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Biomedical subjects

D M Lichtman

Publications and source records attributed to D M Lichtman.

45 records · Page 3Linked to original sources
PubMed1979

Carpal tunnel release under local anesthesia: evaluation of the outpatient procedure.

In 100 consecutive cases of carpal tunnel release done under local anesthesia in an outpatient ambulatory care operating room, 93 had satisfactory results at 6 months without any complications. Two patients developed a neuroma of the palmar cutaneous branch of the median nerve, and five showed early signs of reflex sympathetic dystrophy. These complications are discussed, as well as the prevention of other complications of this procedure.

Ambulatory Surgical Procedures↗
PubMed1979

Fibular autografts for distal defects of the radius.

A protocol for osteoarticular grafting was established to avoid fracture, nonunion, and loss of motion when replacing the distal radius. Proximal fibular autografts were used and stabilized proximally by compression plating and, at the wrist, by ligamentous reconstruction. Postoperative splinting and therapy were coordinated with graft healing, which was monitored by bone scans and roentgenograms. Graft incorporation in three patients appeared to be well-established within 1 year, but functional use of the extremity and return to duty were achieved much earlier.

Adult↗
PubMed1978

Complications of surgical release for carpal tunnel syndrome.

Review of a series of 186 operative cases of carpal tunnel release revealed 34 complications in 22 patients, for an incidence of 12%. Complications were grouped into seven categories: (1) inadequate section of the transverse carpal ligament (associated with both transverse and curved incisions), (2) symptoms related to damage to the palmar cutaneous branch of the median nerve, (3) reflex sympathetic dystrophy, (4) unsightly hypertrophic scar due to inappropriate incision, (5) damage to the superficial palmar arch following blind sectioning of the transverse carpal ligament, (6) bowstringing of the flexor tendons after excision of the transverse carpal ligament, and (7) adherence of the flexor tendons following excision of the mesotenon. Except for four of the complications, two each of bowstringing and reflex sympathetic dystrophy which occurred in our own practice, all of the complications were seen in patients referred for care. Most complications can be prevented by proper operative technique.

Adult↗
PubMed1977

Kienböck's disease: the role of silicone replacement arthroplasty.

A review of thirty-eight patients with Kienböck's disease indicated that both delay in diagnosis and prolonged treatment by plaster immobilization led to progressive collapse of the lunate and an unsatisfactory result in most instances. Four clinical and roentgenographic stages were identified, and the results of silicone replacement arthroplasty were correlated with the preoperative stage after an average follow-up of twenty-seven months. The results were satisfactory in fourteen of twenty wrists in which the procedure was performed before collapse of the lunate had occurred. The importance of early diagnosis and early surgical treatment of this disorder was emphasized by the findings in this study.

Adolescent↗
PubMedDate not supplied

The Elmslie-Trillat procedure: evaluation in patellar dislocation and subluxation.

The Elmslie-Trillat procedure for correction of patello-femoral malalignment was evaluated in 27 knees in 22 patients with an average followup of 42 months (minimum of 24 months). Preoperative and postoperative pain and activity levels were recorded for all knees. The quadriceps angle was recorded in 22 knees preoperatively and in 19 knees postoperatively. Good or excellent results were obtained in 81% overall and in 91% of those knees with patella alta. The postoperative quadriceps angle (Q-angle) correlated with the result. Correction of 10 degrees or less was always associated with a good or excellent result. In contrast, all patients with a fair or poor result had Q-angles at 15 degrees or greater. The preoperative Q-angle did not correlate with the eventual result. We concluded that inadequate medial displacement of the anterior tibial tuberosity may lead to unsatisfactory results and that this may be avoided by intraoperative measurement of the Q-angle; that significant distal advancement of the tibial tuberosity is not required in patella alta; and that correction of the Q-angle to 10 degrees or less correlates with a good or excellent result from the Elmslie-Trillat procedure for treatment of patella subluxation and dislocation.

Adolescent↗
PubMedDate not supplied

Diagnostic and operative arthroscopy of the knee under local anesthesia with parenteral medication.

Arthroscopy of the knee under local anesthesia was performed on 102 patients for operative and diagnostic purposes between January and December of 1985. The procedures were performed on a same day basis without a pneumatic tourniquet. The operative record of each patient was reviewed to determine postoperative diagnosis and treatment. The data was matched to a patient questionnaire that measured individual reaction to local anesthesia. The effectiveness and level of patient acceptance of this anesthetic technique for operative arthroscopy was then evaluated. Ninety-one patients responded to the questionnaire, 82 of whom had prior anesthetic experience. Ninety-five percent of the patients had minimal or no discomfort during the procedure. Eighty percent indicated a preference for local anesthesia in the event of subsequent arthroscopy. No complications relating to the anesthetic agent were noted. Arthroscopy of the knee under local anesthesia for routine operative arthroscopy was found to be safe, reliable, practical, and to have a high patient acceptance rate.

Adolescent↗
PubMedDate not supplied

Kienbock's disease: diagnosis and treatment.

Kienbock's disease, or osteonecrosis of the lunate, can lead to chronic, debilitating wrist pain. Etiologic factors include vascular and skeletal variations combined with trauma or repetitive loading. In stage I Kienbock's disease, plain radiographs appear normal, and bone scintigraphy or magnetic resonance imaging is required for diagnosis. Initial treatment is nonoperative. In stage II, sclerosis of the lunate, compression fracture, and/or early collapse of the radial border of the lunate may appear. In stage IIIA, there is more severe lunate collapse. Because the remainder of the carpus is still uninvolved, treatment in stages II and IIIA involves attempts at revascularization of the lunate-either directly (with vascularized bone grafting) or indirectly (by unloading the lunate). Radial shortening in wrists with negative ulnar variance and capitate shortening or radial-wedge osteotomy in wrists with neutral or positive ulnar variance can be performed alone or with vascularized bone grafting. In stage IIIB, palmar rotation of the scaphoid and proximal migration of the capitate occur, and treatment addresses the carpal collapse. Surgical options include scaphotrapeziotrapezoid or scaphocapitate arthrodesis to correct scaphoid hyperflexion. In stage IV, degenerative changes are present at the midcarpal joint, the radiocarpal joint, or both. Treatment options include proximal-row carpectomy and wrist arthrodesis.

Carpal Bones↗