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Biomedical subjects

J W Littler

Publications and source records attributed to J W Littler.

At least 19 recordsLinked to original sources
PubMed1992

Injection injuries to the median and ulnar nerves at the wrist.

Carpal tunnel syndrome is often treated nonoperatively with temporary wrist immobilization and local steroid injections. A direct injection into a peripheral nerve can result in permanent damage. Two cases of median nerve injection injury and one involving the ulnar nerve are presented; all were treated with neurolysis and debridement of the injected material. At follow-up ranging from 1 to 11 years, all patients showed significant improvement, but with some functional loss. The literature is confusing because of the variety of injection techniques used for the treatment of carpal tunnel syndrome, some of which put the median nerve at risk. We recommend that the injection be made midway between the palmaris longus tendon and the flexor carpi ulnaris tendon just proximal to the proximal edge of the transverse carpal ligament in a line with the superficialis tendon of the ring finger. The injection should be stopped and redirected if the patient experiences paresthesia of any kind.

Adult↗
PubMed1992

Trapeziometacarpal joint injuries.

This article begins with discussions of anatomy and thumb movement. Palmar (anterior) ligament reconstruction is then discussed. Peritrapezial arthritis is also discussed.

Anatomy↗
PubMed1990

Surgical treatment of infections and lesions of the perionychium.

This article will discuss acute and chronic bacterial, viral, and fungal infections involving the perionychium. Special emphasis will be placed on the surgical treatment of these entities including the surgical approach to subungual tumors and the technique of total onychectomy.

Acute Disease↗
PubMed1988

[Dissection technic for the superficial flexor tendon of the ring finger].

Raising of the superficial flexor of the ring finger for tendon transfer may leave major sequelae, especially if the blood supply of the deep tendon is damaged. For this reason, the authors stress two important points: raising of the flap proximal to the chiasma to avoid damage to the blood supply of the deep tendon, stepped section for opening of the tendon sheath to prevent any mechanism of adherence. The intersection should be followed by gentle traction by means of a splint.

Dissection↗
PubMed1985

Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb.

Arthrosis of the trapeziometacarpal joint of the thumb is a predictable sequelae of ligament laxity. A new technique of tendon interposition arthroplasty with ligament reconstruction using the flexor carpi radialis tendon for a painful arthritic trapeziometacarpal joint of the thumb is described. Twenty-one patients had 25 operative procedures; 14 were women and seven were men. All of the patients presented with intractable pain, crepitus, and varying degrees of laxity of the basal joint. Pinch strength was diminished. Follow-up averaged 37 1/2 months. After surgery, 91.7% of patients had good to excellent results, and 56% were completely pain free. Range of motion and grip and pinch strengths were equal on the operated and unoperated sides.

Adult↗
PubMed1984

Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment.

An extra-articular ligament reconstruction to stabilize the thumb carpometacarpal (CMC) (basal) joint by routing a portion of the flexor carpi radialis (FCR) through the base of the thumb metacarpal has been performed on more than 100 patients since 1967. This study reviews the first 50 consecutive reconstructions with an average follow-up of 7 years. Intractable pain was the primary indication for surgery. Each joint was examined both pre and postoperatively and rated as a stage I through stage IV according to the radiographic appearance. Of the patients with zero or minimal articular changes (stages I and II), 95% achieved good or excellent results because of having little or no postoperative pain. Of the patients with moderate to advanced degenerative changes (stages III and IV), 74% achieved good or excellent results. All stage I cases and 82% of stage II cases were free of recognizable degeneration on follow-up radiographs up to 13 years postoperatively. These findings suggest that ligament reconstruction that is now recommended only for stage I or stage II disease will restore stability, reduce pain, and possibly even retard joint degeneration in a large proportion of patients with painful instability of the thumb CMC joint.

Finger Joint↗
PubMed1979

Primary care of the injured hand, part 1.

Because the hand is the most frequently injured part of the body, primary recognition of injured structures, careful assessment of damage, and appropriate treatment or referral by the primary care physician are critical. Most fingertip injuries heal with conservative care. Ideally, the healed wound should be covered with well-padded skin, be free of scar tissue, and not adhere to underlying bone. Crushing fingertip injuries associated with underlying fractures are often overlooked initially, with resultant infection, nonunion, and nail deformity. In the evaluation of flexor tendon injuries, recognition of the location of severed tendon is critical. Improved surgical techniques, when performed by an experienced hand surgeon, have yielded gratifying results, especially in the primary repair of tendon severance in the distal portion of the digit and palm. Mallet deformities at the distal interphalangeal joint are treated with extension splinting for minimum of six weeks without immobilization of the proximal interphalangeal joint. Open reduction is often required when an associated fracture involves more than 30% of the articular surface.

Amputation, Traumatic↗
PubMed1979

Primary care of the injured hand, part 2.

Nerve injuries in the forearm and hand are common, especially with concomitant tendon lacerations. The optimal time for repair of a clean sharp laceration is within the first 24 to 48 hours using magnification to achieve precise surgical reapproximation. Transfer to a facility equipped to perform replantation is indicated for multiple digit amputations, any thumb amputation, transmetacarpal amputation, wrist and arm amputation, and major amputations in children. Acute paronychial infections are treated with warm soaks, antibiotics, elevation, and immobilization. Surgical drainage is often indicated for a felon and should be done through a high midaxial incision. fractures of the hand are extremely common and require accurate diagnosis and precise anatomic reduction. Ensheathment syndromes--carpal tunnel syndrome, trigger finger, de Quervain's disease--are the most common nontraumatic disorders of the hand. If recognized and treated early they may resolve without need for surgery.

Abscess↗
PubMed1978

The spiral oblique retinacular ligament (SORL).

A procedure is described for reconstruction of the oblique retinacular ligament using a small tendon graft in a spiral fashion to act as a dynamic tenodesis to restore distal interphalangeal extension and to restrain proximal interphalangeal hyperextension. The method has been uniformly successful in the treatment of post-traumatic "swan-neck" or "mallet" deformity. Although the concept is simple, the procedure demands thorough understanding of digital anatomy for successful completion.

Adolescent↗
PubMed1977

Abduction-pronation and recession of second (index) metacarpal in thumb agenesis.

Thumb dysplasia imposes a proportionately greater functional deficit than does dysplasia of any other digit. To simulate an opposable unit, the child with but four normal fingers naturally will turn to the next most radial (index) digit and by abducting and pronating will widen his first cleft. When the thumb is absent bilaterally, formal neurovascular pollicization of at least one index digit is the logical choice. The inherent deficiencies in formal pollicization, however, may detract from its use in certain instances, for example, unilateral thumb aplasia or thumb aplasia associated with radial club hand. A simpler procedure performed at age 3 or 4 years avoids many of these deficiencies while still creating a more functional pinch and grasp. Through a small web incision, the index metacarpal is separated from the adjacent metacarpal. The base of the index metacarpal is sectioned and shortened 1.5 cm. The digit is recessed, rotated and abducted radially and palmarly, then immobilized by a K-wire fixation to its base. Since 1960, 17 procedures have been performed with good functional results and acceptable appearance.

Bone Diseases, Developmental↗
PubMed1977

Ununited fracture of the hook of the hamate.

Of nine ununited fractures of the hook of the hamate, eight were treated by surgical excision of the fragment. All eight patients had relief from persistent pain and regained the preinjury level of function. This fracture occurs frequently in athletes and is often not diagnosed because it can be demonstrated only by special roentgenographic views. It is concluded that this fracture may be less rare than is commonly believed and that surgical excision permits early return of function, especially in athletes and laborers who must be able to grip hard objects strongly.

Adult↗