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Biomedical subjects

D A Capen

Publications and source records attributed to D A Capen.

24 records · Page 2Linked to original sources
PubMed1985

Surgical stabilization of the cervical spine. A comparative analysis of anterior and posterior spine fusions.

Two hundred twenty-two cervical spine stabilization procedures in 212 patients are reviewed. In 114 posterior cervical fusions, 88 anterior fusions, and ten combined procedures, no deaths occurred. Surgical complication rates were similar, but more severe complications were noted with anterior cervical fusions, including tracheoesophageal problems and transient neurologic loss. Six cases of graft dislodgement requiring reoperation also occurred. In long-term follow-up evaluations, 36 anterior fusion patients developed progressive kyphotic deformity averaging 22 degrees between surgery and the time solid fusion was obtained. Degenerative changes above and below the fusion mass were detected in 36 of 59 patients treated by anterior surgery. Posterior cervical fusion patients were noted to have no significant late change in alignment, and degenerative changes were infrequent. However, 73 of 98 patients had significant extension of fusion mass beyond the originally intended levels of stabilization. Because anterior cervical spine fusion was associated with significant complications of graft dislodgement and tracheoesophageal trauma, as well as postsurgical progressive deformity, the authors recommend posterior wiring and fusion as the procedure of choice to treat cervical spine instability and permit halo-free postsurgical rehabilitation. When anterior neural decompression and fusion is necessary, concomitant posterior wiring and fusion or halo vest immobilization may be necessary to maintain reduction and prevent kyphotic angulation, because posterior ligamentous disruption is not always grossly evident on radiographic examination.

Adolescent↗
PubMed1976

Proximal row carpectomy with muscle transfers for spastic paralysis.

Fourteen patients with spastic paralysis from various causes (eight with cerebral palsy) who needed minimal two handed activities to assist in self-care and who desired improvement in appearance were treated by proximal row carpectomy. In twelve transfer of flexor carpi ulnaris to extensor carpi radialis brevis was done, and in two the extensors of the wrist were shortened. Various other procedures were done in some patients. Prolonged splinting was carried out. Better extension of the wrist was obtained and supination improved more when the transfer was subcutaneous around the ulnar border than when through the interosseus membrane. Less tendency for the carpus to displace ulnarward was seen when the distal half of the scaphoid was not removed. Strength of grasp and pinch improved, but ability to release objects was diminished due to the more dorsiflexed position of the wrist. Subjective use for two handed activities was improved and the patients were satisfied with the appearance.

Adolescent↗
PubMedDate not supplied

Occipito-cervico-thoracic spine fusion in a patient with occipito-cervical dislocation and survival.

A 16-year-old man with occipito-cervical dislocation and survival was treated at Rancho Los Amigos Medical Center. The patient had ligamentous instability between the occiput and the cervical spine. His neurologic level was complete at the C1 level, and he was dependent on a mechanical respirator. Sternocleidomastoid and other neck musculature were not functional. A fusion of the occiput to cervical spine and cervical spine to thoracic spine was performed to obviate the need for external neck support. The patient went on to fuse and is now independently mobile with a tongue-switch driven wheelchair with a respirator trailer 2 years after injury. The patient has no need for external support as a result of his fusion.

Adolescent↗
PubMedDate not supplied

Superior entrapment of the clavicle.

Three degrees of acromioclavicular separation are commonly recognized. A Type III separation with entrapment of the clavicle on the top of the acromion is frequently not recognized while in its acute phase and amenable to closed reduction. The sign of this type of acromioclavicular separation is an apparent Type III in which one cannot manipulate the clavicle. The acute case is treated by local anesthesia, manipulation, and splinting. The chronic case is treated by excision of the outer end of the clavicle. In 1979 we treated three acute and one chronic superior entrapment of the clavicle on the acromion. During this time interval 67 acromioclavicular separations of Grade I, II, and III were treated. This amounted to 6% of our acromioclavicular separations treated during 1979.

Adult↗
PubMedDate not supplied

Compression arthrodesis of finger joints.

Compression arthrodesis is useful for treatment of finger and thumb joints in arthrosis, scleroderma, hypermobile joints, paralytic deformities, and rheumatoid arthritis. A dorsal incision exposes the joint. Its surfaces are prepared in a ball-and-socket arrangement using a high-speed burr. A longitudinal pin 1.1 mm in diameter is passed distally and then retrograde to determine the angle of fusion and to prevent migration of bone ends as the longitudinal compression is applied. Transverse pins 1.5 mm in diameter are put in one-third of the distance from the joint. A Charnley clamp, as modified by Micks and Hager, is applied and tightened. At 6 weeks, the arthrodesis is checked for solidity and, if stable, X-rays are examined for new bone. When solid, the joints should be protected by external splinting for an additional 2 weeks to be sure that the fusion is complete. Compression arthrodesis was obtained in 49 of 54 joints. Solid fusion was usually attained within 6 weeks, without loss of mobility of other joints.

Adolescent↗