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Biomedical subjects

H H Stark

Publications and source records attributed to H H Stark.

At least 19 recordsLinked to original sources
PubMed1995

Management of civilian gunshot injuries to the hip.

The orthopedic surgeon at a civilian trauma center is likely to encounter a gunshot injury to the hip. The nonmilitary literature regarding this injury gives few guidelines regarding an appropriate diagnostic evaluation or the indication for arthrotomy. We found that the best diagnostic test to detect joint penetration was hip aspiration followed by an arthrogram. Selected cases can be treated successfully with antibiotic therapy without an arthrotomy. These cases involve a low-velocity missile that passes through the joint, causes minimal bone disruption, and is free of bowel contaminants. If an arthrotomy is not performed, the physician must follow the patient with repeated physical examinations, complete blood counts, and a hip aspiration whenever infection is suspected. All transbdominal hip injuries require an immediate arthrotomy. In this series, bullets left in contact with joint fluid resulted in joint destruction or infection. Each patient with a displaced femoral neck fracture had a poor outcome with internal fixation. Hip arthroplasty or fusion should be considered as elective procedures for definitive management of these injuries.

Algorithms↗
PubMed1991

Tendon arthroplasty of the fifth carpometacarpal joint for treatment of posttraumatic arthritis.

Resectional arthroplasty with interposition of a rolled tendon spacer was used to treat posttraumatic arthritis of the fifth metacarpal-hamate joint in eight patients. The average follow-up was 5 years. All of the patients subjectively rated the functional capability and the cosmetic appearance of their hands as good or excellent. After operation, there was a net increase of 30% in the average grip strength of the study group. The motion preserved at the small finger carpometacarpal joint facilitated power function of the hand.

Adult↗
PubMed1989

Bridge flexor tendon grafts.

In adults, when flexor tendons cannot be repaired until weeks or months after injury or when tendons have ruptured and part of the tendon is nonviable, it is often inadvisable to suture the tendon ends together. When a primary repair has failed, when there has been a delay in tendon reconstruction to allow skin coverage or joint mobilization, or when repair has been delayed because of infection, continuity of a profundus tendon or flexor pollicis longus tendon can often be restored by using a free graft to bridge the defect. Many patients treated by this procedure will have a satisfactory result providing that the flexor tendon is undamaged within its digital sheath and the muscle is intact and has adequate amplitude. In the study reported here, satisfactory function was restored to 28 of 37 fingers and to eight of ten thumbs treated by this method.

Adult↗
PubMed1989

Fracture of the hook of the hamate.

We removed the fracture fragment from fifty-nine patients who had an isolated fracture of the hook of the hamate. Preoperatively, all had complained of pain and tenderness on the ulnar side of the palm or on the dorsal ulnar aspect of the wrist. Most fractures were thought to have occurred while the patient was swinging a racquet, golf club, or baseball bat. Some fractures were caused by striking the palm on a solid object, by falling on the palm, or by a crush injury to the hand. Most of the fractures were diagnosed conclusively on a carpal tunnel roentgenogram or on a special oblique roentgenogram of the wrist supinated. We now believe that computed axial tomography is the best imaging technique for demonstrating this fracture. Except for two patients who had a crush injury, all of the patients returned to their regular occupational and athletic pursuits. There were no surgical complications.

Adult↗
PubMed1988

Toxic shock syndrome after a human bite to the hand.

The first known case of toxic shock syndrome resulting from a human bite is reported. An awareness of the presenting features and clinical manifestations are needed in the early recognition and intensive medical management of this life-threatening condition.

Adult↗
PubMed1988

Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation.

Of 151 ununited fractures of the scaphoid that were treated with iliac bone grafts and Kirschner-wire fixation through a volar approach, all but four (97 per cent) healed in an average of seventeen weeks, Three of the four failures resulted from obvious technical errors. Neither the preoperative existence of necrosis of the proximal fragment nor the location of the fracture affected the results. When there was mild radiocarpal arthritis preoperatively, it did not progress postoperatively; if there was moderate radiocarpal arthritis preoperatively, progression seldom was seen if a radial styloidectomy was done. Displaced and unstable ununited fractures healed even if the deformity was not corrected completely. The principal benefit of the procedure was relief of pain rather than an increase either in motion of the wrist or in strength of grip.

Adolescent↗
PubMed1987

Dupuytren's disease in women: evaluation of long-term results after operation.

A study of the long-term results after operation on 66 women (83 hands) with Dupuytren's disease showed that women are twice as likely as men to have a postoperative flare reaction. Why a flare reaction develops is uncertain. In this study, patients who had a carpal tunnel release at the time of operation for treatment of Dupuytren's disease or those who had an extensive fasciectomy, as opposed to removal of only the contracted tissue, were more apt to have a flare reaction. In addition, after operation, moderate or severe loss of finger flexion occurred in 35% of hands without a flare reaction and in 76% of those who had a flare reaction. This suggests that women having an operation for treatment of Dupuytren's disease are apt to have a worse result than men.

Aged↗
PubMed1987

Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits.

Thirty-six digits with an intra-articular fracture of the dorsal aspect of the distal phalanx that involved one-third or more of the articular surface were treated by open reduction and internal fixation with Kirschner wires. After an average length of follow-up of forty-six months, roentgenograms of the distal joint in twenty-six digits appeared essentially normal. Ten digits had minor roentgenographic changes but, with the exception of one digit, the joint space was congruous and free of significant abnormalities. The average loss of extension of the distal joint was 2 degrees, and the average arc of flexion of the distal joint was 69 degrees. The average strength of pinch in all digits that were operated on was essentially equal to the strength of pinch in the contralateral digit. Exact reduction and internal fixation using the technique described resulted in excellent motion and function.

Adolescent↗
PubMed1986

Fractures and dislocations of the carpal bones.

The most common wrist fractures in athletes are fractures of the scaphoid and fractures of the hook of the hamate. Accurate diagnosis and conservative treatment are extremely important. A physician should not compromise principles of treatment for a rapid return of the athlete to competition, because all too often this will jeopardize eventual recovery and his or her future career. It is far better to be conservative, to insist upon complete recovery before permitting competition, especially in high-school and college students, and to be more concerned with the athlete's potential achievements than immediate accomplishments. These axioms are especially applicable when treating young individuals with suspected or proven wrist injuries.

Athletic Injuries↗
PubMed1984

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report.

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.

Adult↗
PubMed1984

Treatment of selected patients with an ununited fracture of the proximal part of the scaphoid by excision of the fragment and insertion of a carved silicone-rubber spacer.

An ununited scaphoid fracture whose proximal fragment is small, sclerotic, fragmented, or badly deformed is usually not suitable for bone-grafting. We treated twenty-one such patients by excision of the small proximal fragment through a volar incision and the insertion of a hand-carved silicone-rubber spacer. After surgery, twenty patients (95 per cent) were able to return to work and engage in strenuous activities, including sports. Pain was significantly relieved, although wrist motions and grip were only minimally improved. Preoperative and postoperative comparative measurements of carpal collapse and translation showed only insignificant changes after this procedure.

Adult↗
PubMed1981

Use of a hand-carved silicone-rubber spacer for advanced Kienböck's disease.

We found that the use of a hand-carved silicone-rubber (Silastic) spacer was reasonably effective in relieving symptoms in thirty-six patients with advanced Kienböck's disease, even though there was still some residual postoperative loss of wrist motion and grip strength. Preoperatively all patients had pain and limited motion of the wrist as well as weakness of grip. Roentgenographically all had fragmentation and collapse of the lunate, and 92 per cent had measurable carpal collapse. Most had had symptoms for longer than one year. After removal of the deformed lunate through a dorsal incision, a silicone-rubber spacer was shaped to fit the defect. Patients were followed for an average of fifty-four months. Thirty-two patients were followed for at least two years; all but three were improved. This procedure is not recommended when the shape of the lunate is normal or not significantly altered, or when the lunate has not collapsed as measured by precise determinants.

Adolescent↗
PubMed1978

Tendon transfers for radial nerve palsy: use of superficialis tendons for digital extension.

Since 1959, 22 patients have had wrist extension restored by transfer of the pronator teres to the extensor carpi radialis longus and brevis, common finger extension by transfer of the superficialis of the long finger, independent thumb and index finger extension by transfer of the superficialis of the ring finger, and abduction of the thumb by transfer of the flexor carpi radialis at the wrist joint level. Twenty-one of 22 patients have been evaluated from 8 months to 15 years after operation, with an average follow-up of 4.5 years. By our new system of evaluation, there were 10 excellent results, six good results, five fair results, and all patients improved. Sixteen patients obtained full, independent thumb-index finger extension, three had fair function, and two obtained thumb-index extension by tenodesis of the transfer. This procedure allows full metacarpophalangeal extension independent of wrist position, provides thumb-index finger extension independent of the ulnar three digits, and maintains the dorsal-radial-to-volar-ulnar plane of functional motion of the wrist by retaining the flexor carpi ulnaris.

Adolescent↗
PubMed1977

Flexor tendon graft through intact superficialis tendon.

During a 14-year period, the flexor profundus mechanism was reconstructed with a free tendon graft in 25 fingers. The graft was passed either through or alongside the intact superficialis tendon. Five of the profundus tendons had ruptured, and 21 had been severed. One patient was under 10 years of age and only three were over 21 years of age. The result was considered to be satisfactory if the finger flexed to 3.2 cm or less of the mid-palm, had at lease 20 degrees of voluntary flexion of the distal joint, and lacked no more than 30 degrees of extension of the proximal interphalangeal joint. Additionally, to be satisfactory, the combined loss of extension of the proximal interphalangeal and distal interphalangeal joints ahd to be 40 degrees or less for an index or middle finger, and 60 degrees or less for a ring or little finger. Using these criteria, 20 patients were satisfactory, four were unsatisfactory, and one was unchanged. Selected patients who are between the ages of 10 and 21 years will benefit from this operation, providing that the finger had limber joints and minimal scar, and the superficialis tendon flexes the proximal interphalangeal joint at least 80 degrees.

Adolescent↗