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At least 811 records · Page 45Linked to original sources
PubMed1997

The use of frozen-allograft radial head replacement for treatment of established symptomatic proximal translation of the radius: preliminary experience in five cases.

Five patients with disabling symptoms related to proximal translation (> 1 cm) of the radius following radial head excision (Essex-Lopresti lesion) were treated with implantation of a frozen-allograft radial head prosthesis. Following restoration of neutral ulnar variance at the wrist, a size-matched frozen radial head allograft was implanted and secured to the proximal radius with internal fixation. In three patients, this was a two-stage procedure; radial length was restored gradually using an ilizarov external fixation device and the allograft was placed later. Patients were evaluated clinically and radiographically at a mean follow-up time of 3 years (range, 1-7 years). All patients had relief of wrist and elbow pain and were satisfied with the outcome of the operation. Forearm rotation improved by a mean of 37 degrees and wrist motion improved by a mean of 45 degrees. Forearm reconstruction with frozen radial head allograft implantation may be a beneficial method of treatment for this difficult problem.

Adult↗
PubMed1994

Clinical evaluation of the modular electromechanical lock actuator for above-elbow prostheses: a preliminary report.

The Modular Electromechanical Lock Actuator (MELA) is the result of research and development (R&D) conducted under the direction of Dudley S. Childress, PhD, at the Northwestern University Prosthetics Research Laboratory (NUPRL), Chicago, Illinois. NUPRL, based upon their experience with prostheses for persons with high-level, upper-limb amputations, developed MELA to provide users with more efficient, versatile control and operation of their existing, cable-operated, positive-locking elbow and wrist components. The design of MELA has advanced to the point where it has the potential to improve the functionality and effectiveness of existing, body-powered or manually positioned above-elbow prostheses. This R&D effort has resulted in a pre-market model that is now ready for the national field evaluation part of the technology transfer process coordinated through the VA Rehabilitation Research and Development Service, Technology Transfer Section.

Activities of Daily Living↗
PubMed1981

Acupuncture in phantom limb pain.

A case of a 36-year-old man, with a history of traumatic amputation below the elbow on the left side, resulting in intractable phantom limb pain, is described. The patient failed to respond to a variety of medications including several analgesics, tranquilizers, and a beta-blocker. Other extended series of conventional treatment modalities, which included stellate ganglion and peripheral nerve blocks and neuromal excision with the anterior transposition of the ulnar nerve, did not relieve the pain. Acupuncture was then attempted with the subjective relief of phantom limb pain and the objective result that the patient could wear a prosthesis.

Acupuncture Therapy↗
PubMed1993

Microsurgery in gaining paediatric vascular access for haemodialysis.

One hundred and one surgical procedures performed in children for construction and maintenance of vascular accesses for haemodialysis were retrospectively analyzed. There were 86 operations performed to create a new fistula in patients without vascular access or with nonrecoverable failed angio-access. Fifteen surgical procedures were performed to treat fistula complications. The new fistulas were radiocephalic n = 60 (70%), ulnar-basilic n = 5 (5.8%), antecubital n = 9 (10.3%), and PTFE grafts n = 12 (14%). Microsurgical techniques were used in all cases, including PTFE graft fistulas. A microscope was used in 56 cases (55.4%) and magnifying loupes (x 2.5 magnification) in the rest of the operations. Early-failure rate for radiocephalic fistulas was 10%. Cumulative patency rates in radiocephalic fistulas were 79%, 75%, and 70% at 1, 2, and 5 years, respectively. No statistical differences were found from the cumulative patency curve of 730 radial-cephalic fistulas performed in adults during the same period of time. Radiocephalic fistulas can be constructed in most paediatric cases using microsurgical technique. Elbow fistulas can be the second-choice vascular access, and PTFE grafts can be reserved for children with exhaustion of autologous veins. Brachial-jugular PTFE grafts can be used in cases of subclavian vein stenosis.

Adolescent↗
PubMed2006

Shoulder arthroplasty in cases with avascular necrosis of the humeral head.

Avascular necrosis (AVN) is a relatively uncommon cause of glenohumeral arthritis. Previous retrospective reviews of shoulder arthroplasty for AVN have shown very good results in small numbers of patients. This study prospectively evaluated a consecutive series of 21 shoulders in 19 patients treated with the same modular prosthesis at a single institution. Of the shoulders, 8 developed AVN after a proximal humeral fracture, 1 was associated with a massive rotator cuff tear, 10 developed after corticosteroid therapy, and 2 were idiopathic. The patients, 14 women and 5 men, with a mean age of 54 years, were followed up for a mean of 4.7 years (range, 2 to 8 years). Hemiarthroplasty was performed in 15 shoulders, whereas 6 required total shoulder arthroplasty. Assessment included visual analog scales, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons Shoulder Score Index (SSI). Physical examination was performed, and radiographs were obtained. The visual analog scale scores for pain and function improved significantly after surgery (P < .01). The mean SSI score rose from 36 to 81 (where 0 indicates the worst outcome and 100 indicates the best outcome). The mean number of positive responses on the Simple Shoulder Test increased from 3 to 10. Mean active elevation increased from 88 degrees to 123 degrees . External rotation improved from 7 degrees to 34 degrees , and internal rotation improved from L4 to T12. No difference in outcome was noted based on age or sex. Patients with steroid-related or idiopathic AVN had greater pain and functional impairment preoperatively (mean SSI score, 26) than those with prior fracture or rotator cuff tear (mean SSI score, 49) (P < .01). Postoperatively, however, these groups fared equally well (mean SSI score, 78 vs 82). Shoulder arthroplasty for AVN produces good pain relief and function, although a concurrent series with osteoarthritis yielded better results. Forward elevation did not approach normal as had been previously reported.

Adult↗
PubMed1979

Discrimination of phantom hand sensations elicited by afferent electrical nerve stimulation in below-elbow amputees.

The necessity for a sensory feedback system that would enhance patient acceptability of motorized hand prostheses is now generally acknowledged. Afferent electrical stimulation of the nerves in the amputation stump can convey sensory feedback from prostheses with the advantage of eliciting sensations in the phantom image of the lost hand. Experiments with percutaneous nerve stimulation of the amputation stump in below-elbow amputees showed that with stable electrode conditions, amplitude modulated stimulation was better than frequency modulated stimulation in terms of accuracy, delay, and transinformation both with intermittent and uninterrupted stimulation. With unstable electrode conditions, different results were noticed, since amplitude modulated stimulation is very sensitive even to minor changes in electrode position. It is concluded that afferent electrical nerve stimulation with adequate training and stable electrodes had characteristics of accuracy, transinformation and delay which are good enough to make it a suitable method of conveying information in a prosthesis feedback system.

Adult↗
PubMed1990

A prosthetic harness adaptation.

A prosthetic harness adaptation was used with four burn patients with below-elbow amputations. Severe restriction of shoulder and trunk mobility made it impossible for these patients to don and doff their prostheses using the traditional figure-of-eight harness. The adaptation enabled the patients to enlarge the harness for donning and doffing and to tighten it for use.

Adult↗
PubMedDate not supplied

The results of the surgical treatment of bone tumors using massive homoplastic grafts.

We reviewed our experience as concerns 588 patients treated by resection for bone tumor and reconstructed by massive bank bone implant. The period taken into consideration goes from 1984 to 2001. The mean age of the patients was 24 years with a minimum of 1 and a maximum of 77 years: in 186 cases (31.6%) age was lower by 14 years. Most of the patients were referred for a diagnosis of malignancy (85%), and of these, 70% had undergone antiblastic therapy postoperatively according to the modalities of the protocols. Of the cases that were not treated by chemotherapy there are 16 that had a homoplastic graft after failure of a previous one. In a high number of cases (189) surgery included reconstruction of an intercalar segment of a long bone. Of these, 106 were in the femur, 69 in the tibia, and 14 in the humerus. One joint reconstruction was carried out in 128 cases of which 52 in the knee, 49 in the shoulder, 10 in the elbow, 11 in the wrist, 3 in the ankle, and 3 in the metatarsals. Fusion, which was one of the most frequent indications in the eighties, is used less today; overall it was carried out in 91 cases of which 65 in the knee, 14 in the hip, 9 in the ankle and 3 in the wrist. This type of implant may also be used in the pelves, and this took place in 56 cases using different procedures of reconstruction. The most current method of reconstruction for a joint is composite prosthesis, and this was used in 124 cases of which 67 around a knee, 53 in the hip, 4 in the shoulder. Finally, in 78 cases a vascularized fibula transplant was associated with an intercalar graft, fusion, or osteoarticular graft to increase the mechanical capacity of the implant together with a more rapid integration of the implant, particularly at the osteotomic lines. Despite the excellent results demonstrated in the first 3 years of follow-up, infection, resorption, delay in consolidation and fracture led to 18% failures of the implant. Massive homoplastic graft is still a good means of reconstruction that allows for excellent functional results, but despite this intense research activity is required to improve its mechanical hold in time together with better and complete integration.

Adolescent↗
PubMed1985

Total joint replacement: latest developments for the geriatric patient.

Total joint replacement has significantly improved the treatment of patients with severe, disabling arthritis. Following replacement of the hip, knee, shoulder, or elbow, the vast majority of patients can expect excellent pain relief and functional improvement. The components of a successful total joint replacement include proper patient selection, optimal preoperative and postoperative management of associated medical problems, meticulous surgical technique, a comprehensive rehabilitation program, and proper prophylaxis against infection.

Adrenal Cortex Hormones↗
PubMed1994

[Arteriovenous fistulas for hemodialysis--patency rates and complications--a retrospective study].

In this study we investigated 213 forearm-fistulas, 233 elbow-fistulas, 21 bridge-fistulas and 3 axillo-axillary vascular accesses. 129 revisions were necessary to preserve the vascular access. The patency rates of the 170 primary forearm fistulas and the 140 primary elbow fistulas were 45 resp. 54%. We preferred the end-to-end-anastomosis for the forearm position and for the elbow the side-to-end-anastomosis. There were no differences between the type of anastomosis, localization and the second constructions as regards the patency rates. The results of the-end-to-end-fistulas were much better in male than female patients. Besides we had better results after thrombectomy in the elbow position compared to the forearm position. We found that a vein diameter less than 2 mm gave worse results. The most frequent complication of the fistulas was the thrombosis. Autologous and alloplastic transplants (grafts) were only taken if it wasn't possible to create an arteriovenous fistula by the orthotopic vessels.

Adolescent↗
PubMed1996

Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis.

OBJECTIVE: To try and establish a consensus about the ideal secondary access for haemodialysis by assessing factors that affect the longevity of various access routes. DESIGN: Multicentre survey, by questionnaire. SETTING: General hospital, Athens. SUBJECTS: All 1516 patients in the Athens area receiving chronic haemodialysis. MAIN OUTCOME MEASURES: Longevity of present and any previous access routes (n = 2323). Data including type of access, age, sex and the existence of diabetes, hypertension, hyperlipidaemia, or other systematic diseases were recorded. RESULTS: Some 1220 (80%) of the patients were using autologous access, 1049 (69%) arteriovenous (AV) fistulas at wrist and 171 (11%) at elbow. Variables were analysed using Cox's proportional hazard model. Age and female sex were significantly associated with failure of autogenous access (p < 0.001) although not affecting synthetic grafts. Autogenous fistula at the elbow was the only secondary access that was less likely to fail than the initial (baseline) fistula at the wrist. Among the various grafts, straight arm grafts had the best prognosis and straight forearm grafts were the most likely to fail (p < 0.001). CONCLUSION: An AV fistula at the elbow should be considered the second best after the fistula at wrist, but is not always feasible. A synthetic graft is more likely to be needed in elderly patients and women, in whom an autogenous AV fistula is more likely to fail.

Age Factors↗
PubMed1997

Results of humeral stump angulation osteotomy.

Between 1972 and 1989 angulation osteotomy was performed on 61 patients with long humeral stumps at the Orthopaedic Hospital of Heidelberg University. Marquardt's surgical technique was used to improve function in patients who had undergone above-elbow amputation and in children with a risk of terminal osseous overgrowth. Thirty-one patients with 43 angulation osteotomies were followed up. Of the 10 adults followed up, the osteotomy had not straightened, whereas with the 33 angulation osteotomies in children, one had straightened out within 6 months, seven within 12 months and a further 12 up to 24 months after surgery. The only recognizable reason for this difference was the patient's age depending on whether humeral growth was not yet completed. Marquardt's angulation osteotomy, however, is still the only surgical technique that improves humeral stump function, providing a rotation-stable humeral prosthesis and a free-moving shoulder joint.

Adolescent↗
PubMed1991

Resection of malignant bone tumors about the shoulder. A preliminary report of reconstruction with a new modular spacer.

Reconstruction after resection of malignant bone tumors about the shoulder is difficult. Twelve patients had reconstruction using a new titanium modular spacer. This modular system allows the surgeon to reconstruct variable lengths of the proximal humerus. Although the patient has no active shoulder motion, excellent hand and elbow function is preserved. The spacer serves as a temporary device in the young active patient. A more definitive reconstructive procedure can be performed after the completion of chemotherapy and a sufficient disease-free interval.

Adolescent↗
PubMed1987

New bone formation at amputation sites in electrically burn-injured patients.

Sixty-one amputation sites in 43 electrically injured men were examined for significant new bone formation. Twenty-eight amputations were classified as long bone (6 above knee, 4 below knee, 4 above elbow, 14 below elbow); 28 small bone (9 hand or finger and 19 foot or toe); and 5 disarticulations. Significant new bone formation occurred at the amputation site in 23 (82%) of the 28 long bone cases, but none occurred in the small bone or disarticulation cases. This difference was significant at the 0.0001 level (chi square = 40.53, 2 df). Fourteen (78%) of upper and nine (90%) of lower extremity sites had significant new bone formation. The average time from amputation to diagnosis of new bone was 38 weeks, range from 5 to 110 weeks. Eight of these 23 patients required surgical revision of the stump and/or revision or reconstruction of their prosthesis. Clearly, the ability to predict new bone formation in electrical burn amputees has important clinical and economic applications.

Adolescent↗
PubMed2002

Complications of total ankle replacement.

Total ankle arthroplasty with second-generation prostheses is gaining popularity. Complications do and will occur with this group of replacements, just as they do with all other arthroplasties, whether at the knee, hip, elbow, shoulder, or wrist. Even if the complications are understood and the preventative measures or solutions are well thought out, there is occasionally no clear-cut answer to the problem. Although there are many obstacles to a successful outcome, most of the complications reported here are preventable with good patient selection and technique or at least treatable once they occur.

Arthritis↗
PubMed1995

Postoperative brachial plexus neuropathy after total knee replacement under spinal anaesthesia.

We describe a case of idiopathic postoperative brachial plexus neuropathy. A 68-yr-old man underwent elective total knee replacement under spinal anaesthesia. Two days after surgery, there was sensory loss and weakness in the right forearm and hand, which suggested an ulnar nerve neuropathy. Two weeks later the patient complained of a dull ache between the scapulae, followed by a burning sensation in the forearm and severe pain in the elbow. A diagnosis of brachial plexus neuropathy was made based on clinical examination and nerve conduction studies. The pain disappeared after a few months, although weakness of the right arm persisted 9 months later. The differential diagnosis between brachial plexus neuropathy and ulnar nerve neuropathy is important, as the prognosis of brachial plexus neuropathy is generally good.

Aged↗
PubMedDate not supplied

Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study.

Shoulder arthroplasty outcomes have been reported in many case series. Typically, these series have followed either a single prosthesis used to treat a variety of arthritic disorders of the shoulder or experience in a single institution. In contrast, this report of a prospective study summarizes the experience of several surgeons with a single prosthetic design for treatment of primary osteoarthritis of the shoulder. A prospective, multicenter clinical outcome study evaluated 176 shoulders in 160 patients with primary osteoarthritis. This study evaluated a single prosthetic design (Global Shoulder) used by 19 contributing surgeons. Enrollment included 133 total shoulder replacements and 43 humeral head replacements (hemiarthroplasty) in 98 men and 62 women. Neither age nor sex affected whether hemiarthroplasty or total shoulder arthroplasty was performed. Patients with full-thickness cuff tears preferentially had hemiarthroplasty. The decision to perform total shoulder arthroplasty or hemiarthroplasty was based on the surgeon's preference. There were significant improvements (P <.001) in all evaluated and self-assessed outcome parameters from the preoperative baseline for both total shoulder arthroplasty and hemiarthroplasty. The results confirm that prosthetic arthroplasty leads to dramatic improvement in pain, function, and patient satisfaction. Intraoperative complications occurred in 5.4% of cases, and postoperative complications occurred in 7.8%. The most common intraoperative complications were intraoperative fractures, occurring in 9 cases. The most common postoperative complications were glenoid component loosening and humeral head subluxation. Almost all cases of humeral head instability were associated with rotator cuff tears or glenoid component loosening (or both). Seven shoulders underwent 9 additional surgeries during the 5-year study period. Thirteen shoulders in 11 patients were lost as a result of death unrelated to the procedure; 2 shoulders in 1 patient were lost within 3 days/3 months after the bilateral replacements as a result of death from pulmonary embolism. Nine percent of the shoulders (16/176) had full-thickness rotator cuff tears. Eight of the 16 shoulders with full-thickness supraspinatus cuff tears had hemiarthroplasty. All of these tears were isolated to the supraspinatus tendon, and all were repairable. There were no differences in postoperative pain, function, American Shoulder and Elbow Surgeons scores, or range of motion. There were no differences between total shoulder arthroplasty and hemiarthroplasty in those patients with a reparable rotator cuff tear. Total shoulder arthroplasty and hemiarthroplasty for treatment of primary osteoarthritis result in good or excellent pain relief, improvement in function, and patient satisfaction in 95% of cases. Avoiding intraoperative humeral shaft fractures through use of an uncemented, canal-filling prosthetic stem requires careful attention to reaming and component sizing. Postoperative humeral head subluxation is often associated with other factors including rotator cuff tears or glenoid component loosening.

Aged↗
PubMedDate not supplied

Electric versus pneumatic power in hand prostheses for children.

Most externally powered hand prostheses for children with a unilateral congenital below-elbow amputation are myoelectrically controlled. All of them are electrically powered. Despite the success of fitting children with this kind of prostheses, there are some disadvantages: prosthetic weight is high, operating speed is low, the system is vulnerable and its size prohibits fitting it to patients with a long fore-arm stump. It will be shown that pneumatic power can overcome most of these disadvantages.

Artificial Limbs↗