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Biomedical subjects

G E Omer

Publications and source records attributed to G E Omer.

At least 19 recordsLinked to original sources
PubMed1993

Magnetic resonance imaging to visualize the internal anatomy in the Baller-Gerold syndrome.

The Baller-Gerold syndrome is identified by radial aplasia with craniosynostosis. Only 12 cases have been reported previously in the literature; none of the reports describe surgical treatment for the radial aplasia. We report the case of a 10-month-old female infant with this syndrome, including severe bilateral radial clubhands. A radial anlage, which was tethering growth of the ulna, was suspected on physical examination and confirmed with magnetic resonance imaging. Resection of the anlage resulted in dramatic improvement in elbow extension, but additional follow-up will be necessary to determine the complete functional effect of the procedure.

Craniosynostoses↗
PubMed1992

Median nerve compression at the wrist.

Median nerve decompression at the wrist is one of the most common operative procedures performed by hand surgeons, yet studies report surgical failure rates of 7% to 20%. Symptoms must be coordinated with diagnostic studies. Initial paresthesias should be documented with delayed sensory conduction time. Threshold tests of sensibility, such as the Semmes-Weinstein monofilaments, are more consistent and reliable tests of decreased sensibility than innervation density tests, such as the Weber two-point discrimination test. Thenar atrophy should be documented with electromyographic studies. The median nerve should be evaluated from the fingertips to the cervical spine. Basic laboratory studies should test for collagen disease, thyroid or renal disorders, and diabetes mellitus. Appropriate roentgenograms must be obtained. Patients with normal laboratory and diagnostic studies should be offered nonoperative treatment. Factors that are important in predicting the patient's response to nonoperative treatment include: age over 50 years, constant paresthesias, intermittent paresthesias of more than 10 months duration, stenosing flexor tenosynovitis, and a wrist flexion test (Phalen) that is positive in less than 30 seconds. Fewer than 10% of patients with three or more of these factors present have been cured by nonoperative management. Surgical decompression of the carpal tunnel is done with tourniquet control and optical magnification. A longitudinal "zig-zag" incision is preferred that extends along the thenar crease, then proceeds ulnarly to reach the distal palmar crease at a point in line with the long axis of the ring finger, and then proceeds radially to the tendon of the palmaris longus. After release of the transverse carpal ligament, the motor branch should be explored and decompressed.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal Tunnel Syndrome↗
PubMed1991

New Mexico rattlesnake bites: demographic review and guidelines for treatment.

The demographic features, treatment, and outcome of 36 rattlesnake envenomation cases are reviewed. Two populations at special risk are identified: (1) young children (12/36) who sustain lower extremity bites, and (2) adults who consume alcohol and handle snakes (10/36) who sustain upper extremity bites. Antivenin was used in 22 cases with only one serious case of serum sickness. Three definite diagnoses of compartment syndrome were made on the basis of elevated compartment pressures. Hand bites accounted for 20 of the 36 cases. The greatest functional disability followed digit bites in that 11 patients developed decreased motion and sensation. The indications for fasciotomy and debridement are discussed, both for digit and non-digit envenomations. General treatment recommendations are given.

Adolescent↗
PubMed1990

The development of orthopedic certification in the United States.

The development of medical education standards and state licensure requirements occurred simultaneously in the 1900s. The result was that annual state licensure became the physician's certification. Eventually, the explosion of scientific knowledge due to hospital-based clinical practices and stimulation from national societies led to specialization within medicine. Primary specialty boards were organized in the 1930s to issue credentials and define qualifications for specialists. Just as licensure became the certification of a physician, primary boards became the certification of a physician specialist. Certification has become progressively more important in relationship to individual patients, national societies, hospitals, and third-party carriers. Recertification is the recognition by a primary board of a diplomate's continuing qualifications. The majority of primary boards have plans to institute recertification in order to evaluate pertinent cognitive knowledge of a diplomate and to respond to inadequate ongoing peer review. The expansion of scientific and technical knowledge, which led to specialization in the 1930s, inevitably has led to subspecialization. Orthopedic surgeons are using a wide range of fellowships, especially those just completing their residency education. The first certificate of added qualifications for orthopedics was in surgery of the hand.

Certification↗
PubMed1986

Latissimus dorsi muscle transfer for restoration of elbow flexion after brachial plexus disruption.

Five patients between 10 and 46 years old were reviewed after a latissimus dorsi muscle transfer to restore elbow flexion. Loss of elbow flexion resulted from traumatic brachial plexus paralysis in all five patients. All had some weakness in other muscle groups in the upper extremity. The follow-up period was from 25 to 68 months (average = 39.4 months). A range of motion of 0 degrees/115 degrees, 10 degrees/100 degrees, 0 degrees/110 degrees, 0 degrees/70 degrees was obtained. After the transfer, three patients could supinate the forearm, and supination of 90 degrees, 15 degrees, and 10 degrees was measured. Two patients could lift 4 lb, while two others could lift 1 and 1.5 lb, respectively. Evaluation of activities of daily living by a standardized test revealed disappointing results. The two patients with less than 90 degrees elbow flexion had initial paralysis of the latissimus dorsi muscle at the time of injury. This procedure should not be done unless the latissimus dorsi muscle is normal.

Activities of Daily Living↗
PubMed1986

Acute management of peripheral nerve injuries.

Acute management includes physical examination at the time of injury as a baseline for more detailed evaluations of motor and sensory function. The decision regarding type of nerve suture is based on the extent of the extremity wound and the cause of injury. In the closed extremity injury, spontaneous nerve recovery can be correlated with cause of injury. The evaluation of clinical recovery is based on nerve return and extremity coordination.

Arm Injuries↗
PubMed1985

Bilateral subluxation of the base of the thumb secondary to an unusual abductor pollicis longus insertion: a case report.

Bilateral subluxation of the trapeziometacarpal joint was related to abnormal insertion of the abductor pollicis longus (APL) tendon and an atrophic extensor pollicis brevis tendon. The APL tendon had four slips, all of which inserted into the fascia of the abductor pollicis brevis muscle distal and palmar to the trapeziometacarpal joint. Active pinch of the thumb resulted in subluxation of the trapeziometacarpal joint. To prevent reciprocal distal deformity, the proximal thumb was held in dynamic balance by attaching two slips of the APL tendon to the radiodorsal base of the first metacarpal. One tendon slip supplemented the tendon of the extensor pollicis brevis muscle. The lax capsule of the trapeziometacarpal joint was reinforced with the remaining tendon slip. The patient retains excellent bilateral function without subjective weakness after surgery.

Adolescent↗
PubMed1985

Congenital ulnar deficiency. Natural history and therapeutic implications.

We have reviewed the natural history of congenital ulnar deficiency in 15 limbs in our series and in 185 limbs in the literature. The natural history suggests that there is little progression of deformity. Specific variables for prognosis have not been determined. There are no data that discuss relative ulnar length or relative forearm shortening of the involved extremity. We compared function in our 15 limbs with standards of function in the general population. Based on our findings, treatment must be individualized to maximize function and should be conservative regarding ulnar deviation of the wrist, radial head dislocation, and preservation of forearm pronation and supination. Standard reconstruction of hand anomalies is most rewarding for functional results.

Abnormalities, Multiple↗
PubMed1985

Reconstruction of a balanced thumb through tendon transfers.

The ability to use the thumb determines its functional relation to the fingers and the resulting dexterity of the hand. Median palsy results in a failure of abduction and pronation. Ulnar palsy results in loss of adduction and flexion at the metacarpophalangeal joint. Following median, ulnar, and even radial palsy, the thumb can develop adduction deformity. Thumb contracture must be released prior to tendon transfers. Abduction and pronation are best substituted by transfer of the extensor indicis proprius. Adduction is best substituted by transfer of the extensor carpi radialis brevis and arthrodesis of the metacarpophalangeal joint. Median cutaneous sensibility should be reconstructed after appropriate tendon transfers are functional.

Arthrodesis↗
PubMed1985

Congenital proximal radio-ulnar synostosis. Natural history and functional assessment.

We evaluated the cases of twenty-three patients with thirty-six congenital proximal radio-ulnar synostoses who had been followed between 1938 and 1984. None of the patients had had any attempt at surgical correction or any ipsilateral congenital anomalies. Emphasis was placed on analyzing the natural history of the lesion in these patients who had not been operated on, and on determining the effect of a fixed position of the forearm on function. Ten patients had unilateral and thirteen, bilateral synostosis. Their mean age when last examined was twenty-two years (range, three to fifty years). Eight patients were female and fifteen, male. The forearms were fixed in an average of 30 degrees of pronation. The position of the forearm was not found to be related to subjective functional limitations, employment status, or the results of the hand-function test of Jebsen et al. Most patients had few or no functional limitations, and were employed in jobs that demanded extensive use of the forearm. Contrary to the findings of other studies, we observed four distinct radiographic patterns based on the presence of an osseous synostosis and the position of the radial head. However, we noted no relationship between any of these patterns and function. We concluded that operative treatment of congenital radio-ulnar synostosis is rarely indicated, that less emphasis should be placed on the single factor of the position of the forearm, and that objective functional tests should be included in the assessment of these patients.

Activities of Daily Living↗