Replantation of completely and incompletely amputated hand parts, case reports.
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Adolescent↗
Biomedical subjects
P M Weeks
Publications and source records attributed to P M Weeks.
A cause of painful clicking wrist: a case report.
In a patient with symptomatic unilateral clicking of the wrist, a partial tear of the scapholunate ligament with subsequent scarring of the proximal third of the dorsal portion of the ligament had occurred. At operation the dorsomedial edge of the proximal pole of the scaphoid had snapped over the dorsal edge of the lunate as the palmar-flexed wrist was being returned to a neutral position. Release of the scarred portion of the scapholunate ligament was associated with widening of the scapholunate joint space to normal dimensions and cessation of the clicking phenomenon. Fourteen months after operation there was complete relief of symptoms, a full range of wrist motion and no radiographic evidence of widening of the scapholunate space, ligamentous instability, or rotatory subluxation of the scaphoid.
Adult↗
The rate of bursting strength gain in repaired nerves.
The sciatic nerve in 60 rats was transected and repaired with 9-0 nylon under magnification. The repairs were tested for bursting strength at 2, 3, 6, 9, and 12 weeks and expressed as a percentage of the bursting strength of a paired control from the opposite leg. The mean percent bursting strength was 25, 42, 53, 45, and 62, respectively. There was no statistically significant gain in bursting strength from the third to the ninth week after nerve repair. However, there was a significant difference in bursting strength at 3 weeks and 12 weeks after repair. A similar experiment was performed in monkeys. At 4 weeks, the repaired nerves had regained 77% of the bursting strength of the normal median and ulnar nerves. These studies call into question earlier claims that repaired nerves regain normal bursting strength within 3 to 4 weeks of repair.
Animals↗
Factors influencing final range of motion in the fingers after fractures of the hand.
We evaluated 123 patients in which we treated 150 fractured fingers primarily. Sixty-seven percent of these fractured fingers required open reduction with internal fixation; the remainder had closed reduction with internal or external fixation, or immediate arthrodeses. Active and passive range-of-motion (ROM) exercises were usually begun within 3 days after injury. The active and passive ROM of all joints of each finger in the involved hand were measured at regular intervals until no further change in ROM occurred. An associated crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significantly more frequent decrease in the final ROM of the unfractured fingers of the same hand. An associated joint injury, more than one fracture per finger, a crush injury, a flexor or extensor tendon injury, or a skin loss (each) caused a significant decrease in the ROM of the fractured fingers. After treatment of a simple fracture, the ROM in both the fractured and the unfractured fingers was essentially normal.
Adolescent↗
Bursting strength of microarterial repairs.
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Animals↗
Reconstruction of a large unilateral nasal defect.
A modification of the nasal septal technique for reconstruction of a large unilateral defect of the nose is presented that provides cartilaginous support of the nasal defect and mucosal lining. This is accomplished by rotation of the cartilaginous nasal septum and its contralateral mucosal lining into the nasal defect. Coverage with a nasolabial flap allows complete reconstruction in one operation.
Aged↗
The results of non-operative management of stiff joints in the hand.
We selected 500 patients randomly from a total of 1300 patients seen in our Hand Rehabilitation Center between 1971 and 1975; 212 of the 500 presented with a chief complaint of stiff hand joints. Of the 212 patients treated non-operatively, 173 responded sufficiently to this treatment alone. Of the 789 stiff joints, 686 responded sufficiently to this treatment alone. The results of this regime of non-operative treatment of stiff joints provide excellent functional improvement in most patients, with a large saving of money through the reduction in disability payments required.
Exercise Therapy↗
Experimental study of the optimal time for tenolysis.
We have attempted to define the optimal time for tenolysis by evaluating the blood supply, the rupture rate, and the tensile strength of tenolysed and control tendons. In 128 chickens tenolysis was performed 1, 3, 6, 12, 16, and 24 weeks after primary tendon repair. Tenolysis at 1 and 3 weeks resulted in devascularization, weak tendons, and high rupture rates. Tenolysis at 6 weeks after the primary repair had mixed effects on the blood supply but weakened the tendon. Tenolysis at 12 weeks after the tendon repair did not weaken the tendon and resulted in an increased blood supply. Tenolysis at 16 and 24 weeks did not weaken the tendon, but had varied effects on the blood supply. We recommend an interval of 12 weeks between primary tendon repair and tenolysis.
Animals↗
The surgical management of stiff joints in the hand.
Significant and lasting improvement in stiff MP and PIP joints can be achieved by operative management. Operative intervention should be considered only after persistence of stiffness after a vigorous program of nonoperative therapy. In our series of 135 such stiff finger joints, capsulotomy increased the range of motion in MP joints by more than 30 degrees in 68 percent of the patients, more than 50 degrees in 57 percent, and more than 70 degrees in 32 percent. The increased range of motion for the PIP joints was more than 30 degrees in 63 percent of the patients, more than 50 degrees in 41 percent, and more than 70 degrees in 25 percent.
Exercise Therapy↗
Post-traumatic ligamentous instabilities of the wrist.
Dorsiflexion, palmar flexion, ulnar translocation, and dorsal carpal subluxation are four, not uncommon, post-traumatic carpal ligamentous instabilities. Palmar carpal subluxation is a theoretical possibility. Dorsiflexion and palmar flexion instabilities are named for the way the distal lunate articular surface dorsally and palmarly, respectively. Ulnar translocation, and dorsal and ventral carpal subluxations are named according to movement of the entire carpus at the radiocarpal joint. Early detection of traumatic carpal instabilities is necessary to encourage optimal treatment of these significant carpal malalignments. These and other patients with disabling wrist problems may be evaluated by a "ligamentous instability series."
Adult↗
Time of mobilization of repaired tendons.
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Animals↗
A cause of wrist pain: non-specific tenosynovitis involving the flexor carpi radialis.
We describe 4 patients who complained of pain over the course of the flexor carpi radialis tendon at the wrist, and who presented with point tenderness there. These 4 patients presented a spectrum of non-specific tenosynovitis involving the flexor carpi radialis tendon at the wrist, ranging from slight tenderness and swelling to complete disruption of the tendon. Their clinical course and treatment is presented.
Adult↗
A comparison of conjunctival and subciliary incisions for orbital fractures.
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Adolescent↗
Scar carcinoma: prognosis and treatment.
A 30-year experience with 31 cases of squamous cell carcinoma arising in scars is reviewed. Mean age of the patients was 58 years. Average time from injury to diagnosis was 23 years. The male to female ratio was 4:1. Tumors were well differentiated in 23 cases and poorly differentiated in eight cases. Three-year survival rate was 94% for patients with well-differentiated lesions, but only 38% for those with poorly differentiated ones which were more likely to metastasize. Implications of these findings are discussed in relation to therapy.
Adult↗
Median nerve compression and trigger finger in the mucopolysaccharidoses and related diseases.
Patients with Hurler's syndrome (MPS-1H), I-cell disease (ML-II) and pseudo-Hurler's syndrome (ML-III) had median nerve compression and triggering of the fingers which limited finger extension. To our knowledge, this combination has not been reported previously in patients with mucopolysaccharidoses and related disorders. In all of our 3 cases the median nerve was compressed by thickened flexor tenosynovium. Synovectomy and resection of the volar carpal ligament improved the hand function in all, including the mentally retarded patient with Hurler's syndrome. Release of the fibroosseous tunnel in two patients was followed by an increased range of motion (but not full extension). A fourth patient, without a mucopolysaccharide storage disorder, also had the combination of trigger finger and carpal tunnel syndrome.
Carpal Tunnel Syndrome↗
Clinical treatment of partial tendon lacerations without suturing and with early motion.
Partial lacerations of flexor tendons in chickens come out the strongest and glide best if they are not sutured and not immobilized. We treated 17 patients with 20 partial flexor tendon lacerations by not suturing the tendon and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 percent of the cross-sectional area. Sixteen of obtained excellent function of the digit, and one obtained good to excellent function. This technique should be used only in cooperative patients.
Adolescent↗
Rate and extent of functional recovery after flexor tendon grafting with and without silicone rod preparation.
Forty-six consecutive patients requiring flexor tendon grafts were evaluated at 4, 6, 8, 10, 12, 16, 20, 22, 24, 28, 34, and 52 weeks after grafting. The patients were divided into two groups: those who did not require a silicone rubber rod prior to tendon grafting (Group I), and those who did require a silicone rubber rod prior to grafting (Group II). Analysis of the rate of functional recovery as measured by total active motion, gross grip strength, and pinch grip strength showed no significant difference between the two groups. Analysis of the extent of functional recovery at one year, as measured by total active motion and distance of digital pulp from distal palmar crease, showed no significant differences between Groups I and II.
Adolescent↗