Biomedical subjects
Publications and source records attributed to H Towfigh.
We report on three patients who were operated on peripheral nerve compression syndromes in the hand and forearm caused by a lipoma. After surgical removal of the lipoma, distinct improvement or even recovery of symptoms was observed.
We compared the motion-stable wire suture by Towfigh (MSWST) with a modified Kessler suture (MKS) by following up flexor tendon repairs (MSWST, n = 21/39 digits; MKS, n = 20/31 digits). For MSWST we found 31 (79.5%) "excellent", 3 (7.7%) "good", and 5 (12.8%) "fair" results, when using the scoring system of Buck-Gramcko. In 3 (14.3%) patients the MSWST had to be removed owing to local irritation. In a further 3 (14.3%) patients, this was done when secondary tenolysis was necessary. The latter was also performed in 4 (20.0%) patients in whom the MKS was used. Here we found 23 (74.2%) excellent, 7 (22.6%) good, and 1 (3.2%) fair result. The statistical evaluation of the data concerning the patients' age, sex, the involved zone, the side, and the functional outcome did not reveal a significant difference (P < 0.05) between both groups and the chosen type of repair. The results of MSWST and MKS are similar, but MSWST allows early motion therapy without a splint or rubber-band protection.
In most cases, perilunar dislocations of the wrist are caused by high speed accidents. Usually these injuries occur by a fall on the dorsiflexed superextension of the hand. The instability caused by injuries of various erticular structures (ligament, bone) show various developmental stages. Clinical symptoms are reduced and painful movement, instability of the carpus, snapping and swelling. The diagnosis is established by X-ray, cinematography, arthrography MRT or CT. Perilunar instability with or without associated fractures and particularly de Quervain must be reduced and treated operatively including suture of the ligament and stabilization of the fracture.
Hypercalcinosis of the hand in association with scleroderma represents a rare and benign soft-tissue calcification. Reported are two cases of symmetric affection of soft-tissue layers of both hands in association with scleroderma. Superinfection and exulcerations necessitated surgical treatment. Diagnosis, therapy, and progress are described.
The proximal fracture of the humerus is still the domain of conservative treatment. In 80% of our patients the humerus fracture was not operated. The remaining 20% were treated surgically. Neer's classification was used for a differentiated approach. In case of surgical therapy the guiding principle should be to choose the least invasive surgical treatment offering the greatest benefit. Minimal treatment should be preferred to prevent necrosis. Further, one should strive to gain an axial adjustment of the fracture rather than placing too much emphasis on compression. The aim should be an early and graded treatment and an early functional therapy. In fractures III, IV and V according to Neer, minimal osteosynthesis should be preferred. This will, if the fracture is not accompanied by other injuries and if there is adequate physiotherapy after surgery, result in a recovery of the function. In relatively young patients with solid spongiosa, good stability and anatomical restoration can be achieved by osteosynthesis. Unfortunately in fractures II and IV according to Neer, as well as in four-segment-fractures unsatisfactory results can not be avoided. In such cases minimal surgery should be performed. Implantation of a shoulder prosthesis is indicated only in case of a secondary painful arthrosis. The only cases in which primary alloarthroplasty is indicated are fractures of group II. In these cases implantation is promising because of the totally preserved muscular insertion. In four-segment and luxation fractures, atraumatic surgical reconstruction should be aimed at.
Late results following operative and conservative treatment of 215 ligamentous injuries with injured metacarpophalangeal and interphalangeal joints are presented. These 215 cases represent 77,4% of all hand injuries which were treated in the years 1976 to 1981 at the Traumatological Department of Essen University. Mobility, stability, and function were used to evaluate and compare the late results. A modification of the scheme of Buck-Gramcko et al. for the evaluation of finger's mobility after flexor tendon injuries was employed. 75% of late results were judged to be "good to very good", 16,5% "satisfactory", and 8,5% "poor". The most important influences on the late results were found to be the time between injury and treatment and the patient's age. Further factors were open injuries and the destruction of large parts of the palmar plate. The late results in cases after surgery were much better than those after conservative treatment. Only injuries without total rupture of the palmar plate or collateral ligaments - which were in nearly all cases treated conservatively - reached good or very good late results in over 90%. A better evaluation of the bony injuries could be achieved by special X-ray technique such as magnification views of the involved joints. If the duration of immobilisation is shortened a better restoration of full joint mobility is ensured without disturbing joint stability.
A case of an aneurysmatic dilatation of the ulnar artery with compression of the ulnar nerve in Guyon's canal is described. The etiology, symptomatology, and therapy are illustrated. Acute or chronic trauma in the hypothenar eminence caused pain not only here but also in the ulnar side of the hand with paraesthesia in the ulnar region. It was due to compression of the ulnar nerve in the loge de Guyon by a largely dilated and thrombosed arterial aneurysm. The diagnosis was confirmed by angiogram of the arm and hand. Resection and reconstruction was advised and showed good results.
Combined skeleto-vascular lesions of the proximal parts of the extremities endanger not only the limb but also life. Operative treatment has to be carried out as soon as possible. Stabilisation of the fracture has priority over vascular reconstruction. This paper reports 39 skeleto-vascular lesions. The most important singular factor to improve the prognosis is the reduction of the time interval between the accident and the restoration of regional blood flow. This can be achieved by avoiding time consuming diagnostic measures, quick stabilisation of the fracture by external fixation, temporary circulation by an intraluminal shunt, and by simultaneous operation. It is important to avoid a post-ischaemic compartment syndrome by early fasciotomy.
A case is described of diffuse idiopathic phlebectasia and its clinical symptoms; dilatation of veins were located in superficial and deep systems. The arteries had no changes. Genuine diffuse phlebectasia must be differentiated from phlebarteriectasia and cirsoid angioma. Angiography shows the absence of the ulnar artery and of some of the digital arteries. It shows excessive dilatation of veins and some phleboliths. The X-rays show cortical changes of the bones of the hand skeleton.
In fractures of the distal radius, standard operations including Kirschner-wire fixation, plating and fixation by external fixator may be carried out to restore the distal articular surface. Whereas the indication for Kirschner-wire osteosynthesis is limited, plating is used in irreducible fractures, in radius defects and in the case of a combination with fractures of carpal bones. In sprains and comminuted fractures the use of external fixator combined with Kirschner-wire and plating is the approved technique. Best results with plating can be attained in primary or early secondary treatment within the first two weeks after injury. In case of injuries of the radius and the carpal bones together with injuries of the soft parts, a two-phase-treatment can be recommended--first external fixation and then after recovery of the soft parts, arthrodesis with interposition of a cortico-cancellous wedge and osteosynthesis.
Complete dorsal dislocation of the metacarpophalangeal joint of the index finger is rare and closed reduction of this peculiar dislocation is usually impossible. The injury is produced by striking of the outstretched index against a resistant object, usually in a fall on the hand. The base of the proximal phalanx is displaced over the dorsum of the metacarpal head. The fibrocartilaginous palmar plate remaining attached to the phalanx, is folded into the joint where it becomes wedged between the metacarpal head and the base of the proximal phalanx. In this type of dislocation closed reduction is unsuccessful. Open reduction should be performed through a palmar incision. Description of a typical case.
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Plating of the distal radius is indicated in: a) flexion fractures, b) irreducible intraarticular fractures, c) unstable extraarticular extension fractures, d) chisel fractures of the radial styloid process and the navicular bone, e) correction osteotomies after defective bone healing. The paper presents the final results of 124 radial plate fixations. 73.4% had excellent and good, 20.1% fair, and 6.5% bad results. There was a close correlation between radiologic appearance and clinical function. Early secondary surgery (4th-14th day) showed the best results. Old age had a highly negative influence.
Closed ruptures of the extensor pollicis longus tendon usually appear as a consequence of fractures of the wrist joint or the carpal bones or ensue from polyarthritic changes or result from a process of degeneration. Mechanical injury of the tendon is quite rare but can be observed after direct trauma or after operative treatment of a distal fracture of the radius. Closed traumatic ruptures of the extensor pollicis longus tendon in the absence of pathological changes are--in spite of the frequency of rotation injuries of the forearm--very rare. The patient in the case described is a 45-year-old locksmith whose forearm and hand had been caught in a lathe. This led to sudden, extreme rotation and pronation of the hand. Clinically distinct signs of a rupture of the extensor pollicis longus tendon could be seen. During operation a tear of the muscular portion of the long extensor tendon of the thumb was found. The function of extension was restored by transfer of the extensor indicis tendon.
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Ergotamine is used today for the symptomatic treatment of migraine. It is known that the intake of ergotamine-containing medicaments in cases of migraine causes disturbance of the blood-flow to the peripheral arteries of the extremities. Most of these spastic occlusions are due to medicaments containing ergotamine tartrate. Thus, ergotism is one of the frequent causes of spastic occlusion. The symptoms of blood-flow disturbances due to ergotamines do not differ from other geneses. Extreme cases develop gangrene of the finger tips, leading to a wrong diagnosis and subsequent amputation. A careful history and arteriography showing smooth stenoses usually give the correct diagnosis. An antidote to ergotamine is not known but the spastic occlusion and the neuropsychiatric complications are usually gone some days after the ergotamine-containing substance is discontinued. Anticoagulants and low-molecular dextran are indicated in order to prevent irreversible thrombosis.
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Anomalous muscles at the hand and forearm are described in several studies. They may be confused with ganglia or with other soft-tissue tumours. Two rare cases of atavistic muscles in the area of the back of the hand are described which caused intense pain of the wrist during some months. During the operation an enlongated muscle directly below the extensor tendon, was found which was covered by the extensor retinaculum. It is an extensor digiti brevis manus, which exists in amphibia and is replaced in man by the long tendonous part of the extensor digitorum.