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1.
J Hand Surg Am ; 25(1): 176-82, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10642490

ABSTRACT

A wire interlock technique useful for harvesting a partial-width tendon graft with an intact insertion for local reconstructive procedures is described. This technique is rapid and reliable for procuring attached tendon grafts with minimal exposure. The technique was used to harvest a flexor carpi radialis tendon graft for basal joint interposition arthroplasty in 12 patients. This method also may be readily applicable for other procedures requiring local ligament reconstruction with a partial-width tendon graft. (J Hand Surg 2000; 25A:176-182.


Subject(s)
Tendon Transfer/methods , Tissue and Organ Harvesting/methods , Bone Wires , Humans , Osteoarthritis/surgery , Stainless Steel , Tendon Transfer/instrumentation
2.
J Hand Surg Am ; 24(2): 405-12, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10194029

ABSTRACT

A recurrent aneurysmal bone cyst of the proximal phalanx treated with curettage, cryosurgery, and bone grafting is presented. There is no evidence of recurrence after 5 years. Although cryosurgery is commonly used as an adjuvant for intralesional treatment for aneurysmal bone cyst, there have been no reports of its use for the treatment of a lesion arising in the hand.


Subject(s)
Bone Cysts, Aneurysmal/surgery , Cryosurgery , Fingers , Adolescent , Bone Cysts, Aneurysmal/diagnostic imaging , Bone Cysts, Aneurysmal/pathology , Bone Transplantation , Curettage , Fingers/diagnostic imaging , Fingers/pathology , Fingers/surgery , Humans , Magnetic Resonance Imaging , Male , Radiography , Recurrence
4.
J Bone Joint Surg Am ; 79(11): 1675-84, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9384427

ABSTRACT

We performed a prospective study in order to assess the utility of high-resolution magnetic resonance imaging in the detection and specific localization of tears of the triangular fibrocartilage complex. Seventy-seven patients who had pain in the wrist were studied with use of a dedicated surface coil and three-dimensional gradient-recalled techniques with a field of view of eight centimeters and a slice thickness of one millimeter. The patients had pain on the ulnar side of the wrist, ligamentous instability, occult ganglia, or a combination of these. Magnetic resonance images were assessed for radial or ulnar avulsion, or both; central defects; degenerative intrasubstance changes; and complex tears of the triangular fibrocartilage complex. Partial tears were differentiated from complete tears. The findings on the magnetic resonance images were then compared with the arthroscopic findings. Fifty-seven of the fifty-nine tears that were suspected on magnetic resonance images were confirmed with arthroscopy; the two suspected tears that were not confirmed had been interpreted as small partial tears on the magnetic resonance images. With use of arthroscopy as the standard, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-seven of fifty-seven), a specificity of 90 per cent (eighteen of twenty), and an accuracy of 97 per cent (seventy-five of seventy-seven) for the detection of a tear (kappa = 0.93, p < 0.00001). Fifty-three of the fifty-seven tears were localized correctly with use of magnetic resonance imaging. With regard to the location of the tear, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-three of fifty-three), a specificity of 75 per cent (eighteen of twenty-four), and an accuracy of 92 per cent (seventy-one of seventy-seven) (kappa = 0.9, p < 0.0001). We concluded that high-resolution magnetic resonance imaging permits accurate depiction and localization of tears of the triangular fibrocartilage complex. When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist.


Subject(s)
Cartilage, Articular/injuries , Magnetic Resonance Imaging/methods , Wrist Injuries/diagnosis , Wrist Joint/pathology , Adolescent , Adult , Aged , Arthroscopy , Bone Diseases/diagnosis , Carpal Bones/injuries , Carpal Bones/pathology , Cartilage Diseases/diagnosis , Cartilage, Articular/pathology , Female , Humans , Image Enhancement/methods , Joint Dislocations/diagnosis , Joint Instability/diagnosis , Ligaments, Articular/injuries , Ligaments, Articular/pathology , Male , Middle Aged , Pain/diagnosis , Predictive Value of Tests , Prospective Studies , Radius/injuries , Rupture , Sensitivity and Specificity , Synovial Cyst/diagnosis , Ulna/injuries , Ulna/pathology
5.
Clin Orthop Relat Res ; (342): 42-5, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9308523

ABSTRACT

The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed.


Subject(s)
Arthroplasty/methods , Finger Joint/surgery , Ligaments, Articular/surgery , Tendon Transfer , Thumb/surgery , Activities of Daily Living , Carpal Bones/surgery , Finger Joint/diagnostic imaging , Follow-Up Studies , Hand Strength , Humans , Prospective Studies , Radiography , Range of Motion, Articular , Thumb/diagnostic imaging
6.
J Hand Surg Am ; 22(4): 585-91, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9260611

ABSTRACT

Thirty-six consecutive patients with 37 complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint were treated with primary repair using a miniature intraosseous suture anchor. Thirty patients were evaluated by clinical examination or by questionnaire at an average of 11 months after repair. Loss of interphalangeal joint motion averaged 15 degrees on the involved side versus the other side, while loss of MP joint motion averaged 10 degrees. There was no significant difference on stress testing measurements between repaired and nonrepaired thumbs. There were no instances of nerve injury, infection, device failure, or reoperation. The authors concluded that this is a safe and effective method for repair of complete tears of the ulnar collateral ligament of the thumb MP joint.


Subject(s)
Collateral Ligaments/injuries , Collateral Ligaments/surgery , Metacarpophalangeal Joint/injuries , Metacarpophalangeal Joint/surgery , Sutures , Thumb/injuries , Acute Disease , Adolescent , Adult , Female , Finger Injuries/surgery , Humans , Male , Middle Aged , Orthopedics/methods , Thumb/surgery
9.
Skeletal Radiol ; 23(5): 327-32, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7939829

ABSTRACT

We reviewed 20 cases of soft tissue masses of the hand and wrist, and compared the impressions from the original magnetic resonance (MR) imaging reports with the preoperative clinical impression and postoperative pathological diagnoses. The most commonly occurring masses were ganglia, lipomas, and giant cell tumors of tendon sheaths. MR imaging suggested the correct diagnosis in 16 of the 20 cases, whereas the clinical impression was correct in 10 instances. Confident was correct in 10 instances. Confident preoperative diagnosis may be made with MR imaging due to the characteristic appearances of many benign soft tissue tumors.


Subject(s)
Hand/pathology , Magnetic Resonance Imaging , Soft Tissue Neoplasms/diagnosis , Synovial Cyst/diagnosis , Wrist/pathology , Adult , Aged , Child , Child, Preschool , Female , Humans , Lipoma/diagnosis , Male , Middle Aged , Synovitis, Pigmented Villonodular/diagnosis
10.
J Hand Surg Am ; 18(6): 1019-25, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8294734

ABSTRACT

Forty-six patients with histologically confirmed osteoid osteoma of the upper extremity seen from 1947 to 1990 were retrospectively reviewed. The patients' age at presentation averaged 20 years. Twenty-four of the lesions were located in the wrist and hand and 22 in the arm and forearm. The average duration of symptoms before diagnosis was 15 months. Pain was the presenting symptom in 44 of 46 patients. Of the 28 patients who took aspirin for pain, 24 obtained at least partial relief. A mass or swelling was more commonly noted in lesions of the hand and wrist as compared to the arm and forearm. The diagnosis of osteoid osteoma was made by plain x-ray films alone in 35 cases. Bone scans were performed on 13 patients; all were positive at the site of the lesion. Tomography was performed in 13 cases to identify the intraosseous location of the lesion. All lesions were treated by excision and curettage. Thirty-four of the 46 patients were followed at our institution for more than 6 months, with an average follow-up period of 27 months. Six of the patients had persistent lesions. Of the six persistent osteoid osteomas, five occurred in the wrist or hand (p = .0012). A total of 15 procedures were required to excise these lesions.


Subject(s)
Arm , Bone Neoplasms , Osteoma, Osteoid , Adolescent , Adult , Bone Neoplasms/diagnosis , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Child , Child, Preschool , Female , Humans , Male , Osteoma, Osteoid/diagnosis , Osteoma, Osteoid/pathology , Osteoma, Osteoid/surgery , Retrospective Studies
11.
J Rheumatol ; 17(7): 958-64, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2213764

ABSTRACT

A cross sectional survey of a randomly selected population of 2,261 textile workers form an overall population of 8,539 eligible workers was performed to evaluate the prevalence of tendinitis in related upper extremity disorders. Of the sample, 2,047 respondents (91.3%) participated in a nurse screening history and examination: 1,091 (53%) had no upper extremity symptoms or abnormalities on examination; 959 (47%) with positive findings were examined by trained physicians. Of these, 347 (36.5%) were found to have no abnormality, whereas, 548 (57.3%) workers were assigned a diagnosis. Of these 227 were considered to fall into the categories of tendinitis (n = 69) or related disorders (n = 158). The projected prevalence of tendinitis and related disorders for the overall group was 11.6% (carpal tunnel syndrome 1.1%, epicondylitis 2.0%, tendinitis 3.5%, shoulder condition 2.3%, ganglion 2.3%, neck conditions 4.0%). Tendinitis was less frequent in the older age group and those employed for a longer time. The prevalence of tendinitis was found to be statistically higher in physically demanding job categories. Ninety-four percent of ailments were of mild or moderate severity. Although our study provides prevalence data for these conditions in a large manufacturing workforce across several job categories.


Subject(s)
Arm , Occupational Diseases/epidemiology , Tendinopathy/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Male , Occupational Diseases/diagnosis , Occupational Diseases/pathology , Prevalence , Random Allocation , Sampling Studies , Tendinopathy/diagnosis , Tendinopathy/pathology
12.
Clin Orthop Relat Res ; (216): 179-82, 1987 Mar.
Article in English | MEDLINE | ID: mdl-3469054

ABSTRACT

The survival of patients with bone sarcomas has improved dramatically with the advent of modern chemotherapeutic regimens, fostering a present trend toward limb sparing procedures. In skeletally immature patients, prosthetic replacement of resected bones and joints is unrealistic because of continued expected growth in the limbs. A stump-lengthening procedure, the reduction-rotation-plasty, has become a valuable alternative to high above-knee amputation. A rhombus-shaped skin incision around the thigh and calf, originally described by Kotz and Salzer, led to a significant discrepancy of the circumference of the proximal and distal skin borders. A circumferential skin incision at the midthigh and a fishmouth-shaped incision at the upper calf was designed to decrease this disproportion. This incision has been used in five consecutive patients with osteosarcoma about the knee. The cosmetic results were excellent, prosthetic fittings were facilitated, and neither vascular nor wound healing problems were encountered.


Subject(s)
Dermatologic Surgical Procedures , Femoral Neoplasms/surgery , Leg/surgery , Osteosarcoma/surgery , Artificial Limbs , Child , Humans , Male , Methods
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