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Biomedical subjects

M H Gonzalez

Publications and source records attributed to M H Gonzalez.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cementless total hip arthroplasty in patients with advanced avascular necrosis.

We retrospectively reviewed a series of 40 cementless total hip arthroplasties in 31 patients with advanced avascular necrosis. The average follow-up was 58 months (range, 24 months to 108 months). The clinical failure rate was 20% (8 hips in 7 patients). Three of 7 threaded cups failed, and 2 of 32 porous coated hemispherical cups failed. Of the 5 stem failures, 1 was due to technical error, and 4 were well ingrown porous stems that succumbed to progressive osteolysis.

Adult↗
PubMed1996

Laparoscopic repair of recurrent hernia.

BACKGROUND: Failure rates for recurrent hernioplasties vary from 3% to 30%. To help explain this high incidence of recurrence, we reviewed our 4-year experience using a laparoscopic approach and analyzed the characteristics of the recurrent hernias repaired. METHOD: One hundred fifty-two patients with 173 recurrent hernias and 942 patients with 1,230 primary hernias were laparoscopically repaired using either a transabdominal preperitoneal or a totally extraperitoneal laparoscopic approach. RESULTS: With a median follow-up of 24 months, one recurrence developed in the recurrent and four in the primary group. The incidence of bilateral disease (80% versus 46%), and the complexity of the hernias repaired (28% versus 14%) were significantly increased in the recurrent patients. CONCLUSION: The importance of intrinsic weakness and missed hernias as factors that contribute to the failure of recurrent hernioplasties was supported by our findings. The low early failure rate of our laparoscopic approach suggested that this technique may help in eliminating these causes of failure.

Adolescent↗
PubMed1996

Necrotizing fasciitis of the upper extremity.

Twelve cases of necrotizing fasciitis were identified retrospectively over a 5-year period. All were associated with a history of substance abuse by injection or with diabetes. Eleven of the 12 infections were associated with beta-hemolytic Streptococcus, a mixed anaerobic aerobic infection, or both. Three of five patients tested for human immunodeficiency virus had positive test results. A wide extensile approach was used to debride necrotic fascia. An average of 3 debridements were necessary, with a range of 1-6 debridements. Two patients under-went shoulder disarticulation because of uncontrollable infection. The rapid and destructive nature of this disease makes early recognition, aggressive debridement, and antibiotic therapy necessary to minimize morbidity.

Adult↗
PubMed1996

Anatomy of the extensor tendons to the index finger.

An anatomic study was performed to better delineate the extensor tendons of the index finger. Seventy-two cadaver hands were dissected. Classically, a single slip of the extensor digitorum communis (EDC) and a single slip of the extensor indicis proprius (EIP) are said to run to the index finger. The EIP is said to be ulnar to the EDC at the level of the metacarpal head. In dissections in this study, the classic description was noted in 58 of the hands. Ten hands had a double slip of the EIP. Two hands had a double slip of the EDC running to the index. Two hands had a single slip of the EIP either volar or radial to the EDC at the level of the metacarpal head. Thirteen hands (19%) showed anatomic variants of the EIP and EDC tendons at the level of the metacarpal head, differing from the classic description. Additionally, two hands showed aberrant tendons. A knowledge of these variants when performing tendon repair or EIP transfer is necessary.

Fingers↗
PubMed1996

Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand.

The use of intramedullary fixation for fixation of fractures of the metacarpal and proximal phalanx is reported. Flexible intramedullary rods are used for unstable transverse and short oblique diaphyseal fractures of the proximal phalanx and metacarpal. The fracture site is not opened and the rods are introduced under xray control. The rods are cut flush with the bone so that there is no soft tissue tethering. Intramedullary spacers are used in comminuted metacarpal fractures associated with crush injuries and gunshot wounds. The fracture site is opened and a single rod is placed to fill the intramedullary canal. A supplementary plate may be used to control rotation, and bone graft is usually necessary. A new spacer has been designed that has proximal and distal locking screws to control length and rotation. This also is used routinely with bone graft. The techniques outlined stabilize the fracture site allowing immediate motion postoperatively.

Adult↗
PubMed1996

The deep branch of the ulnar nerve in Guyon's canal: branching and innervation of the hypothenar muscles.

Thirty-seven embalmed, unpaired cadaver hands were dissected to delineate and classify the innervation of the hypothenar musculature. The deep branch of the ulnar nerve passed between the abductor digiti minimi and flexor digiti minimi and then pierced the opponens in all specimens. All branching occurred on the ulnar aspect of the deep branch of the ulnar nerve. A classification based on proximity of the different branches is prepared. Five different patterns have been noted.

Cadaver↗
PubMed1996

Proprioception after arthroplasty: role of the posterior cruciate ligament.

To test the hypothesis that retaining the posterior cruciate ligament during total knee arthroplasty helps preserve the threshold of proprioceptive sensation, a machine was designed that permitted direct measurement of passive angular deflection from a resting point to the threshold of patient perception. Sixty patients with unilateral primary total knee arthroplasties were evaluated; 30 with posterior cruciate ligament retaining prostheses and 30 with posterior cruciate ligament substituting prostheses. All patients had a minimum postoperative followup of 1 year, a good or excellent result as defined by the Hospital for Special Surgery Knee Score, and no evidence of peripheral neuropathy. The gender and age distributions were equivalent between groups. The average threshold of perception for the posterior cruciate ligament retention group was 2.4 degrees. The average threshold of perception for the posterior cruciate ligament substitution group was also 2.4 degrees. Substitution or retention of the posterior cruciate ligament makes no clinical difference in proprioception as measured by threshold testing. This study provides new information for surgeons performing total knee arthroplasty to aid in the decision to retain or substitute the posterior cruciate ligament. Previous proprioception evaluation in patients with posterior cruciate ligament retaining versus posterior cruciate ligament substituting arthroplasties, using different testing methods, has revealed different results.

Adult↗
PubMed1995

Laparoscopic hernioplasty. TAPP vs TEP.

This study compares the results of two laparoscopic hernioplasties: the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP). Over a 43-month period 1,115 laparoscopic hernioplasties, 733 TAPP and 382 TEP, were performed in 866 patients. There were 11 major complications in the TAPP group (2 recurrences, 6 trocar hernias, 1 small-bowel obstruction, 1 trocar, and 1 dissection injury of the small bowel) compared to 1 recurrence and no intraperitoneal complications in the TEP group. Five TEP procedures required conversion to the TAPP approach, resulting in one umbilical hernia. The median time to return to work did not vary with the approach, but was prolonged in patients compensated for time off, 16 vs 8 days for noncompensated patients. Results suggested that both techniques shortened recovery and eliminated most early failures, but the totally extraperitoneal approach reduced the potential for intraperitoneal complications and may be the procedure of choice in most situations.

Abdomen↗
PubMed1995

Flexible intramedullary nailing for metacarpal fractures.

A 5-year retrospective review of 83 patients with 98 metacarpal fractures was performed. Fractures of the thumb metacarpal were excluded. Ninety-six closed metacarpal fractures were reduced closed and fixed with flexible intramedullary fixation, using multiple 0.8-mm prebent rods. Two open metacarpal fractures were also fixed with this technique. Fractures amenable to flexible intramedullary fixation include short oblique and transverse fractures. Contraindications include long oblique and bicortical comminuted fractures. The average follow-up time was 9 months (range, 2 to 34 months) with 15 patients lost to follow-up examination. All fractures went on to heal. Three complications occurred: backing out of a rod in one case and bending of the rods after repeat trauma in two. There were no infections. Flexible intramedullary nailing of specific metacarpal fractures affords excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.

Adolescent↗
PubMed1995

The first dorsal extensor compartment: an anatomic study.

Sixty-six cadaver hands were dissected to better define the anatomic variations of the first dorsal compartment and the superficial radial nerve. A septum was present in 31. A separate compartment enclosed the extensor pollicis brevis tendon in 29 and a slip of the abductor pollicis longus in 2. Multiple slips of the abductor pollicis longus tendon were noted in 38. Accessory slips inserted into the trapezium and thenar musculature. Partial separation or grooving of the abductor pollicis longus tendon was common but did not necessarily define a separate tendon slip.

Cadaver↗
PubMed1995

Intramedullary nailing of proximal phalangeal fractures.

A retrospective review of 25 consecutive patients with 28 proximal phalangeal fractures was performed. Fractures of the thumb were excluded. Twenty-five fractures were closed and three were open. All fractures were reduced, closed, and fixed using flexible intramedullary fixation with 0.8-mm prebent nails. Fractures amenable to flexible intramedullary fixation include short oblique and transverse fractures. Contraindications include long oblique, spiral, and bicortical comminuted fractures. The average follow-up time was 10 months (range, 2-20). Five patients with six fractures were lost to follow-up evaluation. All of the remaining 23 fractures healed and there were no infections. An average of 2 degrees angulation was seen on anteroposterior x-ray films. One patient showed 4 degrees of angulation on the lateral x-ray film. No shortening was noted. One fracture showed appreciable malrotation of 10 degrees. Flexible intramedullary rodding of specific proximal phalangeal fractures provides excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.

Adolescent↗
PubMed1995

The extensor tendons to the little finger: an anatomic study.

Fifty cadaver hands were dissected to better delineate the extensor tendon anatomy to the little finger. The extensor digitorum communis was present in 35. Of 15 hands without an extensor digitorum communis, 12 had a junctura present. Three hands lacked both extensor digitorum communis and juncturae. Transfer of the extensor digiti minimi tendon in these hands could cause loss of extension to the little finger. Ten hands had a direct attachment of the extensor digiti minimi tendon on the abductor tubercle. Twenty-two hands had either an attachment of the extensor digiti minimi on the abductor tubercle, an unbalanced ulnar slip of the extensor digiti minimi, or both, anatomic factors that could--in the event of ulnar nerve compression or laceration--cause Wartenberg's sign. Twenty-eight hands did not have an anatomic variant of the extensor that could cause ulnar deviation of the little finger.

Cadaver↗
PubMed1993

Abscesses of the upper extremity from drug abuse by injection.

A 4-year retrospective review of 59 consecutive upper extremity abscesses associated with drug abuse by injection is reported. There were 57 patients, with the most common location being the forearm. All abscesses were treated with incision, drainage, and intravenous antibiotics. Seventeen patients required more than one debridement; nine were complicated by fasciitis, osteomyelitis, septic arthritis, or septic tenosynovitis. Thirty-one patients had human immunodeficiency virus testing, and nine results were positive. Bacteriology showed the most common organisms to be streptococcus, Staphylococcus aureus, and Eikenella corrodens. Nineteen percent of the abscesses had anaerobes cultured. Most of the organisms cultured were common oral or skin flora.

Abscess↗
PubMed1993

Osteomyelitis of the hand after a human bite.

Twenty-four cases of osteomyelitis of the hand after human bite were reviewed. The mechanism of injury was equally divided between incisor bites and clenched fists. Eleven of twelve of the clenched-fist injuries showed a tooth mark in the bone or cartilage at the site of inoculation. The incisor bites showed initial infection of the soft tissues or joint with a secondary infection of the bone. Factors leading to the development of osteomyelitis included a delay of more than 24 hours before debridement or inadequate initial treatment. Bacteriologic study commonly showed mixed infections with skin and oral flora. The infections were prone to relapse, and nine patients required more than one surgical debridement.

Adult↗
PubMed1993

Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting.

The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. Follow-up averaged 12 months, with a range of 4 months to 7 years. Primary bone union was achieved in all metacarpals. The average range of motion was 65 degrees for the metacarpophalangeal joint, 72 degrees for the proximal interphalangeal joint, and 60 degrees for the distal interphalangeal joint. Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

Adolescent↗
PubMed1990

Thrombosis of the vena comitantes of the ulnar artery.

A case of traumatic aneurysm of the vena comitantes of the ulnar artery is reported, which was seen initially as a painful hypothenar mass after blunt trauma. Ligation and excision produced complete relief without recurrence.

Adult↗
PubMed1988

Fracture of a metal-backed acetabular component in total hip arthroplasty. A case report.

Metal-backed acetabular components offer the advantage of a lower incidence of loosening. The case of a 33-year-old man emphasizes the potential problem of fracture of both the polyethylene and metal-backed structures. Although this case report may represent an unusual and infrequent occurrence, it emphasizes a potential failure mode for acetabular components with metal backing. While fracture of the polyethylene has been previously reported, little thought has been given to the further potential of fracture of metal-backed support. The clinical profile as well as the roentgenographic appearance of such a phenomenon is presented for further sophistication of the surgeon when dealing in the challenging area of hip arthroplasty.

Acetabulum↗