Biomedical subjects
Publications and source records attributed to L K Ruby.
A 41-year-old man who was taking 60 mg of prednisone a day for dermatomyositis developed a wound dehiscence following a carpal tunnel release and flexor tenosynovectomy. Coverage of the exposed carpal contents was provided by using the abductor digiti minimi as a local transposition flap.
This study measured the diameter of the arteries at the level of the diaphysis of the proximal phalanges of the index, long, ring, and small fingers. We measured the diameter of the vessel on ten normal arteriograms and on six amputated specimens. The larger vessel was usually on the ulnar border of the index and long fingers and on the radial border of the ring and small fingers. By the Hagen-Poiseuille equation, we assume that the larger vessel has the greater flow and, therefore, represents the dominant vessel to the digit. This observation may have clinical relevance in the reimplantation and revascularization of digits.
Although the scapholunate interosseous ligament has been studied anatomically and functionally by several investigators, its exact role in wrist kinematics is still controversial. We designed and executed an experimental study with four cadaver specimens to compare various carpal motions before and after section of this ligament. Our results suggest that injury to this structure significantly changes carpal motion especially between the scaphoid and lunate.
Patients with old scaphoid nonunion have a high risk of developing wrist arthritis. Although some patients remain asymptomatic, some will have pain sufficient to seek treatment. There are several treatment options available. The authors prefer wrist arthrodesis for most of these patients.
Three patients exhibiting acute onset of proximal forearm pain and muscle weakness are reviewed. After nonoperative therapy failed, surgical exploration revealed compression of the median nerve at the level of the lacertus fibrosus. All three patients experienced complete recovery after release of the lacertus fibrosus.
Juvenile rheumatoid arthritis seldom involves the small joints of the hand. We are reporting three patients with proximal interphalangeal joint synovitis as the initial manifestation of juvenile rheumatoid arthritis. This form of presentation of the disease should be recognized so that treatment will not be unduly delayed especially for the ophthalmologic manifestations of juvenile rheumatoid arthritis.
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Multiple level amputation has been described as a contraindication to replantation. This is a case report of a patient with a double level amputation through the palm and forearm that was successfully replanted. Because of the need for multiple stages of reconstructive surgery, it was not clear until the end result that the replantation was worthwhile. The patient developed an acute respiratory distress syndrome that was probably caused by the reperfusion phenomenon. The stages of reconstruction are described in detail, as are the problems encountered. The final result included a reasonably functional hand that was far superior to the prosthetic alternative.
Ten patients with moderately to severely displaced supracondylar fractures were retrospectively reviewed. All were treated with skeletal traction with the arm positioned at the side. As a result of this treatment, eight of the ten patients had an excellent result, with restoration of both full range of motion and normal carrying angle.
We report our continuing experience with the rat epigastric free vascularized flap as a transplant model. Four groups of ten pure-bred rats underwent transplantation of epigastric vessel based skin flaps. The flaps were immediately revascularized in the recipient animal and the results recorded. No immunologic manipulation was performed. Rejection and acceptance of the flaps occurred according to known genetic predictions in these 40 procedures. This study will serve as a control for immunologic manipulation experiments.
A review of all cases of osteoid osteoma of the hand seen by four hand surgeons over the last 10 years was performed. Seven cases were documented. Average follow-up was 28.3 months. Average age of the patients was 21.1 years. Five men and two women participated. Six lesions were in the right and one in the left upper extremity. Delay from presenting symptoms to definitive treatment averaged 13.5 months with a range of 7 to 30 months. Surgical excision was curative in all cases. We concluded that although a very unusual occurrence, osteoid osteoma of the hand should be considered in the differential diagnosis of pain in the hand.
A boy with bilateral idiopathic congenital carpal tunnel syndrome was first seen at the age 4 years 6 months. He presented with triggering of the finger flexors at the wrist, abnormal posturing of the fingers and inability to pinch on one side. The triggering was relieved by transection of the transverse retinaculum. Pinch was restored by a tendon transfer. There have been no previous reports of idiopathic carpal tunnel syndrome present since birth. The literature and case are reviewed.
We reviewed the cases of fifty-six scaphoid non-unions in fifty-five patients, none of whom had received treatment of any kind before examination. In the thirty-two patients who had been injured five years or more earlier, arthritis developed in thirty-one (97 per cent). The one patient in whom osteoarthritis developed less than four years after injury also had avascular necrosis of the scaphoid. The incidence of osteoarthritis increased with time after injury. We concluded that patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop.
We have described the advantages and disadvantages of using the rat epigastric free flap as a means of studying transplantation phenomena. The study comprises 20 epigastric free flap autografts in rats. After 1 1/2 years of working on the model, we achieved a 75% success rate in the last 20 consecutive procedures. From our experience with this model, we feel that the rat epigastric flap has a place in the study of transplantation phenomena in the experimental laboratory. In addition, we feel that this is an excellent technical exercise for maintaining proficiency in performing microvascular anastomoses.
Isolated capitate fractures that result in the development of aseptic necrosis of the proximal pole are uncommon. Five patients were treated who developed aseptic necrosis of the proximal pole. Four had a history of trauma with radiographic evidence of nonunion. In vitro arterial injection studies were done to correlate clinical problem with intraosseous capitate vascularity. Palmar vessels were found to contribute the majority of the blood supply to the capitate. Three patterns of intraosseous blood supply were seen. In each pattern, the proximal pole received its blood supply exclusively in a retrograde fashion across the capitate waist analogous to the proximal scaphoid. Aseptic necrosis without collapse of the proximal pole was successfully managed with curettage and bone grafting in three patients. The remaining two patients, with collapse and pericapitate degenerative changes, were managed with intercarpal fusion.
A case of unusual displacement of the proximal pole of an acute scaphoid fracture is presented. The usual mechanism of scaphoid fracture, dorsiflexion of the wrist, probably did not pertain in this case. We believe that a palmar hyperflexion injury to the wrist drove the proximal pole through the dorsal capsule. On extension of the wrist, the dorsal lip of the radius sheared off the proximal pole.
Common injuries to the hand and wrist of athletes have been discussed under the headings of ligament injuries, fractures, tendon injuries, and neurovascular injuries. Although the frequency and mechanisms of certain injuries may be different in the athlete than in the nonathlete, the principles of proper early diagnosis and adequate treatment are the same whether the patient is an athlete or not.