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Biomedical subjects

H Gellman

Publications and source records attributed to H Gellman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Flexible implant resection arthroplasty of the proximal interphalangeal joint in patients with systemic inflammatory arthritis.

Forty proximal interphalangeal joint silicone elastomer flexible implant arthroplasties in 19 patients with systemic inflammatory arthritis were reviewed. The follow-up period averaged 94 months. Before surgery, the average arc of motion was 26 degrees for the 20 digits with boutonniere deformities and 23 degrees for the 16 digits with swan-neck deformities. Eight digits had moderate (grade 2) pain, and four digits had severe (grade 3) pain. After surgery, the deformity was completely corrected in six digits. Digits with a preoperative boutonniere deformity (20 digits) achieved the same (26 degrees) arc of motion after surgery, whereas those with a preoperative swan-neck deformity (16 digits) actually lost 18 degrees. Six digits had moderate pain and one digit had severe pain at the final follow-up evaluation. Thirteen digits (7 patients) with a boutonniere deformity before surgery and a concurrent or previous silastic metacarpophalangeal arthroplasty had significantly better results than those without. Overall, there were 12 good, 18 fair, and 10 poor results. Based on this study, flexible silicone implant arthroplasty has a limited role in the treatment of proximal interphalangeal joints affected by systemic inflammatory arthritis. When performing the arthroplasty, attention should be directed first toward correction of the deformity at the metacarpophalangeal joint.

Adult↗
PubMed1994

Dorsal pin placement and external fixation for correction of dorsal tilt in fractures of the distal radius.

Insertion of a dorsal fixation pin was performed in 10 patients treated for distal radius fractures associated with dorsal angulation of the distal fragment. These fractures did not improve position with direct traction. Reduction was achieved with the use of a dorsal pin, used as a lever, to correct dorsal tilt of the fracture and to reestablish anterior angulation of 10 degrees in the distal joint surface of the radius. The dorsal pin was then fixed to an external fixator bar. All of these fractures healed in good position with appropriate alignment and without complications.

Adult↗
PubMed1994

Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma.

Six tetraplegic patients (eight forearms) who had a supination contracture were evaluated after lengthening and rerouting of the biceps brachii. Preoperatively, the mean range of supination and pronation of the forearm was 85 and 14 degrees, respectively. Pronation increased a mean of 75 degrees without affecting the strength of flexion or the flexion-extension arc of motion of the elbow. The forearms that had a satisfactory result had a mean active range of supination of 69 degrees, while those that had a poor result had no active supination. The mean duration of follow-up was twenty-seven months (range, twelve to seventy-two months). The result was considered satisfactory for six limbs and unsatisfactory for two. Functional gains were made in the patients' ability to feed and groom themselves, in their ability to tend to personal hygiene, and in writing and typing skills when the dominant extremity was treated. The results were less predictable for the non-dominant extremity. The maximum gain in the range of motion occurred at three months and the maximum functional gain, by six months.

Activities of Daily Living↗
PubMed1994

Single-stage reconstruction of key pinch and extension of the elbow in tetraplegic patients.

The results in ten arms of nine patients who had post-traumatic tetraplegia at the fifth or sixth cervical level were reviewed after combined transfer of the brachioradialis to the flexor pollicis longus and of the posterior part of the deltoid to the triceps tendon to restore key pinch and extension of the elbow. The average age of the patients was twenty-nine years, the average time from the injury to the operation was five years, and the average duration of follow-up was thirty-one months. Key pinch improved from essentially none preoperatively to an average of 2.0 pounds (0.9 kilogram) postoperatively: an average of 3.0 pounds (1.4 kilograms) for the patients who had tetraplegia at the sixth cervical level and an average of 0.9 pound (0.4 kilogram) for those who had tetraplegia at the fifth cervical level. Key pinch was favorably influenced by extension of the wrist, while the position of the elbow had no effect. Maximum active extension of the elbow against gravity was within 20 degrees of full extension in eight of the ten arms. There was an improvement in the performance of activities of daily living, including wheelchair use, and most of the patients discontinued use of special equipment for the upper extremity. The results of this study, when compared with those of each procedure performed separately, suggest that a combination of the operations improves function of the upper extremity and shortens the duration of dependence postoperatively.

Activities of Daily Living↗
PubMed1994

Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment.

Scaphoid nonunion can cause pain, loss of wrist motion, and loss of grip strength. Because initial roentgenograms are not always definitive, patients suspected of having a scaphoid fracture despite negative initial radiographs should undergo bone scan. Treatment of acute nondisplaced fracture of the scaphoid generally nonoperative, involving immobilization in a cast. Treatment of scaphoid nonunion is generally operative, and many procedures and their associated risks are reviewed. There is no consensus about the clinical implications of scaphoid malunion.

Adolescent↗
PubMed1994

The relationship of the interosseous membrane to the axis of rotation of the forearm.

Fresh anatomic specimen forearms were studied using a mechanical device, the axis finder, to locate the axis of rotation. The relationship of the axis to the membrane was demonstrated directly using a small jig. The axis of rotation of the forearm is constant and independent of elbow flexion or extension. It runs from the center of the radial head to the center of the distal ulna. All fibers of the interosseous membrane cross the axis of rotation near their distal insertion into bone. This relationship of the ligaments to the axis of rotation is similar to those of the ankle, knee, and thumb joints. The membrane does not limit forearm rotation and can provide little stability if the bony ring is disrupted.

Forearm↗
PubMed1992

Sequential infection of silicone metacarpophalangeal joint arthroplasties resulting from skin breakdown.

We report a case of late multiple infected metacarpophalangeal silicone implants in a patient who had had replacement arthroplasty for treatment of rheumatoid arthritis. The patient had done well for 10 years after metacarpophalangeal joint arthroplasty when an implant infection developed. Over the next 4 years the remaining three implants on her dominant extremity also became infected necessitating their removal. The origin of the infections is thought to be the result of excessive and improper usage of the hand.

Arthritis, Rheumatoid↗
PubMed1992

Embedded ring injuries.

Two patients, each with a history of mental illness, were assessed for embedded rings. Removal of the ring was accomplished without loss of digit or further loss of function in one patient. The other patient refused treatment. Altered mental status is a common finding in patients with embedded ring injuries.

Adult↗
PubMed1992

Complications of smooth pin fixation of fractures and dislocations in the hand and wrist.

A retrospective review of patients treated with internal fixation of fractures or dislocations of the hand or wrist over a four-year period was undertaken to determine the complication rates of pin fixation for stabilization of these injuries. One hundred thirty-seven patients who received 422 pins were studied. All pins were unthreaded, measured 0.035-0.069 inches (0.9-1.8 mm) in diameter, were placed with a power drill, and were left protruding through the skin. The mean time that pins were left in place was 6.5 weeks, (range, two days to 24 weeks). Minimum follow-up time was 43 days after pin removal. Thirty-four complications occurred in 24 patients, and the overall complication rate was 18%. Forty-five of the 422 pins were involved (11%). Complications included infections in ten patients (7%), pin loosening without infection in six (4%), loss of reduction in six (4%), symptomatic nonunion in six (4%), impaled flexor tendon in two (2%), asymptomatic pseudarthrosis in one (1%), pin migration in one (1%), median nerve injury in one (1%), and radial artery injury in one (1%). Osteomyelitis developed in two of the patients with infections. Pin tract infection occurred at a mean time of ten weeks and aseptic loosening at a mean time of eight weeks. The frequent complication rates emphasize the need for meticulous pin placement, adequate intraoperative evaluation of pin position, and satisfactory patient compliance. Despite the frequency of these complications, serious permanent sequelae did not occur in most patients.

Bone Nails↗
PubMed1992

Fracture of the trapezial ridge.

The trapezial ridge is a longitudinal projection of bone on the palmar surface of the trapezium and serves as an attachment for a portion of the transverse carpal ligament. It can be fractured from a fall onto the outstretched palm. Presented here is a case report of a young woman who sustained a fracture of the trapezial ridge. Point tenderness was a key initial symptom. Standard anteroposterior, lateral, and oblique roentgenograms did not demonstrate the fracture, and the diagnosis was repeatedly missed. The carpal tunnel view was obtained seven weeks after the original injury and showed a nondisplaced fracture through the trapezial ridge. Cast immobilization initiated at that time was not successful in obtaining fracture union. The delay in diagnosis and subsequent nonunion resulted in chronic discomfort and weakness of pinch and grasp. Careful clinical examination for point tenderness over the palmar surface of the trapezium and proper roentgenographic analysis should minimize delays in diagnosis and treatment of this fracture.

Adult↗
PubMed1992

Fractures of the forearm resulting from low-velocity gunshot wounds.

Thirty-seven extraarticular fractures of the forearm resulting from low-velocity gunshot injuries were treated by cast immobilization or open reduction and internal fixation with dynamic compression plates. All patients received 72 h of intravenous antibiotics. There were 14 isolated ulna fractures, 17 isolated radius fractures, and six both-bone (radius and ulna) fractures. Cast immobilization was used in 22 of 23 nondisplaced or minimally displaced fractures and eight of 14 displaced fractures. The remaining seven fractures were treated by open reduction and internal fixation. All fractures united within 16 weeks of injury regardless of the method of treatment. Poor clinical results related to the fracture occurred in six patients, five of whom were treated by cast immobilization. Fourteen patients had nerve palsies; eight resolved spontaneously and six had permanent neurologic deficits. There were two compartment syndromes and one ulnar artery transection. There were no infections. We conclude that displaced fractures of the radius, and both bone fractures, are best treated by open reduction and internal fixation. All patients should be closely monitored for 24 h for compartment syndrome, regardless of the fracture type or pattern. Early dynamic splinting is important when associated nerve injuries are present.

Academic Medical Centers↗
PubMed1992

Tennis elbow (lateral epicondylitis).

Tennis elbow (lateral epicondylitis) is the pattern of pain most commonly seen at the origin of the wrist extensors from the lateral epicondyle of the humerus and less commonly seen at the origin of the flexor-pronator from the medial epicondyle. This article discusses methods of diagnosis and both conservative and operative treatment techniques.

Diagnosis, Differential↗
PubMed1992

Upper extremity pain in the postrehabilitation spinal cord injured patient.

The purpose of this study was to determine the prevalence of upper extremity (UE) pain in outpatients with chronic spinal cord injury (SCI). A total of 239 SCI outpatients (136 with quadriplegia and 103 with paraplegia) were interviewed for the presence of UE pain at the shoulder, elbow, wrist, and hand. The average age of the subjects at the time of interview was 37.4 years, and the average time since onset was 12.1 years. Subjects who reported pain were referred to SCI clinics to determine the etiology. Fifty-five percent of the patients with quadriplegia reported UE pain, most commonly at the shoulder. Prevalence of reported pain was highest for subjects in the first five years postinjury. Sixty-four percent of patients with paraplegia reported UE pain. Complaints related to carpal tunnel syndrome were the most common, followed by those related to shoulder pain. This study documents the prevalence and nature of UE pain in chronic SCI patients and emphasizes the need for further research to develop strategies for prevention and treatment of pain syndromes.

Activities of Daily Living↗
PubMed1991

Nodular fasciitis: a rapidly growing tumor of the hand.

Nodular fasciitis is an uncommon benign neoplasm infrequently seen in the hand. There are often difficulties in diagnosis of this tumor. It is usually surgically excised while it is still small. The patient described here had a large and aggressive tumor that ruptured through the skin of the hand and extended to the periosteum of the ring metacarpal.

Adult↗
PubMed1991

Fracture of the index metacarpal base with subluxation of the trapeziometacarpal joint. A case report.

A 40-year-old man fell on his outstretched arm and suffered a fracture of the index metacarpal base with subluxation of the thumb basal joint. The small fracture fragment at the base of the index metacarpal was attached to the base of the thumb metacarpal by a strong ligament, as noted at the time of surgery. This pattern of injury, a ligament-reversed Bennett's fracture, seems not to have been previously reported.

Adult↗
PubMed1991

Complications associated with carpal tunnel release.

A number of complications can result from surgical treatment of carpal tunnel syndrome. They can be diminished with the use of a longitudinally directed incision, complete visualization of the median nerve, and an understanding of the anatomic variations of the median nerve. However, some complications (eg, a painful scar, infection, and wrist weakness) may not be completely prevented.

Carpal Tunnel Syndrome↗
PubMed1990

Carpal tunnel syndrome secondary to wrist and finger flexor spasticity.

Ten patients with spastic wrist flexion deformities secondary to traumatic brain injury were evaluated for carpal tunnel syndrome. The angle of wrist flexion deformity averaged 75 degrees (range, 58 to 115 degrees). Nerve conduction studies demonstrated prolonged median motor and/or sensory latencies in all patients. Preoperative wick catheter measurements of carpal tunnel pressures in eight patients averaged 11 mm Hg in the resting position, 21 mm Hg in maximal wrist flexion, and 15 mm Hg in maximal extension. Each patient had carpal tunnel release with simultaneous wrist and finger flexor tendon releases or lengthenings. At surgery nine of the median nerves were constricted at the proximal edge of the transverse carpal ligament. The presence of normal carpal tunnel pressures and impingement of the median nerve at the proximal edge of the transverse carpal ligament indicates that the chronically flexed posture of the wrist resulted in median nerve compression, and this condition may be aggravated by underlying pressure from the spastic finger flexors.

Adolescent↗