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Biomedical subjects

C P Melone

Publications and source records attributed to C P Melone.

At least 19 recordsLinked to original sources
PubMed2000

Thumb collateral ligament injuries. An anatomic basis for treatment.

This anatomic and clinical study leads to the following conclusions: 1. The ulnar and radial proper collateral ligaments are the critical lateral stabilizers of the thumb MP joint; both are highly vulnerable to complete disruption, with resultant disabling joint instability. 2. The intrinsic anatomy of the radial side of the MP joint is not a mirror image of the ulnar aspect. Significant anatomic differences account for distinctive patterns of instability. Whereas disruption of the ulnar collateral ligament in conjunction with dorsal capsular tears is apt to result in combined radiovolar subluxation, disruption of the radial collateral ligament, coupled with the unopposed dynamic force of the adductor pollicis, characteristically is prone to a rapid pathologic sequence of profound joint instability, with progressive ulnar and volar subluxation and, ultimately, degenerative joint disease. 3. Optimal management of the complete collateral ligament lesion requires prompt diagnosis, most accurately confirmed with physical and radiographic stress testing, and precise surgical repair. Immobilization alone is insufficient treatment for these serious ligament disruptions, characterized by considerable displacement with wide separation of torn ends. 4. Although early direct repair affords the best opportunity for restoration of joint integrity with a highly favorable functional recovery, secondary repair and free tendon grafting, prior to joint deformity, provide consistently successful options for chronic instability.

Athletic Injuries↗
PubMed2000

Boxer's knuckle. Traumatic disruption of the extensor hood.

The unique function of the boxer's hand requires persistent, forceful punching in a constantly clenched fist posture, therefore, the metacarpophalangeal joints are continually exposed to blunt trauma and highly vulnerable to injury. This injury is traditionally termed boxer's knuckle. Although a myriad of metacarpophalangeal joint derangement is apt to result from isolated or repetitive blows inflicted and absorbed by the hand, the most serious and disabling type of boxer's knuckle is extensor hood disruption. Based on experience with 27 surgical cases, this article describes characteristic extensor hood pathology and operative techniques that have afforded a consistently favorable outcome.

Adult↗
PubMed2000

Perilunate injuries. Repair by dual dorsal and volar approaches.

Controversy persists regarding optimal management of perilunate injuries. Traditionally, closed treatment, with or without percutaneous pin fixation, was advocated for these highly unstable carpal disruptions, but the inconsistent and often disappointing outcome of closed reduction, coupled with the recognition that functional recovery closely parallels the accuracy of restoring carpal alignment, have led to increasing enthusiasm for open treatment. The favorable outcome reported in this article supports both the contention that the acute perilunate injury affords the opportune time for operative preservation of carpal stability and the efficacy of the combined dorsal and volar approaches as the optimal means of surgical repair. This clinical experience also corroborates experimental evidence that perilunate injuries are apt to cause a predictable spectrum of osseous and soft tissue lesions--lesions usually suitable for early, precise repair. For the skilled athlete, prompt recognition and precision treatment of all components of injury are the critical factors to attain a functional outcome commensurate with a successful return to competition.

Athletic Injuries↗
PubMed1999

Surgical management of the hand in scleroderma.

Disabling deformity of the hand is a hallmark feature of the person afflicted with scleroderma. However, existing literature provides little guidance to operative treatment for the wide spectrum of hand derangement. Although arthrodesis is generally recommended for severe flexion contractures of the interphalangeal joints, other surgical procedures such as arthroplasty, excision of painful calcinosis, and digital sympathectomy have been employed sparingly, undoubtedly due to potentially hazardous soft tissue conditions. Based on experience with 70 scleroderma patients requiring 272 hand operations, this article provides further insight as to the role of surgical treatment for the scleroderma hand. The favorable results in this relatively large series of cases support the efficacy of precisely timed and skillfully executed surgery in the alleviation of pain, prevention of tissue loss, preservation of function, and improvement in aesthetics. For the ischemic tissues of the scleroderma hand the prerequisite for uncomplicated surgery is a tension-free wound, often requiring judicious skeletal shortening and healing by secondary intention.

CREST Syndrome↗
PubMed1998

Wrist fractures in the athlete. Distal radius and carpal fractures.

The primary prerequisites for optimal management of the athlete's fractured wrist are prompt diagnosis, anatomic and stable reduction, effective immobilization until healing is thorough, and comprehensive rehabilitation of the injured parts. Fulfillment of these fundamental criteria consistently leads to a highly favorable outcome with minimal risk of re-injury. In contrast, a compromise of these principles, especially for the sake of a speedy return to sports, invariably results in suboptimal recovery and, not infrequently, a permanent loss of skills. The exceptions to the cardinal rule that successful treatment of wrist fractures requires precise restoration of anatomic relationships are specific: displaced hamate hook fractures, displaced trapezial ridge fractures, and comminuted pisiform fractures. In such instances, successful union essentially is precluded, and early excision of the displaced fragments is the logical means of facilitating an uncomplicated recovery. For the more complex fractures requiring stabilization, continual refinements in methods of fixation are considerably diminishing fracture morbidity. The availability of small screws that provide rigid fixation of the carpus is, with increasing consistency, promoting accelerated union and rapid rehabilitation. Well-conceived combinations of low-profile, mechanically efficient external fixators and precisely used Kirschner wires achieve highly secure fracture stability for the distal radius that similarly enhances recovery with a minimum of complications. Improvements in both design and application of internal and external fixation techniques undoubtedly constitute a major advance in the management of wrist fractures among athletes. For some athletes, the return to competition can be safely expedited by the use of custom-fit protective gloves, splints, or casts. For most, however, the treatment regimen usually entails a minimum of 3 to 4 months. Although the healing and rehabilitation process is often lengthy and may seem costly, particularly in terms of time lost from competition, seldom do athletes regret the investment once they return to their highly skillful activities unencumbered by wrist impairment. Never does the sports medicine physician regret compliance with the principles of optimal care.

Athletic Injuries↗
PubMed1995

Clinical applications of MR imaging in hand and wrist surgery.

MR imaging is emerging as an invaluable tool in the diagnosis of hand and wrist disorders. It is extremely accurate in the diagnosis of stage 1 Kienbock's disease when plain radiographs are equivocal and in evaluating bone and soft-tissue tumors of the hand and wrist. MR imaging is replacing arthrography as the imaging modality of choice for disruptions of the TFCC. With refined technology and improved resolution, abnormalities involving the intercarpal ligaments ultimately will be able to be detected with a high degree of precision.

Carpal Bones↗
PubMed1993

Distal radius fractures: patterns of articular fragmentation.

Distal radius articular fractures principally result from the die-punch mechanism of injury that leads to consistent patterns of articular disruption with readily identifiable radiographic signs of instability and reducibility. In the vast majority of articular fractures, prompt recognition of these key radiographic features serves as a sound basis for optimal management. Whereas the type I stable injury can be managed by short-term immobilization, the most frequently encountered type II unstable die-punch fracture requires stabilization provided by external fixation, frequently coupled with percutaneous internal fixation, to maintain an accurate reduction. Restoration of articular congruity in an irreducible type IIB dorsal die-punch fracture, in contrast, can only be accomplished by open treatment, usually comprising a limited exposure for reduction and internal fixation of the radiocarpal articular surface, supplementary external fixation, and adjunctive iliac bone grafting. The irreducible type IIB articular fracture with volar displacement is most suitable for stabilization by plate and screw fixation; however, in patients with excessive comminution, Kirshner wires provide a satisfactory alternative method of fixation. The type III spike fragment is secured with either small screws or wires in conjunction with closed or limited open articular restitution and appropriate nerve and tendon surgery. The irreducible type IV fracture demonstrating wide separation of articular components always requires extensive open treatment for restoration of articular congruity as well as repair of associated skeletal and soft tissue injuries. In the type V explosion injury, provisional stabilization employing, external fixation provides a sturdy framework for critical revascularization or resurfacing procedures and serves to maintain radial alignment before definitive articular reconstruction. In more severe injuries, early detection and repair of frequent periarticular injuries are essential for a favorable recovery. In those fractures requiring open reduction with internal fixation, supplementary external fixation and iliac bone grafting have proved to be increasingly beneficial adjuvants to management. In all cases, preservation of articular congruity with precise restoration of key medial fragments is the principal prerequisite for a successful outcome.

External Fixators↗
PubMed1993

Unstable articular fractures of the distal radius. Comparative techniques of ligamentotaxis.

Ligamentotaxis employing either pins and plaster or external fixators, frequently in conjunction with supplemental Kirschner wire internal fixation, has proved to be a reliable means of maintaining an accurate reduction of unstable articular fractures of the distal radius. Critical preoperative evaluation and surgical restoration of articular congruity along with attention to key technical details have resulted in a reproducible successful recovery. In our experience, the advantages of the pins and plaster technique are its relatively simple methodology, its comparatively low cost, and its high level of patient acceptance. The distinctive advantages of the external fixator are its superior mechanical efficiency, its capacity for fracture adjustment during the healing period, and the fact that it ensures unimpeded access to wounds. Nonetheless, regardless of the specific method chosen, this study clearly supports the contention that precision in patient selection and pin placement are the prerequisites for successful ligamentotaxis in the management of distal radius fractures.

Adolescent↗
PubMed1992

Pisiform-hamate coalition with ulnar neuropathy.

Two cases of pisiform-hamate coalition with compression of the ulnar nerve at the wrist are reported. Pisiform-hamate coalition is a rare entity previously thought to be exclusive to West Africans and without clinical significance. These cases occurred in white patients. This is the first description of a carpal coalition resulting in ulnar neuropathy at the wrist.

Adolescent↗
PubMed1992

Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy.

The surgical pathology in 42 cases of traumatic triangular fibrocartilage complex (TFCC) disruption comprised a spectrum of injury resulting in five basic stages of increasingly severe ulnar wrist instability. In all cases, detachment of the articular disk from its ulnar insertion was the principal cause of distal radioulnar joint instability; in 28 (67%), concomitant injury to the adjacent extensor carpi ulnaris sheath, the ulnocarpal ligaments, or the peritriquetral ligaments compounded the instability. Thus, rather than an isolated event, peripheral disruption of the disk often proved the major constituent of multicomponent lesions--lesions consistently suitable for repair. In this series of destabilizing TFCC disruption requiring operative treatment, awareness that some injuries selectively affect the articular disk, whereas others compromise wider zones of wrist anatomy, was essential to successful surgery.

Adolescent↗
PubMed1991

Distal ulna resection, extensor carpi ulnaris tenodesis, and dorsal synovectomy for the rheumatoid wrist.

We conclude from this study that distal ulna resection coupled with stabilization by ECU tenodesis is a highly useful technique with a reproducibly successful outcome for DRUJ destruction resulting from rheumatoid arthritis. In this series, like those noted previously, alleviation of pain, preservation of wrist mobility, prevention of tendon rupture, and improved function have been consistently observed. Moreover, with adjunctive dorsal synovectomy this combined procedure has proved applicable to cases demonstrating not only mild but also moderate stages of radiocarpal disease, thereby avoiding the more extensive and less desirable surgical alternatives of complete wrist arthrodesis or total wrist arthroplasty. Recognizably, the long-term benefit of this surgery depends on maintaining stability of both the reconstructed radioulnar joint and the synovectomized radiocarpal joint. Although the data reported herein strongly support the efficacy of the tenodesis in preserving distal ulna stability and similarly indicate a favorable influence on maintenance of radiocarpal architecture, one must be cognizant that progressive radiocarpal deterioration is a characteristic, albeit somewhat unpredictable, manifestation of the chronic rheumatoid process, and is the principal factor apt to compromise an initially satisfactory result. In such cases demonstrating excessive carpal malalignment preoperatively and for those with an unremitting postoperative course of ulnar translocation or volar subluxation, additional radiocarpal stabilization, preferably by arthrodesis, is essential to salvage the benefits of distal ulna resection and ECU tenodesis.

Adult↗
PubMed1989

Tears of the triangular fibrocartilage of the wrist: MR imaging.

Magnetic resonance (MR) imaging of the wrist was performed in 35 patients with specific complaints of pain and soft-tissue swelling in the medial side of the wrist. Twenty of the 35 subsequently underwent surgery. In 14 of the patients who underwent surgery, a diagnosis of triangular fibrocartilage (TFC) tear was made at MR imaging; in 13 of the 14 the tear was confirmed by surgical findings. In the six patients with an MR diagnosis of an intact TFC, surgical findings confirmed the diagnosis. These patients were operated on for an abnormality in the vicinity of the TFC (avascular necrosis, ganglion cyst, xanthoma). On the basis of findings from the 20 patients with surgical correlation, the accuracy of MR imaging in the detection of TFC tears was 95%. MR imaging is a valuable noninvasive method in the study of pathologic conditions of the TFC.

Adolescent↗
PubMed1988

Classification and management of intra-articular fractures of the distal radius.

A classification of distal radial articular fractures is described, based on observations of consistent patterns of fracture fragmentation and displacement. The classification categorizes articular fractures into four types, with the medial complex assuming a pivotal position as the cornerstone of both the radiocarpal and distal radioulnar joints. The purpose of this classification is four-fold: (1) to afford identification and an understanding of the displacement characteristics of the major fracture components, (2) to provide practical and rational guidelines for the management of these injuries based on specific fracture patterns, (3) to emphasize the frequency of concurrent soft tissue and other skeletal injuries associated with the more severe types of articular disruption, and (4) to serve as a prognostic gauge for the varied spectrum of distal radius articular injury. Optimal management of distal radius fractures necessitates the differentiation of articular from extra-articular fractures as well as prompt detection of unstable injuries. While the majority of unstable fractures can be successfully managed by closed methods, a substantial and increasing number require open treatment for restoration of articular congruity as well as repair of concomitant soft tissue and skeletal injuries. In all cases, precise reduction of the key medial fragments is essential to maximum recovery.

Bone Nails↗
PubMed1988

Total elbow replacement.

The historic development of prosthetic total elbow arthroplasty is traced and results of constrained, semiconstrained, and nonconstrained designs reported. The authors' personal experience with the semiconstrained total elbow replacement, surgical indications with an emphasis on careful patient selection, and highlights of operative technique are discussed. Pain, instability, ankylosis, and arthritic degeneration of the elbow have inspired many surgical attempts to improve function and relieve pain. The most sophisticated surgical options now include total elbow replacement. This paper reviews the development of total elbow arthroplasty and assesses the experience with semiconstrained total elbow replacements performed at the New York University Medical Center over the last eight years.

Adult↗
PubMed1987

The acutely injured wrist. An anatomic basis for operative treatment.

Rational guidelines are provided for the early operative treatment of the severely injured wrist. The prominent anatomic features of the wrist as well as clinically relevant kinematics and pathomechanics are reviewed. Diagnostic and operative techniques applicable to acute injury are described. The authors point out that while the concept of prompt restoration of normal anatomic relationships in the acutely injured wrist may appear to be simple, the clinical application of the concept is quite difficult. However, an accurate diagnosis along with early meticulous surgical intervention will generally lead to a good result.

Biomechanical Phenomena↗
PubMed1987

The basal joint pain syndrome.

Disabling trapeziometacarpal osteoarthritis is often associated with other skeletal or soft tissue pathology that necessitates simultaneous treatment. In this study of 100 trapezium arthroplasties, 65% of the patients required at least one concurrent operative procedure and, overall, 75% have received treatment for related problems before, during, or after the arthroplasty. In order of frequency, scaphotrapezial arthritis, carpal tunnel syndrome, hyperextension deformity of the thumb metacarpophalangeal joint, trigger digits, and tenosynovitis of the wrist have been the most prevalent concomitant conditions requiring surgery. Awareness that trapeziometacarpal arthritis is frequently the focal site of a widespread inflammatory process involving other structures of the hand--termed herein the "basal joint pain syndrome"--is essential to optimal management of patients with pain at the base of the thumb.

Arthroplasty↗
PubMed1986

Rigid fixation of phalangeal and metacarpal fractures.

Rational use of rigid fixation in hand surgery requires awareness of the advantages as well as the potential pitfalls of this relatively complex method of fracture management. A rational decision also necessitates familiarity with closed techniques of internal fixation which, in most cases, provide superior alternatives for the phalanges and metacarpals. The optimal application of screws, plates, and tension-band wires to small bone fractures can be ascertained only by critical assessment of large series of cases employing these devices and comparisons with similar series using other techniques of internal fixation. Nonetheless, rigid fixation is the logical choice for treatment of unstable fractures when other methods are predictably less effective. Injuries most suitable for screw or plate fixation include displaced phalangeal condylar fractures, irreducible oblique phalangeal fractures, irreducible transverse metacarpal fractures, disabling malunions, and nonunions requiring multiple adjunctive procedures. For selective fractures, especially those with established deformity or serious joint contractures, the capacity of rigid fixation to effect immediate skeletal stability and facilitate early digital motion can considerably enhance recovery. Complications are minimized by precision--in case selection and surgical techniques.

Bone Nails↗