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Biomedical subjects

S H Kuschner

Publications and source records attributed to S H Kuschner.

At least 19 recordsLinked to original sources
PubMed1992

Sequential infection of silicone metacarpophalangeal joint arthroplasties resulting from skin breakdown.

We report a case of late multiple infected metacarpophalangeal silicone implants in a patient who had had replacement arthroplasty for treatment of rheumatoid arthritis. The patient had done well for 10 years after metacarpophalangeal joint arthroplasty when an implant infection developed. Over the next 4 years the remaining three implants on her dominant extremity also became infected necessitating their removal. The origin of the infections is thought to be the result of excessive and improper usage of the hand.

Arthritis, Rheumatoid↗
PubMed1992

Tinel's sign and Phalen's test in carpal tunnel syndrome.

Tinel's sign and Phalen's test are two provocative tests used in the diagnosis of carpal tunnel syndrome. A review of the literature reveals a wide range of sensitivity for these tests. Analyzing the historical data and comparing these to the Tinel's sign and Phalen's test results of 100 individuals without carpal tunnel syndrome (200 wrists), we conclude that the Tinel's sign is not useful in the evaluation of patients with carpal tunnel syndrome, whereas Phalen's test, which has a greater sensitivity and specificity, can be of use.

Adolescent↗
PubMed1992

Concomitant injuries of the hip joint and abdomen resulting from gunshot wounds.

Septic arthritis is a devastating complication of transabdominal gunshot wounds to the hip. Five patients sustained gunshot wounds to the hip which violated the alimentary tract. Diagnosis was established with plain radiographs in three patients, arthrogram in one patient, and a gastrointestinal series in one patient. Three patients had an exploratory laparotomy with diverting colostomy followed by immediate hip arthrotomy within 24 hours and no joint infections occurred. In the other two patients, hip involvement was identified late after septic arthritis occurred. Early diagnosis, diverting colostomy, and immediate arthrotomy are recommended for gunshot wounds to the hip which involve the alimentary tract.

Abdominal Injuries↗
PubMed1992

Embedded ring injuries.

Two patients, each with a history of mental illness, were assessed for embedded rings. Removal of the ring was accomplished without loss of digit or further loss of function in one patient. The other patient refused treatment. Altered mental status is a common finding in patients with embedded ring injuries.

Adult↗
PubMed1992

Fractures of the forearm resulting from low-velocity gunshot wounds.

Thirty-seven extraarticular fractures of the forearm resulting from low-velocity gunshot injuries were treated by cast immobilization or open reduction and internal fixation with dynamic compression plates. All patients received 72 h of intravenous antibiotics. There were 14 isolated ulna fractures, 17 isolated radius fractures, and six both-bone (radius and ulna) fractures. Cast immobilization was used in 22 of 23 nondisplaced or minimally displaced fractures and eight of 14 displaced fractures. The remaining seven fractures were treated by open reduction and internal fixation. All fractures united within 16 weeks of injury regardless of the method of treatment. Poor clinical results related to the fracture occurred in six patients, five of whom were treated by cast immobilization. Fourteen patients had nerve palsies; eight resolved spontaneously and six had permanent neurologic deficits. There were two compartment syndromes and one ulnar artery transection. There were no infections. We conclude that displaced fractures of the radius, and both bone fractures, are best treated by open reduction and internal fixation. All patients should be closely monitored for 24 h for compartment syndrome, regardless of the fracture type or pattern. Early dynamic splinting is important when associated nerve injuries are present.

Academic Medical Centers↗
PubMed1992

Review of treatment results for Kienbock's disease.

A review of the literature reveals that Kienbock's disease has been treated in many different ways. Excision of the lunate, with or without replacement arthroplasty, and joint-leveling procedures (radial shortening or ulnar lengthening) are the most popular procedures, but other methods of treatment (nonoperative, wrist denervation, lunate revascularization, intercarpal arthrodesis and proximal-row carpectomy) have also been performed. Based on our current understanding of the etiology, a joint-leveling procedure seems to make the most sense when surgery is indicated. However, other procedures have yielded a high success rate as well.

Carpal Bones↗
PubMed1991

A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid.

The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.

Biomechanical Phenomena↗
PubMed1991

Nodular fasciitis: a rapidly growing tumor of the hand.

Nodular fasciitis is an uncommon benign neoplasm infrequently seen in the hand. There are often difficulties in diagnosis of this tumor. It is usually surgically excised while it is still small. The patient described here had a large and aggressive tumor that ruptured through the skin of the hand and extended to the periosteum of the ring metacarpal.

Adult↗
PubMed1991

A comparison of the healing properties of rabbit Achilles tendon injuries at different levels.

Rabbit Achilles tendons were transsected at the muscle-tendon junction (Group 1), midtendon (Group 2), or at the calcaneus insertion (Group 3). Treatment consisted of immobilization in a long leg cast without surgical repair. The contralateral leg served as a control. Tensile testing was performed at four weeks. Groups 1 and 2 failed most often in the proximal muscle rather than at the healing site. In contrast, Group 3 failed more often at the healing site than in the muscle and was statistically superior to Groups 1 and 2 with respect to strength and stiffness. Statistically, control specimens showed failure at the musculotendinous junction at greater loads and were stiff compared to the experimental groups.

Achilles Tendon↗
PubMed1991

Fracture of the index metacarpal base with subluxation of the trapeziometacarpal joint. A case report.

A 40-year-old man fell on his outstretched arm and suffered a fracture of the index metacarpal base with subluxation of the thumb basal joint. The small fracture fragment at the base of the index metacarpal was attached to the base of the thumb metacarpal by a strong ligament, as noted at the time of surgery. This pattern of injury, a ligament-reversed Bennett's fracture, seems not to have been previously reported.

Adult↗
PubMed1991

Complications associated with carpal tunnel release.

A number of complications can result from surgical treatment of carpal tunnel syndrome. They can be diminished with the use of a longitudinally directed incision, complete visualization of the median nerve, and an understanding of the anatomic variations of the median nerve. However, some complications (eg, a painful scar, infection, and wrist weakness) may not be completely prevented.

Carpal Tunnel Syndrome↗
PubMed1990

Results of dorsal wrist synovectomies in the rheumatoid hand.

Seventy-eight patients with rheumatoid arthritis had 102 dorsal wrist tenosynovectomies, intraarticular synovectomies, and Darrach resection from 1962 to 1982. Follow-up after surgery averaged 11 years, with a range from 3 to 20 years. Pain was diminished in all but 17 wrists and motion decreased an average of 13 degrees. Synovitis recurred in 16 wrists and x-ray evidence of progressive intraarticular destruction was seen in 45 wrists. Revision surgery was necessary in 28 wrists.

Adolescent↗
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↗
PubMed1990

Malignant tumors of the upper extremity in children.

Of the 422 primary malignant tumors of bone and soft tissue treated at one institution between 1968 and 1988, the 29 found in the upper extremity in children are reviewed. In the latter group, there were 13 patients with osteosarcoma; one was lost to follow-up shortly after diagnosis, one was alive and disease free four years after surgery, two are currently being followed, and nine are dead. All of the four patients with Ewing's sarcoma died. Three patients had chondrosarcoma; one was lost to follow-up after surgery, and the other two were disease free at four and 14 years' follow-up. Two of the nine patients with soft-tissue sarcomas died as a result of their tumors.

Adolescent↗