Biomedical subjects

Thomas R Kiefhaber

Publications and source records attributed to Thomas R Kiefhaber.

7 recordsLinked to original sources

PubMed2006

Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations.

PURPOSE: Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach. METHODS: A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture-dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws. RESULTS: A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70 degrees (range, 55 degrees -90 degrees ). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85 degrees , and the average PIP joint motion for the remaining 7 patients was 65 degrees . One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14 degrees . Seven patients had no pain, and 2 had pain only with heavy activity. CONCLUSIONS: Open reduction and internal fixation of unstable dorsal PIP joint fracture-dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Activities of Daily Living↗

PubMed2005

Proximal row carpectomy.

BACKGROUND: Proximal row carpectomy is an accepted motion-sparing surgical procedure for the treatment of degenerative conditions of the wrist. However, there is little information regarding the long-term clinical and radiographic results following this procedure. METHODS: Twenty-two wrists in twenty-one patients underwent proximal row carpectomy for the treatment of degenerative arthritis between 1980 and 1992. Objective and subjective function was assessed after a minimum duration of follow-up of ten years (average, fourteen years). RESULTS: There were four failures (18%) requiring fusion at an average of seven years. All four failures occurred in patients who were thirty-five years of age or less at the time of the proximal row carpectomy (p = 0.03). The wrists that did not fail had an average flexion-extension arc of 72 degrees , associated with an average grip strength of 91% of that on the contralateral side. The patients were very satisfied with fourteen of the eighteen wrists that did not fail and were satisfied with the remaining four. The patients rated nine wrists as not painful, four as mildly painful, five as moderately painful, and none as severely painful. The average Disabilities of the Arm, Shoulder and Hand score was 9 points. Radiographs revealed no loss of the radiocapitate space in three of the seventeen wrists for which radiographs were made, reduced space in seven, and complete loss of the space in seven. With the numbers available, there was no significant association between loss of joint space seen on radiographs and subjective and objective function. CONCLUSIONS: At the time of long-term followup, all patients older than thirty-five years of age at the time of a proximal row carpectomy had maintained a satisfactory range of motion, grip strength, and pain relief and were satisfied with the result. Caution should be exercised in performing the procedure in patients younger than thirty-five years of age. Although degeneration of the radiocapitate joint was seen radiographically in fourteen of the seventeen wrists, it did not preclude a successful clinical result.

Adult↗

PubMed2004

Palmar midcarpal instability: the results of treatment with 4-corner arthrodesis.

PURPOSE: Palmar midcarpal instability (PMCI) is one type of nondissociative carpal instability. The optimal treatment for PMCI is uncertain. The purpose of this investigation was to evaluate the results of capitate-lunate-triquetrum-hamate (4-corner) arthrodesis for PMCI. METHODS: Over a 10-year period 8 patients were treated with 4-corner arthrodesis for PMCI. The instability was diagnosed clinically and confirmed with cineradiography. The symptomatic instability began in all patients after a notable trauma; 6 of the patients were injured at work and 2 were injured in a motor vehicle accident. Patients were evaluated at an average of 34 months after surgery. RESULTS: Seven of the 8 patients were satisfied with the surgery and 6 of 8 patients had no pain or mild pain. Both patients injured in motor vehicle accidents returned to all preinjury activities. Four of the 6 workers' compensation patients returned to work, 3 at full duty and 1 in a restricted position. Two patients, both with workers' compensation, did not return to their pre-injury jobs. One had occasional moderate pain and the other had chronic pain. The average wrist flexion/extension arc of motion decreased with surgery from 135 degrees to 75 degrees. The average grip strength increased significantly with surgery from 20 kg to 32 kg; however, grip strength remained significantly lower than the opposite side strength of 54 kg. CONCLUSIONS: Four-corner arthrodesis is a reasonable option for PMCI. Compared with previous reports of soft tissue reconstruction 4-corner arthrodesis may provide a more reliable solution for this difficult problem.

Adult↗

PubMed2004

Proximal row carpectomy: study with a minimum of ten years of follow-up.

BACKGROUND: Proximal row carpectomy is an accepted motion-sparing surgical procedure for the treatment of degenerative conditions of the wrist. However, there is little information regarding the long-term clinical and radiographic results following this procedure. METHODS: Twenty-two wrists in twenty-one patients underwent proximal row carpectomy for the treatment of degenerative arthritis between 1980 and 1992. Objective and subjective function was assessed after a minimum duration of follow-up of ten years (average, fourteen years). RESULTS: There were four failures (18%) requiring fusion at an average of seven years. All four failures occurred in patients who were thirty-five years of age or less at the time of the proximal row carpectomy (p = 0.03). The wrists that did not fail had an average flexion-extension arc of 72 degrees , associated with an average grip strength of 91% of that on the contralateral side. The patients were very satisfied with fourteen of the eighteen wrists that did not fail and were satisfied with the remaining four. The patients rated nine wrists as not painful, four as mildly painful, five as moderately painful, and none as severely painful. The average Disabilities of the Arm, Shoulder and Hand score was 9 points. Radiographs revealed no loss of the radiocapitate space in three of the seventeen wrists for which radiographs were made, reduced space in seven, and complete loss of the space in seven. With the numbers available, there was no significant association between loss of joint space seen on radiographs and subjective and objective function. CONCLUSIONS: At the time of long-term follow-up, all patients older than thirty-five years of age at the time of a proximal row carpectomy had maintained a satisfactory range of motion, grip strength, and pain relief and were satisfied with the result. Caution should be exercised in performing the procedure in patients younger than thirty-five years of age. Although degeneration of the radiocapitate joint was seen radiographically in fourteen of the seventeen wrists, it did not preclude a successful clinical result.

Adult↗

PubMed2003

Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.

PURPOSE: This retrospective study was designed to evaluate the clinical and radiographic results of a hemi-hamate autograft for the treatment of comminuted dorsal proximal interphalangeal (PIP) joint fracture/dislocations. METHODS: Thirteen consecutive patients underwent hemi-hamate autograft for the treatment of an unstable dorsal PIP fracture dislocation. The fractured middle phalangeal base was debrided and the defect was replaced using a size-matched portion of the dorsal/distal hamate osteoarticular surface and was secured with miniscrews. The average middle phalangeal volar lip involvement on initial radiographs was 60% (range, 40% to 80%). The average time to surgery was 45 days (range, 2-175 d). Range of motion, stability, and grip strength were measured at a mean follow-up evaluation of 16 months. Radiographs were evaluated for union, graft incorporation, and/or collapse. Subjective data, satisfaction, and return to work were obtained on 12 of the 13 patients at a mean follow-up evaluation of 17 months. RESULTS: The average arc of motion at the PIP joint was 85 degrees (range, 65 degrees to 100 degrees ). The distal interphalangeal (DIP) joint average arc of motion was 60 degrees (range, 35 degrees to 80 degrees ). Average grip strength was 80% of the uninjured side. Bony union was achieved in all patients. One graft showed ulnar collapse but graft resorption was not noted. Except for 2 patients with recurrent dorsal subluxation there were no complications. The average pain level was 1.3 (as rated on a visual analog scale of 0-10). Eleven of 12 patients were very satisfied with their function and one was somewhat satisfied; one patient was lost to follow-up. CONCLUSIONS: When greater than 50% of the volar base of the middle phalanx is fractured in a PIP fracture/dislocation or the joint remains unstable despite a lesser degree of involvement, a hemi-hamate autograft should be considered. This procedure reconstructs the cup-shaped contour of the middle phalangeal articular surface and facilitates a stable, functional arc of motion at the PIP joint. Additionally, in our experience the procedure renders minimal disability and has a low complication rate.

Adolescent↗

PubMed2003

The relationship between basal joint arthritis and carpal tunnel syndrome: an MRI pilot study.

PURPOSE: This investigation explored 2 questions. First, does basal joint arthritis lead to morphologic alterations that significantly narrow the carpal tunnel? Second, does trapezial excision alter the morphology of the carpal tunnel and decompress the median nerve? METHOD: Four patients with basal joint arthritis alone were treated with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Three patients with basal joint arthritis and carpal tunnel syndrome were treated with LRTI and carpal tunnel release. Preoperative and postoperative magnetic resonance imaging (MRI) scans were obtained to assess differences in carpal tunnel volume and morphology between the groups before and after surgery. RESULTS: The difference in preoperative carpal tunnel volume between groups was not significantly different. Carpal tunnel volume increased by 7% with LRTI and by 24% after LRTI and carpal tunnel release. The anteroposterior diameter of the carpal canal increased in both groups to allow a volar migration of the median nerve. CONCLUSION: LRTI increases the anteroposterior diameter and volume of the carpal tunnel. A larger comparative study would be necessary to determine whether LRTI is sufficient to decompress the carpal tunnel.

Aged↗

PubMed2002

PIP Fracture/Dislocation Treatment Technique: Use of a Hemi-Hamate Resurfacing Arthroplasty.

The nature of injury following a PIP fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered and can be classified based on stability. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement; the larger the palmar lip fracture, the more unstable the joint becomes. When there is persistent instability or greater than 30 degrees of flexion is required to maintain reduction, treatment must be aimed at reconstituting the cup shaped geometry and buttressing effect of the volar lip of the middle phalanx if stability is to be restored. The use of a hemi-hamate autograft to reconstruct the base of the middle phalanx is a new technique that restores joint congruity and stability while allowing for early motion. This operative technique replaces the damaged palmar lip of the middle phalanx with a size-matched portion of the hamate obtained from its distal dorsal articular surface between the 4th and 5th metacarpals. By restoring both articular congruity and osseous stability the advantage of this procedure is that it allows more immediate rehabilitation with a potential for earlier motion, less stiffness and possibly less post-traumatic arthritis.

Journal Article↗