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Biomedical subjects

Matthew M Tomaino

Publications and source records attributed to Matthew M Tomaino.

29 records · Page 2Linked to original sources
PubMed2003

Anatomic parameters for planning of interosseous ligament reconstruction using computer-assisted techniques.

PURPOSE: Longitudinal radioulnar dissociation may result when both interosseous ligament (IOL) disruption and radial head fracture occur. Although radial head salvage or arthroplasty and temporary distal radioulnar joint pinning constitute the standard treatment for this injury, IOL reconstruction has been proposed to restore more normal forearm axis mechanics. To help provide an anatomic basis for IOL reconstruction, the purpose of this study was to characterize the geometry of the central band of the IOL and simulated IOL reconstructions. METHODS: Twenty forearms free of pathology were dissected to bone-IOL-bone and computed tomography scans were taken. Computer models of radius-IOL-ulna were created from the computed tomography CT images, and computer-aided design software was used to measure key parameters for IOL reconstruction and simulate anatomic IOL reconstructions. RESULTS: The insertion site locations of the IOL central band along the radius and ulna from the wrist were 57 +/- 3% and 34 +/- 4% of bone length, respectively. The angle at which the IOL central band inserts with the ulna was 24 +/- 4 degrees, which agrees with previously reported values. We found that the minimum graft length needed to anatomically span both cortices through tunnels was 112 +/- 14 mm. CONCLUSIONS: These data will help to provide a basis for planning and performing IOL reconstruction in cases of longitudinal radioulnar dissociation.

Computer Simulation↗
PubMed2003

Management of peroneal nerve injuries associated with knee dislocations.

Peroneal nerve palsy after knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal nerve function. In light of the current state of microneural surgery, and the potential to reconstruct lengthy nerve defects, this review addresses the appropriate evaluation of peroneal nerve palsy and provides recommendations regarding surgical treatment.

Action Potentials↗
PubMed2003

Brachial artery rupture without median nerve dysfunction after closed elbow dislocation.

When closed elbow dislocation results in brachial artery injury, concomitant median nerve dysfunction often results because of anatomic proximity. In the absence of median nerve paresthesia or palsy, however, a pink hand may erroneously suggest that vascular injury has not occurred. In such cases, inadequate clinical assessment of hand perfusion may delay diagnosis of vascular injury and result in serious complication. We report a case of closed elbow dislocation that resulted in brachial artery rupture without median nerve symptoms or loss of perfusion to the hand. We underscore the importance of appropriate vascular assessment and describe surgical treatment.

Adult↗
PubMed2002

Neurophysiologic and clinical outcome following medial pectoral to long thoracic nerve transfer for scapular winging: a case report.

The use of nerve transfers (neurotization) in the reconstruction of nerve palsy is not new, but its clinical efficacy is still largely based on reports of successful restoration of elbow flexion and shoulder abduction following brachial plexus avulsion. Although its potential application extends beyond the brachial plexus, little has been written about additional indications or associated postoperative outcomes. The case described in this report illustrates yet another indication for which neurotization may be a useful technique. Medial pectoral nerve transfer to the long thoracic nerve was performed via an 11-cm sural nerve graft to treat scapular winging 4 months following nerve injury caused during axillary node dissection. Neurophysiologic and clinical outcome 18 months postoperatively revealed successful reinnervation of the serratus anterior muscle, decreased scapular winging, and symptomatic improvement from the patient's perspective.

Axilla↗
PubMed2002

Insulin growth factor-1 decreases muscle atrophy following denervation.

Despite modern microsurgical techniques for nerve repair, functional outcome following proximal injury is often unsatisfactory because irreversible muscle atrophy may develop before reinnervation occurs. Because insulin growth factor-1 (IGF-1) has been shown to improve muscle regeneration after injury, and may have a role in muscle preservation following denervation, the purpose of this investigation was to evaluate the histological, immunohistochemical, and electrophysiological differences between normal, denervated, and IGF-1-injected denervated muscle over an 8-week period. Denervated mice gastrocnemius muscles demonstrated a decrease in muscle weight, a decrease in myofiber diameter, an absence of muscle regeneration, an early increase in the number of neuromuscular junctions (NMJs), and a decrease in fast-twitch and maximum tetanic strength as compared to normal muscle up to 8 weeks following denervation. IGF-1-injected denervated muscle, on the other hand, sustained muscle diameter and muscle weight, maintained a smaller number of NMJs, and relatively sustained fast-twitch and maximum tetanic strength as compared to normal muscle over 8 weeks. These data suggest that IGF-1 may help prevent muscle atrophy and secondary functional compromise after denervation.

Animals↗
PubMed2002

The Essex-Lopresti fracture-dislocation factors in early management and salvage alternatives.

Treatment recommendations for the Essex-Lopresti lesion have not come very far in 50 years. Although there have been multiple biomechanical studies, the biomechanics of forearm loading and stability remain somewhat elusive. Clinical studies have yielded some insight, but predictable outcomes are exceptional. More studies are needed to further understand the biomechanics of the forearm and provide a basis for reconstruction of the IOL. Although current clinical studies regarding IOL reconstruction and radial head replacement seem promising, long-term results with substantial patient numbers are needed. In the short term, the Essex-Lopresti lesion continues to challenge clinicians.

Biomechanical Phenomena↗
PubMed2002

Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures.

OBJECTIVES: To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors. DESIGN: Prospective cohort study, mean follow-up of 9.8 years. SETTING: Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. PARTICIPANTS: Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures. METHODS: Five hundred twenty-seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures. RESULTS: The overall incidence of fracture was 7.3/1,000 person-years. Twenty-seven percent of the fractures were intra-articular; 73% were extra-articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm(2)) at the distal radius ( relative risk ( RR)=1.8, 95% confidence interval ( CI)=1.6-2.1), a history of recurrent falls ( RR=1.6, 95% CI=1.2-2.0), and having had a previous fracture since age 50 ( RR=1.3, 95% CI=1.1-1.6). Current use of oral estrogen was protective ( RR=0.6, 95% CI=0.4-0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra-articular fractures occurred more than twice as frequently in women with diabetes mellitus. CONCLUSIONS: This is the first large long-term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.

Aged↗
PubMed2002

Malignant epithelioid hemangioendothelioma presenting as an aneurysm of the superficial palmar arch: a case report.

A patient with a malignant epithelioid hemangioendothelioma that presented as an aneurysm of the superficial palmar arch and third common digital artery had complete excision of the aneurysm and vascular reanastomosis. After pathologic diagnosis and surgical staging she received local irradiation to the hand. This case suggests that an aneurysm in the hand may develop in the setting of an underlying malignancy of blood vessel. When aneurysms in the hand require surgical intervention, we recommend that resection be complete, pathologic examination undertaken, and marginal tissue well-labeled to allow precise pathologic examination.

Adult↗
PubMed2002

Rationale for and efficacy of digital arterial reconstruction in scleroderma: report of two cases.

Two patients with scleroderma, ischemic pain, non-healing digital ulceration, and digital arterial obstruction were successfully treated with peripheral sympathectomy and digital arterial reconstruction using a reversed small-caliber vein graft. Postoperatively, digital blood flow increased and ulceration healed in both patients. Peripheral sympathectomy alone may not adequately improve digital perfusion, when the benefits of decreased vasospasm are offset by the presence of digital arterial insufficiency. When technically feasible, digital arterial reconstruction improves digital blood flow in scleroderma patients in whom digital collateral circulation appears inadequate after sympathectomy.

Adult↗
PubMed2002

Complete sciatic nerve palsy after open femur fracture: successful treatment with neurolysis 6 months after injury.

Although relatively uncommon, peripheral nerve can be injured secondary to fracture or dislocation. As therapeutic strategies may vary with the status of the nerve involved, accurate diagnosis is critical. The case described in this report involves a complete sciatic nerve palsy occurring after an open femur fracture treated 6 months earlier. The palsy was erroneously attributed to ischemic neuropathy from compartment syndrome, but late surgical exploration showed that the sciatic nerve was in continuity but enveloped by scar. Neurolysis resulted in full motor and sensory recovery below the knee. Accurate interpretation of physical findings and neurophysiologic tests in the management of fractures associated with nerve injury is emphasized.

Accidents, Traffic↗