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Biomedical subjects

J D Lubahn

Publications and source records attributed to J D Lubahn.

At least 19 recordsLinked to original sources
PubMed2000

The anatomical relationship between the posterior interosseous nerve and the supinator muscle.

Understanding the anatomical relationships in the region of the supinator muscle is crucial in limiting surgical morbidity. The course, length, and muscular innervations of the posterior interosseous nerve, as well as a detailed dissection of the supinator muscle, were described and recorded in 31 specimens from 16 adult cadavers. In our study, the radial nerve bifurcated into the posterior interosseous nerve and superficial radial nerve 8.0 +/- 1.9 cm distal to the lateral intermuscular septum. The bifurcation of the radial nerve occurred 3.6 +/- 0.7 cm proximal to the leading edge of the supinator, with the posterior interosseous nerve exiting the supinator muscle 3.8 +/- 0.9 cm distal to the proximal margin. The arcade of Frohse was membranous in 68% of our specimens and tendinous in 32%. The supinator had one semicircular head or layer in 71% of specimens and 2 distinct heads or layers, as defined by diverging muscle fibers, in 29%. With 2 heads, or layers, the superficial layer extended to the lateral epicondyle while the deep layer extended to the ulna, below the radial notch.

Adult↗
PubMed2000

Orthopaedics, ethics, and industry. Appropriateness of gifts, grants, and awards.

At the Academic Orthopaedic Society meeting in San Francisco on November 8 and 9, 1996, the membership addressed the issue of ethics and industry in an academic setting. Using a Delphi panel technique, they arrived at a definition of conflict of interest, and 41 separate points of acceptable and unacceptable behavior related to gifts, research awards, and funding of various activities. The Academic Orthopaedic Society Delphi Committee also mailed 191 questionnaires (157 department chairpersons and 34 program directors) to 157 training programs. The respective department chairpersons and program directors were asked to copy and distribute the questionnaires to staff (faculty) and house officers (residents and fellows) to complete anonymously and return them for collation. Ninety-one programs (58%) responded. Three hundred and fifty-two questionnaires were returned (237 from staff, 115 from house officers), each of which expressed agreement or lack of agreement with the Delphi panel report using a Likert scale technique. With only modest (and usually predictable) disagreement on certain items, the final statements by the Delphi panel were supported strongly by the survive results. The Academic Orthopaedic Society believes that the major points arrived at by the panelists should serve as the basis for ethical guidelines in the relation between academic orthopaedic institutions and industry.

Awards and Prizes↗
PubMed1999

Open-palm technique and soft-tissue coverage in Dupuytren's disease.

Dupuytren's disease remains a condition rich with history and tradition. New ideas in pathophysiology have stimulated research in basic science and the continuing search for the cause. The pathoanatomy, although well understood, challenges the surgeon with difficult dissection and the need to understand the blood supply to the palm. The author still recommends the open-palm technique, initially described by Dupuytren and later popularized by McCash, as the treatment of choice in Dupuytren's disease.

Dupuytren Contracture↗
PubMed1996

Fractures of the distal interphalangeal joint.

Fractures at the distal interphalangeal joint present a therapeutic challenge to the hand surgeon because of the relatively small bones and joint surfaces involved and the limited internal fixation devices available. Knowing which patients and which fractures are best treated surgically is key to a successful result. The normal anatomy and biomechanics of the joint are outlined and overviewed and the anatomy, etiology, therapy, and classification are discussed. Comminuted fractures of the articular surface of the distal phalanx are presented as are epiphyseal fractures of the distal phalanx. Avulsion of the profundus tendon (jersey finger) is discussed, emphasizing Leddy and Packer's Types I, II, and III injuries and the recommended treatment. Condylar fractures of the articular surface of the middle phalanx at the distal interphalangeal joint are the subject of the next section, with London's classification scheme and recommended treatment. Finally, complex open injuries and replantation through the distal interphalangeal joint are presented with guidelines for salvage and treatment.

Finger Injuries↗
PubMed1996

Cross leg flap in a bilateral traumatic amputee.

A case report of a bilateral traumatic amputee who underwent a cross leg flap to preserve a knee disarticulation level amputation is presented. Salvage of amputated parts in the lower extremities to preserve stamp length provided our patient with better stability and decreased energy expenditure with ambulation.

Adult↗
PubMed1995

Radial polydactyly: an outcome study.

Radial polydactyly is a relatively common congenital disorder that frequently occurs as thumb duplication. A paucity of information exists on outcomes of Bilhaut-Cloquet procedures. To evaluate clinical outcomes, the results of various operative and nonoperative treatments were reviewed. Follow-up by retrospective chart review was performed on 21 patients treated between 1979 and 1994 at the Shriners Hospital for Crippled Children in Erie, Pennsylvania. Patient interview or physical examination, or both, was performed on 16 of these patients. The study was comprised of 9 boys and 12 girls (average age, 7.8 years; range, 1.5-15.8 years) and included 26 thumbs. Ablation alone was performed in 6 thumbs (6 patients), a combined procedure consisting of ablation with radial collateral ligament reconstruction and shaving of the metacarpal in 10 thumbs (9 patients), and a Bilhaut-Cloquet procedure in 5 thumbs (4 patients). Five thumbs (4 patients) with Wassel type I classification were managed without surgical intervention and simply observed. Of the 6 thumbs treated with ablation alone, 5 required subsequent procedures (radial collateral ligament reconstruction). Ablation with collateral ligament reconstruction and articular surface shaving improved clinical alignment and stability but did not return normal interphalangeal joint motion. The Bilhaut-Cloquet procedure improved the overall cosmetic and functional appearance but likewise did not restore normal joint motion. Our findings support current literature that finds that ablation of the thumb without reconstruction is contraindicated because of the high reoperation rate. Although techniques have evolved that improve alignment and stability or appearance, none guarantee normal joint motion. All patients were satisfied, however, that the thumb was significantly improved compared with the preoperative condition.

Adolescent↗
PubMed1994

Bipolar coagulation at different energy levels: effect on patency.

Determining the extent of damage caused by bipolar coagulation at different levels is critical in microsurgery. If no significant damage occurs at known levels, this technique can be used instead of ligation, saving considerable time. One hundred eighty Sprague-Dawley rats were divided into six groups of 30 each. The effects of bipolar coagulation were assessed at either 2 or 10.4 watts at the junction between the common femoral artery and a branch vessel. Three common clinical settings were used: branch coagulation without interruption of blood flow in the common femoral artery; branch coagulation with interruption of blood flow for 30 minutes; and branch coagulation with arterial anastomosis 3-5 mm distal to the branch. Control procedures without coagulation were performed on the contralateral vessels. The animals were re-explored at 5-7 days. No differences occurred in patency of the coagulated vessels at 2 or 10.4 watts of delivered energy as compared with controls. Recanalization of the side branch occurred in approximately 80% (144/180) of specimens. Extensive damage to endothelium, tunica intima, and tunica media occurred for 1-2 mm around the site of the coagulated branch. The forceps pick-up test demonstrated little difference in flow of the cauterized vessel compared with controls. However, the cauterized vessel had a clinically weaker pulse stream of the transected common femoral artery. Recanalization of the coagulated side branch commonly occurred with a fibrin cap at the end of the vessel. Manipulation of the branch vessel frequently caused rebleeding. Our study shows that bipolar coagulation can be used effectively if coagulation is located at least 2 mm from the main vessel.

Animals↗
PubMed1994

Palmar lipomas associated with compression of the median nerve.

The records of five patients who had had a palmar mass associated with altered sensibility in the distribution of the median nerve were reviewed retrospectively. Three-dimensional imaging (computerized tomography or magnetic resonance imaging) proved useful for establishment of the diagnosis of a lipoma and planning of the operative procedure. Treatment included release of the transverse carpal ligament, excision of the tumor, and exploration of the carpal canal and the median nerve and its distal digital branches. At an average of twenty-four months postoperatively, all patients had a complete return of sensibility and resolution of the discomfort.

Adult↗
PubMed1993

The Hoffmann-Tinel sign. 1915.

The aim of this article is to show that the well-known Tinel sign is really a Hoffmann-Tinel sign. The translation of the two papers of Hoffmann, published in the same year that Tinel wrote his article (1915), is completed by a short biography of Paul Hoffmann.

Germany↗
PubMed1990

Role of antibiotics in open fractures of the finger.

The role of antibiotics was investigated prospectively in 91 open fractures of the finger. Antibiotics were administered to alternate patients with open phalangeal fractures. Only finger fractures distal to the metacarpophalangeal joint were included. Both groups were treated with aggressive surgical irrigation and debridement. In four patients in each group clinical signs of infection eventually developed; osteomyelitis did not develop in any patients, and no secondary surgical procedures were required in either group. This data indicates that vigorous irrigation and debridement is adequate primary treatment for open phalangeal fractures in fingers with intact digital arteries.

Adolescent↗
PubMed1988

Dorsal fracture dislocations of the proximal interphalangeal joint.

Dorsal fracture dislocations of the proximal interphalangeal joint with or without subsequent instability require a careful initial clinical examination followed by appropriate operative or nonoperative treatment. Attention to detail is crucial in achieving a successful outcome, regardless of the treatment selected. This article outlines the various classification systems available for dorsal fracture dislocation of the proximal interphalangeal joint and the appropriate treatment. It further describes management of cases that present late and require secondary reconstructive procedures.

Acute Disease↗
PubMed1986

[The Penrose drain as a finger tourniquet: a study].

As finger tourniquets are used frequently in surgery of the hand, it is necessary to study the safety of this technique in order to prevent complications of ischemia such as described by Dove and Clifford in 1982. Finger tourniquets applied with high pressure compromise the blood flow to the finger as well as damage the digital nerves. The authors use their previously described technique for controlling the pressure beneath a penrose drain and measure the tissue pressure generated by such a technique by placing a Wick catheter along the neurovascular bundle of a cadaver finger as well as in the soft tissue of an in vivo Sprague Dowley rat hindlimb preparation. The pressures measured by this technique were consistent with what one would expect based on the estimated pressure generated by placing marks spaced 26 mm apart and stretching them the circumference of an average sized adult finger.

Adult↗
PubMed1985

The digital tourniquet: how safe is it?

To measure the pressure generated beneath a digital tourniquet, this study was based on the mathematical relationship between pressure and resistance in latex rubber. The digital tourniquets were either a 1/4-inch Penrose drain or a rolled glove finger. Pressures generated beneath the rolled glove finger were noted to range between 200 and 1200 mm Hg. Pressure beneath the Penrose drain ranged between 100 and 650 mm Hg in one study group and between 120 and 500 mm Hg in a second study group consisting of fingertip injuries. A method was developed based on the same mathematical relationship to control pressure. Marks spaced 26 mm apart on a Penrose drain are wrapped around a finger until the marks touch and the Penrose drain is clamped. With this technique, the pressure beneath the Penrose drain will remain between 250 and 375 mm Hg. Less strain will be required for smaller fingers and more strain will be required for larger fingers; however, the pressure will remain within a predictable range.

Fingers↗
PubMed1985

The denervated first dorsal interosseous muscle flap: a case report.

Coverage of a dorsal defect on the hand of a child with exposed extensor tendons was provided by a denervated first dorsal interosseous muscle and splitthickness skin grafting. We do not recommend routine use of the first dorsal interosseous muscle as a flap; however, its use in cases in which the muscle has been denervated would seem justified.

Child↗
PubMed1984

Fasciectomy and Dupuytren's disease: a comparison between the open-palm technique and wound closure.

An analysis of 153 patients treated surgically for Dupuytren's disease is presented. One hundred fifteen patients were treated with the closed-palm technique, while 38 patients were treated with the open-palm technique. The groups were comparable in terms of preoperative metacarpophalangeal and proximal interphalangeal joint involvement, as well as the total number of rays involved. The patients were analyzed in terms of average pre- and post-operative total active motion (TAM) in the digital joints. The patients in the closed-palm group had a 10% improvement in TAM surgery, while those in the open-palm group had a 17% improvement (p less than 0.05). The complication rate in the closed-palm group was 19% and in the open-palm group, 8%. There were no hematomas in the open-palm group and no infections in either group. In a later follow-up of 103 patients who could be contacted, 33 of the 78 closed-palm group showed residual contracture (42%), while five of the 25 open-palm group were similarly affected (20%).

Dupuytren Contracture↗