Search PubMed⌕ Search

Biomedical subjects

H K Watson

Publications and source records attributed to H K Watson.

At least 19 recordsLinked to original sources
PubMed1992

Matched distal ulna resection for posttraumatic disorders of the distal radioulnar joint.

In 1985 we published the results of the matched ulna resection in 44 patients, the majority of whom had rheumatoid arthritis. The matched ulna resection maintains the continuity of the distal ulna to the ulnar sling mechanism, including the triangular fibrocartilage complex (TFCC), and resects the distal ulna in a smooth, curved, convex fashion to match the contour of the radius throughout forearm rotation. This article presents the results of the procedure in patients with posttraumatic and mechanical disorders of the distal radioulnar joint. Good to excellent results were noted in 24 of 32 patients. The outcome was related to the severity of the patient's initial problem.

Adolescent↗
PubMed1991

Simultaneous carpal tunnel release and Dupuytren's fasciectomy.

Simultaneous operations for carpal tunnel syndrome and Dupuytren's disease have been reported in only one study which recommended staged treatment because there was an 87% complication rate with simultaneous treatment. The present study reviewed simultaneous treatment of 30 patients during a 20-year period. Complications and unfavourable results were compared to similar groups of patients who underwent either Dupuytren's fasciectomy or carpal tunnel release as sole procedures. Early complications (13%) were far less than in previous studies and were easily corrected. The incidence of recurrence and extension (20%) was lower than in the Dupuytren's fasciectomy group and much lower than in previous reports. Simultaneous carpal tunnel release and Dupuytren's fasciectomy are strongly recommended when these conditions are both present in the same hand.

Adult↗
PubMed1991

Pathologic anatomy.

The typical case shows one or more thickened bands overlying the flexor tendons in the palm that connect with one another via the transverse palmar fascia. Vertical septae fix the bands securely to the underlying fascia and transverse metacarpal ligaments. These septae pass deep between the tendon and neurovascular tunnel. Bands running into the fingers represent thickening and fibrosis of the natatory ligaments. Typically, a central band continues into the finger, forks, and dissipates just distal to the PIP joint. This dissipation occurs with bifurcation of the central band into two thickened bundles that pass deep to the neurovascular bundle and attach to the flexor sheath of the middle phalanx. There are also thickenings of Grayson's ligaments that run from the central cord laterally and dorsally. Understanding the anatomy of the palmar aponeurosis is essential to the effective treatment of Dupuytren's contracture. Because the cause is unknown, treatment is best directed at anatomic deformities. Although not systemic or lethal, poorly treated Dupuytren's contracture can lead to significant morbidity and long-term disability. The palmar aponeurosis and its substructures are more than just passive barriers. They integrate hand parts and when pathologically fibrosed can contract joints, deform skin, and deviate neurovascular structures. The best treatments are recognition of the contracture, meticulous dissection, and local radical fasciectomy. Special attention is directed toward protecting spiralling neurovascular bundles. Difficult releases are enhanced by judicious release of checkreins, tendon sheath attachments, and disease on the radial side of the hand.

Dupuytren Contracture↗
PubMed1991

Dystrophy, recurrence, and salvage procedures in Dupuytren's contracture.

Postoperative complications can jeopardize the results of surgery. These can be avoided by Y-V plasties that allow for efficient skin "lengthening" and wound healing. Proper dressing techniques can prevent hematoma formation. The patient must be started on early active motion to prevent stiffness, and the physician must monitor for reflex sympathetic dystrophy. If RSD should occur, the dystrophile program is the most effective means of treatment. Fasciectomy alone is not always successful in correcting Dupuytren's contracture, especially in longstanding cases. The surgeon should be prepared to correct other entities such as checkreins, sheath fibrosis, and tendon adhesions. Occasionally, a severely compromised finger is not amenable to correction. In this case, salvage procedures are available, such as the concentric arthrodesis that preserves the length of the volar structures. Only when all other attempts fail should one resort to amputation.

Dupuytren Contracture↗
PubMed1990

Degenerative arthritis at the triscaphe joint.

The clinical presentation of triscaphe arthritis and the results of arthrodesis are presented. Twenty-one patients had triscaphe arthrodesis for treatment of arthritis of the triscaphe joint between 1972 and 1986. Seven also had rotary subluxation of the scaphoid and one had Kienböck's disease. Twenty patients were available for examination at an average of 5 years after operation. All had relief of pain and the average flexion-extension arc was 101 degrees. One patient had a nonunion successfully treated by refusion, and in two patients a dystrophy developed, which was relieved by a stress loading program. No progression of arthritis was seen elsewhere in the wrist.

Adult↗
PubMed1990

A double-blind study of hyposensitization with an alginate-conjugated extract of Dermatophagoides pteronyssinus (Conjuvac) in patients with perennial rhinitis. II. Immunological aspects.

In a 2-year double-blind placebo controlled study an immunological evaluation was carried out on 33 patients (15 males, 18 females, mean age 29.2 years) with mite-induced perennial rhinitis who were submitted to specific immunotherapy (IT) with an alginate-conjugated extract of D. pteronyssinus. The behaviour of IgE, IgG, IgG1 and IgG4 antibodies specific to D. pteronyssinus and its major allergen Der p1 was characterized by assessment of their changes in serum, and changes in IgG in nasal secretions during the treatment. The placebo-treated patients did not show any significant variation in the levels of specific antibodies, while in the actively treated patients we found: a statistically significant decrease (P less than 0.005) of specific IgE, a statistically significant increase of specific IgG (P less than 0.005), IgG1 (P less than 0.005) and IgG4 (P less than 0.005) in serum and a statistically significant increase (P less than 0.001) of specific IgG in nasal secretions. The IgG response showed an early relative predominance of the IgG1 subclass and a late absolute predominance of IgG4 subclass, that confirmed the model of IgG4 restriction in prolonged allergen stimulation. No correlation was found between immunological and clinical data.

Adjuvants, Immunologic↗
PubMed1989

Radial styloid impingement after triscaphe arthrodesis.

Painful radial styloid impingement after a successful triscaphe arthrodesis has been seen a number of times in a review of our patients undertaken to study this problem. Ninety-one patients with 93 triscaphe arthrodeses were seen at an average of 23 months after operation. Thirty-one patients (33%) were believed to have radial styloid impingement characterized by radial side pain on wrist flexion or limitation of motion in radial deviation. Average time of presentation was 19 months. Patients who had rotary subluxation of the scaphoid tended to develop impingement more frequently than those whose operation was done for treatment of degenerative arthritis or avascular necrosis of the lunate. Seventeen patients (18%) subsequently had a partial radial styloidectomy for treatment of this impingement. On the basis of these findings we now incorporate a partial radial styloidectomy as a routine procedure during a triscaphe arthrodesis.

Adolescent↗
PubMed1989

Ulnar impingement syndrome after Darrach procedure: treatment by advancement lengthening osteotomy of the ulna.

The Darrach procedure was the standard treatment for painful disorders of the radioulnar joint for several decades. However, recent articles have described unsatisfactory results after this procedure including dorso-palmar instability of the ulna, clicking upon rotation of the forearm, ulnar translocation of the carpus, and a painful ulnar impingement syndrome. Management of these problems following an ulnar shortening procedure requires restoration of ulnar length to provide stability to the triangular fibrocartilage complex and ulnar sling mechanism. Also, recurrent impingement must be prevented. A technique of ulnar lengthening by advancement step osteotomy in conjunction with a "matched" resection of the advanced ulna is presented. Three case reports illustrate its use.

Adult↗
PubMed1989

Triquetral-lunate arthritis secondary to synostosis.

Until recently the problem of painful, symptomatic arthritis of the wrist secondary to congenitally incomplete separation of carpal bones has been infrequently recognized. Five patients with either excessive stress loading or trauma had eight symptomatic wrists with congenitally incomplete separation of the triquetral-lunate joint. Three of these patients had bilateral symptoms. Six of the wrists had been treated by a limited wrist arthrodesis of the triquetral-lunate joint resulting in asymptomatic wrists and improved range of motion. It appears that patients with this congenital condition poorly tolerate stress loading or trauma secondary to deficient intra-articular cartilage formation resulting in a clinical and anatomic state similar to degenerative arthritis. We suggest a limited wrist arthrodesis as definitive treatment for symptomatic congenitally incomplete separation of the triquetral-lunate joint, with possible application in incomplete separation of the other intercarpal joints.

Adult↗
PubMed1989

Acute scaphoid fracture with scapholunate gap.

Disruptive forces from wrist trauma are thought to fracture bone or disrupt ligaments. Two cases are presented to demonstrate the simultaneous occurrence of acute scaphoid fracture and scapholunate gap. Recommended treatment in acute cases is open reduction and internal fixation of the fracture and open stabilization of the scaphoid. In chronic cases, we recommend open reduction and internal fixation with bone graft to the scaphoid nonunion combined with fusion of the scaphoid-trapezium-trapezoid joint.

Adolescent↗
PubMed1989

Reevaluation of the cause of the wrist ganglion.

The cause of the wrist ganglion is uncertain. We reviewed our experience with rotary subluxation of the scaphoid after ganglion excision. Seventeen patients had triscaphe arthrodesis for treatment of rotary subluxation of the scaphoid at an average of 35 months (range, 6 to 130 months) after ganglion excision. In addition, dynamic or static rotary subluxation of the scaphoid was found in 8 of 10 patients who were examined at an average of 16 years (range, 11 to 19 years) after excision of a ganglion. These patients had no symptoms at the time of review. Only single case reports of rotary subluxation of the scaphoid after ganglion excision have been previously reported. We believe our data supports a hypothesis that the ganglion is a secondary manifestation of underlying periscaphoid ligamentous injury. Persistent symptoms after ganglion excision should lead one to suspect underlying scaphoid instability.

Adolescent↗
PubMed1989

Revision of painful distal tip amputations.

From 1968 to 1987, 22 patients were diagnosed with dysfunctioning digits after complete distal digital amputations. Each patient had the proximal portion of the partially amputated phalanx left within the injured digit. On average, 21 months after the initial injury, each patient underwent an excision of the remnant portion of the phalanx which averaged 6 mm (range 1 to 17 mm). All 22 patients reported excellent postoperative results of full function and no residual pain with an average follow up of 9 months. We theorized that localized synovitis produces joint pain related to: 1) nontolerated joint stress loading due to a change in the lever arm length of the amputated phalanx, or 2) inadequate cartilage nutrition owing to lack of stress applied to this joint. Maintaining digital length must be rethought with emphasis placed on painless function. Considering the losses to these patients in terms of time, employment, and money, a distal remnant measuring 4 mm or less should be excised, regardless of the digit, at the time of the injury.

Adolescent↗
PubMed1979

Treatment of Dupuytren's contracture by extensive fasciectomy through multiple Y-V--plasty incisions: short-term evaluation of 170 consecutive operations.

The zigzag incision with Y-V closure has unique advantages for the treatment of Dupuytren's disease. Much skin can be mobilized to the longitudinal finger axis. There is rarely a need for skin grafting in spite of full correction of the deformity. This approach, combined with properly applied tamponade bulk dressing, allows for early use of the hand with minimal morbidity.

Dupuytren Contracture↗
PubMed1979

The carpal boss: surgical treatment and etiological considerations.

We report on 30 symptomatic cases of carpal boss which were treated surgically. The condition represents a highly localized degenerative arthritis at the base of the middle metacarpal, and is seen primarily in relatively young patients. Symptomatic relief was obtained by excision of degenerated tissue in all these patients.

Adolescent↗