25th Anniversary Presentation. Time to think.
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Documentation↗
Biomedical subjects
F W Bora
Publications and source records attributed to F W Bora.
The evaluation of tension in an experimental model of external fixation of distal radius fractures.
A cadavaric model was used to evaluate the previously reported methods of determining excessive tension when applying an external fixator across the wrist. An osteotomy of the distal radius was performed and tension was applied incrementally across the joint in 9 cadaveric specimens. The fingers of each specimen could fully flex to the palm at all levels of tension tested. Although the radiocarpal and midcarpal joint spaces did lengthen with incremental changes in the amount of tension, there was no statistically significant correlation that could be made about the difference between the radiocarpal and midcarpal spaces and tension applied across the wrist. Although the carpal height ratio increased significantly from 0 to 10 lb of traction, the carpal height ratio appeared to plateau after further increases in tension. In conclusion, surgeons need to be careful when using any of these previously reported techniques for determining the optimal tension to be applied with an external fixator across the wrist. These techniques may not reproducibly allow the surgeon to detect whether there is excessive distraction across the distal radius fracture.
External Fixators↗
The effect of shear stress on fibroblasts derived from Dupuytren's tissue and normal palmar fascia.
This study examines the real-time intracellular calcium changes of palmar fascia from normal and Dupuytren's diseased fibroblasts in response to shear stress. The real-time cytosolic calcium changes were measured using fluorescence microscopy image processing. The preconfluent primary cultured cells were exposed to 1 minute of flow at 25 dyne/cm2 after a 2-minute baseline of no flow. Additionally, the cells were exposed to an influx of Hank's buffered saline solution with 2% newborn bovine serum to examine the response to serum-born (chemical) agonists. Cytosolic calcium changes were measured as the percentage change over the 2-minute baseline of the mean [Ca2+]i peak. The mean change of the peak [Ca2+]i response of the normal palmar fascia was significantly greater than that of the cells from the Dupuytren's nodular and perinodular tissue. The response to the chemical agonist showed a robust but not statistically different response between the 3 cell types. Our work supports the hypothesis that palmar fascia responds to mechanical stress, specifically laminar fluid flow. These findings may help to explain that an underlying abnormality in the cells of the palmar fascia may be expressed by exposure to laminar fluid flow, a physical signal, rather than a chemical agonist.
Adult↗
Radiocarpal dislocation: a report of two cases and a review of the literature.
Two cases of radiocarpal dislocation without associated intra-articular distal radius fractures are described. Treatment is dependent on the ability to reduce the dislocation and associated intercarpal instability. Satisfactory results have been reported with closed reduction and cast immobilization, although one should beware of associated carpal instability. Open reduction and internal fixation are required for irreducible dislocations and cases in which there is intercarpal instability.
Adult↗
Vascular calcification as a source of hand pain and weakness in a patient with end-stage renal failure.
This article describes a unique case of vascular calcification of the hands complicated by pain and weakness. The case demonstrates the interaction of the skeletal and renal systems and the consequences of an unrecognized imbalance of calcium and phosphorus metabolism. Definitive medical management to keep the calcium-phosphate product below 70 through the judicious use of aluminum phosphate binders and diet should be coordinated to prevent and limit the extent of these calcifications.
Calcinosis↗
Diagnosis of closed central slip injuries. A cadaveric analysis of non-invasive tests.
Four non-invasive tests for central slip integrity were analysed using 20 fresh frozen cadaver fingers. A pre-boutonnière deformity was simulated by dividing the central slip. A passively correctable boutonnière was simulated by dividing the central slip, triangular ligament and oblique fibres of the extensor expansion. The test described by Boyes, which evaluates distal interphalangeal joint flexion, was found not to be reliable for the diagnosis of either injury. The test described by Elson, which evaluates distal interphalangeal joint rigidity while actively extending the flexed proximal interphalangeal joint, was the only manoeuvre which was able to discern central slip integrity in both simulated injuries. The central slip tenodesis test and testing resistance of active proximal interphalangeal joint extension should be performed with the proximal interphalangeal joint in flexion to weaken the effectiveness of the lateral bands.
Biomechanical Phenomena↗
In vivo inflammatory response to silicone elastomer particulate debris.
Silicone elastomer particles (Silastic silicone elastomer, Dow Corning, Midland, MI), polymethylmethacrylate particles, and monosodium urate particles smaller than 10 microns were injected into a rat subcutaneous air pouch lined with synovial membrane-like cells. Inflammatory exudate from the air pouch was retrieved at 6 hours, 24 hours, 48 hours, and 72 hours after injection. White blood cell count, tumor necrosis factor, and prostaglandin E2 were measured in the exudate. White blood cell and tumor necrosis factor levels in the exudate were the highest for the silicone group at 6 and 24 hours. Prostaglandin E2 was also significantly higher in the silicone group at 24 hours. We conclude that the acute inflammation is particle-type specific and that Silicone elastomer particles are acutely inflammatory.
Animals↗
Health care utilization and attitudes toward health insurance. A comparison of privately insured and medical assistance or uninsured patients.
A questionnaire was distributed to 108 patients to find if there were differences in health care resource usage and attitudes towards health insurance between patients seen in the hand clinic, designed for patients with medical assistance or without insurance (57 patients), and those seen in the private offices of staff hand surgeons (51 patients). Clinic patients reported a mean of 18 visits to their physician in the past year as compared with 7 for private patients (P < 0.0005) and attended 52% of their scheduled appointments as compared to an 83% attendance rate for private patients (P < 0.001). Patients enrolled in a medical assistance program were less willing to pay for their health care than were private patients. Sixty-two percent of clinic patients responded that they would not be willing to pay anything at all for their health care coverage. These data suggest that health care and health insurance is a lower priority for the clinic patient. Any new health care system that includes the uninsured and underinsured must be prepared to handle different attitudes toward health care and an increase in utilization of resources.
Adult↗
Lipofibromatous hamartomas of the median nerve.
Five cases of lipofibromatous hamartoma of the median nerve are reported. The initial onset of symptoms and recognition of a mass occurred in adults in four cases. The fifth patient was an infant when the mass was first noticed, and she also had macrodactyly. Treatment included carpal tunnel release in three patients, one of whom required a second procedure for excision of the mass and sural nerve grafting. Nerve ablation without grafting was performed in the other two patients; one of these patients noticed no sensory or motor deficit after surgery. From this small series we cannot recommend a preferred treatment for these patients; each case must be approached on an individual basis. The diagnosis is best confirmed by biopsy.
Adolescent↗
Neural injuries associated with supracondylar fractures of the humerus in children.
A retrospective review of displaced extension-type supracondylar fractures of the humerus in 101 children who were seen consecutively revealed eighteen associated neural injuries in thirteen children. Nine of the neural injuries in eight patients spontaneously resolved at a mean of 2.5 months (range, 1.5 to five months) after injury. The remaining nine lesions in five patients were explored at a mean of 7.5 months (range, five to fourteen months) after injury, because clinical and electromyographic studies showed no return of function. Neurolysis was performed on eight of the nerves that were explored (in five patients), and the remaining radial nerve was found to be completely lacerated and needed nerve-grafting. The length of follow-up after neurolysis averaged twenty-five months (range, thirteen to forty-four months). All five patients had functional recovery, as documented by range-of-motion, grip-strength and lateral pinch-strength, and von Frey and two-point-discrimination sensory testing. The patient who had had nerve-grafting never recovered neural function, and tendon transfers were needed. We concluded that observation and supportive therapy is the preferred initial approach for children who have a neural injury associated with a closed, displaced supracondylar fracture of the humerus. However, if there is no clinical or electromyographic evidence of return of neural function at five months after injury, exploration and neurolysis should be performed. If the nerve is in continuity, the prognosis after neurolysis is excellent.
Adolescent↗
Kienböck's disease in a patient with Crohn's enteritis treated with corticosteroids.
In a patient with Crohn's enteritis treated with oral corticosteroids simultaneous Kienböck's disease and femoral head osteonecrosis developed 2 years after the administration of corticosteroids. The patient had no history of trauma or any other risk factor known to be associated with Kienböck's disease. This case suggests that corticosteroid administration may be an additional factor in the multifactorial causes of Kienböck's disease.
Adrenal Cortex Hormones↗
Prosthetic nerve grafts: a resorbable tube as an alternative to autogenous nerve grafting.
The use of a prosthetic nerve graft, composed of a resorbable polyorthoester tube, as an alternative to free autogenous nerve grafting for the treatment of a gap in a peripheral nerve was studied, with a cat sciatic nerve as the model. The results demonstrate that regeneration will occur through a resorbable tube spanning a 1.5 cm gap and reinnervate end organ muscle. In those muscles showing evidence of reinnervation, nerve regeneration through the tubes as assayed by electrophysiologic examination demonstrated no difference compared with autogenous nerve grafts, with the exception that the initial rate of regeneration was delayed by 4 to 6 weeks.
Animals↗
The treatment of ruptures of multiple extensor tendons at wrist level by a free tendon graft in the rheumatoid patient.
We report the results of the treatment of multiple ruptures of extensor tendons to the fingers at wrist level in the rheumatoid patient by free tendon grafts. Twenty-three patients averaged 65 degrees of active motion at the metacarpophalangeal joints when seen at an average follow-up of 43 months.
Adult↗
Compression neuropathies.
Nerve compression, frequently from entrapment at specific anatomic locations, is a common clinical entity, especially in patients with predisposing occupations or with certain medical disorders. It should be pointed out that a nerve can be compressed at more than one level. Early recognition and treatment are the most effective means of preventing long-lasting disability, since, despite the capacity for regeneration bestowed on the peripheral nervous system, functions lost as a result of denervation are never fully restored.
Animals↗
Joint physiology, cartilage metabolism, and the etiology of osteoarthritis.
Articular cartilage is hypocellular, avascular, aneural, and alymphatic. Nutrition derives predominantly from the synovial fluid. The cartilage matrix is hyperhydrated. Water represents 80 per cent of the total weight. The water is very important in joint lubrication and wear resistance. The dry weight consists mainly of proteoglycan and type II collagen. Osteoarthritis is not the result of a diminution in metabolic activity but is a very active catabolic process. Matrix synthesis and cell replication proceed at greater rates in damaged than in normal cartilage. Lysosomal enzymes that degrade cartilage are released. Proteoglycan content diminishes in proportion to the disease severity. Despite the heightened synthetic activity, the chondrocyte's capacity is eventually exceeded by the rate of matrix degradation and the cartilage becomes eroded. A multitude of hypotheses have been suggested to explain the etiopathogenesis of osteoarthritis. These hypotheses fall into two categories: those that point to excessive stresses imposed upon normal tissue and those that emphasize the inadequacy of the chondrocyte response. The factors that initiate the process are not fully known. Trauma, aging, joint laxity, diet, hormones, crystal deposition, bone microfractures, and immunologic factors have all been implicated.
Animals↗
Peripheral nerve grafts: the relationship of axonal growth cone and biomechanical properties.
Cat sciatic nerves containing 2 and 4 cm nerve grafts were subjected to tensile testing with the finding that a significant decrease in force at failure occurs at the distal suture line at a time after surgery that is graft length dependent. Tritiated labeling of regenerating axons and qualitative electromyography demonstrated that this effect was unrelated to the leading edge of the axonal growth cone, but temporally related to the functional reinnervation of denervated muscle.
Animals↗
Sarcoid flexor tenosynovitis of the finger: a case report.
A case report of flexor tenosynovitis of the right ring finger in a 27-year-old black woman leading to the diagnosis of sarcoidosis is presented. Sarcoidosis of a flexor tendon sheath is rare. Flexor tenosynovectomy provided material for histologic diagnosis and increased the function of the hand.
Adult↗