PubMed Health⌕ Search

Biomedical subjects

J A Mehta

Publications and source records attributed to J A Mehta.

12 recordsLinked to original sources
PubMed2002

Local osteopenia associated with management of intra-articular distal radial fractures by insertion of external fixation pins in the distal fragment: prospective study.

PURPOSE: To assess the restoration of the bone mass of the distal radius following the use of implants in the distal radial fragment. Highly comminuted Frykman type 7 and 8 fractures were studied to determine whether the use of fixation pins in the comminuted distal radial fragment leads to osteopenia in the distal radial fragment after healing of the fracture. METHODS: As part of a clinical trial, 30 patients with comminuted intra-articular fractures of the distal radius were treated with closed reduction, external non-bridging fixation, and early postoperative mobilisation. To detect local osteopenia, bone density measurements were taken at the distal metaphysis and mid-diaphysis following healing of the fractured radius and the contralateral unaffected radius in 12 patients. RESULT: The mean age of the 12 patients for whom bone density measurements were recorded was 52.5 years (range, 39-87 years). There were 9 females and 3 males included in the study. Seven patients had a Frykman type 8 fracture and 5 patients had a Frykman type 7 fracture. Significant osteopenia was absent despite the use of four 2.5-mm fixation pins in the distal fragments of the healed distal radial fracture. The median value of the maximal step was 2.8 mm (range, 0-9.1 mm). The median value of the intra-articular interfragmentary gap was 1.8 mm (range, 0-13.4mm). CONCLUSION: The findings of this study do not suggest long-term osteopenia following the use of four 2.5-mm pins in the distal fragments. The non-bridging fixator, by allowing early physical activity, possibly led to satisfactory functional and structural results.

Adult↗
PubMed2000

Surgical approaches to the elbow.

The recent explosion of interest in the elbow and the need for better surgical approaches, has produced numerous new approaches and the modification of other approaches, the result of which is a much shorter but more useful list of surgical approaches. Surgeons who perform a large number of elbow procedures have found that these approaches permit them to perform the majority of elbow procedures with only one skin incision, usually a straight posterior midline incision. Knowledge of the deep intermuscular and internervous intervals allows the surgeon to expose the elbow circumferentially through one skin incision. This approach has been associated with fewer wound complications and has allowed immediate active motion of the elbow.

Elbow↗
PubMed2000

Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach.

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of < or =1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain.

Adult↗
PubMed1999

An overview of distal radial fractures.

Fractures of the distal radius include a wide spectrum of fracture patterns. As well as involving the distal radius, these injuries can involve the wrist, the distal radio-ulnar joint and the distal ulna. The management of these injuries is consequently diverse, ranging from a plaster cast to advanced surgery. The principles of treatment are to reduce and maintain the reduction by restoring the radial height, volar tilt and intra-articular step. The acceptable reduction is to have radial height to within 2 mm of the ulnar, volar tilt greater than 0 degree and intra-articular step less than 1 mm. The present paper reviews the current concepts in the diagnosis, management and complications of distal radial fractures.

Emergency Medical Services↗
PubMed1998

Charcot restraint orthotic walker.

Five patients (three with insulin dependent diabetes mellitus (IDDM), one with noninsulin dependent diabetes mettlitus (NIDDM), and one with hereditary sensorimotor neuropathy (HSMN)) with stage 1 Charcot's neuroarthropathy involving the midfoot and or subtalar and ankle joints were fitted with a Charcot restraint orthotic walker (CROW). The rationale for this orthotic management was to maintain a plantigrade foot for ambulation and to protect the joints and skin by the uniform transfer or distribution of weight over the foot until the time when the pathology reached the stage of coalescence. The patients were able to fully bear weight and to ambulate with the CROW. All patients noted varying measures of improvement in symptoms and function at an average 12-month follow-up. The CROW is a useful orthosis in the armamentarium for treating neuroarthropathy of the pedal joints.

Adult↗
PubMed1998

Dynamic external fixation for injuries of the proximal interphalangeal joint.

Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement. Most (70%) of the patients had a chronic lesion and the mean time from injury to surgery was 215 days (3 to 1953). The final mean range of movement was 12 to 86 degrees. Complications included redislocation and septic arthritis, which affected the outcome. Four pin-track infections and two breakages of the hinge did not influence the result. The PIP Compass hinge is a useful adjunct to surgical reconstruction of the injured PIP joint.

Adolescent↗
PubMed1997

Operative fluoroscopy in hand and upper limb surgery. One hundred cases.

We reviewed the use of a low radiation portable fluoroscopy unit in 100 patients. The most common indication was closed reduction of distal radial fractures. Fracture and joint stability were assessed on the real-time monitor and stored on videotape. Static images were stored on thermographic paper. Fluoroscopically guided joint injections and localization of implants, foreign bodies and bone tumours were performed. Fluoroscopy is a useful adjunct to arthroscopic assisted fracture reduction and other arthroscopic procedures such as distal ulnar resection. These new generation units produce superior resolution images, are easy to manoeuvre and do not require a radiographer.

Bone Neoplasms↗
PubMedDate not supplied

The dynamic elbow suspension splint.

Elevation of the upper extremity after elbow surgery has rarely been advocated and can be difficult to achieve. Usually the extremity is elevated with the elbow at 90 degrees of flexion, so that swelling from the hand drains to the elbow but the elbow remains dependent. Excessive swelling causes discomfort and compromised wound healing, makes early mobilization difficult, and predisposes to joint contracture. We report on a dynamic elbow suspension splint, which is analogous to the Thomas splint used for femoral shaft fractures. The arm is held in full extension with an above-elbow plaster slab and is secured to the Thomas splint with skin traction. The splint is suspended on a Balkan frame at an angle of 60 degrees. We prefer to use the new Zimmer Thomas splint, because it is radiolucent and has self-adhesive sheep-skin supports that can be simply applied. It allows the patient to mobilize in bed and is well tolerated by patients and nursing staff. The dynamic elbow suspension splint is a useful adjunct after complex elbow surgery or trauma, because it reduces swelling and maintains the elbow in extension.

Elbow Joint↗
PubMedDate not supplied

Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: an anatomic study.

Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock. The needles were then removed and the position of the shoulder changed to determine the effect on the position of the axillary nerve. The axillary nerve was held to the shoulder capsule with loose areolar tissue in the zone between 5 and 7 o'clock and was close to the glenoid in the neutral position, in extension, and in internal rotation. With shoulder abduction, external rotation, and perpendicular traction, the capsule became taut and the axillary nerve moved away from the glenoid. Abduction, external rotation, and perpendicular traction increase the zone of safety during arthroscopic anteroinferior capsulotomy adjacent to the glenoid between the 5 and 7 o'clock positions.

Aged↗