Cubital tunnel syndrome in a child with hemophilia.
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Child↗
Biomedical subjects
M S Moneim
Publications and source records attributed to M S Moneim.
Ulnar translation of the carpus in rheumatoid arthritis: an analysis of five determination methods.
Five x-ray methods of assessing ulnar translation of the carpus were compared to each other. Overall, we found the uncompensated semiquantitative method proposed by Gilula et al. to be the most practical and the best method with a sensitivity index of 82%, a specificity index of 88%, an accuracy of 87%, and an interobserver correlation of 90%. The method, however, decreased in specificity and accuracy when a corrective formula was applied to adjust the ulnometacarpal angle to zero degrees deviation. Our conclusion is that the sensitivity indices are relatively low for all methods, and underdiagnosis may occur. At present the semiquantitated method of Gilula et al. is the most practical, with the highest sensitivity index, and is recommended as a screening tool for assessment of ulnar translation of the carpus.
Adult↗
Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques.
To study quantitative differences in the fatigue strength and stability obtained with 5 types of internal fixation of metacarpal fractures, 105 preserved human metacarpals were cyclically tested in bending, torsion, and axial loading after oblique osteotomies of the metacarpal and internal fixation. The dorsal plate with lag screw was superior in all modes, followed by the two dorsal lag screws, crossed Kirschner wire tension banding, and intramedullary Kirschner wire fixation. The five intramedullary and the paired intramedullary Kirschner wire fixations were not statistically different. The fatigue life of the plate fixation was significantly larger in bending (1.5 times), torsion (1.6 times), and axial loading (2.5 times) than the second strongest fixation, two dorsal lag screws. Its initial rigidity was significantly higher in axial loading (1.5 times) but was not statistically different in bending and torsion.
Fracture Fixation, Internal↗
Isokinetic dynamometric technique for spasticity assessment.
This study was conducted to determine the feasibility of quantifying spasticity by measuring the resistance to passive movement using an isokinetic dynamometer. A quantifiable method was developed by determining the summation of the four consecutive resisting torque amplitudes during flexion and extension of the knee at specified speeds and range of motion. A more rigorous assessment was made by finding the slope of the linear regression curve of torque-velocity data. Although the values of maximum torque were higher in the spastic group than in the normal group, the difference was statistically significant only when the sum of the torque amplitudes was considered (P < 0.0028). Values of the maximum torque as well as the sum of the torque amplitudes increased in a linear fashion (r > 0.75) with increasing velocity. The slopes of the torque-velocity curves were greater in spastic subjects than in normal subjects. The sensitivity to the rate of stretch was statistically greater (P < 0.0004) for the spastic group than normals only when the sum of torque amplitudes was considered. The corresponding data obtained during the flexion and extension of the knee were not statistically different (P > 0.05). Serial summation of torque amplitudes and measurement of slope in the torque-velocity curve are sensitive and repeatable methodologies for the measurement of spasticity assessment.
Adult↗
Evolution of bone inhomogeneity around a hole in an orthotropic plate of bone: theoretical predictions.
The problem of the evolution of bone inhomogeneity around a hole in a plate of bone with orthotropic symmetry is considered. The internal remodeling theory of Cowin and Hegedus is employed to show the existence of final inhomogeneity following stress concentration. The speed of remodeling around the hole and its variation with respect to distance is investigated. Results indicate that the effect of stress concentration around a hole is slightly less pronounced if bone is considered orthotropic rather than transversely isotropic. The speed of remodeling is found to be unaffected but the amplitude of inhomogeneity with respect to distance drops and disappears slightly faster if bone is considered orthotropic.
Bone Density↗
Pullout strength of power- and hand-driven staples in synthetic bone: effect of design parameters.
The pullout strength of power-driven and hand-driven staples of different sizes and different leg profiles was investigated in a synthetic bone model. Consistent material properties were reflected in the relatively small standard deviation in pullout strength, which was less than 7% of the mean value for power-driven and less than 10% of the mean value for hand-driven staples. An approximate linear relationship was shown to exist between the mean value of pullout strength and foam density. In paired studies, the mean value of pullout strength was significantly (p less than 0.0005) greater for the power-driven staples than similar size hand-driven staples. It was also shown that a square cross section creates significantly (p less than 0.017) more resistance to pullout force than a circular section of similar or even larger area. Although the pullout strength was not a function of the staple's width, the staple's leg length contributed to its pullout strength in a nonlinear fashion. This study suggests that narrow, long, power-driven staples of rectangular cross section have the best pullout strength for similar cross-sectional area.
Bone Density↗
Ulnar nerve compression at the wrist. Ulnar tunnel syndrome.
Compression neuropathy of the ulnar nerve at the wrist can be caused by several lesions. The most common cause is a carpal ganglion followed by occupational repeated trauma to the hypothenar area. This process is in contrast to carpal tunnel syndrome in which the majority of the cases are idiopathic in nature with no local cause found except for synovitis of the flexor tendons. The site of the lesion will determine the clinical picture whether it is both motor and sensory abnormalities, only motor paralysis or only sensory abnormality. The latter is rare. If the abnormality is purely motor, then the compression is distal in the ulnar tunnel and the hypothenar muscles are usually spared. Carpal ganglia must be sought and removed. After an extensive search through the literature, I found only one report in which thickening of the volar carpal ligament was found to be the cause of ulnar nerve compression. I encourage the use of the term "ulnar tunnel syndrome" to discuss these lesions and the classification outlined by Shea to determine the site of the lesion. Patients with type 2 syndrome usually present late because of the lack of sensory changes. Average delay in obtaining a diagnosis of 5 months was found in my patients. The condition should be suspected if spontaneous clumsiness or awkwardness of the use of the hand occurs in a middle-aged patient.
Humans↗
New Mexico rattlesnake bites: demographic review and guidelines for treatment.
The demographic features, treatment, and outcome of 36 rattlesnake envenomation cases are reviewed. Two populations at special risk are identified: (1) young children (12/36) who sustain lower extremity bites, and (2) adults who consume alcohol and handle snakes (10/36) who sustain upper extremity bites. Antivenin was used in 22 cases with only one serious case of serum sickness. Three definite diagnoses of compartment syndrome were made on the basis of elevated compartment pressures. Hand bites accounted for 20 of the 36 cases. The greatest functional disability followed digit bites in that 11 patients developed decreased motion and sensation. The indications for fasciotomy and debridement are discussed, both for digit and non-digit envenomations. General treatment recommendations are given.
Adolescent↗
The effect of prolonged blood stasis on a microarterial repair.
There is much controversy in the literature about the effect of blood stasis on the patency rate following microvascular repair. Sixty Sprague Dawley rats underwent transection and repair of their femoral arteries. The rats were divided into three groups, which had their repaired arteries clamped for 1 1/2, 2, and 2 1/2 hours. Patency was evaluated by the "stripping test," and the presence of a "flicker" both immediately and on the second day of the experiment. At the time of evaluation on the second day, all arteries in Group I were patent, in Group II two were thrombosed and in Group III, five out of 20 thrombosed. The only significant statistical difference was found between Groups I and III in both immediate (p less than 0.0025) and second day (p less than 0.05) evaluations. Results indicate that the "safe limit" for blood stasis in a repaired artery of 0.8 mm diameter is 1 1/2 hours.
Anastomosis, Surgical↗
Management of greater arc carpal fractures.
Greater arc injuries are fracture dislocations that involve the perilunar carpal bones. The commonest of these injuries is the dorsal transscaphoid perilunate fracture dislocation. The recommended treatment for acute injuries is open reduction and Kirschner wire fixation of the scaphoid fracture through a dorsal midline approach. Stability to the midcarpal joint is thus provided and no further pins are needed. Established scaphoid nonunions are treated by bone grafting and Herbert screw fixation through a volar approach. Scaphocapitate fracture syndrome is treated by open reduction and pin fixation of the displaced capitate fragment through the dorsal approach. If the scaphoid is displaced it is also openly reduced and pinned.
Carpal Bones↗
Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption.
Five patients between 10 and 46 years old were reviewed after a latissimus dorsi muscle transfer to restore elbow flexion. Loss of elbow flexion resulted from traumatic brachial plexus paralysis in all five patients. All had some weakness in other muscle groups in the upper extremity. The follow-up period was from 25 to 68 months (average = 39.4 months). A range of motion of 0 degrees/115 degrees, 10 degrees/100 degrees, 0 degrees/110 degrees, 0 degrees/70 degrees was obtained. After the transfer, three patients could supinate the forearm, and supination of 90 degrees, 15 degrees, and 10 degrees was measured. Two patients could lift 4 lb, while two others could lift 1 and 1.5 lb, respectively. Evaluation of activities of daily living by a standardized test revealed disappointing results. The two patients with less than 90 degrees elbow flexion had initial paralysis of the latissimus dorsi muscle at the time of injury. This procedure should not be done unless the latissimus dorsi muscle is normal.
Activities of Daily Living↗
Salvage of replanted parts of the upper extremity.
Twelve patients with fifteen replanted parts had vascular exploration in order to salvage the replantation after impending failure developed. Arterial occlusion only was found in eleven parts, while arterial and venous occlusion was found in the other four. Vein grafts were used in ten parts, with success in eight. Thrombectomy was done in six, with success in only one. It was possible to salvage nine of the fifteen replanted parts. The best results were obtained when the revision was done within eleven hours after the replantation.
Adolescent↗
Carpal tunnel syndrome in hemophilia.
Carpal tunnel syndrome occurring as a complication of hemophilia is documented in the literature. Most reports, however, indicate that the condition can be relieved by splinting and replacement therapy. Two cases of carpal tunnel syndrome in hemophiliacs are presented. In one patient, replacement therapy was successful in relieving the condition. However, in the other patient, decompression of the carpal tunnel and internal neurolysis of the median nerve were carried out after replacement therapy failed. To our knowledge, this is the first time that intraneural bleeding in the nerve has been documented as a cause of peripheral neuropathy in hemophilia. Surgical release of the carpal canal together with the epineurectomy and internal neurolysis resulted in complete recovery.
Adult↗
Brachial artery disruption following closed posterior elbow dislocation in a child--assessment with intravenous digital angiography. A case report with review of the literature.
An 11-year-old boy sustained complete brachial artery disruption following closed posterior elbow dislocation. This is the first documentation in the English-language literature of this type of arterial transection following closed elbow dislocation in a child. It is also the first report of surgical repair of the brachial artery following elbow dislocation in a child. The patient's radial pulse was absent the day following the injury, and on Doppler examination blood flow was audible over the radial artery. Hand perfusion, however, remained excellent. Intravenous digital angiography demonstrated complete disruption of the brachial artery. This procedure is relatively painless compared with conventional angiography with percutaneous arterial puncture. The procedure provides the treating physician with an objective method for assessing brachial artery integrity. Arterial repair may decrease the potential risks of delayed complications, e.g., cold intolerance, potential growth disturbance, and possible delayed neurovascular residues associated with localized ischemia to the forearm and hand.
Brachial Artery↗
Transscaphoid perilunate fracture-dislocation. Result of open reduction and pin fixation.
Sixteen patients with 17 transscaphoid perilunate fracture-dislocations were treated by open reduction and pin fixation. Open reduction was performed through a volar approach in only one wrist, a dorsal approach in nine wrists, and combined volar and dorsal approaches in seven wrists. Primary bone grafting was performed in four patients. The follow-up period was from five months to eleven years and two months, with an average of 2.69 years. Seven patients had median nerve injury and all recovered. Of the 17 wrists, the scaphoid fracture healed in 15. This injury should be treated by early open reduction through a dorsal incision and pinning of the scaphoid fragments in an anatomic position. Avascular necrosis of the proximal fragment is not an indication for further surgery as long as the fracture is well reduced with evidence of healing. This replacement of necrotic bone by new bone requires several years. Primary bone grafting is unnecessary.
Adolescent↗
Volar dislocation of the metacarpophalangeal joint. Pathologic anatomy and report of two cases.
Of two cases of volar metacarpophalangeal joint dislocation, the thumb was affected in one. This is the first case of its kind reported in the English-language literature. Patients with this injury are older than patients with the more common dorsal dislocation. The mechanism of injury seems to be direct trauma to the dorsum of the hand with the metacarpophalangeal joint acutely flexed. The pathologic anatomy may be a combination of a dorsal capsular tear, a tear of one or both collateral ligaments, and a tear of the volar plate with interposition in the joint. Attempt at closed reduction, even if a pin is used percutaneously to transfix the joint, almost invariably will lead to recurrence of the deformity. The recommended treatment for such very rare injuries is open reduction through dorsal, or both dorsal and volar, approaches; removal of the incarcerated volar plate from the joint; and repair of all torn ligaments.
Adult↗
Unusually high division of the median nerve.
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Aged↗
Interfascicular nerve grafting.
Interfascicular nerve grafting is a useful method to repair nerves with gaps. Good motor recovery can be obtained, and return of some degree of sensibility is possible. The procedure can be used to overcome small gaps that result from neglected sharp lacerations or after failure of primary repair, or large gaps that result from loss of nerve substance or traction lesions. Primary nerve repair should be done for acute lacerations. However, in old lacerations (more than three weeks old) and in nerve gaps of more than 2 cm in length, a functional recovery can still be expected after nerve grafting. The recovery of intrinsic function in median and ulnar nerve lesions above the elbow was poor. The intrinsic recovery in these patients will be reported when long-term follow-up results are available. Recovery of intrinsic function in median nerve grafts at the wrist level was much better than for lesions of the ulnar nerve at the same level. This may be related to the anatomy of the ulnar nerve in this area. By separating the dorsal cutaneous branch from the main trunk of the nerve, using it as a donor graft, better results are to be expected.
Adolescent↗