Biomedical subjects

Gregory I Bain

Publications and source records attributed to Gregory I Bain.

18 recordsLinked to original sources

PubMed2006

Arthroscopic excision of ulnar styloid in stylocarpal impaction.

Stylocarpal impaction is an uncommon cause of ulnar-sided wrist pain in which the long ulnar styloid affects the triquetrum. Previous authors have described an open excision of the ulnar styloid. We present a new technique for arthroscopic identification and subsequent excision of the ulnar styloid. The diagnosis was suspected on plain radiographs and was confirmed by dynamic fluoroscopy. Four patients with ulnar styloid impaction were successfully managed. A diagnostic arthroscopy was performed. With the arthroscope in the 4-5 portal, a 3.5-mm burr was introduced into the 6 U portal. By palpation, the burr was placed onto the tip of the ulnar styloid and confirmed with fluoroscopy. Sufficient ulnar styloid was removed to prevent impingement; this was confirmed on fluoroscopy. We undertook resection of the ulnar styloid to 3 mm (normal, 3 to 6 mm). Adjacent soft tissue structures were not violated. Arthroscopic ulnar styloid identification and excision is a relatively simple procedure. Disruption of the triangular fibrocartilage, dorsal ulnar capsular ligament, and volar ulnar carpal ligament is avoided. Fluoroscopy is valuable in providing preoperative and intraoperative identification of the ulnar styloid and impingement. Postoperatively, patients can recommence activities of daily living as comfort allows.

Arthroscopy↗

PubMed2006

Arthroscopic assessment and classification of Kienbock's disease.

The authors have utilised arthroscopy to assess and classify Kienbock's avascular necrosis of the lunate. The classification is based on the number of articular surfaces of the lunate and adjacent articulation, which are non-functional. Kienbock's disease usually affects the proximal surface of the lunate first with subsequent secondary changes to the lunate facet of the radius. Advanced cases and those with a coronal fracture of the lunate will cause involvement of the mid carpal joint. Surgery is aimed to debride the joint, classify the level of disease and direct the definitive procedure to be performed. If the articular surfaces are intact, a synovectomy or radial shortening would be indicated. If there is involvement of the lunate but an intact lunate facet a proximal row carpectomy would be indicated. If there is involvement of the proximal lunate and lunate facet then a radio-scapholunate fusion could be utilised. More extensive involvement of the joint would require a wrist fusion. Arthroscopy provides a valuable assessment and subsequent classification of Kienbock's disease.

Arthrodesis↗

PubMed2006

Dynamic assist splinting for attenuated sagittal bands in the rheumatoid hand.

The extensor mechanism of the hand is complex, requiring effective functioning of all involved structures, including the sagittal bands. The sagittal bands function to maintain the extensor tendons in midline and to limit their distal excursion. Injury to the sagittal bands or sagittal band attenuation can cause instability and ulnar displacement/subluxation of the extensor tendons into the valleys between the digits and lead to a subsequent loss of active finger extension at the metacarpophalangeal joints. Secondary conditions may also develop, such as swan-neck deformity, as is frequently observed in the rheumatoid arthritis population. To prevent or reduce an extension lag and secondary changes and to maintain the functional use of the hand, a dynamic metacarpophalangeal extension assist splint is necessary. This splint enables extension at the metacarpophalangeal joints, thus enabling the functional use of the hand. This article reviews the biomechanics of the sagittal bands and the corrections that enable finger extension at the metacarpophalangeal joints, thus preventing secondary conditions.

Arthritis, Rheumatoid↗

PubMed2006

Simultaneous reconstruction of medial and lateral elbow ligaments for instability using a circumferential graft.

Reconstructing elbow instability remains a challenging problem. Techniques described have included techniques for the lateral ligamentous complex, including the lateral ulnar collateral ligament, and techniques to reconstruct the medial collateral ligament. We describe a new circumferential technique to reconstruct both the lateral and medial ligament complexes, using 1 circular graft. A hole is drilled through the center of rotation of the distal humerus and through the insertion sites of the medial and lateral ligament complexes. A hamstring tendon graft is passed through the humerus twice to reconstruct the anterior and posterior bands of the medial collateral ligament and sutured onto itself. Endobutton fixation is used to fix the graft on either side of the ulna. The graft is tightened on the lateral and medial sides and fixed into the humerus using interference fit screws. Advantages of the technique described include stabilization of both the medial and lateral ligament complexes with 1 graft. The strength of fixation allows for individual tensioning in all limbs of the reconstruction and the multiple passes of the graft through a single humeral tunnel increasing the strength of the reconstruction. Potential complications could include ulnar nerve damage, recurrent instability, elbow stiffness, and wound breakdown. Complications related to the potential use of a hinged external fixator are not specific to this procedure but can be associated. Early active mobilization can be initiated because of the strong stability provided by the circumferential graft and good fixation.

Contraindications↗

PubMed2005

Endoscopic release of the ulnar nerve at the elbow using the Agee device: a cadaveric study.

PURPOSE: The purpose of this study was to assess the safety and efficacy of the Agee endoscopic system (3M, Orthopedic Products, St. Paul, MN) for ulnar nerve decompression at the elbow. TYPE OF STUDY: A cadaveric study. METHODS: The ulnar nerve was identified through a 3-cm longitudinal incision between the medial epicondyle and olecranon. A release of the ulnar nerve was performed with the Agee device under endoscopic magnification. A complete open assessment of the ulnar nerve, its branching, and structures divided was performed under loupe magnification. RESULTS: In all 6 cadaveric specimens, the arcade of Struthers, the cubital tunnel retinaculum, and the flexor carpi ulnaris aponeurosis were completely divided. In all specimens, the ulnar nerve and all motor and capsular branches were preserved. CONCLUSIONS: This study has demonstrated that the Agee endoscopic ulnar nerve decompression at the elbow is both safe and effective in a cadaveric model. CLINICAL RELEVANCE: This cadaveric study shows that a surgical decompression of the ulnar nerve can be safely and effectively performed with a single endoscopic portal using the Agee device.

Cadaver↗

PubMed2004

Elbow dislocations in adults and children.

Elbow dislocations occur following acute trauma to the elbow with associated disruption of the ligamentous complexes of the elbow. Observations regarding the details of ligament injuries are presented. Clinical presentation, examination, and investigations are included. Details of the management of dislocations including management of complex cases that require repair or reconstruction of the ligamentous complexes are included.

Adult↗

PubMed2004

Surgical approaches to the elbow.

Success in elbow surgery depends on a thorough understanding of its anatomy and the access to its various compartments and components.This article has reviewed the current applied surgical anatomy of the elbow and the related surgical approaches. For acute elbow injuries the Global approach is preferred, because this incorporates a posterior skin incision to expose the medial and lateral sides of the joint. The "Z"arthrotomy algorithm avoids PLRI when exposing the lateral joint capsule. The acute distal biceps tendon avulsion can be repaired with a minimally invasive anterior approach.

Arm Injuries↗

PubMed2004

Arthrodesis of ring finger and little finger metacarpal bases for little finger carpometacarpal joint arthritis.

Five patients with localized little finger carpometacarpal arthritis were treated by excision of the little finger metacarpal base and arthrodesis of the little and ring metacarpals. A dorsal periosteal/capsular flap was used as an interposition graft. All patients achieved significant pain relief, good cosmesis and satisfactory grip strength. All returned to activities of daily living. This procedure, the Dubert procedure, is indicated for localized pathology of the hamate-little finger metacarpal joint. It has theoretical advantages over arthrodesis and resection or interposition arthroplasty as it preserves little finger length, rotation and alignment and maintains some mobility of the transverse carpal arch and the little finger ray.

Activities of Daily Living↗

PubMed2004

Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization.

BACKGROUND: Radial head fractures often occur in association with other elbow fractures and soft-tissue injuries. Radial head replacement is indicated for irreparable radial head fractures associated with elbow instability. The purpose of this study was to analyze the results after treatment of such injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow. METHODS: Sixteen patients with sixteen Mason type-III radial head fractures and collateral ligament injury were treated with use of a titanium radial head prosthesis over a five-year period at the Royal Adelaide Hospital and Modbury Public Hospital in South Australia. The surgery was performed acutely in ten patients and was delayed an average of thirty-seven days (range, fifteen to seventy-nine days) in six. All patients were followed clinically and radiographically for a mean of 2.8 years (range, 1.2 to 4.3 years). RESULTS: Eight patients had an excellent result; five, a good result; and three, a fair result, according to the Mayo Elbow Performance Score. The three fair results occurred in patients with delayed surgery. The mean flexion contracture was 15 degrees (range, 0 degrees to 42 degrees ), with an average loss of 10 degrees (range, 0 degrees to 25 degrees ) of full flexion compared with that of the contralateral elbow. Both pronation and supination decreased an average of 12 degrees (range, 0 degrees to 45 degrees ) compared with that of the contralateral forearm. CONCLUSIONS: The results of treatment of Mason type-III radial head fractures with a monoblock titanium radial head prosthesis and soft-tissue reconstruction are satisfactory. Early mobilization of the elbow is important for the restoration of elbow range of motion and function.

Adult↗

PubMed2003

Results of arthroscopic debridement for isolated scaphotrapeziotrapezoid arthritis.

PURPOSE: Symptomatic isolated scaphotrapeziotrapezoid joint arthritis affects approximately 10% of the population. Investigation of the technique of arthroscopic debridement of this joint was done to assess symptom relief achieved and record any resulting postoperative morbidity. METHODS: Ten consecutive patients with persistent symptoms were assessed prospectively by a research nurse. Measurements of range of motion and grip strength were obtained before and after surgery. Visual analogue scores for pain and satisfaction levels also were recorded and any limitation to activities of daily living were noted. RESULTS: Good or excellent subjective results were achieved in 9 patients at final review at an average of 36 months (12-65 mo) after arthroscopic debridement. One patient graded the result as fair owing to failure to achieve normal range of motion. All patients showed a reduction in visual analogue pain scores, which improved from a mean of 86 to 14 points. The mean Green and O'Brien wrist scores improved from 63 to 91. CONCLUSIONS: Arthroscopic debridement can provide good short-term symptomatic relief for isolated scaphotrapeziotrapezoid arthritis with low risk for surgical complications.

Adult↗

PubMed2003

Validity of the patient-focused wrist outcome instrument: do impairments represent functional ability?

The development of outcome instruments has been reported to be a long process, often taking years to complete. In a previous article, we reported on the rationale behind the construction of a new wrist outcome instrument that assesses, from the wrist-injured individual's perspective, their ability to perform activities of daily living following a wrist disorder. Content validity and test-retest reliability of the wrist outcome instrument also was demonstrated. Here we report on the results of the assessment of other aspects of validity, specifically construct validity of the wrist outcome instrument and the ability of the instrument to detect change over time. We evaluated these psychometric properties against frequently used clinical tests that assess impairments and thus report on the relationship between the ability to perform activities of daily living and impairment measures.

Activities of Daily Living↗

PubMed2003

Development of a patient-focused wrist outcome instrument.

Many types of wrist outcome instruments are used in the clinical setting to determine the effectiveness of treatment. The authors have previously identified that the individual's perspective and the use of compensatory mechanisms are important factors to consider in the measurement of outcome following a wrist disorder. No published wrist outcome instrument currently addresses these factors, however. Therefore, the aim of this study was to develop a wrist outcome instrument that assessed, from the wrist-injured individual's perspective, their actual ability to perform activities of daily living following a wrist disorder. This article reports on the rationale and procedures used to construct the new instrument and presents the results of preliminary psychometric testing of the wrist outcome instrument.

Activities of Daily Living↗

PubMed2003

Arthroscopically assisted treatment of intraosseous ganglions of the lunate: a new technique.

PURPOSE: A minimally invasive technique of debridement and grafting the intraosseous ganglions of the lunate was investigated. MATERIALS AND METHODS: Eight patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently pre- and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 years). RESULTS: All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 degrees to 114 degrees. CONCLUSIONS: The technique of debridement of intraosseous ganglions of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period.

Adult↗

PubMed2003

Flexor tenolysis using a free suture.

The authors present a simple technique to release flexor tendon adhesions. It utilizes a suture which "snares" the adhesion and divides them like a Gigli saw. This minimizes collateral damage.

Journal Article↗

PubMed2003

Derotation taping for metacarpal and phalangeal fractures.

Derotation taping for metacarpal and phalangeal fractures is a simple, noninvasive technique for management of acute fractures with malrotation. Ulnar nerve or ring block is performed followed by a closed reduction using a Jahss technique and then a rotatory manipulation. Plaster tape is applied, providing a supination torque on the finger. Those patients with a late presentation of a rotatory malunion are managed with a "K wire osteoclasis" which involves multiple percutaneous cortical K-wire perforations and then a manipulation.

Journal Article↗

PubMed2003

Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb.

INTRODUCTION: Arthritis in the trapeziometacarpal joint of the thumb can cause swelling and loss of motion. Treatment options include arthrodesis, replacement arthroplasty and interposition arthroplasty. Our objective in this clinical study was to determine outcomes after trapezial arthroplasty with a silicone rubber implant and the relationship between self-reported and measured outcomes. METHODS: At the Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ont., a tertiary care centre, we reviewed a series of 26 patients with advanced osteoarthritis who underwent silicone rubber trapezial arthroplasty. The follow-up averaged 6.5 years. We assessed the outcomes subjectively, and by clinical, functional and radiographic examination. RESULTS: Although 88% of patients reported some improvement in pain and satisfaction, when quantified the improvement was less impressive: only 5.7 (on a visual analogue scale of 1-10, poor-excellent) for pain and 5.6 for satisfaction. Superior subjective results were reported by patients older than 60 years. Osteoarthritic changes had caused pronounced functional impairment in the hands of patients who underwent surgery and those who did not, so that any long-term benefit of surgery was not measurable. Patients had difficulty manipulating both small and large objects on the Jebsen's hand function test. Peri-implant and carpal radiographic lytic changes were observed in 90% of patients. Six patients (20%) required revision surgery (3 early, 3 late), including 1 with a pathologic scaphoid fracture. CONCLUSIONS: Although clinical, functional and radiographic results were poor, they did not predict either satisfaction or pain improvement reported by patients, illustrating the need for a comprehensive standardized outcome evaluation to make informed decisions on the value of surgical intervention for osteoarthritis of the trapeziometacarpal joint.

Adult↗

PubMedDate not supplied

Repair of chronic distal biceps tendon ruptures using autologous hamstring graft and the Endobutton.

The purpose of this study was to report the results of anatomic repair for chronic distal biceps tendon ruptures by use of a semitendinosus autograft with the Endobutton. All 9 patients were satisfied with their outcome (mean, 8.0 on a visual analog scale ranging from 1-10) and were able to return to their jobs. The mean pain score was 0.5, and the postoperative flexion arc was from 3 degrees to 147 degrees, with supination to 75 degrees and pronation to 62 degrees. The mean Mayo Clinic Elbow Score was 96.3 (range, 85-100). Cybex testing was carried out on 1 patient, demonstrating a marked improvement in supination strength. This technique yields good results with a high degree of patient satisfaction and no complications. An advantage of the technique is the concept of prefabrication, allowing the graft to be sutured to the biceps outside the wound and locked onto the radial tuberosity with the Endobutton.

Adult↗

PubMedDate not supplied

Posterolateral rotatory instability of the elbow.

Posterolateral rotatory instability of the elbow is a three-dimensional displacement pattern of abnormal external rotatory subluxation of the ulna coupled with valgus displacement on the humeral trochlea. This pattern causes the forearm bones to displace into external rotation and valgus during flexion of the elbow. Injury to the lateral ulnar collateral ligament allows abnormal supination of the ulna on the humerus. The radial head, being locked in the sigmoid (radial) notch of the proximal ulna by the annular ligament, subluxates posterior to the capitellum. The abnormality is usually posttraumatic and presents with locking, snapping, clicking, catching, and recurrent dislocation of the elbow. The clinical diagnosis is suspected from history and confirmed by the physical examination, which includes the posterolateral rotatory instability test. This test often is best performed under fluoroscopy or general anesthesia. Usually the instability is managed with either a repair of the ligament or an isometric reconstruction using a tendon graft.

Arthroscopy↗