessels were studied by both light and transmission electron microscopy (TEM) following injection of the infrarenal aorta with Renografin-60 or saline at intervals from 2 hours to 56 days. None of the specimens studied showed significant cellular, interstitial, or intravascular injury. TEM demonstrated electron-dense particles which migrated from the vessel lumen into the endothelial cytoplasm and basal lamina and subsequently diffused back into the cytoplasm. This study demonstrates the absence of microvessel damage from a radiopaque contrast medium administered by techniques designed to parallel the clinical model.

Animals↗
PubMed1981

Distraction-fixation in the primary treatment of metacarpal bone loss.

Nine patients seen in civilian practice with severe open injuries of the hand, including loss of portions of some or all of the metacarpals, were treated by primary restoration of metacarpal length and alignment by distraction-fixation with the use of transverse intermetacarpal Kirschner wires. An external fixation device was added in two of the nine patients. Severe associated soft tissue injuries were present in all but one patient. Two injuries were caused by firearms, and the other seven by heavy machinery. Contractures of the joints were prevented by the use of a second set of wires to position the metacarpophalangeal joints in 70 degrees of flexion and the first metacarpal in abduction and pronation. Staged closure of wounds by local or distant flaps and secondary reconstructions by bone, nerve, and tendon grafts or transfers were necessary in all and required an average of almost 2 years until treatment was completed. All except the one child and the one most recently injured patient have returned to employment or vocational retraining. Follow-up was 24 to 78 months from injury.

Accidents, Occupational↗
PubMed1981

Repair of fingertip lacerations and amputations.

Even minor losses of fingertip skin or subcutaneous tissue can be disabling. The location, size and orientation of the defect must be meticulously assessed. Particular attention to technique is required in providing digital block anesthesia, in using Z-plasty to redirect wounds which cross flexion creases and in providing adequate coverage of fingertip amputations. A correct repair will allow rapid recovery and an early return to activities.

Amputation, Traumatic↗
PubMed1981

Toe-to-hand free tissue transfer for thumb construction with multiple digit aplasia.

Successful one-stage toe-to-hand free tissue transfers were performed for bilateral aplasia of the radial digits of both hands in a 9-year-old boy with associated congenital bilateral cleft foot deformity. The results indicate that toe-to-hand free tissue transfer can successfully create a functional, movable, sensate, radial, prehensile digit in hands that are markedly deficient in local reconstructive tissues.

Abnormalities, Multiple↗
PubMed1980

Multicentric giant-cell tumor of bone.

Five patients with primary multicentric giant-cell tumor of bone (eighteen lesions) were followed for four to fourteen and one-half years from the time of the original diagnosis. Only fifteen such cases (fifty-two lesions) have been reported previously. In our series the course of each lesion was similar to that expected of the monostotic tumor. There was a high incidence of lesions in the small bones of the hand (eleven of the eighteen). The histological features were generally typical, but some lesions had a stroma composed mostly of spindle cells. All of the lesions were excised and there was a recurrence in four patients. Of eight lesions treated by curettage with or without autogenous bone-grafting, six recurred. All lesions in the hand that were treated by curettage recurred. There was only one recurrence of the lesions treated by amputation or en bloc resection. Infection occurred in one patient. There were no metastases.

Adolescent↗