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Biomedical subjects

J H Roth

Publications and source records attributed to J H Roth.

At least 37 records · Page 2Linked to original sources
PubMed1995

In-vitro strength of flexor-tendon repairs.

OBJECTIVE: To compare the standard Tajima technique for flexor-tendon repair of the hand with three new techniques with respect to strength and technical ease of the repair and bulk at the repair site. DESIGN: A randomized analysis of human cadaver flexor digitorum superficialis tendon repairs. SETTING: A musculoskeletal research laboratory at a university-affiliated health centre. MATERIAL: Thirty-nine fresh-frozen cadaveric flexor digitorum superficialis tendons from index, long and ring fingers harvested and divided transversely. The tendons were randomly allocated for repair by the current standard technique or one of three new techniques. INTERVENTIONS: The standard Tajima (modified Kessler) technique, and the Halsted, Savage or Silfverskiold technique. MAIN OUTCOME MEASURES: The time to perform each repair, the cross-sectional dimension and the load to failure of the tendon repairs. RESULTS: The Savage repair tolerated the highest loads, followed by the Halsted, Silfverskiold and Tajima repairs. The Silfverskiold technique was the least time-consuming to perform, followed by the Tajima, Halsted and Savage repairs. All of the techniques increased the cross-sectional dimensions of the tendon: the Silfverskiold repair by at least 50% and the Savage repair by over 100%. Although none of the techniques tested performed ideally, all three new techniques provided greater initial static strength than the standard Tajima method. CONCLUSION: Further in-vitro and in-vivo studies of these new techniques of flexor-tendon repair of the hand are necessary to optimize the treatment of these injuries.

Biomechanical Phenomena↗
PubMed1995

Arthroscopic treatment of triangular fibrocartilage tears.

Lesions of the TFCC are more frequently implicated as a cause of ulnar-sided wrist pain. Accurate diagnosis of TFCC pathology must be based on a thorough history and physical examination. Imaging modalities of particular use include plain radiographs, triple compartment arthrography, and MR imaging. The most sensitive and accurate diagnosis of the extent as well as the clinical significance of intra-articular pathology on the ulnar side of the wrist is by means of the arthroscope. With the advent of smaller and more elaborate arthroscopic instrumentation, the ability to perform arthroscopic surgery on the TFCC has dramatically increased over the past decade. The present arthroscopic treatment of traumatic central and radial lesions consists of debridement of unstable flaps, whereas dorsal and ulnar-sided lesions can be directly repaired. Centrally located degenerative perforations can be debrided in conjunction with an arthroscopic wafer procedure on the distal ulna.

Arthroscopy↗
PubMed1995

The role of arthroscopy in arthritis. "Ectomy" procedures.

Advances in arthroscopic techniques and instrumentation have enabled the surgeon to extend the therapeutic possibilities of wrist arthroscopy. The introduction of suction punches and smaller, lighter motorized resectors and burrs have facilitated the arthroscopic removal of bone and soft tissue. Arthroscopy provides the surgeon with a magnified view of all intra-articular structures, including those areas difficult to access via an arthrotomy. With the new instrumentation and the excellent views, bone and soft tissues can be resected with precision. Now the wrist arthroscopist can effectively perform a synovectomy; debride a torn TFC, chondral defects, and osteoarthritis; remove loose bodies; and resect the distal ulna and carpal bones. The surgeon should follow the anatomic principles that have been developed for open surgical procedures. Arthroscopic surgery is minimally invasive, hence patients rehabilitate quickly with fewer complications. "Ectomy" surgery of the wrist requires a higher level of skill from the surgeon but, when mastered, provided considerable benefit to the patient.

Arthritis↗
PubMed1994

Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis.

We assessed the functional results of simultaneous proximal carpal carpectomy and radius to distal carpal row arthrodesis. A retrospective review of patients undergoing wrist arthrodesis for degenerative joint disease was performed. Patients with rheumatoid arthritis or spastic hemiplegia were excluded. Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis was performed in 38 patients using AO plates and 3.5 mm diameter screws. The mean follow-up time was 16 months, the fusion rate was 100%, and the average grip strength was 24 kg force or 79% of the contralateral hand measured at 10 degrees wrist extension. Patients with three or more screws placed in the metacarpal had significantly more plate-related complications and a higher rate of plate removal than those with two screws distally. Simultaneous proximal row carpectomy and radius to distal carpal row arthrodesis did not decrease the postoperative grip strength.

Adult↗
PubMed1994

Endoscopic carpal tunnel release.

OBJECTIVE: To assess the efficacy and safety of a new technique for carpal tunnel release. DESIGN: A single-group prospective cohort study. SETTING: A referral-based hand-surgery university practice. PATIENTS: Ninety-five consecutive adults; 1 patient was excluded (35 men, 59 women). They underwent 108 surgical procedures. No patients were lost to follow-up. INTERVENTIONS: Endoscopic carpal tunnel release. Outpatient surgery with neuroleptic anesthesia. Two-portal Chow technique of release. MAIN OUTCOME MEASURES: Symptom relief, return to work, medication use and complication rate. RESULTS: The average preoperative duration of symptoms was 3.9 years. Nerve conduction studies were positive in 101 of the 108 hands. Only two patients required open release. Only eight patients complained of intraoperative pain. Six patients failed to obtain relief of symptoms; two of them required secondary open release owing to persistent symptoms. Of the 61 patients who were employed, 52 returned to their previous jobs without restriction. The mean time for return to work was 36.4 days for patients who were Workers' Compensation Board cases and 19.5 days for patients who were not (p < 0.01). Men returned to work in 17.7 days and women in 24.7 days (p < 0.05). Complications occurred in four patients (3.8%). No nerve injury, vascular injury or reflex sympathetic dystrophy was noted. Patients who had undergone previous contralateral open release noted less pain and earlier return to work after endoscopic carpal tunnel release. CONCLUSIONS: Endoscopic carpal tunnel release was effective in relieving symptoms and had a low complication rate. The technique was associated with early return to work and minimal palmar pain.

Adult↗
PubMed1993

Functional outcome of upper limb tendon transfers performed in children with spastic hemiplegia.

Children with spastic hemiplegia often present with upper limb muscle imbalance. The purpose of this paper was to determine whether reconstructive surgery improved their functional ability. 17 children under the age of 16 years with spastic hemiplegia underwent reconstruction that included tendon transfers, tendon lengthenings and thumb metacarpophalangeal fusion. They were assessed pre-operatively and at an average follow-up period of 2.6 years. Children's abilities were classified according to House's functional rating scale. Tendon transfers improved functional grading by two grades, from good passive assist to fair active assist. Improvement in the arc of wrist motion and forearm rotation was also seen. Parental satisfaction was high. Reconstructive surgery improved the functional abilities in this group of children with spastic hemiplegia.

Adolescent↗
PubMed1993

Ulnar artery palmar to palmaris brevis: cadaveric study and three case reports.

Three cases in which the ulnar artery was palmar to the palmaris brevis muscle at the level of the wrist are described and the results of a cadaveric study are presented. The anomaly was confined to the level of Guyon's canal with a normal position of the artery proximally in the forearm and distally in the palm. In spite of its superficial location, the artery was patent in all patients and no symptoms referable to the ulnar artery were present. The ulnar nerve was found dorsal to the palmaris brevis in Guyon's canal in all three patients. An accessory muscle was found in one patient, but no other anatomic anomalies were seen. A cadaveric study of 43 limbs revealed a similar anomaly of the ulnar artery in 1 cadaver. In the presence of this anomaly the ulnar artery may be at increased risk during surgical exploration of Guyon's canal. Exposure of the artery in the forearm prior to exploration of Guyon's canal is recommended.

Cadaver↗
PubMed1993

Use of the external fixation apparatus for percutaneous insertion of pins in the distal one-third of the radius: an anatomic study.

OBJECTIVE: To assess the risk of soft-tissue injury during percutaneous placement of external fixation pins in the proximal radius. DESIGN: An anatomic study with embalmed cadaver limbs. SETTING: Hand and upper limb centre at a university-affiliated hospital. INTERVENTIONS: Two 4-mm Hoffman half pins were percutaneously placed along the dorsoradial ridge of the radius, four finger breadths proximal to the radial styloid process. MAIN OUTCOME MEASURES: Injuries to soft tissues including tendons, nerves and vessels were noted. RESULTS: Nerve or tendon injuries occurred in 7 of 26 forearms. Three pins transfixed either the superficial branch of the radial nerve or lateral antebrachial cutaneous nerves. Tendon injuries included the brachioradialis in two forearms, the extensor carpi radialis brevis in three forearms, and the extensor carpi radialis longus and the abductor pollicis longus in one forearm each. CONCLUSIONS: Percutaneous pin placement in the distal radius is unsafe. The authors recommend open pin placement for fractures of the distal radius.

Bone Nails↗
PubMed1993

Pin-site radioulnar synostosis after external fixation of a distal radial fracture: two case reports.

Complications of distal radial fracture and external fixation are common, but the authors report, in two patients, a previously unrecognized complication, that of radioulnar synostosis. In both cases the proximally placed pins extended across the interosseous region, and the distal ends were adjacent to the ulna. Hematoma and osseous debris were introduced into the interosseous region. Several weeks after the external fixator was removed, the patients were noted to have a restricted range of pronation and supination. A radioulnar synostosis had formed across the interosseous region. Resection of the synostosis restored pronation and supination. With careful pin placement this complication will be avoided.

Adult↗
PubMed1991

Radial shortening osteotomy for treatment of Kienböck's disease.

Sixteen patients who had radial shortening osteotomy for treatment of Kienböck's disease were reviewed. Ulnar minus variance averaged 3.3 mm. All patients had conservative management that failed. Six were stage II, six were stage III, and four were stage IV. Average follow-up was 4.5 years. In all patients osteotomies united within 3 months. Thirteen patients were totally relieved of pain, and three had mild pain. Motion in the dorsal palmar plane improved, on average, 15 degrees. Grip strength increased 20% to 30% after the operation. Follow-up radiographs did not show continued collapse of carpal height or disease progression except in one patient. No radiographic evidence of degenerative changes at the distal radioulnar joint materialized. As a safe, reliable, and consistently successful method of managing Kienböck's disease, we strongly recommend radial shortening. Excluding the rare extended stage IV disease in which midcarpal arthritis with or without intercarpal instability is present, we have successfully applied this technique to all stages of Kienböck's disease. We recognize that further collapse and progression of disease may occur in stage III and IV disease, as was evident in one patient 5 years after osteotomy.

Adult↗
PubMed1991

A preliminary study of magnetic resonance relaxation times (T1 and T2) in inflammatory and degenerative synovial fluids.

Multiple synovial fluid samples from 21 patients were analysed using standard synovial analysis techniques and by nuclear magnetic resonance spectroscopy. Significant negative correlations were noted between both T1 (P less than 0.01) and T2 (P less than 0.0006) relaxation times and synovial fluid total protein. No differences in T1 or T2 relaxation times were noted in synovial fluid between 16 patients with inflammatory forms of arthritis and five patients with degenerative arthritis. In a single rheumatoid arthritis patient with concurrent staphylococcal arthritis, T1 and T2 relaxation times did not vary between the active phase and the recovery phase. The lack of any significant differences in the measured relaxation times as a function of joint condition suggest that in vivo magnetic resonance measurements of T1 or T2 for joint analysis may not reveal information of either a diagnostic or pathophysiological nature.

Analysis of Variance↗
PubMed1990

Arthroscopic "-ectomy" surgery of the wrist.

Arthroscopic surgical techniques are well suited for the removal of diseased tissue. This article illustrates anecdotally some of the feasible arthroscopic "-ectomy" procedures of the wrist: centrum excision of the triangular fibrocartilage complex following injury; synovectomy in the management of wrist rheumatoid arthritis; proximal row carpectomy for degenerative arthritis; and hemiresection of the distal ulna.

Arthroscopy↗
PubMed1990

Use of laser Doppler flowmetry to determine blood flow in and viability of island axial pattern skin flaps in rabbits.

Perfusion and viability of island axial pattern skin flaps were tested in 37 healthy New Zealand white rabbits, using laser Doppler monitoring of blood flow in the capillary loops and the subpapillary plexus of the dermis. Skin flaps, selected on the basis of the caudal superficial epigastric vein and artery, were lifted and replaced in their original locus after selective occlusion of their vascular pedicles. Subjects were allotted into groups: control group (n = 10); arterial occlusion (n = 7); venous occlusion (n = 10); and arterial and venous occlusion (n = 10). The rabbits were monitored from 48 hours before surgery until euthanasia 48 to 72 hours after replacement of the flap. Flap viability was assessed on a clinical basis, using a comparative scoring method based on a numeric scale. The degree of necrosis in histologic sections was evaluated, using a scoring system. Laser Doppler measurements were obtained on 3 consecutive days before surgery, to establish the normal basal blood flow in the skin. Postsurgical measurements were obtained at 2-hour intervals for the first 8 hours and at 24, 48, and 72 hours after surgery. Measurements of basal blood flow varied significantly (P less than 0.05) from site to site on the surface of individual flaps and over time. When laser Doppler flowmetric (LDF) measurements from 6 sites on a flap were used as a measure of laser Doppler flow for the total flap, there was no significant difference between contralateral flap areas outlined on the abdomen of the rabbits. Temporal variations over 3 days for each rabbit or among rabbits were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Intramedullary rod fixation of femoral shaft fractures: comparison of open and closed insertion techniques.

Meta-analysis of published series of intramedullary rod fixation in fractured femurs revealed significantly higher union rates, lower deep infection rates and a better range of knee motion when closed rather than open techniques of insertion were used. A separate retrospective review of 58 femoral fractures at one hospital showed outcomes consistent with those reported in the literature; these results were obtained during a 6-year period when staff were learning closed techniques. Technical failures of the closed technique can be avoided by paying attention to well-established operative details. A system for grading outcomes was developed to compare objectively the results of treatment of fracture patients. The literature and the authors' experience support the adoption of closed techniques for intramedullary rod insertion in femoral shaft fractures.

Adolescent↗
PubMed1988

Hand instrumentation for small joint arthroscopy.

This is the second in a series of articles on arthroscopy of small joints. Hand instrumentation for small joint arthroscopy has been adapted from instruments previously developed for large joint arthroscopy. They have been downsized and altered for use in the smaller confines of joints such as the radiocarpal, temperomandibular, and midcarpal articulations. Although smaller, the instruments must remain strong and easy to use. Each instrument should perform a simple function. Their shape must conform to the joint and they should be smooth to minimize the risk of articular cartilage damage. We have found several instruments that have been helpful in arthroscopic surgery of the wrist.

Arthroscopes↗