Biomedical subjects
Publications and source records attributed to A I Froimson.
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.
Surface replacement, popularized in the early 1970s has fallen into disfavor by much of the orthopedic community. To date, the authors' experience with 29 cemented total articular replacement arthroplasties (TARAs) in 25 patients has been quite favorable. Factors associated with these favorable results include: a physiologic age less than 60, good bone quality, viability of the remaining femoral head, and preservation of the acetabular subchondral plate. The mean age of cases in this study was 52 years, with patient follow up ranging between 3.5 and 7 years; there were two failures. Today, although conventional cementless total hip arthroplasty seems to be in vogue, real and potential problems exist. These concerns, in conjunction with the good results reported in this series, should encourage the orthopedic surgeon to take a second look at resurfacing arthroplasty, especially in the select group of patients defined in this article. Pending the long-term results of non-cemented prostheses the surgeon may even consider using cementless TARA components.
Angiomyoma of the upper extremities is not commonly encountered by the orthopedic surgeon. A case of a vascular leiomyoma developing in a 79-year-old woman is discussed along with a review of the literature.
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.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The two most common solid benign tumors in the hand are lipoma and xanthoma, both painless; however, these tumors enlarge slowly until they are recognized (because of their unsightly appearance or interference with joint function) and treated.
Osteoarthritis of the thumb carpal metacarpal joint is effectively managed by complete excision of the trapezium or excision of the distal half of the trapezium with maintenance of the space by insertion of interposition tendinous material from palmaris longus or flexor carpi radialis. The more recent modification of partial trapezium excision has improved pinch strength and maintenance of thumb length and so has enhanced the final results. Carpal metacarpal ligament reconstruction is demonstrated because it is occasionally necessary.
A case of a variant of congenital indifference to pain, in which the patient initially developed lower extremity neurogenic arthropathy ultimately requiring bilateral above-the-knee amputations, is presented. After he began using his upper extremities for weight bearing and load bearing, the patient developed bilateral severe neurogenic arthropathy of his hands and wrists.
Mallet finger injuries are commonly seen in the emergency room and the treatment is usually simple, consisting of extension splinting of the DIP joint. The hyperextension mallet finger is a rare variant. The diagnosis can be made if the fracture fragment involves more than 50% of the joint surface. For this injury splinting is inadequate and open reduction is the treatment of choice.
Fracture dislocations of the glenohumeral joint in children 10-years-old and under are extremely rare. There are no case reports of this injury documented in the literature. This report documents a traumatic anterior Salter 3 fracture dislocation in a 10-year-old boy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Genu recurvatum may be due to weakness of the muscles that stabilize the knee, with secondary bone changes. The more common etiology is primary bone deformity of the proximal tibia, which may result from multiple causes. An operation is described for the anatomical correction of the latter type. A corrective opening wedge osteotomy is maintained with full thickness bicortical iliac triangular wedges. This technique has been successfully used in one patient who has been followed for 12 years.
A flexor digitorum profundus tendon avulsion occurring at the site of a pathological fracture through an enchondroma is reported. The avulsion appears to be the result of direct trauma crush to the distal phalanx of the little finger. The lesion was curetted and grafted using autogenous bone, the fracture was stabilized with a K-wire and the tendon was advanced and secured using Bunnell pullout wire technique. The lesion healed and function was restored.
Osteotomy may be indicated in digital phalanges to correct angular or rotational deformity resulting from malunited fracture, epiphyseal arrest, or congenital or developmental causes. The use of fine power tools facilitates precise correction. lateral angulation is corrected by closing wedge osteotomy, dorsal angulation by opening wedge and bone graft, rotational deformity by transverse osteotomy, and derotation through the involved phalanx. Smooth Kirschner wires stabilize the osteotomies to permit early joint motion. These procedures can safely be performed in children.
Compression neuropathy of the ulnar nerve at the elbow is treated by neurolysis and excision of the medial humeral epicondyle without transposing the ulnar nerve anteriorly. Removal of the medial humeral epicondyle is not associated with loss of motion at the elbow or reduction in strength of finger or wrist flexion because of the multiple muscle origins, as well as the firm healing of the common flexor origin to the resected bone surface. Thirty cases were treated between 1965 and 1977. Treatment halted progression of the disease in all patients. Discomfort and pain subsided in every instance. All 12 of the grade I patients had return of normal nerve function. Four of the 12 grade II patients were left with some weakness. Four of the six grade III patients improved to grade II status. None required secondary procedures on the ulnar nerve.
Explore the source record for details and available documents.