Search PubMed⌕ Search

Biomedical subjects

J A Nunley

Publications and source records attributed to J A Nunley.

At least 19 recordsLinked to original sources
PubMed1996

Centrocentral anastomosis with autologous nerve graft treatment of foot and ankle neuromas.

Painful neuromatas in the foot and around the ankle can be difficult to treat. Five patients of clinically and histologically proven neuromas underwent centrocentral union with autologous transplantation. Three patients had previous toe amputations involving multiple operations. One patient had failed multiple operative treatments for Morton's neuroma in his 3rd web space. One patient had a neuroma in his superficial peroneal nerve caused by a gun shot wound. All patients but one showed definitive subjective and objective improvement after centrocentral union with the interposed autologous nerve graft. The patient with "recurrent" Morton's neuroma had the least improvement. This technique can be recommended as an alternative for the prevention of painful stump neuromata.

Adult↗
PubMed1995

Fracture of a supracondylar humeral myositis ossificans.

Although myositis ossificans is a well-known sequela of elbow trauma, reinjury to the affected region can also occur, resulting in acute symptoms from a fracture of the myositis ossificans. An 18-year-old man presented with localized pain, soft-tissue swelling, and a bony mass along the anterolateral distal humerus with restricted elbow range of motion after injury to his elbow during football. One year earlier he had sustained a similar crush injury to his elbow that resulted in a limited, although painless, arc of motion. Radiographs and tomograms established the diagnosis of a fractured supracondylar humeral myositis ossificans. Surgical excision of the large mature ossified fragment confirmed the diagnosis and restored a full range of motion of the elbow.

Adolescent↗
PubMed1995

Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

The results for 103 consecutive hips (eighty-nine patients) that had been treated with free vascularized fibular grafting because of symptomatic osteonecrosis of the femoral head were reviewed in a prospective study. The disease was associated with consumption of alcohol in 30 percent of the hips, use of steroids in 17 percent, trauma in 13 percent, and Perthes disease in 3 percent; in the remaining 38 percent, the condition was idiopathic. All patients, except for one who died of unrelated causes 4.5 years after the operation, were followed for at least five years. By the time of the most recent follow-up evaluation, a total arthroplasty had been performed in thirty-one hips: two of the nineteen that were in stage II, according to the criteria of Marcus et al., at the time of the operation; five (23 percent) of the twenty-two that were in stage III; seventeen (43 percent) of the forty that were in stage IV; and seven (32 percent) of the twenty-two that were in stage V. Kaplan-Meier survivorship analyses demonstrated that the probability of conversion to a total hip arthroplasty within five years after free vascularized fibular grafting was 11 percent for the stage-II hips, 23 percent for the stage-III hips, 29 percent for the stage-IV hips, and 27 percent for the stage-V hips. There was a trend toward a lower rate of conversion to a total hip arthroplasty in patients who were less than thirty years old, but this difference did not reach significance (p = 0.06). No association was found between a causative factor and the probability of conversion to a total hip arthroplasty. The average Harris hip scores had improved at the latest follow-up evaluation, compared with the preoperative values (p < 0.001). For the stage-II hips, the average score improved from 56 to 80 points; for the stage-III hips, from 52 to 85 points; for the stage-IV hips, from 41 to 76 points; and for the stage-V hips, from 36 to 75 points. An outcome questionnaire, completed for 73 percent of the hips, revealed that 59 per cent of the hips that had not been subsequently treated with an arthroplasty did not limit or only slightly limited the patient's ability to carry out daily activities, and 62 percent did not limit or only slightly limited the patient's ability to work.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

The restoration of elbow flexion with intercostal nerve transfers.

Seventeen patients with absent elbow flexion secondary to brachial plexus avulsion injury underwent intercostal neurotization of the biceps muscle. Followup was performed at an average of 5 years. The average age in this series was 21.8 years; the mean time interval from injury to the surgical procedure was 6 months. Eight of the 17 patients (47%) obtained good or excellent results as defined by Nagano et al. Five patients had muscle function ratings of M2 but were unable to power the elbow against gravity. The overall success rate theoretically may be increased by (1) decreasing the time interval from injury to neurotization to < 5 months; (2) selecting patients < 50 years of age; and (3) using adjuvant surgical procedures after neurotization, including tendon transfers and shoulder arthrodesis, which may improve results from good to excellent.

Adolescent↗
PubMed1995

A nursing career leadership program.

A three-level leadership track to parallel the clinical career ladder focuses on communication and interpersonal skills, professional, clinical and leadership experience, continuing education and leadership training. The program's success has led to career ladders in respiratory, physical and occupational therapy.

Career Mobility↗
PubMed1995

Interlocked supracondylar intramedullary nails for supracondylar fractures after total knee arthroplasty. A new treatment method.

Supracondylar fractures in patients with total knee prostheses are challenging surgical problems for which there has been no single satisfactory method of management. The authors present four cases to show that a fully cannulated, closed-section, stainless steel supracondylar intramedullary nail can be inserted in a closed fashion through a 3 cm longitudinal patellar splitting incision between the metal condyles of a nonconstrained femoral component of a total knee prosthesis. The nail can be interlocked with percutaneous screws and provides primary stability of a supracondylar femoral fracture, even in the presence of total knee and total hip prostheses.

Aged↗
PubMed1994

Fractures of the supracondylar process of the humerus.

The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.

Adolescent↗
PubMed1994

A biomechanical comparative analysis of two techniques for tibiotalar arthrodesis.

Two commonly used techniques for tibiotalar fusion were quantitatively compared using instrumented testing of the strength of the construct. The tibiae and tali from 10 pairs of fresh-frozen cadaveric limbs were used. One joint of each pair was fused using two 6.5-mm crossed cancellous screws from proximal to distal while the contralateral joint was fused using two 6.5-mm parallel cancellous screws from distal to proximal. Each specimen was subjected to cantilever bending and torsional testing by servohydraulic actuators. The bending tests included plantarflexion, dorsiflexion, inversion, and eversion, and measured the load during deflection applied 10 cm distal to the fusion site. The rigidity was expressed as newtons per millimeter of deflection. The torsional tests measured construct stiffness in external and internal rotation, and were expressed as newton-meters per degree of rotation. For the bending tests, the crossed screw construct was more rigid in eversion (23.1 N/mm, P = .0004) and dorsiflexion (16.9 N/mm, P = .02), while the parallel screw construct was more rigid in inversion (22.8 N/mm, P = .02) and plantarflexion (22.3 N/mm, P = .0007). In torsional testing, the crossed screw construct was at least 1.5 times stiffer than the parallel screw construct in resisting internal (1.7 N-m/deg versus 0.9 N-m/deg, P = .0001) and external (1.4 N-m/deg versus 0.9 N-m/deg, P = .02) rotation. In laboratory testing, the crossed screw technique is more rigid than the parallel screws, especially in resisting torsional stresses.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle Joint↗
PubMed1994

Results after replantation and revascularization in the upper extremity in children.

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that had been injured, the number of arteries that had been repaired, or the use of venous grafts. The rate of survival after replantation of completely amputated parts was 72 per cent (twenty-eight of thirty-nine parts) when the amputation had resulted from a laceration injury and 53 per cent (eighteen of thirty-four parts) when the amputation had resulted from a crush or an avulsion injury. The rate of survival after revascularization of incompletely amputated parts was 100 per cent (all forty-five parts) when the injury had been the result of a laceration and 75 per cent (thirty-three of forty-four parts) when it had been the result of a crush or an avulsion. We did not find any relationship between the age of the patient and the rate of survival of the amputated part after revascularization; however, there was a significantly higher rate of survival (p , 0.02) after replantation in children who were less than nine years old (77 per cent [twenty-four of thirty-one parts]) compared with the rate in those who were nine to sixteen years old (52 per cent [twenty-two of forty-two parts]). The viability of the digit was in jeopardy after twenty-nine (40 per cent) of the seventy-three replantations and nineteen (21 per cent) of the eighty-nine revascularizations. Immediate reoperation resulted in the salvage of only two of the twenty-one replanted parts and six of the twelve revascularized parts that had a reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1993

Free vascularized fibula in traumatic long bone defects and in limb salvaging following tumor resection: comparative study.

In this retrospective analysis, we present our experience with two groups of patients who had long bone defects secondary to trauma or tumor resection and who were treated with a free vascularized fibular graft for skeletal reconstruction. Both groups were comparable in number and average age of patients, length of bone defect, and mean follow-up (average 3 years both groups). The number of surgical procedures prior to microvascular grafting was significantly higher for the traumatic defects. Primary bone union in a mean period of 6 months occurred at a higher rate in the tumor patients; the trauma patients had a significantly higher nonunion rate, which required multiple additional surgical procedures. The latter did not, significantly, improve the rate of success in the trauma group. Residual limb shortening was present in one-half of the patients with traumatic defects. On the basis of this review, it appears that the scarred and relatively avascular soft tissues surrounding the long bone defects secondary to trauma affect the course and the final outcome of the microvascular fibular grafting. A similar procedure applied for limb salvaging after tumor resection is better.

Adolescent↗
PubMed1993

Secondary reconstruction after vascularized fibular transfer.

We evaluated the results of skeletal reconstruction performed through a mature, vascularized fibular graft in five patients. The average time-interval between the original transplant and the secondary reconstruction was sixty-eight months. The indication for the initial graft had been the loss of bone secondary to trauma in one patient, a skeletal defect due to ablation of a tumor in two patients, and osseous loss due to resection of a congenital pseudarthrosis in two patients. The indication for the second reconstruction was non-union of a fracture as a result of a new traumatic injury in two patients and complex angular deformity in three patients; one of the patients in the latter group had an associated leg-length discrepancy. In all five patients, the second reconstruction was successful, and the vascularized fibular graft responded to the procedure in a manner similar to normal cortical bone.

Adolescent↗
PubMed1993

The effect of upper extremity trauma on handedness.

The effect of severe trauma on handedness was studied through patient responses from 146 questionnaires that were correlated with individual chart review. Subjects were asked to designate their hand use preference, before and after injury, when performing 16 activities. The incidence of change in hand use was determined within four diagnostic types and five designated anatomical levels of injury. Results indicated a significant difference in the way subjects in different diagnostic types and anatomical levels of injury performed. Simple, short activities that did not require sustained fine motor coordination were reported as being performed more easily with a different hand after injury than complex, continuous activities that required sustained fine motor coordination. Significant differences in job duties and place of employment were found for the anatomical level of an injury but not for diagnostic type. Findings suggest that the diagnostic type, the anatomical level of an injury, and the complexity of a task should be considered before changes in hand use are recommended.

Activities of Daily Living↗
PubMed1993

The management of soft-tissue problems associated with calcaneal fractures.

Soft-tissue problems associated with fractures of the calcaneus are common and can present many pitfalls. A classification of soft-tissue problems has been devised to facilitate treatment: Type 1, closed fractures treated by open reduction and internal fixation with an inability to close the skin. Type 2, wound break down after open reduction. Type 3, open fractures of the calcaneus with traumatic large soft-tissue loss but with adequate bone stock. Type 4, traumatic loss of soft tissue and bone. Type 5, calcaneal osteomyelitis. Type 6, chronic unstable soft tissue over the calcaneus. There are various surgical options of skin graft, rotational flaps, and free-tissue transfers that best reconstruct each of these individual problems.

Adult↗
PubMed1993

Distal forearm fractures in children. Complications and surgical indications.

Appropriate indications for operative management of pediatric distal forearm fractures include: 1. Compartment syndrome for fasciotomy. 2. Open fractures for irrigation and debridement. 3. Soft tissue/nerve entrapment. 4. Displaced intra-articular physeal fractures. 5. Displaced or angulated fractures when the patient is close to skeletal maturity. 6. Correction of physeal arrest with malalignment or malrotation. 7. Gross displacement with cosmetic deformity.

Adolescent↗
PubMed1992

Direct end-to-end repair of flexor pollicis longus tendon lacerations.

Between 1976 and 1986, 38 consecutive acute isolated flexor pollicis longus lacerations were repaired. This study excluded all replanted or mutilated digits and all lacerations with associated fracture. Average follow-up was 26 months. Tendon rehabilitation was standardized. Range of motion and pinch strength were measured postoperatively. Seventy-four percent (28/38) of the flexor pollicis longus injuries occurred in zone II. Neurovascular injury occurred in 82% of the lacerations, and this correlated with the zone of tendon injury. In 21% of the patients (8/38) both digital nerves and arteries were transected. Postoperative thumb interphalangeal motion averaged 35 degrees and key pinch strength was 81% that of the uninjured thumb. One rupture occurred in a child. Laceration of the flexor pollicis longus is likely to involve damage to neurovascular structures, and repair may be necessary. Direct end-to-end repairs within the pulley system do at least as well as delayed tendon reconstruction and do not require additional procedures.

Adolescent↗
PubMed1992

Replantation proximal to the wrist.

Technical aspects of importance in replantation proximal to the wrist are somewhat different from those involved with digital replantation. Re-establishing blood flow rapidly by insertion of an arterial shunt, meticulous debridement, stable internal fixation of fractures, fasciotomy, and re-examination of the tissue 48 to 72 hours after replantation are discussed. Indications and contraindications for replantation in addition to maximizing use of "spare parts" are illustrated.

Amputation, Traumatic↗
PubMed1991

Replantation in children.

The authors have replanted 162 parts in 120 children over the past 15 years. The youngest patient, undergoing successful replantation, was aged 7 months, 3 weeks. Unlike an adult, any child suffering a traumatic amputation should be considered for a possible replantation. Replantation should consist of minimal bone shortening to preserve epiphyseal plates, with repair of all severed structures. Longitudinal K-wires usually provide adequate fixation. Our survival rate for complete replantation in children under the age of 16 years is 77%. Long-term study showed that continued skeletal growth occurred and the digit attained 81% of normal longitudinal length at maturity. Recovery of sensibility in the replanted digit is nearly as good as for isolated digital nerve repair. Patient and parent satisfaction is high when replantation is successful, with uniform approval of the extensive effort required.

Bone Wires↗