Postpartum de Quervain's tenosynovitis of the wrist.
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Humans↗
Biomedical subjects
D K Bynum
Publications and source records attributed to D K Bynum.
Simplified functional splinting after extensor tenorrhaphy.
The medical records of 22 patients who had a total of 61 simple or complex lacerations of finger, thumb, and wrist extensor tendons repaired in zones V-VIII (thumb zones TIII-TV) were reviewed. By 7 days after surgery, custom-molded splints were applied to hold the patients' wrists extended (approximately 30 degrees) and the metacarpophalangeal (MP) joints flexed slightly (20 degrees-30 degrees), leaving the interphalangeal (IP) joints free. If thumb tenorrhaphies were done, the thumb carpometacarpal and MP joints were included and splinted in neutral (0 degree extension) position. Patients performed active JP joint range of motion (ROM) exercises as instructed. At a mean follow-up period of 4.5 months (range, 1.5-12 months), there were no residual impairments that interfered with patients' activities of daily living or prevented their return to preinjury employment status; 19 of 22 patients (86%) had good or excellent results, based on objective criteria of active motion. There were no tenorrhaphy failures. The results support the concept of functional splinting techniques, which allow early active IP joint ROM while protecting the repaired tendons, thus resulting in less joint stiffness than older methods of static splinting without being as complicated and labor-intensive as dynamic splinting.
Activities of Daily Living↗
Fractures of the radius and ulna in adults: an analysis of factors affecting outcome.
Concurrent data were collected by the authors for 104 fractures of the shafts of the radius and ulna in 102 adult patients to determine the relationship of subjective, objective, radiographic and economic outcome parameters to the method of treatment, type of fracture (open or closed), degree of comminution, and the presence of other injuries. Patients treated by open reduction and internal fixation (ORIF) had less pain, lost less forearm rotation, and returned to the same work following injury more frequently than those treated by closed reduction and casting (CR) or pins-in-plaster (PIP). The greatest advantages of ORIF over other treatment methods were improved skeletal alignment and forearm rotation, the factors most often associated with return to the same work following injury. Except for a longer time to union and a higher rate of infection, the outcomes of open and closed fractures were very similar. The presence of other injuries was a strong predictor of a compromised end result, primarily because of more pain, greater loss of forearm rotation, and less frequent return to the same work. The inclusion of patient satisfaction and work status in the assessment of outcomes and the concept of "functional malunion", an outcome-based interpretation of a radiographic finding, should help in counselling patients as to the likely economic and functional impacts of these injuries.
Adolescent↗
Radius osteotomy assisted by temporary fixation with the Agee-Wristjack.
A modified technique for performing a distal radius osteotomy, using the Agee-WristJack for temporary fixation, is described. The preoperative and postoperative conditions of a patient, a 26-year-old woman, are illustrated in radiographs.
Adult↗
Closed traumatic rupture of finger flexor pulleys.
Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.
Adult↗
Long-term outcome of Volz total wrist arthroplasties.
The authors determined the outcomes of 18 consecutive Volz total wrist arthroplasties that were followed for an average of 8.6 years. Nine of these wrists were followed for 10 or more years. Fourteen wrists were replaced for rheumatoid arthritis and four for post-traumatic degenerative joint disease. Forty-nine degrees of combined flexion and extension and 25 degrees of combined ulnar and radial deviation were maintained. The balance of wrist motion was dependent upon the design and location of the metacarpal prosthesis. A 24% loss in carpal height (subsidence) occurred during the study period. Four metacarpal components were loose (22%), three of which were placed in patients with degenerative joint disease. One radial component (6%) was loose. Fifteen of 18 wrists (83%) had little or no pain. The three wrists with moderate or severe pain were in patients with degenerative joint disease. There were five (28%) complications. One revision was performed and another was recommended. Overall, the long-term outcome of total wrist arthroplasty was favorable in patients with rheumatoid arthritis.
Adult↗
Diagnosis and treatment of carpal tunnel syndrome.
Carpal tunnel syndrome is a commonly occurring entrapment neuropathy of the median nerve at the wrist. This paper reviews the causes and functional manifestations of this syndrome, as well as the clinical diagnosis and provocative tests that may be useful in establishing it. Surgical results are reliably good and may now be obtained with low morbidity using a variety of minimally invasive techniques performed through limited incisions that involve less extensive exposure than the "classic" open procedure. These include flexor tenosynovectomy without transverse carpal ligament (TCL) division, endoscopic release of the TCL, and subcutaneous TCL division with a two-incision technique. The advantages and disadvantages of these new procedures are examined.
Carpal Tunnel Syndrome↗
Lengthening of below-the-knee amputation stumps using the Ilizarov technique.
Patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.
Adult↗
Repair of peripheral nerves with the argon laser. A functional and histological evaluation.
A technique for repair of peripheral nerves with the argon laser was evaluated with regard to functional and histological recovery. The results were compared with those of reconstruction by a microsurgical epineurial-suture technique. The terminal branch of the peroneal nerve to the extensor digitorum longus in thirty-three New Zealand White rabbits served as the experimental model. Histology and neuromuscular function were evaluated at one, two, and six months after repair. When the diameters of the axons and the morphology distal to the site of repair were evaluated, the nerves that had been repaired with the laser more closely resembled those of the control rabbits. Examination of the site of repair also revealed less foreign-body reaction and axonal outgrowth in the laser-repaired nerves than in those that had been reconstructed with epineurial suture. Neuromuscular function was evaluated by measurement of the force of contraction of the extensor digitorum longus after electrical stimulation of the nerve proximal to the site of repair. Functional recovery paralleled the histological findings. At one month, there was no difference in the neuromuscular function that had been achieved with either technique. At two months, the laser-repaired nerves began to show increased muscular strength at higher frequencies of stimulation (sixteen and thirty-two hertz). Six months postoperatively, the nerves that had been repaired with the laser had consistently better neuromuscular function than those that had been repaired by epineurial suture. The improvement was most marked at higher voltages of stimulation (threshold multiplied by ten) and at frequencies of stimulation of more than sixteen hertz.
Animals↗
Avulsion of the flexor digitorum profundus: anatomic and biomechanical considerations.
Avulsion of the profundus insertion occurs most commonly in the ring finger. The exact reason for this predilection is unknown. Clinical observation of patients with this injury reveals that a common finding is that the ring fingertip is usually more prominent or "longer" than any other fingertip during grip. A laboratory investigation shows that during grip the ring fingertip becomes 5 mm more prominent than any other digit in 90% of subjects and that it absorbs more force than any other finger during pull-away testing. These factors contribute to the susceptibility of the ring finger to the profundus avulsion injury.
Adolescent↗
Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.
A ten-year retrospective review of patients with acute hematogenous pyogenic arthritis at the Duke University Medical Center yielded 14 affected joints in the pediatric group and 32 in adults. Follow-up ranged from six months to eight years. Analysis of factors possibly affecting end results included the joint involved, organism, duration of infection, antibiotics used, age of the patient, and mode of drainage--whether surgical or by needle aspiration. Surgical drainage in the pediatric group yielded uniformly excellent results. In adults, needle aspiration correlated with increased mortality and morbidity. In contrast to other series in the medical literature we found the indications for needle aspiration to be highly restrictive, and we recommend surgical drainage and appropriate antibiotics as the treatment of choice for most patients with pyogenic arthritis.
Adult↗