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Biomedical subjects

R H Brumfield

Publications and source records attributed to R H Brumfield.

12 recordsLinked to original sources
PubMed1997

Silastic metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis.

Two hundred sixty-four patients with rheumatoid arthritis were treated with 901 Swanson silastic arthroplasties of the metacarpophalangeal joints. Average followup was 8 years with a minimum of 2 years. Preoperative ulnar deviation averaged 45 degrees and improved to an average of 15 degrees postoperatively. Active flexion arc averaged 40 degrees preoperatively and 50 degrees postoperatively, an increase of 10 degrees. The extensor lag postoperatively improved to 10 degrees from 50 degrees preoperatively, placing the arc of metacarpophalangeal joint motion between 10 degrees and 60 degrees flexion. Complications included dehiscence and delayed wound healing (2%), superficial infection (0.5%), deep infection (3%), and prosthetic fracture (14%). Subjectively, most patients thought that their postoperative function was improved. This was thought to be attributable in part to the correction of the ulnar deviation deformity of the fingers, and the shifting of the arc of motion of the metacarpophalangeal joints to one allowing increased metacarpophalangeal extension, thereby improving the opening capacity of the digits and the overall function of the hand.

Adolescent↗
PubMed1997

Total wrist arthroplasty in rheumatoid arthritis. A long-term clinical review.

Fourteen total wrist arthroplasties performed in 13 patients with rheumatoid arthritis between 1978 and 1982 were reviewed to evaluate long term outcome. Most patients had Stages III or IV rheumatoid arthritis at the time of surgery. Pain was the primary presenting complaint in 87%. Average followup was 6.5 years (range, 3.5-11.5 years). Pain relief was achieved in 86% of patients. Using objective data obtained from their wrist scores, 72% of the patients had a good result, 14% had a fair result, and 14% had a poor result. No patient had an excellent result. Twenty-seven percent suffered postoperative complications related to their surgical procedure. Although these results help confirm the usefulness of total wrist arthroplasty as an alternative to arthrodesis of the wrist, it is a technically demanding procedure, and should be reserved for the patient who has severely involved arthritis. Additional improvements are needed to decrease the currently high complication and failure rate.

Adult↗
PubMed1994

Flexible implant resection arthroplasty of the proximal interphalangeal joint in patients with systemic inflammatory arthritis.

Forty proximal interphalangeal joint silicone elastomer flexible implant arthroplasties in 19 patients with systemic inflammatory arthritis were reviewed. The follow-up period averaged 94 months. Before surgery, the average arc of motion was 26 degrees for the 20 digits with boutonniere deformities and 23 degrees for the 16 digits with swan-neck deformities. Eight digits had moderate (grade 2) pain, and four digits had severe (grade 3) pain. After surgery, the deformity was completely corrected in six digits. Digits with a preoperative boutonniere deformity (20 digits) achieved the same (26 degrees) arc of motion after surgery, whereas those with a preoperative swan-neck deformity (16 digits) actually lost 18 degrees. Six digits had moderate pain and one digit had severe pain at the final follow-up evaluation. Thirteen digits (7 patients) with a boutonniere deformity before surgery and a concurrent or previous silastic metacarpophalangeal arthroplasty had significantly better results than those without. Overall, there were 12 good, 18 fair, and 10 poor results. Based on this study, flexible silicone implant arthroplasty has a limited role in the treatment of proximal interphalangeal joints affected by systemic inflammatory arthritis. When performing the arthroplasty, attention should be directed first toward correction of the deformity at the metacarpophalangeal joint.

Adult↗
PubMed1990

Functional range of motion of the joints of the hand.

Active ranges of motion of the joints of the hand are well documented, but there is little data reporting the functional ranges of motion required to perform activities of daily living. Electrogoniometric and standard methods were used to measure both active and functional ranges of motion of the metacarpalphalangeal and interphalangeal joints during 11 activities of daily living. In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks. Functional flexion postures averaged 61 degrees at the metacarpalphalangeal joint, 60 degrees at the proximal interphalangeal joint, and 39 degrees at the distal interphalangeal joint. In the thumb, functional flexion postures averaged 21 degrees at the metacarpalphalangeal joint and 18 degrees at the interphalangeal joint using only 32% of the available flexion. Active thumb metacarpalphalangeal joint motion was found to be bimodal in the study group.

Activities of Daily Living↗
PubMed1990

Total elbow arthroplasty.

The results of 36 total elbow arthroplasties in 32 patients are presented. The follow-up period ranged from 3 to 12 years. The preoperative diagnosis was rheumatoid arthritis in 27 patients and posttraumatic degenerative joint disease in 5. There were 23 women and 9 men. Unconstrained prostheses (London) were implanted in 6 elbows, semiconstrained prostheses (MAYO, AMC, and triaxial) in 26, and constrained prostheses (GSB, Schlein) were used in 4. There were five perioperative fractures (14%) that were successfully treated nonoperatively. Three ulnar nerve neuropraxias occurred (8%), one of which required surgical exploration and repeat anterior transfer of the nerve. Two superficial postoperative infections (6%) responded to nonoperative treatment. Major complications necessitating revision surgery occurred in 18 (50%). Loosening of the prostheses occurred in nine (25%); two were treated by reimplantation, with prosthetic removal in the others. Deep infections in four (11%) and dislocations occurring in two (6%) necessitated prosthetic removal. Traumatic fractures occurred in two (6%); one was successfully treated by internal fixation, while the other failed internal fixation, requiring prosthetic removal. Radiolucent lines were seen in 20 (56%).

Adult↗
PubMed1985

Synovectomy of the elbow in rheumatoid arthritis.

The combined procedure of synovectomy and resection of the radial head was performed in thirty-five patients (forty-two elbows) with Stage-III or IV rheumatoid arthritis. These patients were followed postoperatively for a minimum period of two years (average, seven years). The result was graded as excellent in four, good in fifteen, fair in fourteen, and poor in nine elbows. Pain was diminished from the preoperative level in all but six elbows, but motion was not much improved. Synovitis recurred postoperatively in thirteen elbows, but in only five did the destructive process progress to a degree requiring a second operation. We think that synovectomy for relief of pain in the elbow is not contraindicated in the presence of Stage-III or IV rheumatoid disease, but that little improvement of elbow motion can be expected.

Adult↗
PubMed1971

Snow skiing.

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Accidents↗
PubMed1966

Cold injury.

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Cold Temperature↗
PubMedDate not supplied

Surgery of the wrist in rheumatoid arthritis.

One hundred four patients with rheumatoid arthritis of the wrist were evaluated a minimum of 12 months post-operatively (average of 34 months). Seventy patients had 87 arthroplasties and 34 patients had 41 arthrodeses performed on the Arthritis Service of Rancho Los Amigos Hospital (Downey, California), from 1962 to 1975. Seventy-eight per cent of the arthrodeses fused, yet only 69% were painfree. Of the 22% that did not fuse, 67% were pain-free. Carpal and/or intercarpal synovitis recurred in 16% of the fused group and 33% of the nonfused group. Eighty-three per cent of the arthroplasties were pain-free, 91% were stable, and all lost motion which averaged 40 degrees (55%). Spontaneous fusion occurred in 16%). Synovitis recurred in 8.0%.

Arthritis, Rheumatoid↗
PubMedDate not supplied

A biomechanical study of normal functional wrist motion.

Nineteen normal adults were studied by a uniaxial electrogoniometer to determine the range of wrist motion required to accomplish 15 activities of daily living. Activities for personal care requiring placing the hand at various locations on the body were accomplished by motion of 10 degrees of flexion to 15 degrees of extension. Other necessary activities, such as eating, drinking, using a telephone, and reading, were accomplished by motion of 5 degrees of flexion to 35 degrees of extension. Thus, the optimum functional motion for the wrist to accomplish most activities is from 10 degrees of flexion to 35 degrees of extension. This data helps to provide an objective basis for evaluation of wrist disability, position of arthrodesis, functional motion provided by arthroplasties, and aid in the development of wrist prostheses.

Activities of Daily Living↗
PubMedDate not supplied

Total elbow arthroplasty: a clinical review of 30 cases employing the Mayo and AHSC prostheses.

Chronic synovitis of the elbow in rheumatoid arthritics that has not responded to four to six months of optimal nonoperative management should be treated by synovectomy even in the absence of significant intra-articular X-ray changes. When intra-articular damage is significant, an arthroplasty will not only relieve the pain, but may also provide a satisfactory range of motion. It is necessary to consider all the possible complications and the fact that technically, total elbow arthroplasty is a difficult operation to perform. Because of the potential for loosening, one might consider using an unconstrained device in the patient with adequate bone structure, reserving the semiconstrained devices for elbows with disintegrated bone tissues. The constrained prostheses should be used only for the most severely disorganized and unstable elbows.

Adult↗