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Biomedical subjects

H K Watson

Publications and source records attributed to H K Watson.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1988

Acquired Madelung-like deformity in a gymnast.

High-level gymnastic training may cause clinical and radiographic changes in the wrist. A case is reported demonstrating bilateral closure of the ulnar side of the distal radius epiphyseal plate in a patient with a history of high-level gymnastic training. Cumulative microtrauma to the ulnar side of the distal radius epiphyseal plate may cause premature closure leading to a Madelung-like deformity.

Adolescent↗
PubMed1988

Trapezoidal osteotomy of the distal radius for unacceptable articular angulation after Colles' fracture.

Loss of radial palmar tilt in malunion of Colles' fractures alters wrist biomechanics, abnormally loading the tenuous dorsal ligament complex. This can result in midcarpal instability with synovitis, pain, weakness, and possible articular degeneration. An osteotomy to correct radius alignment using a trapezoidal corticocancellous bone graft has been devised. The graft is harvested from the dorsal radius adjacent to the osteotomy and malunion site. When turned 90 degrees, a properly designed trapezoidal graft restores radial length, inclination, and palmar tilt in one step. Functional results in 15 patients at 46 months (range, 18 to 116) were comparable with a series using iliac crest graft and plate- and-screw fixation. This simple technique avoids disruption of the extensor retinaculum and reoperation for hardware removal as Kirschner-wire fixation proved adequate.

Adolescent↗
PubMed1988

Examination of the scaphoid.

Scaphoid manipulation is an important part of the examination of the wrist. The "scaphoid shift" is a maneuver that is helpful in assessing scaphoid stability and in identifying scaphoid and periscaphoid pathology. The anatomic basis of the maneuver is explained and its performance and interpretation discussed.

Carpal Bones↗
PubMed1988

Sensitivity to Parietaria pollen in the Southampton area as determined by skin-prick and RAST tests.

The pollen of Parietaria species is a well-recognized and important inhalant allergen in the Mediterranean area. Parietaria judaica (Pellitory-of-the-Wall) is native to the U.K., flowering from June to September, but is not usually considered to be of any clinical importance by U.K. allergists. We skin tested 62 patients with a clinical history of summer seasonal respiratory symptoms and a control group of 11 patients with perennial respiratory symptoms only. Each was skin tested in duplicate with extracts of grass pollen, birch pollen, Parietaria pollen, Dermatophagoides pteronyssinus, Cladosporium, Alternaria, nettle pollen and negative and positive controls, and serum samples were collected for RAST assays for Parietaria and nettle. Eight of the 62 patients in the main group showed skin reactivity to Parietaria. Five of these eight had never visited the Mediterranean area and therefore it is possible that sensitization occurred in the U.K. Thirteen of the 62 patients were skin reactive to nettle but there was no correlation between skin reactivity to Parietaria and nettle. This supports a recent report that, despite their close botanical relationship, no antigenic cross-reactivity exists between the two species. No correlation was seen between skin reactivity and serum RAST activity to Parietaria or nettle. It is not known whether exposure to Parietaria pollen contributes to the seasonal symptoms of the patients found to be skin reactive. None of the 11 patients in the control group was skin reactive to Parietaria.

Adolescent↗
PubMed1988

Dose response curve of allergen and histamine in skin prick tests.

Twenty-six Dermatophagoides pteronyssinus (D.pt.) sensitive subjects were skin prick tested in duplicate with 15 concentrations of D.pt. ranging from 0.0018 to 17.8 mg/ml, 15 concentrations of the major allergen of D.pt., antigen P1, ranging from 0.0002 to 1.88 mg/ml and 15 concentrations of histamine dihydrochloride solution ranging from 0.048 to 114.0 mg/ml. Weal areas and concentrations were transformed by taking logs and linear and non-linear regression curves fitted, allowing for confounding variables, such as subject, and interactions. The weal areas over all concentrations fitted "S" shaped curves with essentially straight central portions, parallel between materials, with differences between subjects but parallel within subjects. The dose response curves of P1 and D.pt. were coincident when the concentrations were adjusted to allow for differences in potency. The concentrations of allergen and histamine commonly used for standardisation purposes will give weals that can be plotted along a straight line, but at higher and lower concentrations the response will tail off. This accounts for previously ambiguous results. Standardisation of allergens using 10 mg/ml histamine is preferable to 1 mg/mg.

Adult↗
PubMed1988

Hypertrophic ulnar styloid nonunions.

Eleven patients with chronic pain on the ulnar side of the wrist and roentgenographic evidence of a hypertrophic ulnar styloid nonunion were treated with subperiosteal excision of the nonunion fragment. This procedure relieved the localized pain without changing either radiocarpal or distal radioulnar joint stability.

Adult↗
PubMed1987

Treatment of reflex sympathetic dystrophy of the hand with an active "stress loading" program.

Reflex sympathetic dystrophy (RSD) is a syndrome characterized by pain out of proportion to injury, vasomotor and trophic changes, stiffness, and decreased function. It is important to separate the active disease process of RSD from its resultant state of contracture and fibrosis. Our treatment program is based on active "stress loading," which consists of active traction and compression exercises that provide stressful stimuli to the extremity without joint motion. Fifty-two patients with RSD were treated during a 3-year period. Their results and long-term follow-up on 41 patients are presented. The "stress loading" program has been used consistently during the past 20 years. The advantages of the program are its effectiveness, simplicity, safety, and noninvasiveness.

Adult↗
PubMed1987

Arthroplasty of the ulnar carpometacarpal joints.

Fracture-dislocation of the ulnar carpometacarpal (CMC) joints may result in malunion or arthropathy when it is missed or inadequately treated. Partial resection arthroplasty of the ulnar CMC joints was done in 16 patients to treat malunion subsequent to dorsal fracture-dislocation. This procedure is recommended as a reliable means of treatment that preserves the important motion on the ulnar side of the hand.

Arthroplasty↗
PubMed1987

Stenosing tenosynovitis in Dupuytren's contracture.

Patients with symptoms of stenosing tenosynovitis and clinical evidence of overlying Dupuytren's contracture were treated with localized total fasciectomy through multiple Y-V plasties and the excision of the A1 pulley of the affected digit. At operation the stenosing tenosynovitis could be separated into two categories--patients with external compression from contracting vertical septa or patients in whom the tendon constriction appeared unrelated to the overlying fascial disease.

Dupuytren Contracture↗
PubMed1987

Degenerative change in symptomatic scaphoid nonunion.

A retrospective radiographic analysis of 64 patients with symptomatic scaphoid nonunions without previous surgical treatment was accomplished. The results showed a high frequency of degenerative changes occurring in a predictable sequence. For nonunions of 4 years duration, 75% of patients had radioscaphoid changes, and for those of 9 years duration 60% of the patients had midcarpal changes. The pattern of arthritis in scaphoid nonunion is that of scapholunate advanced collapse (SLAC) wrist resulting from rotary subluxation of the distal scaphoid fragment. The radius-proximal scaphoid fragment joint and the radiolunate joint were consistently spared from degenerative changes, even with severe arthritis. Instability was progressive and associated with an earlier onset of arthritis. Patients with symptomatic scaphoid nonunions appear to have a significant likelihood of arthritis developing.

Adult↗
PubMed1987

Salvage of severe recurrent Dupuytren's contracture of the ring and small fingers.

Severe recurrent digital Dupuytren's contracture, with pseudomotor changes and inadequate palmar tissue, is often treated with amputation. In this study, 11 patients had 14 proximal interphalangeal joint fusions with shortening done for salvage of recurrent Dupuytren's rather than amputation. Indications for operation were pseudomotor changes, severe palmar fibrosis, previous operations, and a flexion contracture of greater than 70 degrees.

Arthrodesis↗