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Biomedical subjects

D S Ruch

Publications and source records attributed to D S Ruch.

At least 19 recordsLinked to original sources
PubMed2000

Arterial reconstruction for radial artery occlusion.

This study was designed to detail the history and symptoms of symptomatic radial artery vaso-occlusive disease and to evaluate the results of radial artery reconstruction. Thirteen patients with symptomatic vaso-occlusive disease of the radial artery unresponsive to management by nonoperative modalities were managed with arterial reconstruction. All cases were treated with reversed interpositional vein grafting from the radial artery in the forearm (end-to-side) to the deep arch distally (end-to-end). Patients completed preoperative and postoperative assessments of symptoms and function, cold sensitivity (cold intolerance), and digital microvascular perfusion (isolated cold stress test evaluation with laser Doppler fluxmetry). At the follow-up examination all vascular grafts were patent, as determined by Allen's testing and Doppler ultrasound. The patients reported symptoms and functional status that demonstrated significant improvement following reconstruction. Microvascular evaluations demonstrated a significant improvement in digital microvascular perfusion as assessed by laser Doppler fluxmetry and digital temperature recordings with a resultant resolution of ischemic pain, numbness, and ulceration.

Adolescent↗
PubMed2000

Fixation of three-part proximal humeral fractures: a biomechanical evaluation.

OBJECTIVES: To examine the biomechanical stability of three constructs currently used for the management of three-part proximal humerus fractures. Tension band wires (TBW) with supplemental Enders nails, modified cloverleaf plate and screws, and intramedullary (IM) nailing with proximal and distal interlocks were tested to determine relative stability. DESIGN: A reproducible three-part fracture was made in fresh-frozen stripped proximal humeri. The fracture was stabilized using TBW/Enders nail (n = 6), plate/screws (n = 5), or IM nailing (n = 5). MAIN OUTCOME MEASUREMENTS: Mechanical testing was performed with a small preload followed by deflection of five millimeters at a rate of one millimeter per second in flexion, extension, and varus and valgus relative to the humeral shaft. A load-displacement curve was obtained. Torsional testing was performed in internal and external rotation, and torque-rotation curves were recorded. RESULTS: In cantilever bending, the plate/screws construct and the IM nail construct were superior to the TBW/Enders nail construct for all parameters except extension. There was no statistically significant difference between the IM nail and the plate/screws groups. Torsional stiffness testing revealed that the plate/screws and the IM nail were superior to the TBW/Enders nail construct. There was no statistical difference between the IM nail and the plate/screws groups. CONCLUSIONS: In a cadaveric model of three-part proximal humerus fractures stripped of soft tissue, plate/screws fixation and IM nailing provide greater torsional and bending stiffness than does fixation with TBW/Enders nail. There was no statistically significant difference in torsional or bending stiffness between IM nailing with interlocks and plate/screws fixation in this model.

Biomechanical Phenomena↗
PubMed1999

Anatomic and physiologic evaluation of upper extremity ischemia.

This study assessed the accuracy of arteriography and laser Doppler perfusion imaging (LDPI) as predictors of digital ischemia and correlated upper extremity symptoms, function, and nutritional flow with arteriographic and laser Doppler assessments. Multiple-level occlusive disease was documented in 25 hands (23 patients) by arteriography. LDPI demonstrated one or more hypoperfused digits in 17 hands. Patient questionnaires were used to assess upper extremity symptoms, pain, cold sensitivity, and function. Spearman correlation coefficients indicated that arteriography is a poor indicator of nutritional perfusion as measured by LDPI. Neither arteriography or laser Doppler perfusion imaging served as an indicator of the severity of cold intolerance. However, upper extremity symptoms and functional status correlated with both laser Doppler measurements and the level of cold sensitivity. Laser Doppler perfusion imaging and arteriographic analysis provide complimentary data in the evaluation of upper extremity ischemia.

Adolescent↗
PubMed1999

Arthroscopic resection of the radial head.

The authors describe arthroscopic radial head resection in patients with post-traumatic arthritis after fractures of the radial head or in patients with rheumatoid arthritis of the elbow joint, as an expanded indication for elbow arthroscopy. Arthroscopic radial head resection allows the surgeon to deal with the intrinsic joint pathology, as well as with accompanying symptoms such as synovitis, capsular contracture, or loose bodies. The portals used are the proximal medial, anterolateral, and the midlateral portal. The anterior three quarters of the radial head and 2 to 3 mm of the radial neck are resected with the stone-cutting abrader in the anterolateral portal and the arthroscope in the proximal medial portal. For resection of the posterior portion of the radial head, the abrader may be transferred to the midlateral portal. This permits resection of the remnants of the radial head posteriorly and also at the proximal radioulnar joint. Arthroscopic treatment allows the patient to begin and maintain an aggressive postoperative physical therapy program immediately after surgery, thus decreasing the risk of anterior scarring and reoccurring contracture of the capsule of the elbow joint.

Arthritis↗
PubMed1999

Innervation density of the base of the palm.

Cutaneous nerves of the palm were localized and quantitated by longitudinal axis, proximity to the distal palmar crease, and tissue layer to identify an incision that would avoid injury to the palmar branches of cutaneous nerves. Cadaveric palms (n = 10) harvested en bloc were fixed at physiologic tension and prepared using the celloidin method and hematoxylin-eosin staining. The cutaneous nerves of the palm were counted and classified by their size and location within each tissue layer and longitudinal axis as well as by proximal, middle, and distal locations within each axis. The mean number of large nerves identified within regions of the palm differed by tissue layer and longitudinal axis but not by longitudinal location within axes. The long/ring finger web space was characterized by the lowest innervation density; the index/long finger web space and ring finger axis were characterized by the greatest innervation density. An incision in the long/ring finger web space 2 cm proximal to Kaplan's cardinal line should result in injury to fewer nerves and reduce the incidence of painful neuromas during open carpal tunnel release.

Dissection↗
PubMed1999

The role of arthroscopy in the treatment of lunotriquetral ligament injuries.

The treatment of lunotriquetral interosseous (LTIO) ligament injuries is controversial. It is part of a spectrum of injuries involving the ulnar side of the wrist. Associated injuries may play a greater role in the outcome of treatment than does the LTIO injury. Arthroscopy is the most accurate diagnostic tool available for the evaluation of LTIO ligament injuries; it allows diagnosis and often treatment of associated injuries. This article describes the current approach to the diagnosis and treatment of LTIO ligament injuries and related use of arthroscopy.

Arthroscopy↗
PubMed1998

Arterial reconstruction in the ischemic hand and wrist: effects on microvascular physiology and health-related quality of life.

Patients were evaluated before and after arterial reconstruction surgery (1) to define the physiology of the digital microcirculation in chronic subcritical ischemia, (2) to demonstrate the short-term effects of successful arterial reconstruction on microvascular flow, and (3) to document the effects of surgery on symptoms, function, and health-related quality of life. Arterial insufficiency was the result of a proximal reconstructible occlusive lesion, 1 or more distal unreconstructible occlusions, and secondary reactive vasospasm. Microvascular physiology was evaluated by monitoring digital temperatures, microvascular perfusion (laser Doppler fluxmetry) and perfusion patterns (laser Doppler perfusion patterns (laser Doppler perfusion imaging). Following successful vascular reconstruction, digital temperatures and microvascular perfusion improved significantly, approaching control levels. Although cold sensitivity was unchanged, symptoms decreased and upper extremity function and health-related quality of life improved after successful proximal reconstruction in patients with 2-level arterial occlusion.

Adult↗
PubMed1998

The use of arthroscopy to document accurate position of core decompression of the hip.

The use of hip arthroscopy is documented as a means of determining accurate placement for core decompression of the femoral head. The authors describe the technique whereby the patient is placed on the fracture table in the supine position and the guide wire for the core decompression is inserted into the middle of the infarct. The surgeon is assured of accurate placement within the center of the infarct.

Adult↗
PubMed1998

Arthroscopic removal of a .44 caliber bullet from the hip.

Hip arthroscopy is far less invasive than standard open arthrotomy and offers unparalleled visualization of the acetabulum and femoral head. Diagnostic arthroscopy is becoming increasingly accepted as therapeutic options are still evolving. We report the case of the arthroscopic removal of a .44 caliber bullet from the femoral head of a 45-year-old man. The procedure afforded the opportunity to thoroughly irrigate the joint, debride the articular surface, and remove several loose bodies.

Arthroscopy↗
PubMed1998

Arthroscopic assessment of carpal instability.

The evaluation, classification, and treatment of carpal instability continues to be one of the most controversial topics in hand surgery. One explanation is the lack of standardized findings and radiographic criteria. No good modality to date has been proposed to accurately aid in evaluating carpal instability. Wrist arthroscopy has become increasingly useful in the assessment of mechanical wrist pain. With this technology, specific patterns of injury can more accurately be identified by direct visualization. This will also aid in implementing a reproducible, less subjective means of describing wrist instability. The treatment can then be focused on management of the specific ligamentous injury responsible for the pattern of instability visualized. The following is an attempt to categorize these instability patterns as seen through arthroscopy and provide our proposed treatment options.

Arthroscopy↗
PubMed1998

The arthroscopic treatment of avascular necrosis of the proximal pole following scaphoid nonunion.

The authors describe a technique of treating scaphoid nonunions with associated avascular necrosis consisting of arthroscopic resection of the distal pole of the scaphoid combined with radial styloidectomy. The results at 2-year follow-up showed all three patients to have complete relief of their mechanical pain and improvement in their range of motion as well as high satisfaction with the procedure. Modified Mayo Wrist Scores were a mean preoperatively of 60 and postoperatively of 88. Postoperative radiographs showed no increase in the scapholunate gap. However, the capitolunate angle increased from a mean of 3 degrees to 13 degrees . There was no progression of degenerative changes noted. The advantages of this technique include (1) minimal morbidity, (2) relief of mechanical pain, and (3) improved range of motion with no early degenerative changes. The rate and severity of degenerative change following this procedure remain unknown.

Adult↗
PubMed1998

Significance of cold intolerance in upper extremity disorders.

After upper extremity injury, pain on exposure to cold (cold sensitivity) is a significant problem. This cross-sectional observational study (1) assesses the incidence and prevalence of cold intolerance, (2) evaluates the relationship between functional status and degree of cold intolerance, and (3) correlates health-related quality of life (HRQL) with symptoms of cold intolerance. Patients in a tertiary care center completed questionnaires to document (1) cold sensitivity, (2) upper extremity pain, symptoms, and function, and (3) HRQL. Cold sensitivity was found to be associated with more functional limitations, greater pain, and reduced HRQL. As the severity of cold intolerance increased, functional limitations and pain increased and HRQL decreased. Cold intolerance has a profound effect on HRQL.

Activities of Daily Living↗
PubMed1997

Anterior interosseus nerve injury following elbow arthroscopy.

Elbow arthroscopy is becoming an increasingly invaluable tool for both evaluation of and treatment of a variety of interarticular disease processes. Case reports have documented radial and posterior interosseus injuries following anterior capsular release. To date, this is the first report of an anterior interosseus nerve injury following arthroscopic surgery of the elbow. Arthroscopic surgery offers unparalleled visualization of the multiple articulations and facets of the elbow. It has been reported as useful for removal of loose bodies, synovectomy, release of arthrofibrosis, and the treatment of osteochondritis dessicans. However, the technique does require thorough knowledge of neurovascular structures about the elbow as well as appreciation of the protective layers including the capsule, brachialis, and brachioradialis muscles. This report documents direct injury to the anterior interosseus branch of the median nerve during an elbow debridement and synovectomy in a 65-year-old patient with rheumatoid arthritis.

Aged↗
PubMed1997

The fibula-flexor hallucis longus osteomuscular flap.

Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft. We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy. The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft.

Adolescent↗
PubMed1997

Management of vasospastic disorders of the hand.

Vasospastic disorders of the upper extremity are common and often difficult to treat. Using the proposed classification system (Table 2) allows management based upon pathologic condition, physiologic staging, and response to treatment. Identifying patients in this way also helps in determining which treatments are most appropriate. The basic approach to management includes environmental and behavioral modifications including cessation of tobacco use, protection of hands, and avoidance of situations that trigger the vasospastic response. Pharmacologic therapy may provide good results in a majority of patients. Surgical intervention is reserved for patients with vaso-occlusion, ischemia, and refractory symptoms in spite of attempts at medical management. Surgical options include vascular reconstruction, peripheral sympathectomy, or a combination of techniques. The goal of medical and surgical management is to increase total or nutritional blood flow in the digits.

Hand↗
PubMed1996

Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist.

Outcome was studied in 14 patients with chronic mechanical (crepitant) wrist pain (symptomatic for more than 6 months) who had undergone arthroscopic debridement and early mobilization for the treatment of isolated partial scapholunate and lunotriquetral ligament injuries. Fourteen patients were available for a minimum 2-year follow-up interview, physical examination, and x-ray film evaluation. Eleven patients had complete relief of symptoms and had returned to work within 7 weeks of surgery. The other three (all workers' compensation cases) reported occasional mild wrist pain; two had returned to work a mean of 6.5 weeks after surgery, and the third did not return for 1 year. None of the patients had a statistically significant loss of grip or pinch strength. X-ray films and dynamic examination under fluoroscopy demonstrated no abnormalities. Thirteen of the 14 patients were highly satisfied (although 2 patients still had occasional mild wrist pain). Arthroscopic debridement of partial intrinsic ligament injuries provided excellent relief of painful crepitant symptoms and allowed for early return of wrist function in 13 of 14 cases.

Adolescent↗
PubMed1996

The histological effect of barrier vein wrapping of peripheral nerves.

Twenty-four Sprague-Dawley rats underwent exploration and exposure of the sciatic nerve, followed by sham isolation, irrigation, and subsequent wound closure (Group 1); barrier vein wrapping of the nerve using glutaraldehyde-preserved allograft inferior vena cava (Group 2); or barrier vein wrapping of the nerve with femoral vein autograft from the contralateral extremity (Group 3). Four months later, the rats were sacrificed and the nerves fixed in situ in buffered glutaraldehyde. Sections proximal, mid-portion, and distal to the barrier and vein wrap were fixed with osmium tetroxide, epon embedded, stained with toluidine blue, and studied under x200 and x400 light microscopy. Epineural scar formation increased 10 times in Group 2, compared to Group 3 (p < 0.0001). Epineural thickness and the number of degenerating axons did not differ significantly among all groups. Inflammatory cells in Group 2 increased 100 times, compared to Group 3 (p < 0.0001). Continuing with the underlying epineural layer was apparent grossly and microscopically with all allografts, but with no autografts. Thus, glutaraldehyde-preserved allograft vein wraps appear to incite a marked inflammatory response, with epineural scarring and adherence to the underlying nerve, while autograft vein wraps do not.

Animals↗