Osteosarcoma of the hand: a case report and review of the literature.
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Aged↗
Biomedical subjects
C M Steyers
Publications and source records attributed to C M Steyers.
Outcome after free flap reconstruction of the heel.
We reviewed six free flap reconstructions of the weight-bearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7-6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers. All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.
Adolescent↗
Anatomy of the oblique retinacular ligament of the index finger.
The available literature includes conflicting descriptions of the anatomy and function of the oblique retinacular ligament. We have studied this ligament in the index finger to better define its presence, configuration, points of attachment, length, and relationship to the proximal interphalangeal joint axis. Twenty fresh frozen index fingers were dissected. Five additional specimens were decalcified, mounted, sectioned transversely at 1 mm intervals and studied under the microscope. An oblique retinacular ligament was identified on the radial side of the index finger in 95% and on the ulnar side in 90% of the specimens. The radial oblique retinacular ligament was usually longer and more developed than the ulnar oblique retinacular ligament. Proximally, the ligament arose from the middle third of the proximal phalanx and the A-2 pulley whereas, distally, it inserted into the lateral extensor band with a fan-shaped expansion centered 4 to 6 mm distal to the proximal interphalangeal joint line. In 70% of the specimens, the oblique retinacular ligament was supplemented by a contribution from the proximal cruciform pulley (C-1). Histologic cross sections also confirmed the presence of the oblique retinacular ligament but not the supplemental contribution arising from the C-1 pulley. The relationship of the oblique retinacular ligament to the proximal interphalangeal joint axis is dependent on the proximal interphalangeal joint position; the ligament lies palmar to the proximal interphalangeal joint axis only when the proximal interphalangeal joint is flexed.
Cadaver↗
Extensor tendon injuries.
A thorough knowledge of anatomy, injury patterns, repair techniques, and evolving rehabilitation methods is necessary to best treat extensor tendon injuries. These injuries are conceptualized as occurring in one of eight zones, which are numbered distally to proximally in the hand and forearm. Even though surgical technique and rehabilitation are specific in each zone, injuries over and proximal to the proximal interphalangeal joint tend to yield less satisfactory results. Dynamic postoperative extension splinting is one factor that is improving long-term results.
Hand Injuries↗
Pisiform fractures.
Fractures of the pisiform are often missed due to improper radiographic evaluation and a tendency to focus on other, more obvious injuries. Delayed diagnosis may result in disabling sequelae. A high index of clinical suspicion and appropriate radiographic examination will establish the correct diagnosis. Ten patients with pisiform fracture are presented. The anatomy, mechanism of injury, clinical presentation, radiographic features, and evaluation of this injury are discussed.
Adult↗
Long-term results of extensor tendon repair.
A retrospective analysis was done in 62 patients with 101 digits having extensor tendon injury. Quality of outcome and parameters that might influence outcome were evaluated. The majority of patients were treated with conventional static splinting. Sixty percent of all fingers sustained an associated injury (fracture, dislocation, joint capsule or flexor tendon damage). Patients without associated injuries achieved 64% good/excellent results, and total active motion of 212 degrees. This difference was statistically significant (p less than 0.05). Distal zones (1 to 4) had a significantly poorer result than more proximal zones (5 to 8). The percentage of fingers losing flexion was greater than the percentage of fingers losing extension. In addition, the average degree loss of flexion was greater than the average degree loss of extension. This would seem to indicate that loss of flexion may be a more significant complication from extensor tendon injury than previously thought.
Adolescent↗
A role delineation study of hand surgery.
In 1986, The American Association for Hand Surgery and the American Society for Surgery of the Hand jointly sponsored a Role Delineation Study of Hand Surgery. The purpose of this study was to define the knowledge and skills necessary for competent hand surgery practice and to determine the responsibilities and activities of hand surgeons. Eight hundred thirty-eight hand surgeons returned a self-report questionnaire. This questionnaire was designed to collect information relative to the demographic characteristics of the respondents, the importance of 38 surgical procedures, and 60 categories of knowledge related to hand surgery, and to elicit respondents opinions regarding certification in hand surgery. This study is a first attempt to define the domain of hand surgery. The data collected in this study provide the basis for designing residency fellowship and continuing education programs and may also be used to study manpower needs, regional variations in practice patterns, and to identify the educational needs of the profession of hand surgery.
Education, Medical↗
Tendon ruptures with scaphoid nonunion. A case report.
Intratendinous ruptures of flexor tendons about the hand and wrist are rare. Flexor pollicis longus and index flexor digitorum profundus tendon ruptures, most commonly seen in patients with rheumatoid arthritis, occurred in a nonrheumatoid 48-year-old man with an asymptomatic scaphoid nonunion. This rare injury may simulate an anterior interosseous nerve syndrome. The absence of prior symptoms does not preclude tendon rupture secondary to scaphoid nonunion. Restoration of power pinch provides good function despite limited range of motion.
Carpal Bones↗
A microvascular anastomotic device: part I. A hemodynamic evaluation in rabbit femoral arteries and veins.
This study quantitatively assesses the hemodynamic consequences of inserting a 1.5-mm polyethylene anastomotic device in both small arteries and veins. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Using 20-MHz pulsed ultrasonic Doppler velocimetry techniques, blood flow was measured in 5 immediate postoperative intervals and at the 24-hour and 3-week postoperative intervals. In arteries, volumetric flow (Q) was not statistically different in any postoperative interval; maximum spatial velocity (Vmax) was significantly increased in the immediate postoperative intervals but was not different at 24 hours or 3 weeks. In veins, significant decreases in Q and increases in Vmax occurred in the immediate postoperative intervals, but differences were not noted at the 24-hour or 3-week intervals. The results of this study indicate that the hemodynamic consequences of anastomosing small vessels with a polyethylene device are minimal and that this mechanical technique is an effective method for experimental microvascular repairs.
Anastomosis, Surgical↗
A microvascular anastomotic device: Part II. A histologic study in arteries and veins.
This study analyzes the histology associated with the polyethylene ring-pin device. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Specimens were harvested at 24-hour and 3-week postoperative intervals and were analyzed using light, scanning electron, and transmission electron microscopy. Generally, the reparative process in the arteries and veins was similar. In 24-hour artery and vein specimens, the endothelial cells were absent, the media tapered within the device, but smooth muscle cells (SMC) remained partially viable. In 3-week specimens, the device junction was well healed and reendothelialized. Subintimal hyperplasia was present, the internal elastic lamina was not reconstituted, and the SMCs were partially viable. Small vascular channels formed at the device junction, and small venous valves were noted near the device. Macrophages lined the margins of the device. The early reparative process proceeds favorably, by histologic criteria, after vessel repair with the polyethylene ring-pin device.
Anastomosis, Surgical↗
Measuring ulnar variance: a comparison of techniques.
This study compared three commonly used methods of measuring ulnar variance. The comparison included the project- a-line technique (A), the method of concentric circles (B), and the method of perpendiculars (C). Specific features studied were variations in results generated by each technique as well as the interobserver and intraobserver reliability for each technique. The only significant difference among techniques was between techniques A and B (p = 0.0224), where mean A values were more positive than mean B values. Observers were found to differ significantly (p = 0.0092) independent of technique. All methods studied were highly reliable, although the method of perpendiculars was most reliable for both interobserver (reliability = 0.9801) and intraobserver (reliability = 0.9719) reliability. This study shows that the clinician may choose whichever technique he prefers when measuring ulnar variance.
Anthropometry↗
Large lipomas in the deep palmar space.
Lipoma in the deep palmar space of the hand is an unusual tumor. Our experience with seven of these tumors indicates that they can be unusually large at initial examination, can first be seen with paresthesias in branches of the median nerve, and can be difficult to surgically expose. Marginal resection of this tumor is curative.
Aged↗
Crossed intrinsic transfer.
A retrospective analysis of the long-term results of the crossed intrinsic transfer operation is presented. Twenty-one patients (30 hands) with rheumatoid arthritis and one patient (1 hand) with systemic lupus erythematosus were examined clinically and radiographically. The average follow-up was 12.7 years. The average postoperative ulnar drift for all fingers was 5 degrees. The magnitude of ulnar drift did not increase over time. The average active range of motion for the metacarpophalangeal joints was 47 degrees and for the proximal interphalangeal joints it was 58 degrees. The average radial deviation deformity of the wrist in the resting position was 2 degrees. These variables did deteriorate with time. Extensor carpi radialis longus to extensor carpi ulnaris tendon transfer with crossed intrinsic transfer produced the same result as crossed intrinsic transfer alone. The outcomes for crossed intrinsic transfer attached to the lateral band were similar to outcomes for transfers attached to the collateral ligament of the metacarpophalangeal joint. The crossed intrinsic transfer procedure effectively provides long-term correction of ulnar drift in the rheumatoid hand.
Adult↗