Biomedical subjects
J H Roth
Publications and source records attributed to J H Roth.
Staple versus suture closure of skin incisions in a pig model.
The purpose of this study was to find out whether skin staple closure was a reasonable alternative to conventional nylon suture closure. Mechanical strength, histologic characteristics and time of closure were compared in skin incisions made on the backs of Yorkshire swine. The results showed that stapled and sutured wounds have similar mechanical strength up to 21 days. Stapled wounds are substantially narrower and are associated with less inflammation than sutured wounds. Staple closure is much less time-consuming than suture closure.
Healing of extra-articular angulated apex volar fractures of the distal radius.
Healed extra-articular angulated apex volar fractures of the distal radius are a relatively common orthopedic finding. The functional end-results of treatment of this injury are controversial. Twenty-nine patients with 34 fractures were reviewed by subjective and objective assessment, as well as radiologic examination. Some had unsatisfactory results. These poor results were associated with older age, poor anatomical reduction and, in some, the presence of a midcarpal instability pattern.
The effect of immobilization on goat knees following reconstruction of the anterior cruciate ligament.
Significant patellofemoral chondromalacia was observed three months after operations on goat knees that had an excised anterior cruciate ligament (ACL) replaced and then were immobilized for six weeks with a rigid external pin and frame fixator. To determine if the patellofemoral morbidity rate could be reduced, another group of goats was treated with the same operation but without immobilization. The legs of the animals in the immobilized group had muscle weakness and the animals only occasionally used their legs for the next three to four weeks. The animals in the mobilized group protected the leg for only one to two days after surgery, and by ten to 12 days were actively moving the knee. Severe patellofemoral articular cartilage erosions occurred in the immobilized goats but not in the mobilized group. Postoperative immobilization was detrimental to the joint function and to a successful ACL reconstruction.
Arthroscopic surgery of the wrist.
This article has presented the technique of wrist arthroscopy, reviewed the principles and strategy of arthroscopy, described arthroscopic wrist anatomy, compared wrist arthroscopy and arthrography, and illustrated several cases of arthroscopic wrist surgery. We have not discussed indications. More cases and careful follow-up studies must be performed before definite recommendations can be made. The authors are encouraged by their early achievement and believe that the future of arthroscopy of the wrist is exciting. The hand surgeon who performs wrist arthroscopy considers wrist patients to be among the most interesting. The authors believe that arthroscopic surgery will become as important diagnostically and therapeutically in the wrist as it has in the knee.
Arthroscopic lateral release for anterior knee pain: a study comparing patients who are claiming worker's compensation with those who are not.
The purpose of this retrospective study was to assess the outcome of arthroscopic lateral retinacular release comparing patients who are claiming worker's compensation with those who are not. Twenty-three consecutive patients with anterior knee pain caused by injuries on the job were matched with an equal number of patients with other kinds of injuries on the basis of age, sex, and medical history. A numeric scoring scale, physical examination, isokinetic strength analysis, performance in a one-leg hop test, and radiography of the knee formed the data base. Evaluation of the outcome was based on subjective and objective criteria developed from this data base. Results demonstrated that "compensation" patients had significantly poorer overall subjective outcome (50% good or excellent) compared with "noncompensation" controls (58% good or excellent). When objective criteria were applied, only 46% of patients in each group demonstrated a satisfactory outcome. Subjective variables and poor quadriceps function had a significant effect on final outcome. The extent of patellar cartilage pathology, radiographic incongruity, and closure of the release site demonstrated no effect on final outcome. "Compensation" patients with anterior knee pain were less likely to believe that they had improved following surgery when compared with control "noncompensation" patients.
Postural stability and Colles' fracture.
We have tested the hypothesis that the Colles' fracture is due, not simply to bone loss at the menopause, but to postural instability in a subset of postmenopausal women such that they are rendered more liable to fall. We have measured bone mass by dual photon spinal densitometry and single photon wrist densitometry and measured postural sway in 19 postmenopausal women with a history of Colles' fracture. Our results show that not only do Colles' fracture subjects have a small reduction in bone mass but they have a significantly increased degree of postural sway, a finding which has previously been recognized to characterize older subjects with recurrent falls.
Intra-articular reconstruction of the anterior cruciate ligament with and without extra-articular supplementation by transfer of the biceps femoris tendon.
In a retrospective study to determine whether the efficacy of intra-articular reconstruction of the anterior cruciate ligament is improved by an extra-articular transfer of the biceps femoris tendon, we compared the results in a group of forty-three patients in whom the advancement procedure had been done with those in a group of fifty patients in whom it had not. The minimum length of follow-up was twenty-four months. There was no significant difference between the two groups, and we concluded that advancement of the biceps femoris tendon does not improve the efficacy of an intra-articular reconstruction of the anterior cruciate ligament.
Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain.
The purpose of this prospective study was to compare arthroscopy with arthrography in the diagnosis of ulnar wrist pain. Thirty-seven consecutive patients with ulnar wrist pain but normal routine and stress radiographs had dynamic and static radiocarpal arthrograms (R.G.H.) and arthroscopy (J.H.R.) performed. Sixteen arthrograms demonstrated a leak of contrast into the distal radioulnar joint. Arthroscopy demonstrated a perforation of the triangular fibrocartilage complex in all 16. Seven arthrograms demonstrated a leak of contrast into the midcarpal joint. Arthroscopy demonstrated lunotriquetral instability in two and no abnormality in five. Seventeen arthrograms showed no abnormality. Arthroscopy confirmed no abnormality in nine but also demonstrated seven triangular fibrocartilage perforations and one case of isolated lunate chondromalacia. Arthroscopy findings were confirmed in eight patients who underwent a subsequent arthrotomy. Radiocarpal arthroscopy is superior to arthrography in the diagnosis of chronic ulnar wrist pain.
Experimental mechanical and histologic evaluation of the Kennedy ligament augmentation device.
Reconstruction of the knee with a chronic injury to the anterior cruciate ligament is an unsolved problem. Biologic graft substitutes have failed to maintain knee stability in the longer postreconstruction intervals. In an attempt to overcome the limitations in graft performance, synthetic materials have been proposed to augment the biologic tissue. In this study, a 6-mm polypropylene braid Ligament Augmentation Device (LAD) possessing a tensile strength of 1500 N and excellent fatigue and creep properties was investigated as an adjunct to the MacIntosh/Marshall Over-the-Top repair. A two-year animal study of 54 adult goats was conducted in which experimental ACL defects were created and reconstructed with a transplant consisting of a portion of the rectus femoris tendon, prepatellar tissue, and the central one-third of the patellar tendon. The goats were equally divided between nonaugmented and LAD-augmented groups and sacrificed at three, six, 12, and 24 months after surgery. Mechanically, the augmented transplants were substantially stronger at the time of initial implantation (364N versus 26N) and again at two years (841N versus 528N). Intermediate times did not demonstrate a difference in strength. Histologically, the augmented transplants consisted of a loosely organized fibrous capsule surrounding the LAD. At 24 months, "insertion fibers" were noted to provide continuity between the fibrous tissue and bone on both the tibia and femur.
The results of replantation after amputation of a single finger.
We reviewed fifty-nine consecutive cases of patients who had replantation of a single finger (excluding the thumb) after traumatic amputation, with an average follow-up of fifty-three months. Fifty-one (86 per cent) of the replanted fingers survived. Survival was found to be affected by the age of the patient, the number of vessels that were anastomosed, and the replantation experience of the surgeons. The survival rate was not affected by the gender of the patient, the mechanism of injury, or which finger was amputated. As compared with survival only, the functional results were most dependent on the level of amputation. The proximal interphalangeal joint in amputated fingers that were replanted distal to the insertion of the flexor superficialis tendon had an average range of motion of 82 degrees after replantation, while those amputated proximal to the insertion had an average range of motion of only 35 degrees after replantation. The average operating time was six hours and ten minutes, and the average time until the patient returned to work was 2.3 months. Based on this experience, it is our opinion that replantation of a single finger that was amputated distal to the insertion of the flexor superficialis tendon is justified, but that replantation of a single finger that was amputated proximal to this insertion is seldom indicated.
Comparison of suture ligation, bipolar cauterization, and hemoclip ligation in the management of small branching vessels in a rat model.
In elective microsurgical procedures, it is necessary to occlude small branches when mobilizing vessels in obtaining vein grafts. The purpose of this study was to evaluate the relative merits of suture ligation, bipolar cauterization, and hemoclip ligation, and to determine the minimum safe distance of occlusion. The left inferior epigastric vein and the right profunda femoris artery were ligated under operating microscope magnification with 10-0 nylon suture, small hemoclip, or bipolar cauterization at distances of 0, 1, or 2 mm from the parent vessel in 75 rats. Suture ligation was significantly better than bipolar cauterization (p less than .01) and hemoclip ligation (p less than .001). All cauterization failures occurred at 0 and 1 mm. Hemoclip failures occurred at all three distances. In the management of small branching vessels: suture ligation is safe at 0, 1, and 2 mm; bipolar cauterization is safe at 2 mm; and hemoclip ligation is unsafe.
Office diagnosis and treatment of hand pain.
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How hospital consolidations affect revenues.
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Private practice: nutritional counseling. IV. Forming a local committee on independent clinical practice.
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Distal radius fracture: a prospective outcome study of 275 patients.
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Interrater reliability of pinch and grip strength measurements in patients with cumulative trauma disorders.
The purposes of this study were to examine the interrater reliabilities of grip, lateral pinch, and tripod pinch measurements in patients with cumulative trauma disorders. Thirty-eight patients with unilateral (n = 28) or bilateral (n = 10) cumulative trauma disorders were tested independently by two hand therapists, during a one-hour period. The tests were completed in a normal hand clinic environment using the standard protocol recommended by the American Society of Hand Therapists. Interrater reliability coefficients for the scores obtained using either a single repetition or the mean of three repetitions were very high (intraclass correlation coefficient [ICC] > 0.87) for all strength measurements. As a result, strength determination in this patient group, when performed by different hand therapists, may be considered reliable.
Decision making in detecting abnormal Semmes-Weinstein monofilament thresholds in carpal tunnel syndrome.
Both hands of 39 patients who had symptoms of pain and/or numbness in one or both hands were tested by two hand therapists using the full kit of Semmes-Weinstein monofilaments (SWMFs). The SWMF thresholds were obtained for the thumb, the index finger, and the long and small fingers. These thresholds were classified as normal or abnormal based on four decision rules and two criterion measures. Decision rules were based on whether SWMF 2.83 or 3.22 would be the best limit of normality, and whether the small finger should be used for within-subject comparisons. The criterion measures were the highest threshold of all three radial digits and the highest threshold of the long finger alone. Intertherapist agreement on normality was fair to moderate (kappa = 0.22-0.51), varying according to decision rules and criterion measures. Reliability was higher when the additional comparison with the small finger was omitted. High accuracy in identifying cases of carpal tunnel syndrome (CTS) was possible, but accuracy varied moderately between testers and greatly according to decision rules and criterion measurements. The best overall accuracy (81%-82% sensitivity and 57%-86% specificity) was achieved when SWMF 2.83 was used as the upper limit of normality and the small finger was used for within-subject comparison, and when data from the long finger alone were used for decision making.