Biomedical subjects

H Hastings

Publications and source records attributed to H Hastings.

At least 19 recordsLinked to original sources

PubMed2000

Treatment of ectopic ossification about the elbow.

The surgical treatment of elbow ectopic ossification associated with elbow stiffness has progressed significantly in the past decade. Although previous reports describe inconsistent results and high complication rates, numerous recent reports document not only good results, but also lower complication rates. The current study outlines the authors' treatment of patients with ectopic bone about the elbow. Various modalities have been used for prophylaxis against elbow ectopic ossification in the patient with elbow trauma. However, despite these prophylaxis efforts, periarticular ossification may form and result in disabling elbow stiffness. If ectopic ossification and stiffness develop, operative intervention may be indicated to restore motion. It has been long suggested that operative intervention be delayed for at least 1 year, with earlier intervention thought to predispose to recurrence. Recent reports, however, have documented good results with earlier intervention, from 3 to 6 months after injury. The evaluation of posttraumatic elbow stiffness associated with ectopic ossification is described, followed by a discussion regarding anatomic and functional classifications. Surgery is based on multiple factors including the location of ectopic ossification, the plane(s) of elbow stiffness, and the presence of associated nerve compression. A limited or extended Kocher approach may be used to release most contractures; however, other approaches may be necessary. Surgical technique is described in detail. Meticulous surgical technique is necessary to avoid complications, including triceps avulsion, recurrent elbow stiffness, and hematoma.

Contraindications↗

PubMed1999

Operative release for elbow contracture: the lateral collateral ligament sparing technique.

This article describes the technique of elbow release and debridement using a lateral approach designed to spare the lateral collateral ligament complex and extensor tendon origins of the elbow. This exposure allows for complete exposure of the anterior and posterior ulnohumeral and radiocapitellar joints through a single incision. Advantages include simplified surgical dissection, minimal operative morbidity, and less potential for postoperative instability after release.

Contracture↗

PubMed1998

Metacarpal and phalangeal fractures in athletes.

The high demands placed on the upper extremity in sporting activities subject the competitive athlete to common injuries of the hand. Treatment options are based on the fracture configuration, associated extremity injuries, and status of the surrounding soft tissue. Metacarpal and phalangeal fractures may usually be treated by closed, nonoperative methods, and most athletes may quickly return to play with a protective orthosis. Supplemental methods of fixation, such as percutaneous pins and tension-band wires, may be used for unstable fractures. When required, open reduction and internal fixation can provide optimum stability to the fracture, which allows immediate range-of-motion and early return to play.

Athletic Injuries↗

PubMed1998

Effect of proximal phalangeal fracture deformity on extensor tendon function.

Extensor lag is a common sequella of proximal phalangeal fractures. Proximal phalangeal fractures frequently lead to extensor tendon dysfunction via adhesions and phalanx malunion with angulation and/or shortening. The primary purpose of this study was to quantify the influence of proximal phalangeal angulation and shortening on proximal interphalangeal (PIP) joint extension by examining the effect of isolated proximal phalangeal bone to extensor digitorum communis tendon discrepancy on PIP joint lag. The secondary goal was to determine the reserve of the extensor digitorum communis to overcome the PIP joint lag. A proximal phalangeal bone-extensor tendon discrepancy results in either a PIP lag or a potential lag that must be compensated for by another system, such as by overpull of the extrinsic extensor or by the pull of the intrinsics. Six cadaveric middle fingers were used, proximal phalangeal malunions were simulated, and the extensor lag was measured radiographically. A linear relationship between extensor tendon lengthening and the resulting PIP lag was observed. Similarly, a linear relationship between proximal phalangeal shortening and the lag was observed. For both, the average slope was 12 degrees of lag/mm of bone-tendon discrepancy. For average apex palmar angulations of 16 degrees, 27 degrees, and 46 degrees, PIP lags of 10 degrees, 24 degrees, and 66 degrees, respectively, resulted. The extensor tendon reserve was 2 to 6 mm. The sagittal bands became tight at the limits of the extensor tendon reserve. The results of this study quantify the importance of re-establishing the bone-tendon relationship for proximal phalangeal fractures.

Cadaver↗

PubMed1998

Post-traumatic contracture of the elbow. Operative release using a lateral collateral ligament sparing approach.

We performed a lateral approach for the release of post-traumatic stiffness of the elbow in 22 patients using a modified technique designed to spare the lateral ligaments. They were reviewed after a mean interval of 26 months. The total humeroulnar joint movement had increased from a mean of 74 degrees to 129 degrees and forearm rotation from a mean of 135 degrees to 159 degrees. Both pain and function in the elbow had improved significantly. This modified lateral approach allows release of post-traumatic contracture without disruption of the lateral collateral ligament or the origins of the extensor tendon at the lateral epicondyle of the humerus. The advantages include a simplified surgical procedure, less operative morbidity, and unrestricted rehabilitation.

Adolescent↗

PubMed1998

A systematic approach to handling the distal radio-ulnar joint in cases of malunited distal radius fractures.

The distal radio-ulnar joint (DRUJ) is often the site of persistent symptoms after malunion of distal radius fractures. These malunions alter load transfer across the ulnocarpal joint, disturb DRUJ kinematics, and result in joint incongruity at the sigmoid notch. Treatment of distal radius malunions must not only correct position of the radial platform and joint incongruity but also restore anatomic relationship at the DRUJ. A systematic approach to the surgical reconstruction of these multiplanar deformities using clinical and radiographic parameters is outlined.

Algorithms↗

PubMed1997

Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures.

A new plate designed specifically to address complex wrist pathology was used for the internal fixation of 22 complex fractures of the distal radius in 22 patients in a prospective multicenter trial. The majority of fractures were group C2- and C3-type fractures according to the Comprehensive Classification of Fractures. No plate failures, loss of reduction, nonunions, or infections occurred. Within the average follow-up time of 14 months, the functional results (including an average motion of 76% and an average grip strength of 56% of the contralateral side) were comparable to those reported for similar fractures in previous investigations. Five patients had irritation of the tendons in the second dorsal compartment. This trial serves both as a verification of the safety and efficacy of this distal radius plate as well as a demonstration of its utility in the treatment of complex fractures of the distal radius.

Adult↗

PubMed1997

Urinary and tissue levels of scatter factor in transitional cell carcinoma of bladder.

PURPOSE: We previously reported increased titers of scatter factor in urine of 20 patients with transitional cell carcinoma of the bladder compared to noncancer and cancer control groups. Scatter factor was also found in bladder tumor extracts but the number of samples examined was too small for detailed analysis. We report a followup study of larger numbers of patients with transitional cell carcinoma and controls. MATERIALS AND METHODS: The scatter factor content of urine samples and bladder tissue extracts was measured by enzyme-linked immunosorbent assay. Values were normalized per milligram creatinine or tissue protein. Statistical analysis was performed using the Mann-Whitney U test or, for multiple comparisons, the Kruskal-Wallis H test. RESULTS: Patients with transitional cell carcinoma of the bladder (52) had higher urinary scatter factor titers than did 24 normal subjects (p < 0.001) or 14 with benign prostatic hypertrophy (p < 0.001), 49 with prostate cancer (p < 0.001) and 13 with other genitourinary tract cancers (p < 0.01). Transitional cell carcinoma cases with clinicopathological evidence of disease had greater urinary scatter factor levels than those with no evidence of disease at urine sampling (p < 0.01). However, patients with transitional cell carcinomas in remission still had much greater urinary scatter factors than did normal subjects (p < 0.001). In contrast, patients with active prostate cancer had urinary scatter factor levels similar to those in remission. Patients with muscle invasive or high grade transitional cell carcinomas tended to have higher urinary scatter factor levels than patients with nonmuscle invasive or low grade tumors, respectively, but the differences were not significant. Greater levels of scatter factor were present in tissue extracts of muscle invasive transitional cell carcinomas than in nonmuscle invasive tumors (p < 0.001) or nontumor tissue (p < 0.02). Invasion was more closely related to tissue scatter factor content than tumor grade, since high grade noninvasive transitional cell carcinomas had a scatter factor content similar to that of low grade noninvasive transitional cell carcinomas. CONCLUSIONS: These studies suggest that scatter factor may be a marker of bladder cancer, urinary scatter factor titers tend to reflect disease activity and particularly high tissue titers of scatter factor are found in muscle invasive cancers. A larger prospective study will be necessary to determine the clinical significance of elevated scatter factor titers in transitional cell carcinoma of the bladder.

Carcinoma, Transitional Cell↗

PubMed1997

Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers.

Posterolateral rotatory instability of the elbow has been attributed to disruption of the ulnar part of the lateral collateral ligament. Forty fresh cadavera were studied to define the ligamentous anatomy of the lateral aspect of the elbow specifically as it relates to rotatory instability. The dissections revealed a broad conjoined insertion of the lateral collateral and annular ligaments onto the proximal aspect of the ulna. This insertion was bilobed (type I) in twenty-two specimens and broad (type II) in eighteen specimens. Serial sectioning studies revealed primary and secondary stabilizers of the lateral aspect of the elbow. In addition to the lateral collateral ligament and the annular ligament, the extensor muscle origins provide stability through fascial bands and intermuscular septa.

Cadaver↗

PubMed1997

Fixation of complex elbow fractures, Part I. General overview and distal humerus fractures.

Complex elbow fractures are those intra-articular injuries which result in displacement or incongruity of one or more of the articulations between the distal humerus, proximal radius, or proximal ulna. The article discusses a system for clinical and radiographic evaluation, operative management, and rehabilitation of distal humerus fractures. This review presents detailed descriptions of skeletal reconstructive techniques for these injuries based on a review of the literature, biomechanic principles, and clinical experience. The importance of rigid internal fixation and early postoperative mobilization is emphasized.

Adult↗

PubMed1997

Fixation of complex elbow fractures, Part II. Proximal ulna and radius fractures.

Complex fractures of the elbow often include significant injury to the proximal ulna and/or proximal radius. Such injuries are often combined with injury to the periarticular soft tissues. Appropriate treatment is dependent on accurate diagnosis, definitive treatment of both the skeletal and ligamentous components of injury, and initiation of rehabilitation programs the stress early motion.

Fracture Fixation↗

PubMed1996

A multicenter prospective review of 640 endoscopic carpal tunnel releases using the transbursal and extrabursal chow techniques.

A prospective study involving eight institutions was performed, incorporating 640 cases of carpal tunnel release using a dual portal endoscopic technique. The original transbursal technique described by Chow was used in 110 cases (17%), and the modified extrabursal technique was used in 530 cases (83%). An overall complication rate of 11% was found in the patients in whom the transbursal technique was used, compared with 2.2% in the patients in whom the extrabursal technique was used. The return-to-work status was followed in 291 cases (199 non-worker's compensation cases and 92 worker's compensation cases). The worker's compensation patients returned to work in an average of 57 days, compared with 22 days for non-worker's compensation patients. This study suggests the extrabursal dual portal endoscopic technique is associated with fewer complications than the transbursal approach, and patients covered by worker's compensation return to work later than non-worker's compensation patients.

Adolescent↗

PubMed1996

Arthrodesis of the wrist for post-traumatic disorders.

We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a post-traumatic disorder at one center. Fifty-six patients (fifty-seven wrists) had the arthrodesis with plate fixation, and thirty-three patients (thirty-three wrists) had the arthrodesis with a variety of other techniques. The average age of the patients at the time of the arthrodesis was forty-two years, and the dominant wrist was treated in forty-two patients. Fifty-six (98 per cent) of the fifty-seven wrists that had been fixed with a plate had a successful union at an average of 10.3 weeks postoperatively. Twenty-seven (82 per cent) of the thirty-three wrists that had been treated with other methods had a successful union at an average of 12.2 weeks postoperatively. The difference in the rates of union between the wrists fixed with a plate and those treated with alternative techniques was significant (p = 0.009; Fisher exact test). A total of thirty-nine complications were associated with twenty-nine (51 per cent) of the fifty-seven arthrodeses with plate fixation. Sixteen (41 per cent) of the complications (thirteen wrists) resolved with non-operative treatment. Twenty-six (79 per cent) of the thirty-three arthrodeses with alternative methods of fixation were associated with a total of twenty-nine complications. Twenty-three (79 per cent) of those complications (twenty wrists) resolved with non-operative treatment. The difference between the rate of complications associated with the arthrodeses with plate fixation and that associated with the arthrodeses with alternative methods of fixation was significant (p = 0.03; Fisher exact test).

Adult↗

PubMed1996

Endoscopic carpal tunnel release. Chow technique.

The first cases using the set of instruments designed by James C. Y. Chow, MD, of Mount Vernon, Illinois, were performed in September of 1987 by the developer. His was the first written introduction of the technique of endoscopically assisted carpal tunnel release published by a US author. This technique has been practiced widely for 5 years. Serious complications can occur but may be avoidable.

Carpal Tunnel Syndrome↗

PubMed1995

Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application.

This study demonstrates the ability to obtain a predictable and complete wrist arthrodesis using local bone graft and a dorsal plate. The donor site morbidity often seen in using iliac crest graft is eliminated with this method. We examined the use of local distal radius bone grafting alone with dorsal plate fixation and its ability to provide a predictable fusion. Twenty-eight consecutive patients underwent wrist arthrodesis by a standard plate fixation technique. Average patient age was 34 years with an average period of symptom duration of 2.1 years. The cohort had undergone 17 previous wrist surgical procedures prior to wrist arthrodesis. The average followup examination period was 2 years. Grip strength, x-ray films, and range of motion were evaluated. All patients had a solid wrist arthrodesis at final follow-up examination. Grip strength, pronation/supination, and digital motion did not change significantly from the preoperative status. No patients complained of wrist pain or instability. Complications included extensor tendinitis at the distal aspect of the plate in four patients requiring plate removal, carpal tunnel syndrome requiring decompression, and distal radioulnar joint pain requiring intra-articular injection of corticosteroid.

Adolescent↗

PubMed1995

Upper extremity function after wrist arthrodesis.

Several studies have examined the normal range of wrist motion used to accomplish activities of daily living. Little information is present, however, on what functional limitations might be experienced by patients actually undergoing formal wrist arthrodesis. This study undertook comprehensive functional evaluation of 23 patients who underwent wrist arthrodesis for post-traumatic conditions. Follow-up evaluation averaged 54 months and consisted of a clinical questionnaire, the Jebsen Hand Function Test, and a functional rating devised by Buck-Gramcko/Lohmann. Fifteen of the 23 patients returned to their original jobs, and all patients noted that although the vast majority of tasks could still be performed, these tasks were undertaken in a modified fashion. The most difficult daily tasks for patients with a wrist arthrodesis to perform involved perineal care and manipulating the hand in tight spaces. The Jebsen Hand Function Test demonstrated a 64% task completion rate with the fused wrist compared to a 78% task completion rate for the normal wrist. The Buck-Gramcko/Lohmann evaluations demonstrated an average score of 8.3 out of a possible 10. Patients who have undergone wrist arthrodesis can accomplish most activities of daily living and other functional requirements, although some adaptation to accomplish these tasks is required.

Activities of Daily Living↗

PubMed1994

Flexor digitorum superficialis lasso tendon transfer in isolated ulnar nerve palsy: a functional evaluation.

Twelve patients (23 digits) with isolated ulnar nerve palsy underwent flexor digitorum superficialis lasso tendon transfers for correction of claw deformity, weakness, and asynchronous digital flexion. The average follow-up period from date of injury was 5 years (range, 2-11 years) and from surgery was 3 years (range, 15 months to 7 years). Transfers successfully corrected the claw deformity in 19 of the 23 digits. Three of the four failures occurred in the small finger. Two of the four failures had uncorrected preoperative proximal interphalangeal joint flexion contractures. In 9 of the 12 patients with pre- and postoperative grip strength measurements no significant improvement in grip strength was noted. While this procedure is effective and predictable in correcting deformity and restoring synchronous pattern of finger flexion, it should be used with caution in patients requiring an increase in grip strength.

Adolescent↗

PubMed1994

Differentiation of beats of ventricular and sinus origin using a self-training neural network.

Despite advances in the computerized detection of arrhythmias, arrhythmia recognition by morphological waveform analysis still poses a difficult problem. Artificial neural networks, computer algorithms that are self-trained by an analog of biological synaptic modification to perform pattern recognition, hold great promise for the differentiation of various cardiac rhythms. The goal of this study was to differentiate beats of sinus and ventricular origin on a global basis and on a patient-specific basis by the use of artificial neural network analysis. Neural networks were trained to recognize digitized intracardiac electrograms (9 patients) and surface electrocardiograms (11 patients) obtained during sinus rhythm and ventricular tachycardia. After training, sinus rhythm or ventricular tachycardia beats were input into the neural network, and classified as to their origin. By the use of modified receiver operating characteristic curve plots, it was possible to differentiate with high sensitivity and specificity between beats of sinus origin and ventricular origin in all patients. The addition of high amounts of noise to the beats did not markedly degrade the performance of the surface ECG neural networks, and still allowed high sensitivity in differentiating beats of sinus origin from beats of ventricular origin, especially when noise was added to the training set. Neural networks provided sensitive and specific detection of cardiac electrical activity during sinus rhythm and ventricular tachycardia, and may play an important role in allowing development of improved arrhythmia recognition and management systems.

Aged↗