Biomedical subjects
Publications and source records attributed to J B Bennett.
We have used the pelvic Hoffmann technique successfully on two patients requiring flap coverage and have had no difficulty with its management nor complications with the pelvic pin fixation. We feel that this type of fixation provides significant advantages for the treatment of hand and forearm injuries requiring flap coverage for avulsing injuries to the hand and wrist.
Hand injuries and disorders constitute a major cause of disability and time lost from work. Viewed as relatively minor, they are often neglected until permanent disability and restriction of function occur. The first physician to evaluate and treat an injured hand often determines the ultimate outcome of the patient's hand function. Skillful diagnosis and appropriate treatment are necessary. Neglected or mistreated injury may result in significant impairment in a person whose livelihood depends on the skillful, integrated function of both hands.
Recent advances in the treatment of comminuted distal radial fractures has led to the use of pins and plaster, a concept described by many authors. This paper examines whether the use of pins and plaster maintains reduction of distal comminuted radial fractures, and, if so, if it is accomplished with a minimum of complications. With follow-up ranging from 1 month to 1 year following pin removal, 80 consecutive comminuted distal radial fractures treated with pins and plaster were analyzed for change in fracture reduction, associated injuries, and complications incurred during and as a result of the treatment mode. Thirty-three percent of our patients had some complications due to their pins and 16% required reoperation for carpal tunnel syndrome or replacement of loose pins, sequestrectomy, or extended treatment in long arm casts.
Carpal tunnel compression and its surgical release has been well described. Motor branch anomalies of the median nerve have also been documented in the literature. Independent recurrent motor branch compression of the median nerve appears to exist in the presence of carpal tunnel symptomatology or as an independent entity. Eight presentations of concomitant or independent compression of the recurrent motor branch of the median nerve have been reviewed. These cases can be subdivided into cases presenting with or without carpal tunnel symptomatology, as well as into two types of independent compression patterns: the first being a direct fascial penetration and entrapment and the second being an acute angulation of the recurrent branch with apparent impingement by the transverse carpal retinaculum. Attention should be directed to the inspection and decompression of the motor branch of the median nerve in those cases that present thenar muscle pathology either clinically or electrodiagnostically.
Immobilization of fractures associated with instability and comminution by an external skeletal device facilitates wound care, skin coverage, and ultimate reconstructive surgery. External skeletal fixation was applied in 20 patients who sustained complex open injuries of the upper extremity. All injuries were associated with extensive soft tissue and skin defects. Associated neurovascular injuries included 14 nerve injuries and five major vascular injuries. The Hoffman fixation device was used in the majority of cases. Skin coverage was obtained in all patients by an appropriate method of skin grafts, pedicle flaps, and a free myocutaneous flap. Primary bone union was achieved in five of 16 patients. Ten of 16 patients required secondary procedure to obtain union in cases of delayed union or nonunion, and one case remained with a nonunion. Pin tract infection in three patients and osteomyelitis in two patients were effectively treated with antibiotics and appropriate surgery. The initial treatment goals of limb salvage, skin coverage, and bone stabilization without drainage or persistent osteomyelitis can be accomplished by the use of external skeletal fixation devices.
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Stability or instability of the elbow is contingent upon three distinct but interrelated conditions: radiocapitellar articular continuity, coronoid process integrity and medial collateral ligament competency through an intact anterior oblique ligament. The latter, the anterior oblique ligament of the medial collateral ligament both in anatomic experimentation and clinical cases appears to be the most critical factor in elbow stability. The reconstruction of the unstable elbow must focus on this medial supporting ligament for a predictable result.
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Arthrogryposis multiplex congenita is a rare congenital disorder in which the extremities are affected with severe resistant musculoskeletal contractures. In the upper extremity, these deformities typically consist of internal rotational contractures of the shoulder, extension deformity of the elbow, flexion and ulnar deviation of the wrist, thumb-in-palm deformity, and digital interphalangeal joint flexion contractures occurring singularly or in combination. At the Houston Unit of the Shriners Hospital for Crippled Children, during the interval from 1962 to 1982, 25 patients underwent 56 operative procedures to correct upper-extremity deformities due to arthrogryposis multiplex congenita. Functional improvement was observed clinically and reported subjectively by the patients or their parents in 75% of the cases.
The managed care community and employers have expressed interest in substance abuse prevention, but there has been little consensus about which prevention and health promotion activities are most appropriately provided in the workplace. In the past 5 years, academicians have become increasingly interested in working with healthcare organizations to develop and implement short- and long-term research partnerships. The most helpful prevention research will serve mutual interests and produce mutual benefit. This article presents a preliminary guide to help facilitate greater collaboration among managed behavioral healthcare organizations, employee assistance programs, and health services researchers interested in preventing substance abuse in the workplace. This guide identifies broad objectives, topic areas, critical applications, and assumptions that can guide collaborative efforts in prevention research.
Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome. Recent presentations by Ellman suggest that an effective acromioplasty may be performed arthroscopically. These clinical reports have not been supported by any laboratory experience. The purpose of our study was to examine the feasibility and attempt to quantitate the results of arthroscopic subacromial decompressions. Six acromioplasties were performed according to the recommended technique of Dr. Neer to create a standard for comparison. Fourteen fresh postmortem specimens were studied. In seven shoulders a standard acromioplasty was performed with an osteotome. In seven shoulders an acromioplasty was performed using standard arthroscopic approaches and motorized instruments. In five shoulders an isolated division of the coracoacromial ligament was performed arthroscopically. The coracoacromial ligament was completely divided in all five cases. In the osteotome group adequate bone was resected in 75% (21/28) measured locations. In the arthroscopic group adequate bone was removed at 86% (24/28) location. This difference is not statistically significant. In the cadaver, anterior acromioplasty was performed effectively and predictably with arthroscopic instruments. This compared favorably to a conventional osteotome acromioplasty. It was concluded that coracoacromial ligament division can be accomplished.
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The anterior oblique component of the medial collateral ligament of the elbow is the mainstay of joint stability. Fractures of the medial epicondyle must be anatomically reduced, open if necessary. A fibrous union of a minimally displaced fractured medial epicondyle may result in lengthening and functional compromise of the medial collateral ligament. Chronic elbow instability is an unusual lesion. Repair of chronic elbow instability is best performed by restitution of medial collateral ligament function.
We performed a retrospective review of finger syndactyly releases at Shriners Hospital for Children, Houston Unit, between January 1983 and January 1993. This study was performed in an attempt to compare the long-term postoperative function in patients after release of syndactyly resulting from Poland's syndrome with that in patients with idiopathic forms of syndactyly. Only patients with one involved hand were included in this study. The contralateral hand was used as a control. Twenty-seven patients with only one hand involved underwent syndactyly release during this period. Of these, 13 patients who underwent a total of 30 syndactyly releases were available for evaluation. For each patient, the type of syndactyly was determined. Each patient was subjected to a detailed physical examination and participated in occupational-therapy modalities. We noted statistically significant differences in function between operated-on and control hands in the Poland's group, whereas operated-on hands affected with idiopathic forms of syndactyly did not demonstrate significantly different function compared with contralateral controls. These data suggest that functional deficits in hands affected by Poland's syndrome are attributable to more than the syndactyly alone. Hands affected by idiopathic forms of syndactyly are likely to have little postoperative functional deficit.