Hemangioma of the extensor pollicis brevis in the first dorsal compartment: an unusual cause of bilateral de Quervain's disease.
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Adult↗
Biomedical subjects
H K Watson
Publications and source records attributed to H K Watson.
Congenital triquetral absence: a case report of an asymptomatic wrist.
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Adult↗
Treatment of Kienböck's disease with scaphotrapezio-trapezoid arthrodesis.
The long-term results of 28 cases of Kienböck's disease treated with scaphotrapezio-trapezoid arthrodesis between 1980 and 1990 are presented. The average follow-up period was 51 months. Of these wrists, nine required late lunate excision for pain and limited motion; however, only three patients in the entire series required further wrist salvage procedures (wrist arthrodesis, proximal row carpectomy). At late follow-up examination, range of motion averaged 48 degrees in extension, 52 degrees in flexion, 11 degrees in radial deviation, and 27 degrees in ulnar deviation. Using a subjective pain relief rating scale, patients reported excellent results in 12 cases, good results in 9, fair results in 4, and poor results in 2 (1 case was omitted because of a coexisting different disease).
Adolescent↗
Lateral lunate morphology: an x-ray study.
The lunate has been described by Kauer as being thinner dorsally than volarly when measured proximal to distal. We used an x-ray method to measure the shape of the lunate in order to compare dorsal and volar thicknesses after recognizing clinically a group of patients with scapholunate dissociation in whom volar flexed lunates were present. Using this method, 292 standard lateral views of the lunate were collected randomly and measured. The shape of the lunate could be classified into 3 types: type D lunates have a thinner dorsal segment and correspond to Kauer's description; type V lunates have a thinner volar segment; type N lunates have equal dorsal and volar segments. There were 196 type D lunates (67%), 67 type V lunates (23%), and 29 type N lunates (10%). The radiolunate angles were measured in a random selection from type D and type V lunates to determine any relationship between the volar segment to dorsal segment thickness (wedge) ratio. No relationship within these groups was identified. However, there was a significant difference in the radiolunate angles between these two groups. Recognition of the prevalence of the type V lunate alters concepts proposed by Kauer and warrants further investigation of factors influencing lunate position.
Carpal Bones↗
The carpal boss. A 20-year review of operative management.
Between 1969 and 1989, 116 patients were evaluated and treated surgically for symptomatic carpal boss. Their mean age was 32 years and male and female patients were equally affected. 28 patients gave a history of previous injury. Surgical treatment consisted of excision of the localized bony abnormality and the associated degenerative arthritic process to the level of normal articular surfaces and normal adjacent cancellous bone. The mean follow-up period for the patients in this study was 42 months. Complete symptomatic relief was observed in 94% of the patients undergoing surgical treatment. Recurrence or persistence of symptoms developed in seven surgical patients. Six had a second operation with more extensive removal of sclerotic bone and degenerate cartilage, and all patients had relief of symptoms.
Adolescent↗
Scaphoid nonunion in a child: a case report.
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Bicycling↗
Scapholunate advanced collapse wrist salvage.
Patients with scapholunate advanced collapse (SLAC) wrist do not have to undergo total wrist arthrodesis; the SLAC pattern spares the radiolunate articulation, providing a basis for salvage. We report the results of 100 cases in which a technique comprised of scaphoid excision and limited wrist arthrodesis was used. The average followup period of 44 months revealed excellent functional status and a high rate of patient satisfaction. The majority of employed patients were able to return to their original jobs, and many chose to resume wrist-related recreational activities. Pain relief was good to excellent in most cases. Extension/flexion averaged 72 degrees (53% of a normal opposite wrist), radioulnar deviation 37 degrees (59%), and grip strength 80% of the opposite side. X-ray films revealed only two instances of radiolunate destruction, both in conjunction with ulnar translation of the carpus. The other 98 patients demonstrated a well-preserved radiolunate joint regardless of followup interval. Complications were few. Nonunion occurred in three cases. A dorsal impingement of the capitate and radius (12%) was felt to be technique-related and avoidable by careful capitolunate alignment.
Adult↗
Madelung's deformity. A surgical technique.
15 wrists with Madelung's deformity were operated on between 1972 and 1990, constituting the largest series of radial osteotomies reported for this deformity to date. The technique that evolved is described in detail, as are the preliminary follow-up results. All patients reported symptomatic relief and return to normal activity levels.
Adolescent↗
Dorsal approach to scaphoid nonunion.
The surgical approach for treatment of scaphoid nonunion usually involves various combinations of screws and Kirschner wires, with or without bone grafts. This article reports our results with 36 dorsal-approach bone grafting procedures for treatment of scaphoid nonunion with Kirschner wires. Union was achieved in 89%. The average follow-up was 5 years. Flexion/extension averaged 76% of the opposite wrist, and grip strength was 88% of the opposite hand. Ninety-one percent of the employed patients returned to their original jobs. The dorsal approach provides satisfactory exposure for fragment reduction and bone grafting.
Activities of Daily Living↗
Use of triscaphe fusion in the treatment of Kienböck's disease.
The disability of Kienböck's disease is a manifestation of carpal collapse. Significant loading for any wrist must be taken on the radial side. Triscaphe arthrodesis provides a support mechanism for the collapsed lunate, a solid bone-cartilage mechanism for load transference to the radius, and maintenance of satisfactory motion.
Arthrodesis↗
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↗
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↗
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↗
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↗
Treatment of scapholunate dissociation: preferred treatment--STT fusion vs other methods.
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Arthrodesis↗
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↗
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↗
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↗