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Biomedical subjects

Dean G Sotereanos

Publications and source records attributed to Dean G Sotereanos.

At least 19 recordsLinked to original sources
PubMed2006

Distal biceps tendon reconstruction in chronic ruptures.

The purpose of this retrospective study was to evaluate the results of anatomic reattachment with reconstruction of the distal biceps tendon using an Achilles tendon allograft in 7 male patients with chronic distal biceps ruptures. Through a 1-incision anterior approach, the tendon allograft was attached to the bicipital tuberosity by using suture anchors and then secured to the biceps remnant. Follow-up averaged 29 months. Mean elbow flexion was 145 degrees, an extension deficit of 20 degrees was observed in 1 patient, and mean pronosupination was 170 degrees. All patients had 5/5 strength in flexion and supination on manual testing, and all returned to their employment. Mean supination strength was 87% of the contralateral healthy extremity. Six achieved an excellent and 1 a good rating in the Mayo elbow performance score. No complications were encountered. This technique is an excellent alternative to nonanatomic reattachment to the brachialis muscle for patients with high functional demands in pronosupination.

Achilles Tendon↗
PubMed2006

Open surgical treatment of post-traumatic elbow contractures in adolescent patients.

The results of surgical treatment of post-traumatic elbow contractures in adolescence have been conflicting in the literature. Twelve adolescent patients (mean age 16.7 years, range 13-21) that had open release of post-traumatic elbow contractures were followed-up for a mean of 18.9 months (range 10-42 months). All releases were performed through a lateral approach (sparing the lateral ulnar collateral ligament) with anterior joint release (in twelve) supplemented by posterior release (in four patients). An additional medial approach was used in three patients. In three patients the radial head was excised. A mean gain of 54 degrees in the flexion-extension arc was observed at final follow-up and all patients achieved a functional ROM of at least 100 degrees. The patients maintained 93% of the motion that was achieved intraoperatively. No patient lost motion. Open release in adolescent patients with post-traumatic elbow contractures and no intarticular incongruence or erosion, yielded satisfactory results, similar to those achieved in adults.

Adolescent↗
PubMed2006

Evaluation of passive and active rehabilitation and of tendon repair for partial tendon lacerations after three weeks of healing in canines.

BACKGROUND: Both passive and active rehabilitation have been shown to be superior to immobilization following partial tendon laceration, but few studies have directly compared these two rehabilitation protocols. In addition, controversy still remains over whether a partial tendon laceration should be repaired. METHODS: We evaluated gap formation, adhesions, gliding function and structural properties of repaired and unrepaired tendons following 3 weeks of unrestricted active rehabilitation versus passive mobilization for partial laceration of canine flexor digitorum profundus tendons. An ex vivo radiographic method was used to measure tendon excursion and rotation at each finger joint. The tendon was examined for adhesions, and gapping was measured with calipers. The tendons were tensile tested to failure. FINDINGS: We found no significant differences in tendon excursion, total joint rotation, or adhesions between any groups. Gap size was higher with active mobilization. We found no effect of rehabilitation protocol on the strength or stiffness of healing tendons at 3 weeks. Tendon repair did not affect tendon strength, but did produce higher stiffness in healing tendons at 3 weeks. INTERPRETATION: The results indicate that active rehabilitation appears safe for partial lacerations less than 60 percent. Though repair appears to weaken the tendon in the early stages of healing, it may provide some biomechanical benefit by the middle stages of healing.

Animals↗
PubMed2006

Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability.

PURPOSE: For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure. METHODS: Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results. RESULTS: The mean follow-up period was 33 months (range, 12-76 mo). Three patients had subsequent surgery 9 to 11 months after the procedure. Subsequent surgeries included a dorsal capsulodesis, a four-corner fusion, and a wrist arthrodesis. Of the 8 remaining patients there were 2 excellent, 4 good, 1 fair, and 1 poor result based on the Mayo wrist score. In these patients the mean range of motion was 65 degrees of extension to 59 degrees of flexion and the mean grip strength was 82% of the uninjured contralateral extremity. Although persistent radiographic SL gapping in grip views was noted in all 8 patients none progressed to static instability or dorsal intercalated segment instability. CONCLUSIONS: The results of this technique are suboptimal; however, it may be an option for patients unwilling to have more than an arthroscopic procedure or those requiring maintenance of wrist motion, provided they understand the risks and benefits of this approach. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2006

A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis.

PURPOSE: To evaluate the clinical results of the application of a capsular-based dorsal distal radius vascularized bone graft in scaphoid proximal pole nonunions. METHODS: Thirteen patients with symptomatic nonunion at the proximal pole of the scaphoid (10 with avascular necrosis) were treated and reviewed retrospectively. The vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a wide distally based strip of the dorsal wrist capsule. It was inserted press-fit into a dorsal trough across the nonunion site after scaphoid fixation with a Herbert screw. RESULTS: After a mean follow-up period of 19 months 10 of the 13 nonunions (8 of the 10 with avascular necrosis) achieved solid bone union. No complications other than the 3 persistent nonunions occurred. CONCLUSIONS: Results of the use of a capsular-based vascularized bone graft from the distal radius for proximal pole scaphoid nonunions compare favorably with the results of pedicled or free vascularized grafts. It is a simple technique that eliminates the need for dissection of small-caliber pedicle or microsurgical anastomoses. No donor site morbidity was observed. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2005

Step-cut distal ulnar-shortening osteotomy.

PURPOSE: Several techniques for ulnar-shortening osteotomies have been described in recent years, reflecting the difficulties that sometimes are encountered in what seems to be a relatively simple procedure. We describe the use of a simple step-cut ulnar-shortening osteotomy stabilized with a lag screw and a palmarly placed 3.5-mm neutralization plate. METHODS: Twenty-nine patients had the surgery. The indication was ulnar-impaction syndrome in 23 patients and symptomatic ulnar-plus variance secondary to trauma in 6 patients (4 with previous distal radius fractures, 2 with Essex-Lopresti injuries). The preoperative ulnar variance ranged from +1 mm to +6 mm. RESULTS: The mean follow-up period was 34 months. All osteotomies healed uneventfully. The mean postoperative ulnar variance was +0.2 mm (range, -1 mm to +1.5 mm). Three patients had hardware removal. CONCLUSIONS: The step-cut osteotomy resulted in solid union in all patients. It provides ample bone-to-bone contact and easier control of rotation, and no special instrumentation is necessary. Stable fixation permitted early mobilization of the wrist and palmar placement of the plate minimized the need for plate removal. This is a simple and effective technique for ulnar shortening.

Adolescent↗
PubMed2005

Partial scapholunate ligament injuries treated with arthroscopic debridement and thermal shrinkage.

PURPOSE: To present the early results of arthroscopic debridement and thermal shrinkage using radiofrequency probes for partial (Geissler grades I and II) scapholunate (SL) interosseous ligament injuries of the wrist. METHODS: Sixteen patients with a mean age of 34 years (range, 18-54 y) presenting with chronic dorsoradial wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks were included in this study. No patient showed radiologic signs of static dissociation (SL interval, <3.5 mm; mean SL angle, 49 degrees ) before surgery. Diagnostic arthroscopy showed a partial SL tear in 14 patients and redundancy of the ligament in 2. Partial SL tears involved the membranous (proximal) and volar part of the ligament. All lesions were debrided and treated with thermal shrinkage using a bipolar radiofrequency probe. RESULTS: The mean follow-up period was 19 months (range, 9-34 mo). Fourteen patients experienced substantial pain relief whereas in 2 the pain remained unchanged. Eight patients were completely pain free. The mean flexion-extension arc was 142 degrees and the mean grip strength was 78% that of the unaffected side. No patient showed radiologic signs of arthritis or static or dynamic instability after surgery (SL interval remained <3.5 mm; mean SL angle, 53 degrees ). Based on the modified Mayo wrist score there were 8 excellent, 6 good, 1 fair, and 1 poor result. CONCLUSIONS: Partial SL ligament tears can be a source of radial-sided wrist pain. Scapholunate ligament debridement and thermal shrinkage effectively provided pain relief for most of the patients treated. Stability was maintained radiographically. No complications were noted from the use of radiofrequency probes. These reasonably favorable short-term results should be viewed cautiously. A longer follow-up study is necessary to determine the ultimate efficacy of this procedure.

Adolescent↗
PubMed2004

Dynamic traction and minimal internal fixation for thumb and digital pilon fractures.

PURPOSE: This study evaluates the use of limited internal fixation and dynamic traction for the treatment of severely displaced digital and thumb pilon fractures. METHODS: Six patients were evaluated both clinically and radiographically at an average of 29 months after surgery (range, 18-36 months) for pain, range of motion, and radiographic signs of joint space narrowing and congruence. Surgery involved the placement of a pin for dynamic traction and an assessment of the adequacy of the articular alignment. A limited incision and supplemental K-wires were often used to improve the position of severely displaced fragments or for the repair of the central tendon. RESULTS: Three patients were pain free, 2 patients experienced pain with prolonged activity, and 1 patient had pain associated with activities of daily living. Average digital arc of motion of the proximal interphalangeal joint was 94 degrees (range, 90 degrees-100 degrees) and thumb interphalangeal motion was 62.5 degrees (range, 60 degrees-65 degrees). The average duration of digital traction was 3.5 weeks. Four patients had greater than 1 mm incongruity of the articular surface immediately after surgery. At final evaluation, all patients had good joint congruency and 2 patients had joint space narrowing but were asymptomatic. There was 1 minor pin tract infection. CONCLUSIONS: Dynamic traction combined with limited internal fixation can be an effective treatment for displaced intra-articular pilon fractures. This technique may allow for earlier removal of traction and simultaneous repair of soft tissue injuries.

Activities of Daily Living↗
PubMed2004

Pathogenesis and treatment of osteonecrosis of the shoulder.

Osteonecrosis of the humeral head is an uncommon condition that occurs when bone vascularity is impaired. The causes underlying osteonecrosis of the humeral head seem to be multifactorial and can be traumatic or nontraumatic. Although clinical symptoms and causative factors affect the treatment of each patient, staging is the most objective criterion in deciding on the most appropriate treatment. Conservative treatment can be effective in stages I and II. Surgical intervention is advocated when symptoms are persistent and signs of collapse are evident. The surgical options include arthroscopic débridement, core decompression, vascularized bone grafting, and shoulder arthroplasty.

Adrenal Cortex Hormones↗
PubMed2004

Ulnohumeral arthroplasty: results in primary degenerative arthritis of the elbow.

Our results with the ulnohumeral arthroplasty are presented. Seventeen patients were evaluated at an average followup greater than 36 months (range, 24-50 months). The average age of the patients was 52 years (range, 40-74 years). At final followup, 15 patients had complete pain relief at end ranges of motion whereas two patients had moderate pain after prolonged activity. Extension and flexion were improved by a mean of 12 degrees and 20 degrees, respectively, with a mean range of motion 14 degrees to 118 degrees. Postoperative radiographs showed a correctly placed drill hole with complete osteophyte resection. There were no neurologic or other complications and good stability of the elbow was observed in all patients. We think ulnohumeral arthroplasty is a good procedure for active patients with primary degenerative joint disease of the elbow.

Adult↗
PubMed2003

Multi-directional strength and force envelope of the index finger.

OBJECTIVE: The purpose of this study was to biomechanically evaluate the motor function of the index finger based on multi-directional strengths. DESIGN: An experimental apparatus was developed to measure force production of a digit at various points of force application along the digit and in any direction of force application within the transverse plane of the longitudinal axis of the digit. BACKGROUND: Most existing tests of hand motor function are subjective, semiquantitative, and/or non-specific. METHODS: Eight normal subjects with asymptomatic hands were tested. Maximum voluntary isometric contraction forces were measured at the middle of the proximal phalanx of the index finger in 16 directions that were evenly distributed within 360 degrees. RESULTS: The highest force, 110.7 (SD 9.0) N, was generated in flexion, while the lowest force was generated in extension. The forces in extension, abduction and adduction were 37.6%, 97.9% and 79.3% of the flexion force, respectively. The area of the force envelope was 25739 (SD 3688) N-N. The average percentage quadrant areas, relative to the total force envelope area, for extension-adduction, extension-abduction, flexion-abduction, and flexion-adduction were 12.9%, 20.4%, 36.0%, and 30.8%, respectively. The average percentage quadrant areas for extension, abduction, flexion, and adduction were 9.1%, 33.3%, 35.6%, and 22.1%, respectively. CONCLUSION: The current study provides an advanced level of quantification of hand motor function. RELEVANCE: The methods may be used as a basis to detect changes in the motor function resulting from pathological conditions, disease progression, as well as rehabilitation and treatment of these disorders.

Adult↗
PubMed2003

Neovascularization and other histopathologic findings in an autogenous saphenous vein wrap used for recalcitrant carpal tunnel syndrome: a case report.

A patient suffering from recalcitrant carpal tunnel syndrome despite 4 surgical decompressions was treated successfully with revision carpal tunnel release, neurolysis, and autogenous saphenous vein wrapping of the median nerve. When he subsequently developed compression of the common digital nerve to the middle finger his carpal tunnel was re-explored and the previously applied vein graft underwent a biopsy examination. Histopathologic analysis of the biopsy specimen was remarkable for neovascularization of the vein graft and structural transformation of the vein endothelium, neither of which has been reported in vein wrapping of the upper extremity.

Adult↗
PubMed2003

Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy.

Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24-48 months), and the average age was 71 years (range, 57-84 years). Of these 14 patients, 9 were men and 5 women. None of these patients had undergone previous shoulder surgery, and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Preoperatively, the average active forward flexion was 30 degrees, active external rotation was 10 degrees, and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperatively, the average active forward flexion improved to 88 degrees, active external rotation increased to 37 degrees, and the ASES score improved to 80 points. Of the 14 patients, 12 stated that they had no pain with activities of daily living. Two patients continued to have moderate pain in everyday activity.

Aged↗
PubMed2003

Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head.

BACKGROUND: We are not aware of any clinical studies in the literature comparing the results of vascularized and nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The purpose of this study was to compare the clinical results of free vascularized fibular grafting with those of nonvascularized fibular grafting. METHODS: Two hundred patients (220 hips) with osteonecrosis of the femoral head were treated with free vascularized fibular grafting at the University of Pittsburgh Medical Center, and ninety-nine patients (123 hips) were treated with nonvascularized fibular grafting at the Kyungpook National University Hospital in Korea. From these populations, two groups of fifty hips each, followed for a minimum of three years (average, five years), were matched by the stage, size, and etiology of the lesion and by the mean preoperative Harris hip score. A retrospective case-control study of these groups was then performed to compare the postoperative Harris hip scores as well as the prevalences of radiographic progression and collapse of the femoral head following free vascularized fibular grafting with those measures following nonvascularized fibular grafting. RESULTS: The mean Harris hip score improved for 70% of the hips treated with free vascularized fibular grafting: seventeen hips (34%) were rated excellent, fourteen (28%) were rated good, nine (18%) were rated fair, and ten (20%) were rated poor. The mean Harris hip score improved for 36% of the hips treated with nonvascularized fibular grafting: five hips (10%) were rated excellent; nine (18%), good; sixteen (32%), fair; and twenty (40%), poor. The rate of survival at seven years for the Stage-I and II hips (precollapse) was 86% after treatment with free vascularized fibular grafting compared with 30% after nonvascularized fibular grafting. CONCLUSIONS: The results of this study strongly suggest that vascularized fibular grafting is associated with better clinical and radiographic results.

Adolescent↗
PubMed2002

Insulin growth factor-1 decreases muscle atrophy following denervation.

Despite modern microsurgical techniques for nerve repair, functional outcome following proximal injury is often unsatisfactory because irreversible muscle atrophy may develop before reinnervation occurs. Because insulin growth factor-1 (IGF-1) has been shown to improve muscle regeneration after injury, and may have a role in muscle preservation following denervation, the purpose of this investigation was to evaluate the histological, immunohistochemical, and electrophysiological differences between normal, denervated, and IGF-1-injected denervated muscle over an 8-week period. Denervated mice gastrocnemius muscles demonstrated a decrease in muscle weight, a decrease in myofiber diameter, an absence of muscle regeneration, an early increase in the number of neuromuscular junctions (NMJs), and a decrease in fast-twitch and maximum tetanic strength as compared to normal muscle up to 8 weeks following denervation. IGF-1-injected denervated muscle, on the other hand, sustained muscle diameter and muscle weight, maintained a smaller number of NMJs, and relatively sustained fast-twitch and maximum tetanic strength as compared to normal muscle over 8 weeks. These data suggest that IGF-1 may help prevent muscle atrophy and secondary functional compromise after denervation.

Animals↗