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Biomedical subjects

D S Ruch

Publications and source records attributed to D S Ruch.

36 records · Page 2Linked to original sources
PubMed1998

Arthroscopic assessment of carpal instability.

The evaluation, classification, and treatment of carpal instability continues to be one of the most controversial topics in hand surgery. One explanation is the lack of standardized findings and radiographic criteria. No good modality to date has been proposed to accurately aid in evaluating carpal instability. Wrist arthroscopy has become increasingly useful in the assessment of mechanical wrist pain. With this technology, specific patterns of injury can more accurately be identified by direct visualization. This will also aid in implementing a reproducible, less subjective means of describing wrist instability. The treatment can then be focused on management of the specific ligamentous injury responsible for the pattern of instability visualized. The following is an attempt to categorize these instability patterns as seen through arthroscopy and provide our proposed treatment options.

Arthroscopy↗
PubMed1998

The arthroscopic treatment of avascular necrosis of the proximal pole following scaphoid nonunion.

The authors describe a technique of treating scaphoid nonunions with associated avascular necrosis consisting of arthroscopic resection of the distal pole of the scaphoid combined with radial styloidectomy. The results at 2-year follow-up showed all three patients to have complete relief of their mechanical pain and improvement in their range of motion as well as high satisfaction with the procedure. Modified Mayo Wrist Scores were a mean preoperatively of 60 and postoperatively of 88. Postoperative radiographs showed no increase in the scapholunate gap. However, the capitolunate angle increased from a mean of 3 degrees to 13 degrees . There was no progression of degenerative changes noted. The advantages of this technique include (1) minimal morbidity, (2) relief of mechanical pain, and (3) improved range of motion with no early degenerative changes. The rate and severity of degenerative change following this procedure remain unknown.

Adult↗
PubMed1998

Significance of cold intolerance in upper extremity disorders.

After upper extremity injury, pain on exposure to cold (cold sensitivity) is a significant problem. This cross-sectional observational study (1) assesses the incidence and prevalence of cold intolerance, (2) evaluates the relationship between functional status and degree of cold intolerance, and (3) correlates health-related quality of life (HRQL) with symptoms of cold intolerance. Patients in a tertiary care center completed questionnaires to document (1) cold sensitivity, (2) upper extremity pain, symptoms, and function, and (3) HRQL. Cold sensitivity was found to be associated with more functional limitations, greater pain, and reduced HRQL. As the severity of cold intolerance increased, functional limitations and pain increased and HRQL decreased. Cold intolerance has a profound effect on HRQL.

Activities of Daily Living↗
PubMed1997

Anterior interosseus nerve injury following elbow arthroscopy.

Elbow arthroscopy is becoming an increasingly invaluable tool for both evaluation of and treatment of a variety of interarticular disease processes. Case reports have documented radial and posterior interosseus injuries following anterior capsular release. To date, this is the first report of an anterior interosseus nerve injury following arthroscopic surgery of the elbow. Arthroscopic surgery offers unparalleled visualization of the multiple articulations and facets of the elbow. It has been reported as useful for removal of loose bodies, synovectomy, release of arthrofibrosis, and the treatment of osteochondritis dessicans. However, the technique does require thorough knowledge of neurovascular structures about the elbow as well as appreciation of the protective layers including the capsule, brachialis, and brachioradialis muscles. This report documents direct injury to the anterior interosseus branch of the median nerve during an elbow debridement and synovectomy in a 65-year-old patient with rheumatoid arthritis.

Aged↗
PubMed1997

The fibula-flexor hallucis longus osteomuscular flap.

Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft. We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy. The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft.

Adolescent↗
PubMed1997

Management of vasospastic disorders of the hand.

Vasospastic disorders of the upper extremity are common and often difficult to treat. Using the proposed classification system (Table 2) allows management based upon pathologic condition, physiologic staging, and response to treatment. Identifying patients in this way also helps in determining which treatments are most appropriate. The basic approach to management includes environmental and behavioral modifications including cessation of tobacco use, protection of hands, and avoidance of situations that trigger the vasospastic response. Pharmacologic therapy may provide good results in a majority of patients. Surgical intervention is reserved for patients with vaso-occlusion, ischemia, and refractory symptoms in spite of attempts at medical management. Surgical options include vascular reconstruction, peripheral sympathectomy, or a combination of techniques. The goal of medical and surgical management is to increase total or nutritional blood flow in the digits.

Hand↗
PubMed1996

Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist.

Outcome was studied in 14 patients with chronic mechanical (crepitant) wrist pain (symptomatic for more than 6 months) who had undergone arthroscopic debridement and early mobilization for the treatment of isolated partial scapholunate and lunotriquetral ligament injuries. Fourteen patients were available for a minimum 2-year follow-up interview, physical examination, and x-ray film evaluation. Eleven patients had complete relief of symptoms and had returned to work within 7 weeks of surgery. The other three (all workers' compensation cases) reported occasional mild wrist pain; two had returned to work a mean of 6.5 weeks after surgery, and the third did not return for 1 year. None of the patients had a statistically significant loss of grip or pinch strength. X-ray films and dynamic examination under fluoroscopy demonstrated no abnormalities. Thirteen of the 14 patients were highly satisfied (although 2 patients still had occasional mild wrist pain). Arthroscopic debridement of partial intrinsic ligament injuries provided excellent relief of painful crepitant symptoms and allowed for early return of wrist function in 13 of 14 cases.

Adolescent↗
PubMed1996

The histological effect of barrier vein wrapping of peripheral nerves.

Twenty-four Sprague-Dawley rats underwent exploration and exposure of the sciatic nerve, followed by sham isolation, irrigation, and subsequent wound closure (Group 1); barrier vein wrapping of the nerve using glutaraldehyde-preserved allograft inferior vena cava (Group 2); or barrier vein wrapping of the nerve with femoral vein autograft from the contralateral extremity (Group 3). Four months later, the rats were sacrificed and the nerves fixed in situ in buffered glutaraldehyde. Sections proximal, mid-portion, and distal to the barrier and vein wrap were fixed with osmium tetroxide, epon embedded, stained with toluidine blue, and studied under x200 and x400 light microscopy. Epineural scar formation increased 10 times in Group 2, compared to Group 3 (p < 0.0001). Epineural thickness and the number of degenerating axons did not differ significantly among all groups. Inflammatory cells in Group 2 increased 100 times, compared to Group 3 (p < 0.0001). Continuing with the underlying epineural layer was apparent grossly and microscopically with all allografts, but with no autografts. Thus, glutaraldehyde-preserved allograft vein wraps appear to incite a marked inflammatory response, with epineural scarring and adherence to the underlying nerve, while autograft vein wraps do not.

Animals↗
PubMed1996

Hip arthroscopy.

Explore the source record for details and available documents.

Adolescent↗
PubMed1995

The restoration of elbow flexion with intercostal nerve transfers.

Seventeen patients with absent elbow flexion secondary to brachial plexus avulsion injury underwent intercostal neurotization of the biceps muscle. Followup was performed at an average of 5 years. The average age in this series was 21.8 years; the mean time interval from injury to the surgical procedure was 6 months. Eight of the 17 patients (47%) obtained good or excellent results as defined by Nagano et al. Five patients had muscle function ratings of M2 but were unable to power the elbow against gravity. The overall success rate theoretically may be increased by (1) decreasing the time interval from injury to neurotization to < 5 months; (2) selecting patients < 50 years of age; and (3) using adjuvant surgical procedures after neurotization, including tendon transfers and shoulder arthrodesis, which may improve results from good to excellent.

Adolescent↗
PubMed1993

Arthroscopic categorization of intercarpal ligamentous injuries of the wrist.

Recent advances in our knowledge of wrist ligamentous anatomy, as well as improvements in arthroscopic techniques, permit the diagnosis and treatment of a wide variety of wrist injuries. The authors review current concepts in wrist ligamentous anatomy, patterns of instability, and the role of the arthroscope in the evaluation and treatment of such instability. Specifically, wrist portal anatomy and techniques of arthroscopic treatment of patients with partial and complete intercarpal ligament injuries are described. Chronic complete injuries are a contraindication of arthroscopic treatment. The authors conclude that wrist arthroscopy provides a valuable method of diagnosing and treating partial and complete intercarpal ligamentous injuries.

Arthroscopy↗
PubMed1991

Arthroscopic treatment of Panner's disease.

Panner's disease, or osteochondrosis of the capitellum, may actually be a continuum of disorders. In the past, such lesions were treated conservatively with surgery as a final option. With the advent of arthroscopy, a diagnosis can be made, and treatment with limited invasiveness instituted. This article reviews the diagnostic and therapeutic advantages of arthroscopic techniques in the treatment of Panner's disease.

Arthroscopy↗
PubMed1990

The landscape of meniscal injuries.

This article analyzes meniscal injuries seen in 10,117 knee arthroscopies. The information was compiled by a centralized data base at Surgical Data Management. The study suggests two patterns of meniscal injuries, degenerative and traumatic. Injuries to the menisci occurring with an associated anterior cruciate injury, radial tears, and tears within 3 mm of the meniscosynovial junction are associated with a younger and more active patient who is more likely to sustain a traumatic or sports-related injury. Tears described as complex, horizontal cleavage, and flap tears are associated with an older age group and follow a more degenerative pattern.

Adolescent↗
PubMedDate not supplied

The arthroscopic management of osteochondritis dissecans of the adolescent elbow.

The management of avascular necrosis of the capitellum of the adolescent elbow continues to be a dilemma. This article is a critical retrospective analysis of 12 pediatric patients (mean age at surgery 14.5 years) who underwent arthroscopic debridement alone followed by early range of motion. Follow-up at a mean of 3.2 years (range, 2.0 to 5.7 years) indicated that the average flexion contracture improved from 23 degrees preoperatively to 10 degrees postoperatively. All patients had remodeling of the capitellum by plain radiographs; however, five patients had associated enlargement of the radial head. Eleven patients had minimal mechanical symptoms after the procedure and were highly satisfied. One patient had substantial enlargement of the radial head with continued loss of supination and mechanical symptoms requiring radial head resection 2 years after the index procedure. Five patients had a triangular avulsion fragment present off the lateral capsule. A statistically significant worse subjective outcome was associated with the presence of this fragment (P < .005). There were no complications.

Adolescent↗
PubMedDate not supplied

Arthroscopic debridement for the treatment of Kienbock's disease.

The treatment results of seven patients (age range, 37 to 74 years, male:female ratio, 1:6) with Kienbock's disease (Lichtman stage IIIA-IIIB) who underwent arthroscopic debridement of the necrotic lunate bone and degenerative intrinsic ligaments were studied retrospectively. Osteoarthritic changes of the articular cartilage were documented in all cases. Partial (n = 2) and complete (n = 5) ruptures of the lunotriquetral and scapholunate ligaments, local synovitis (n = 5), and loose fragments (n = 6) occurred most commonly in the radiocarpal joint. All patients were available for an average of 19 months of follow-up (range, 6 to 42 months), physical examination, and radiographic evaluation. All patients reported significant improvement in pain relief and complete relief of mechanical symptoms. Radiographs showed progression of the disease in three cases; two of these were followed-up for more than 2 years. Arthroscopy in Kienbock's disease allows direct visualization and assessment of the exact pathology of the radiocarpal and midcarpal joint and the lunate cartilage. Arthroscopic debridement of the necrotic lunate increased wrist functional range of motion, provided excellent pain relief, and improved health-related quality of life in all patients.

Adult↗
PubMedDate not supplied

Arthroscopic excision of the radial head: Clinical outcome in 12 patients with post-traumatic arthritis after fracture of the radial head or rheumatoid arthritis.

PURPOSE: We performed arthroscopic radial head excision in a series of patients with either post-traumatic arthritis after a radial head fracture or rheumatoid arthritis of the elbow as an expanded indication for elbow arthroscopy. The purpose of the study was to critically examine the results of arthroscopic chondroplasty of the radial head to determine the safety and effectiveness of the procedure. TYPE OF STUDY: Outcome study and retrospective analysis. METHODS: From 1990 to 1997, arthroscopic radial head resection was performed in 12 patients with either post-traumatic arthritis (n = 10, Mason type II or III) or with rheumatoid arthritis (n = 2). Functional outcome and radiographs were analyzed after a mean follow-up period of 39 months (range, 12 to 97 months). Elbow arthroscopy was performed using a standardized technique. The anterior three quarters of the radial head and 2 to 3 mm of the radial neck were resected with the abrader in the anterolateral portal and the arthroscope in the proximal medial portal. For resection of the posterior portion of the radial head, the abrader may be transferred to the mediolateral portal. This permits resection of the remnants of the radial head posteriorly and also at the proximal radioulnar joint. RESULTS: Preoperatively, patients lacked 23 degrees (range, 5 degrees to 40 degrees ) of extension of the elbow on average. Mean flexion was 111 degrees (range, 60 degrees to 145 degrees ). Patients had unrestricted pronation (limitation of 5 degrees in 2 patients). Two patients had a lack of supination of 15 degrees and 30 degrees. Mean follow up was 39 months (range, 12 to 97 months). Postoperatively, patients lacked 9 degrees (range, 0 degrees to 20 degrees ) of extension of the elbow on average. Mean flexion was 136 degrees (range, 90 degrees to 150 degrees ). No patient had subjective or objective evidence of instability of the elbow. All patients except one reported significant improvement in pain relief and complete relief of mechanical symptoms. CONCLUSIONS: This technically demanding surgical procedure should be reserved for situations of persistent, restricted range of motion and chronic pain. Arthroscopic radial head resection combined with arthroscopic synovectomy relieves elbow stiffness. The surgeon is able to deal with the intrinsic joint pathology, as well as with accompanying symptoms such as synovitis, capsular contracture, or loose bodies.

Adolescent↗