Biomedical subjects

Robert N Hotchkiss

Publications and source records attributed to Robert N Hotchkiss.

6 recordsLinked to original sources

PubMed2006

Outcome of open release for post-traumatic elbow stiffness.

BACKGROUND: Post-traumatic elbow stiffness can be caused by a tether and/or a block, and these structures can exist both anteriorly and posteriorly about the joint to prevent motion. The purpose of this article is to report the outcome of elbow release performed for post-traumatic stiffness by a single surgeon. METHODS: A retrospective review of charts and radiographs was performed on 52 case of patients who underwent open surgical treatment for post-traumatic elbow contracture by the senior author (RHN). The mean age of the group was 35.1 years. There were 32 men and 20 women. Contracture release surgery was performed at an average of 14 months from the time of injury. Indication for operative release was functional loss of elbow arc of motion that failed nonoperative therapy and splinting program. Follow-up was 18.7 months. Comparison of ranges of motion was performed with Student's paired t tests. RESULTS: The average extension-flexion arc of motion improved from 57 to 116 degrees and forearm rotation improved from 119 to 145 degrees postoperatively. Fourteen patients (27%) required closed manipulation under anesthesia, in the early postoperative period. Five patients required a second contracture release at an average of 12 months after the index release. Four patients failed because of painful motion (n = 2) and elbow instability (n = 2). Other complications included wound infection (n = 3), cubital tunnel syndrome (n = 3) and reflex sympathetic dystrophy (n = 1). CONCLUSIONS: Open elbow release with excision of tethers and blocks is a valuable procedure for post-traumatic stiffness. Recurrence in postoperative period is common but is responsive to manipulation under anesthesia and repeat releases.

Adolescent↗

PubMed2006

Can the carpometacarpal joint be injected accurately in the office setting? Implications for therapy.

OBJECTIVE: To investigate whether carpometacarpal (CMC) injections can be performed accurately in the office setting in patients with moderate to severe CMC osteoarthritis (OA). METHODS: Patients were recruited from rheumatology and hand surgical practices as part of an open label trial of hylan G-F 20 for CMC OA. CMC injections were performed without radiologic guidance, using anatomic landmarks to guide needle placement. Once injected, the patient was immediately taken to an adjacent ultrasound suite, and the injected CMC joint examined for evidence of intraarticular material and air microbubbles. RESULTS: Thirty-two patients were injected. All patients had ultrasound evidence of intraarticular material: 91% also had evidence of microbubbles in the joint. CONCLUSION: CMC injections can be performed accurately in the office setting, without the need for radiologic guidance, in patients with moderate to severe CMC OA.

Adjuvants, Immunologic↗

PubMed2005

Locking horizontal mattress suture.

The horizontal mattress suture is useful in wounds in which there is a need for wound edge compression to provide hemostasis, closure is under moderate tension, or edge eversion is important. Its primary disadvantage is difficult suture removal and precise wound edge apposition. We describe a locking horizontal mattress technique that facilitates suture removal and provides more control over wound edge placement while providing hemostasis, tensile strength, and eversion.

Dermatologic Surgical Procedures↗

PubMed2005

Hinged elbow external fixation for severe elbow contracture.

BACKGROUND: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open release of a severe elbow contracture. METHODS: Forty-two patients were evaluated at an average of thirty-nine months after operative release of a severe posttraumatic elbow contracture (defined as < or =40 degrees of motion). Twenty-three patients had been treated, during the early part of the study, with a hinged external fixator that incorporated a worm gear to apply static progressive stretch postoperatively. These patients were compared with nineteen patients who had been treated without hinged external fixation during the later part of the study, when the hinge was used less frequently. The operative techniques did not otherwise change during the study period. Demographic and injury characteristics as well as associated problems were comparable between the two groups. RESULTS: The average gain in the range of motion after the index procedure was 89 degrees in the patients treated with a hinge and 78 degrees in those treated without a hinge, an insignificant difference with the numbers available (p = 0.175). Complications associated with use of the hinge included five pin-track infections, one case of pin-track osteomyelitis, one ulnar fracture through a pin site, two broken Schanz screws, and two cases of irritation of the ulnar nerve. CONCLUSIONS: Open release of a severe elbow contracture results in a substantial gain in motion, with or without hinged elbow fixation. The slightly greater improvement in motion provided by the hinge does not justify the associated increase in risk, expense, and complications.

Adolescent↗

PubMed2005

Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.

UNLABELLED: We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗

PubMedDate not supplied

Lateral elbow instability: nonoperative, operative, and postoperative management.

The purpose of this article is to present a treatment approach that has been found to be effective in the early management of lateral elbow instability. Anatomy and joint mechanics related to stability of the elbow are reviewed. Operative and nonoperative treatment is outlined followed by a description of an innovative paradigm for the rehabilitation of elbow instability. Progression of the rehabilitation program as the elbow achieves greater stability is discussed. The authors hope that therapists and surgeons will find this method beneficial in beginning early range of motion for the unstable elbow, thus minimizing joint stiffness while preserving stability at the elbow joint.

Elbow Joint↗