Biomedical subjects
Publications and source records attributed to W D Engber.
The fibrocartilaginous volar plate of the thumb interphalangeal joint is anatomically quite similar to the volar plate of the digital proximal interphalangeal joint. Due to this similarity, Eaton's technique of volar plate arthroplasty may also be utilized in fracture-dislocations of the thumb interphalangeal joint.
Between 1980 and 1990, 31 patients (33 extremities) underwent decompression of the radial tunnel. All procedures were performed at the same institution by the senior author using a brachioradialis muscle-splitting approach. Twenty-three patients (24 extremities) were available for follow-up evaluation at an average of 8 years after surgery. The outcome was determined using the original criteria of Roles and Maudsley and Ritts et al. By the criteria of Roles and Maudsley, outcomes for 15 patients (16 extremities; 67%) were rated as excellent/good and for 8 patients (8 extremities; 33%), as fair/poor. By the criteria of Ritts et al., 16 patients (17 extremities; 71%) had good results and 7 patients (7 extremities; 29%), a fair/poor result. Overall, the majority of patients were satisfied and felt helped by the surgery. Five patients changed their occupation because of continued discomfort. Significant differences in outcome were not found for workers' compensation patients. Similarly, no differences in outcome were found for site of compression, patient sex, history of trauma, or associated neuropathies. The results of this study suggest that complete pain relief and return to activities following radial tunnel surgery is not as predictable as previous studies have indicated. Nineteen patients (20 extremities), however, felt satisfied and helped and believed they gained improved function because of surgical decompression of the radial tunnel.
A long term evaluation was performed on 8 patients who had rupture of the distal biceps tendon repaired using the 2-incision technique. The length of followup ranged from 1 to 11 years with an average of 6 years. Goniometric range of motion and isokinetic strength testing were performed on all patients. All patients attained a full arc of elbow flexion and extension. Supination was diminished more than 30 degrees in 3 patients and pronation was diminished more than 30 degrees in 1 patient. Subjectively, 6 of 8 patients were completely satisfied with the function of their involved arm. Strength and work performed during repetitive exercise were regained to the expected normal levels in elbow flexion. Six of 8 patients continued to have less strength in supination of the injured arm than the uninjured arm. All 8 patients performed less total work with repetitive supination of the injured arm than the uninjured arm.
OBJECTIVE: To determine how the appearance of fracture line bridging and graft incorporation changed on sequential plain films obtained during the healing of successful grafts for scaphoid nonunion. DESIGN: We identified 50 patients who had healed Russe bone grafts for nonunited scaphoid fractures. These patients had 214 sets of wrist radiographs obtained 1-36 months after surgery. Each set of radiographs was reviewed in random order by two observers who were blinded as to the patient's name and the time interval since surgery. Closure of the fracture line and the presence of a linear lucency in each of six zones surrounding the graft were assessed using a three-point grading scale. PATIENTS: Forty-six men and four women were included in the study. Their mean age was 30 years with a range from 21-43 years. RESULTS AND CONCLUSIONS: With increasing time after surgery, there was progressive fracture line closing and disappearance of linear lucencies at the interfaces between the scaphoid and the graft. However, a 20% of the patients had a well-defined lucency in at least one of the six zones around the graft on their last film. Even 1 year after surgery, the fracture line showed no bridging on the radial side in 22% of patients and on the ulnar side in 11%. We conclude that after grafting, most scaphoid nonunions show progressive fracture line closure and graft incorporation. However, the fracture line may not completely close and lucencies may persist in several zones around the graft for more than 1 year. These radiographic appearances should be recognized as part of the normal spectrum of healing.
Sixteen patients with advanced Kienböck's disease (Lichtman stage IIIa and IIIb) were treated with proximal row carpectomy. Two patients were lost to follow-up study. The remaining 14 patients were followed for 3 years (range, 1 to 8 years) and all experienced less pain. Wrist motion was improved or unchanged in 12. Grip strength averaged 72% of the unaffected side. All patients returned to their previous jobs. Proximal row carpectomy in this group of patients provided satisfactory results.
The biomechanical properties of three minifragment plate and screw systems were compared to determine whether plate systems primarily designed for maxillofacial reconstruction are biomechanically sound for use in proximal phalangeal fracture fixation. A middiaphyseal transverse osteotomy was created in each of 30 fresh-frozen human proximal phalanges to simulate an unstable fracture. Each osteotomy was then fixed with four 2.0ml screws through one of three different four-hole minifragment plates in a middorsal position. Plating systems tested included a vitallium plate with self-tapping screws (Luhr), a stainless steel plate with tapped screws (Synthes), and a titanium plate with tapped screws (Synthes). Testing was performed to failure in an apex volar three-point bending mode. The titanium-plated phalanges were the stiffest construct and required the greatest load and total energy absorbed to failure. However, only the load to failure for titanium versus stainless steel was significantly different. Therefore, there is no biomechanical disadvantage to using the titanium or vitallium plate and screw systems in the setting of unstable proximal phalangeal fractures.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A retrospective review was performed of 19 patients with irreducible mallet finger fractures after failed splinting. The patients were treated with open reduction and a tension band technique. Follow-up results were available for 18 patients (95%) at an average 8.2 years postoperatively. Eighty-nine percent of patients had no clinical mallet deformity, troublesome pain, or major functional disability. Distal interphalangeal range of motion averaged 1 degree hyperextension to 69 degrees flexion. All fractures healed with a congruent articular surface. Minor nonmechanical complications were encountered in 11% of cases in which a suture was used as the tension band material. Successful treatment may thus be achieved surgically in this select subset of mallet finger fractures when this technique is employed.
Dislocations and fracture-dislocations of the carpometacarpal joints are rare. Diagnosis requires a high index of suspicion, careful examination, and appropriate radiography. Treatment is controversial and is based upon the injury pattern and the surgeon's experience and preference. This article reviews the pertinent anatomy, mechanism of injury, evaluation, and treatment of patients with carpometacarpal joint injuries.
A biomechanical study was conducted to determine the best fixation technique for mallet finger fracture among four commonly used methods. Considerations were technical complications, biomechanical properties, and maintenance of reduction. Techniques tested included Kirshner wire, figure-of-eight wire, tension band wire, and tension band suture. Technical complications were frequent with both the Kirschner wire and tension band wire techniques. Biomechanical testing yielded significantly greater energy absorbed to failure and a trend toward greater peak loads to failure for both the figure-of-eight wire and tension band suture techniques. Irreversible loss of reduction during testing occurred in all of the Kirschner wire-fixed fractures, in 60% of the tension band wire-fixed fractures, and in 50% of the figure-of-eight wire-fixed fractures. No irreversible failure occurred in the tension band suture group.
Explore the source record for details and available documents.
High pressure injection trauma to the upper extremity is a rare but potentially limb-threatening injury. The index finger on the non-dominant hand of young male workers is most commonly involved. Injected materials include paint, grease and diesel oil. Prompt recognition and initiation of treatment is necessary if a disastrous outcome is to be avoided. Primary treatment consists of surgical decompression and debridement. Amputation may be necessary. With early aggressive treatment, satisfactory results can be obtained. The use of high-pressure devices in industry has resulted in an unusual but potentially limb-threatening injury to the upper extremity known as the "high-pressure injection injury." This injury is a surgical emergency that demands prompt diagnosis and treatment if a disastrous outcome is to be avoided. The purpose of this paper is to present our recent experience and review the clinical features, evaluation and treatment principles.
A case of Lyme arthritis with advanced degenerative changes localized to the midcarpal joint was treated with a limited wrist arthrodesis with relief of pain and improved function. Chronic Lyme arthritis occurs as the third stage of Lyme disease. Serologic testing and a history of a characteristic rash may be helpful in the diagnosis. Radiographic and histopathologic findings are nonspecific, with both degenerative and inflammatory characteristics. Intravenous antibiotics provide an effective treatment of chronic Lyme arthritis.
The Herbert screw has been demonstrated to have widespread clinical applicability. A biomechanical and histological evaluation of the Herbert screw was conducted to better define its applications. When subjected to pull-out, toggle, and compression testing, in a cancellous bone calf model, it was demonstrated to be biomechanically inferior to the 4.0 mm ASIF cancellous screw. The use of two Herbert screws minimized but did not eliminate this difference. Articular cartilage healing in a rabbit model was consistently demonstrated if the Herbert screw was buried deep to the osteochondral junction. However, toluidine blue histochemical staining showed that the hyaline-like repair cartilage differed qualitatively from normal cartilage. Utilization of the Herbert screw should include an understanding of the limitations of its fixation potential and a recognition of the repair response after intraarticular applications.
An unusual case of an unstable dorsal, distal radioulnar dislocation secondary to plastic deformation of the ulna is presented. The etiology and pathomechanics of this rare injury are reviewed.
Most nonunions of the carpal scaphoid bone can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Nine patients with nonunion and three patients with unstable proximal pole fractures were treated with retrograde dorsal Herbert screw fixation and adjunctive bone grafting. Follow-up averaged 25 months. Of the 12 patients, the fracture healed in 11 and one fracture remained ununited. This technique has been successful in our practice and should be considered in the treatment of small proximal pole nonunions and displaced proximal pole fractures.
In a prospective study, 87 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Mean follow-up was 22 months. Thirty-six percent (31/87) of all ganglions treated showed a successful outcome. Twenty-seven percent (16/60) of dorsal carpal, 43% (6/14) of palmar carpal, and 69% (9/13) of palmar digital ganglions did not recur. Immobilization significantly improved the results of treatment of dorsal carpal ganglions. Forty percent (12/30) of those in the immobilization group and 13% (4/30) of those in the early mobilization group had a successful outcome (p less than 0.05).