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Biomedical subjects

W H Seitz

Publications and source records attributed to W H Seitz.

At least 37 records · Page 2Linked to original sources
PubMed1991

Callotasis lengthening in the upper extremity: indications, techniques, and pitfalls.

Bone lengthening through callotasis has been performed in 12 bones of the upper extremity in eight patients. Diagnoses included congenital amputations, phocomelia, radial agenesis, traumatic amputations, and infected fracture with bone loss. Nine of the 12 procedures resulted in complete consolidation of the transport gap with new bone without need for bone graft. One patient died of unrelated illness before completion of treatment but demonstrated early consolidation of the gap. In two cases bone graft was required. Complications included one superficial pin tract infection and one case of premature cessation of lengthening because of hand deviation. Early experience with this technique indicates that it is effective in the management of bone defects in the upper extremity. It appears that in most cases a half-frame lengthening device, rather than a more complex circular frame, can be used in the non-weight-bearing upper extremity. Adequate control of the distal segment, appropriate choice of location for corticotomy, and gentle handling of the bone and periosteum can improve results and minimize complications.

Adult↗
PubMed1991

Repair of the tibiofibular syndesmosis with a flexible implant.

Fractures of the adult ankle with disruption of the tibiofibular syndesmosis require adequate stabilization of the ankle mortise to ensure satisfactory healing of the syndesmotic ligaments. Numerous internal fixation techniques for stabilization of the syndesmosis have been used. However, most techniques require partial device removal before weight bearing can be initiated. The "flexible syndesmosis repair" uses simple, inexpensive, readily available synthetic materials to restore distal tibiofibular stability. Once early fracture healing has been obtained, weight bearing is begun (average 6 weeks). Biomechanical testing on paired cadaver ankles demonstrated a suture tensile strength of 60 lbs and consistent suture-button strength of 49 lbs, whereas tricortical screw fixation was found to have a higher 82 lbs average pull-out strength, but demonstrated a wide variability depending on bone quality. Twelve patients have been managed with flexible syndesmosis repair and followed for 2-4 years. All fractures have healed without deformity and there are no cases of mortise instability. Subsequent analysis of devices removed 8-12 months following implantation has shown that all have remained intact without failure. The flexible syndesmosis repair is a reliable, stable way to restore syndesmosis integrity, allowing early weight bearing without need for interim surgery.

Adolescent↗
PubMed1991

Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow.

Ulnar nerve decompression with medial epicondylectomy was performed in 66 elbows between 1966 and 1986 for compressive ulnar neuropathy at the elbow. This study is an updated review that adds 36 cases to a previously published report on 30 cases. These elbows were graded preoperatively and postoperatively using McGowan's grading system. Eighty-three percent improved one or two grades, and 11% improved subjectively although they showed no objective improvement, 3% noted no change, and 3% were subjectively worse. One early case sustained damage to the ulnar collateral ligament with resultant instability. No other complications occurred. The best results were seen in the Grade I and II lesions, whereas those with Grade III lesions were the least predictable. The procedure is technically uncomplicated with minimal morbidity and reliable results.

Adolescent↗
PubMed1991

Reduction of treatment-related complications in the external fixation of complex distal radius fractures.

Treatment-related complications in the external fixation of complex distal radius fractures may be diminished by the insertion of 4-mm, self-tapping half-pins after predrilling. The pins are placed proximally in the radius and distally through six cortices of the second and third metacarpals. An adaptable fixation device that allows reduction after pin insertion and assembly is recommended. It must allow enough mobility to completely reduce a very unstable fracture after its application. A limited open surgical approach allows direct visualization of the bone where the fixator pins will be placed, as well as central insertion of the pins. It avoids eccentric drill placement, open section defects, redrilling, and damage to soft-tissue structures.

Biomechanical Phenomena↗
PubMed1990

Limited open surgical approach for external fixation of distal radius fractures.

In an effort to reduce treatment-related complications, a surgical procedure has been developed for the insertion and application of an external fixation device in the management of unstable fractures of the distal radius. Clinical experience with this device has demonstrated its effectiveness in reducing complications associated with pin insertion. The surgical technique is presented together with a case example. Results of laboratory tests corroborate our clinical experience and demonstrate the effectiveness of this technique in minimizing complications. Clinical results in 66 cases document the efficacy and safety of this technique.

Adult↗
PubMed1990

Mycotic aneurysm in a digital artery: case report and literature review.

A mycotic aneurysm of the common digital artery at its junction with the palmar arch, extending into the ulnar proper digital artery of the index finger, is reported in a patient with endocarditis. A review of the English-language literature revealed no case of mycotic aneurysm in a digital artery. Diagnosis of the aneurysm was established noninvasively by ultrasound. Because this patient lacked a radial proper digital artery to the finger, the aneurysm was managed by excision and revascularization with a bypass graft from the long finger. Postoperative circulatory monitoring was facilitated by a pulse oximeter.

Aged↗
PubMed1990

Pediatric update #15. Florid reactive periostitis of the digits.

Benign fibrous lesions of the digits can present a considerable diagnostic challenge. Some lesions may resemble sarcomas, resulting in needless amputation. One such benign entity resembles myositis ossificans histologically but presents as an aggressive hand lesions. Unfortunately, this lesion has been given multiple names. It is most appropriately termed florid reactive periostitis. This paper reports a case of florid reactive periostitis in a 12-year-old girl.

Bone Neoplasms↗
PubMed1990

Biomechanical analysis of pin placement and pin size for external fixation of distal radius fractures.

A series of biomechanical analyses were performed to explain the recent reduction in treatment-related complications of external fixation of distal radius fractures using a limited open approach for pin placement and larger 4-mm self-tapping half pins. A comparison of pull-out strength, stress concentration effect, and inherent bending strength of 3- and 4-mm half pins was performed. The effect of proximal pin placement in the radius or in the ulna and the effect of distal pin placement in four, six, or eight metacarpal cortices were determined. These analyses demonstrate that the 4-mm self-tapping half pins result in a significantly higher pull-out strength and only a small decrease in torsional load strength of the bone. They also demonstrate that proximal pin fixation in the radius produces the most stable fixation and that distal pin fixation into six metacarpal cortices produces a strong configuration that does not violate the interosseous muscles of the second intrinsic compartment. The rate of treatment-related complications in the external fixation of distal radius fractures (specifically, pin loosening, bending and breakage, fracture through pin sites, collapse at the fracture site, and intrinsic contracture) are addressed in this study. Such complications can be minimized by using 4-mm pins after central predrilling, with proximal placement in the radius and distal placement through six cortices of the bases of the second and third metacarpals.

Animals↗
PubMed1990

Pediatric update #11. Congenital radioulnar synostosis. A new technique for derotational osteotomy.

Hyperpronation deformity due to congenital radioulnar synostosis has previously been managed by derotational osteotomy through the synostosis, while stabilization has been achieved with K-wires and a long arm cast. The technique presented here uses a small external fixation device that allows precise rotational correction and affords adequate stabilization yet avoids cast immobilization.

Female↗
PubMed1989

Distraction osteogenesis of a congenital amputation at the elbow.

A case is described demonstrating the effectiveness of distraction osteogenesis for the lengthening of a short below elbow congenital amputation. To our knowledge this technique has not been previously used in a patient with a congenital amputation. The surgical technique of corticotomy and postoperative lengthening is detailed. The result converted the level of patient performance from elbow disarticulation to functional below elbow status.

Bone Lengthening↗
PubMed1989

Arthroscopy update #3. Chronic impingement syndrome. The role of ultrasonography and arthroscopic anterior acromioplasty.

Diagnosis of advanced rotator cuff impingement syndrome has been difficult due to dependence on plain radiographs and arthrography, which in the absence of complete tears are frequently inconclusive. Advances in ultrasonography have enabled accurate diagnosis of the more enigmatic partial thickness tears of the rotator cuff. Until recently, advanced impingement syndrome resistant to conservative therapy has been managed by open anterior acromioplasty as described by Neer. This has required a prolonged postoperative rehabilitation program before return to normal activities of daily living and athletic participation. Precise diagnosis with ultrasonography and refined arthroscopic techniques have enabled us to identify 50 patients with resistant impingement syndrome and partial thickness tears of the rotator cuff, and surgically decompress the subacromial space via arthroscopic resection of the coracoacromial ligament and anterior-inferior leading edge of the acromion. Postoperatively there has been minimal pain. Return of nearly full passive range of motion has been achieved in all but two patients within the first week. Active range of motion exercises are begun on the first postoperative day and resistive exercises commence two weeks after surgery. Mean return of normal functioning in activities of daily living has been two months, while return to prior level of athletic activity has averaged five months.

Acromion↗
PubMed1989

Replantation.

Replantation is firmly established as a viable treatment option in many accidental amputations involving the upper extremity. The clinical foundation was laid more than 100 years ago and it is a technique which is now available world wide. The success rate of replantation exceeds 80 per cent. More often than not, appropriately selected patients obtain a functional result which is better than currently available prosthetic devices. The experience gained from small vessel surgery in replantations has aided in the development of reconstructive procedures, including free composite tissue transfers such as toe-to-hand transfers and free flaps.

Amputation, Traumatic↗
PubMed1989

Advances in fracture management in the hand and distal radius.

Indications for internal and external fixation within the hand skeleton and distal radius have been presented and discussed. When used appropriately, these techniques will provide reliable fracture fixation and superior clinical results. Obviously, these techniques are not appropriate for all fractures. There remains a group of fractures well treated by more conservative methods. Additionally, some fractures exist which cannot be well treated by any method currently available. Nonetheless, these new techniques have added significantly to the clinical success available following the onset and treatment of complex fractures occurring within the hand skeleton and distal radius.

Adolescent↗
PubMed1989

Reconstruction of severe burn deformities of the upper extremity.

A case of severe post burn deformity involving multiple joints in both upper extremities is presented. Principles of rehabilitation and surgical reconstruction are detailed which demonstrate the importance of a close working relationship between surgeon, patient and therapist. This case serves as an excellent example of how a systematic approach to severe burn deformities can transform disaster into a favorable functional outcome.

Burns↗
PubMed1989

Multifaceted pediatric congenital hand reconstruction.

The management of a variety of complex congenital hand deformities is presented. The importance of early parental education by the surgeon and the rehabilitation team is stressed so that staged reconstruction can be planned and executed. New surgical techniques are demonstrated that provide the patient with the ability to perform normal bimanual activities at an early age.

Blood Vessels↗
PubMed1988

Management of malunited fractures of the metacarpal and phalangeal shafts.

Malunions of the tubular bones of the hand should be carefully studied to understand the original deforming forces at the time of injury. Once a three-dimensional concept of the deformity is embraced, a careful plan for osteotomy can be developed and executed. Surgical approach must afford adequate access with the least possible injury to soft tissues. Technique of osteotomy must be tailored to the configuration, location, and biomechanical requirements for proper realignment of the malunited fracture. Important principles in the management of metacarpal and phalangeal malunions are: 1. Rotatory deformities are most disabling yet frequently not appreciated. A 10-degree rotational malalignment in the metacarpal results in a 2-cm overlap at the finger tip. Alignment should always be checked with the fingers flexed into the palm. 2. Adherence to biomechanical principles of fracture repair is mandatory. 3. The appropriate form of osteotomy and subsequent fixation must be carefully chosen and applied to each individual deformity. Familiarity with the osteotomy techniques and alternative forms of fixation affords flexibility in managing complex deformities. 4. The presence of malunion suggests the presence of fracture disease in the soft tissues. They must be delicately handled and carefully inspected for the presence of scarring, adhesions, and contractures. Careful protection of delicate structures should be complemented by judicious tenolysis and arthrolysis at the time of osteotomy. 5. Appropriate, functional postoperative rehabilitation is mandatory. Without adequate therapy the best surgery will produce suboptimal results. Adherence to these principles can avoid further complications and problems and provide a successful ultimate outcome.

Biomechanical Phenomena↗