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Biomedical subjects

H H Stark

Publications and source records attributed to H H Stark.

At least 19 recordsLinked to original sources
PubMed1991

Tendon arthroplasty of the fifth carpometacarpal joint for treatment of posttraumatic arthritis.

Resectional arthroplasty with interposition of a rolled tendon spacer was used to treat posttraumatic arthritis of the fifth metacarpal-hamate joint in eight patients. The average follow-up was 5 years. All of the patients subjectively rated the functional capability and the cosmetic appearance of their hands as good or excellent. After operation, there was a net increase of 30% in the average grip strength of the study group. The motion preserved at the small finger carpometacarpal joint facilitated power function of the hand.

Adult↗
PubMed1989

Bridge flexor tendon grafts.

In adults, when flexor tendons cannot be repaired until weeks or months after injury or when tendons have ruptured and part of the tendon is nonviable, it is often inadvisable to suture the tendon ends together. When a primary repair has failed, when there has been a delay in tendon reconstruction to allow skin coverage or joint mobilization, or when repair has been delayed because of infection, continuity of a profundus tendon or flexor pollicis longus tendon can often be restored by using a free graft to bridge the defect. Many patients treated by this procedure will have a satisfactory result providing that the flexor tendon is undamaged within its digital sheath and the muscle is intact and has adequate amplitude. In the study reported here, satisfactory function was restored to 28 of 37 fingers and to eight of ten thumbs treated by this method.

Adult↗
PubMed1989

Fracture of the hook of the hamate.

We removed the fracture fragment from fifty-nine patients who had an isolated fracture of the hook of the hamate. Preoperatively, all had complained of pain and tenderness on the ulnar side of the palm or on the dorsal ulnar aspect of the wrist. Most fractures were thought to have occurred while the patient was swinging a racquet, golf club, or baseball bat. Some fractures were caused by striking the palm on a solid object, by falling on the palm, or by a crush injury to the hand. Most of the fractures were diagnosed conclusively on a carpal tunnel roentgenogram or on a special oblique roentgenogram of the wrist supinated. We now believe that computed axial tomography is the best imaging technique for demonstrating this fracture. Except for two patients who had a crush injury, all of the patients returned to their regular occupational and athletic pursuits. There were no surgical complications.

Adult↗
PubMed1988

Toxic shock syndrome after a human bite to the hand.

The first known case of toxic shock syndrome resulting from a human bite is reported. An awareness of the presenting features and clinical manifestations are needed in the early recognition and intensive medical management of this life-threatening condition.

Adult↗
PubMed1988

Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation.

Of 151 ununited fractures of the scaphoid that were treated with iliac bone grafts and Kirschner-wire fixation through a volar approach, all but four (97 per cent) healed in an average of seventeen weeks, Three of the four failures resulted from obvious technical errors. Neither the preoperative existence of necrosis of the proximal fragment nor the location of the fracture affected the results. When there was mild radiocarpal arthritis preoperatively, it did not progress postoperatively; if there was moderate radiocarpal arthritis preoperatively, progression seldom was seen if a radial styloidectomy was done. Displaced and unstable ununited fractures healed even if the deformity was not corrected completely. The principal benefit of the procedure was relief of pain rather than an increase either in motion of the wrist or in strength of grip.

Adolescent↗
PubMed1987

Dupuytren's disease in women: evaluation of long-term results after operation.

A study of the long-term results after operation on 66 women (83 hands) with Dupuytren's disease showed that women are twice as likely as men to have a postoperative flare reaction. Why a flare reaction develops is uncertain. In this study, patients who had a carpal tunnel release at the time of operation for treatment of Dupuytren's disease or those who had an extensive fasciectomy, as opposed to removal of only the contracted tissue, were more apt to have a flare reaction. In addition, after operation, moderate or severe loss of finger flexion occurred in 35% of hands without a flare reaction and in 76% of those who had a flare reaction. This suggests that women having an operation for treatment of Dupuytren's disease are apt to have a worse result than men.

Aged↗
PubMed1987

Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits.

Thirty-six digits with an intra-articular fracture of the dorsal aspect of the distal phalanx that involved one-third or more of the articular surface were treated by open reduction and internal fixation with Kirschner wires. After an average length of follow-up of forty-six months, roentgenograms of the distal joint in twenty-six digits appeared essentially normal. Ten digits had minor roentgenographic changes but, with the exception of one digit, the joint space was congruous and free of significant abnormalities. The average loss of extension of the distal joint was 2 degrees, and the average arc of flexion of the distal joint was 69 degrees. The average strength of pinch in all digits that were operated on was essentially equal to the strength of pinch in the contralateral digit. Exact reduction and internal fixation using the technique described resulted in excellent motion and function.

Adolescent↗
PubMed1986

Fractures and dislocations of the carpal bones.

The most common wrist fractures in athletes are fractures of the scaphoid and fractures of the hook of the hamate. Accurate diagnosis and conservative treatment are extremely important. A physician should not compromise principles of treatment for a rapid return of the athlete to competition, because all too often this will jeopardize eventual recovery and his or her future career. It is far better to be conservative, to insist upon complete recovery before permitting competition, especially in high-school and college students, and to be more concerned with the athlete's potential achievements than immediate accomplishments. These axioms are especially applicable when treating young individuals with suspected or proven wrist injuries.

Athletic Injuries↗
PubMed1978

Tendon transfers for radial nerve palsy: use of superficialis tendons for digital extension.

Since 1959, 22 patients have had wrist extension restored by transfer of the pronator teres to the extensor carpi radialis longus and brevis, common finger extension by transfer of the superficialis of the long finger, independent thumb and index finger extension by transfer of the superficialis of the ring finger, and abduction of the thumb by transfer of the flexor carpi radialis at the wrist joint level. Twenty-one of 22 patients have been evaluated from 8 months to 15 years after operation, with an average follow-up of 4.5 years. By our new system of evaluation, there were 10 excellent results, six good results, five fair results, and all patients improved. Sixteen patients obtained full, independent thumb-index finger extension, three had fair function, and two obtained thumb-index extension by tenodesis of the transfer. This procedure allows full metacarpophalangeal extension independent of wrist position, provides thumb-index finger extension independent of the ulnar three digits, and maintains the dorsal-radial-to-volar-ulnar plane of functional motion of the wrist by retaining the flexor carpi ulnaris.

Adolescent↗
PubMed1977

Flexor tendon graft through intact superficialis tendon.

During a 14-year period, the flexor profundus mechanism was reconstructed with a free tendon graft in 25 fingers. The graft was passed either through or alongside the intact superficialis tendon. Five of the profundus tendons had ruptured, and 21 had been severed. One patient was under 10 years of age and only three were over 21 years of age. The result was considered to be satisfactory if the finger flexed to 3.2 cm or less of the mid-palm, had at lease 20 degrees of voluntary flexion of the distal joint, and lacked no more than 30 degrees of extension of the proximal interphalangeal joint. Additionally, to be satisfactory, the combined loss of extension of the proximal interphalangeal and distal interphalangeal joints ahd to be 40 degrees or less for an index or middle finger, and 60 degrees or less for a ring or little finger. Using these criteria, 20 patients were satisfactory, four were unsatisfactory, and one was unchanged. Selected patients who are between the ages of 10 and 21 years will benefit from this operation, providing that the finger had limber joints and minimal scar, and the superficialis tendon flexes the proximal interphalangeal joint at least 80 degrees.

Adolescent↗
PubMed1977

Silicone-rubber interposition arthroplasty of the carpometacarpal joint of the thumb.

Since 1969, a slightly modified silicone-rubber neurosurgical burr-hole cover has been used for a type of interposition arthroplasty of the carpometacarpal joint of the thumb. The short stem of the device fits into a hole burred into the distal surface of the trapezium. The flat surface of the device covers the distal surface of the trapezium. Forty-nine operations were done on 42 patients, 35 women and seven men. The age range of the patients was 34 years to 72 years, with an average of 55 years. The average follow-up time was 31 months. Forty results were rated as excellent. There were two failures due to breakage of the device, and in both cases the breakage was due to a technical error.

Adult↗
PubMed1977

Fusion of the first metacarpotrapezial joint for degenerative arthritis.

During a twelve-year period, twenty-eight patients (thirty thumbs) were treated for painful idiopathic arthritis of the metacarpotrapezial joint of the thumb by fusion. Failure of fusion occurred in two thumbs, and in both instances a solid fusion followed a second procedure. Fusion of the metacarpotrapezial joint did not predispose to painful arthritis of the trapezioscaphoid joint, even in patients with pre-existing roentgenographic evidence of minor degenerative changes in this joint. The results after long-term follow-up were gratifying, the patients having painless and stable thumbs with excellent strength. Although patients noted a minor loss of thumb motion, they did not consider this a problem. Fusion is a satisfactory procedure for patients who need or desire a strong, painless thumb, and seems especially worth while in the dominant thumb when both thumbs require surgical treatment.

Adult↗
PubMed1977

Fracture of the hook of the hamate in athletes.

During an eight-year period, four tennis players, seven golfers, and nine baseball players were seen with a fracture of the hook of the hamate. Eighteen of these twenty patients were disabled by pain and after the fracture fragment was removed, all eighteen were relieved so that they returned to their athletic pursuits. Two patients were asymptomatic, their old fracture being discovered accidentally when they were treated for other injuries. Nineteen of the twenty patients had been examined before coming under our care, but the correct diagnosis had been made in only two. Conservative treatment, including rest, physical therapy, and injections of steroids into the wrist and hand, had not been beneficial. From the history and findings, we believe that these fractures were caused by a direct blow against the hook of the hamate caused by the handle of the tennis racket, golf club, or bat during a swing, and not by indirect force produced by the ligaments and muscles attached to the hook. The fracture was demonstrated in all twenty patients by a roentgenogram (profile view) of the carpal tunnel.

Adolescent↗
PubMed1977

The use of paratenon, polyethylene film, or silastic sheeting to prevent restricting adhesions to tendons in the hand.

We treated 132 patients by insertion of paratenon, polyethylene, or Silastic between a digital tendon and a bone, ligament, or fixed fascial structure to prevent adhesions. From 1950 to 1974, autogenous paratenon was used in thirty patients; from 1956 to 1965, polyethylene film was used in sixty-three patients; and from 1965 to 1974, Silastic sheeting was used in thirty-nine patients. By comparing the preoperative and postoperative measurements of joint motion and the changes in the distance separating the pulp of a finger from the palm during flexion, these patients were calssified as improved, unchanged, or worse. In some areas the material used appeared to make little difference, but in other areas one or the other was superior. Silastic sheeting (non-reinforced) proved to be the best material for most conditions, but it should not be employed when the skin is of poor quality or beneath a pedicle flap, and it should not be used adjacent to a tendon graft in an area that has recovered from an infection. Under those circumstances, paratenon is the preferred material.

Adipose Tissue↗
PubMed1976

Capsulodesis of the metacarpophalangeal joint of the thumb in children with cerebral palsy.

A deformity of hyperextension of the metacarpophalangeal joint of the thumb occurring in thirteen children with spastic cerebral palsy was corrected by capsulodesis of the joint. The technique involves shifting the metacarpal attachment of the volar plate more proximally in the metacarpal. When combined with selective release of the involved intrinsic muscles and selective transfer of the extrinsic motors, when indicated, the thumb is brough away from the palm and its function and appearance are improved. Moreover, there is not risk to growth of the thumb such as might follow arthrodesis in a growing child. Results were satisfactory except in two athetoid patients, in whom some of the intial correction was lost, but even their thumbs did not revert into hyperextension. In five patients, for reasons not entirely clear, the previously flexed interphalangeal joint had better extension postoperatively. This improved the function of the thumb, because the broad pulp of the thumb could then be used firmly against the side of the index finger.

Adolescent↗