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Biomedical subjects

J E Imbriglia

Publications and source records attributed to J E Imbriglia.

At least 19 recordsLinked to original sources
PubMed2001

Arthroscopic reduction and internal fixation (ARIF) of lateral tibial plateau fractures.

Arthroscopic reduction and internal fixation of tibial plateau fractures has been well documented over the last 15 years. Better visualization, less traumatic surgery, reconstruction of accompanying injuries and early mobilization have encouraged arthroscopic surgeons to use this technique more widely. With experience, surgeons became more comfortable in using arthroscopy-assisted surgery not only in split fractures of the lateral tibial plateau (41-B1) but also in more complex tibial and femoral fractures. In this study, 31 patients with intra-articular fractures of the lateral tibial plateau were operated on between 1991 and 1996. The fractures were classified as follows: x12 AO-type B1, x7 B2, x10 B3, x2 C3. Diagnostic arthroscopy and repair of soft tissue injuries was followed by arthroscopic reduction in all patients and supplemented with internal fixation in 29 patients. Postoperatively, an aggressive physical therapy regimen was performed with immediate mobilization and early partial weight bearing. All patients were examined for follow-up after 15-32 months (mean 25.1). In all cases the fractures were stable and allowed full weight-bearing. At follow-up, 25 patients had anatomic reduction. Anatomical reduction cannot be restored in all cases of open reconstruction because of cartilage defects. Fracture reduction using arthroscopic techniques is a suitable alternative for joint fracture repair because additional soft tissue damage can be minimized.

Adult↗
PubMed2001

Operative treatment with radial shortening in Kienböck's disease.

Eighty-eight patients underwent radial shortening for Kienböck's disease. Prerequisites for surgery were radiographic studies positive for Kienböck's disease without evidence of radiocarpal arthritis and wrist pain unrelieved by conservative management. Thirty-nine patients were evaluated by subjective questionnaire at a mean postoperative follow-up of 86 months (range: 24-188 months). Following surgery, a significant decrease was noted in pain severity, frequency, and duration. Functional status improved postoperatively, with the most significant gains noted in the following activities: opening jars, opening car doors, carrying bags, and shoveling. Only 3 of 34 patients employed outside the home were unable to return to their original occupations due to their wrist problems. Seventy-six patients were evaluated by physical examination at a mean postoperative follow-up of 31 months (range: 3-87 months). Objective evaluation by physical examination revealed a significant improvement in wrist motion and grip strength. Seventy-seven patients underwent radiographic evaluation at a mean postoperative follow-up of 31 months (range: 3-180 months). A significant progression in Lichtman stage of Kienböck's disease was noted despite the favorable subjective findings and high satisfaction ratings. Thirty-six of 39 patients stated they would undergo the surgery again. The long-term data demonstrate radial shortening in patients with stage II-IIIA Kienböck's disease provides substantial improvement over preoperative status.

Adolescent↗
PubMed2000

A comparison of plate and pin fixation for arthrodesis of the rheumatoid wrist.

This retrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range 12-39 months). Union occurred in 97% of the wrists fixed with plates and in 96% of the wrists fixed with pins. There were 6 (19%) complications in the plate group and 7 (28%) complications in the pin group. Three (12%) wrists fixed with pins moved from the immediate postoperative position to a position of relative volar flexion, while radiographs showed no changes in wrist position in the plate group. With both methods, successful arthrodesis stabilized the wrist in a high percentage of patients. Plate fixation offers an excellent alternative method for arthrodesis of the rheumatoid wrist.

Adolescent↗
PubMed1996

Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model.

Contact stresses in the wrist were measured after simulating displaced fractures of the lunate fossa in the distal radius of eight human cadaver arms. Osteotomies created displaced lunate fossa fractures of 0, 1, 2, and 3 mm. Contact stresses were measured with Fuji pressure-sensitive film after loads of 100 N were applied to the wrist through wrist flexor and extensor tendons. Mean contact stresses were significantly increased with step-offs of 1 mm or more. Maximum stresses and overloaded areas were significantly increased with step-offs of 2 mm or more. As the magnitude of the fracture displacement increased, there was a shift in the focus of the maximum stresses toward the fracture line. In this model, simulated displaced die-punch fractures created alterations in both the magnitude and location of contact stresses in the wrist joint.

Biomechanical Phenomena↗
PubMed1996

Contact stress distributions in malreduced intraarticular distal radius fractures.

Residual articular incongruity of the distal radius following intraarticular fracture has been correlated with early osteoarthritis (OA) and a poor clinical outcome. We developed a simple in vitro fracture model of the distal radius to investigate the relationship between degree of articular incongruity and the resulting distribution of radiocarpal contact stress. Twelve fresh-frozen cadaver arms were dissected, packets of Fuji Pressensor film were inserted into the wrist, and the wrist was loaded through its flexor and extensor tendons. We created a simple intraarticular fracture that allowed controlled distal radius articular incongruity. Loading trials were performed for the intact distal radius, for a fully reduced case, and for step-offs of 0.4, 1, 2, and 3 mm. Mean contact stress was significantly greater than the anatomically reduced case at only 3 mm of step-off. Contact area was greater than the anatomically reduced case at 0.4, 1, and 2 mm of step-off. The elevations in contact stress that we observed were only modest, suggesting that other factors may be involved in the pathogenesis of radiocarpal OA in the presence of residual articular incongruity.

Adult↗
PubMed1995

Radial instability of the metacarpophalangeal joint of the thumb. A biomechanical investigation.

Human cadaver thumbs were tested to evaluate stability of the radial side of the MP joint. The contributions of the dorsal capsule, radial collateral ligament, accessory collateral ligament, and volar plate were examined with the joint in 0 degrees and 30 degrees of flexion. At 0 degrees flexion, the average joint angulation increased 4 degrees following isolated radial collateral ligament transection and 6 degrees following isolated accessory collateral ligament transection. Release of both the accessory and radial collateral ligaments produced marked instability with joint angulation of at least 46 degrees. The accessory collateral ligament helped to stabilize the extended MP joint. There were no significant contributions to stability from the dorsal capsule and volar plate when the collateral ligaments were intact. In the laboratory setting, radial-side instability of the MP joint of the thumb requires transection of both the proper and accessory radial collateral ligament.

Biomechanical Phenomena↗
PubMed1993

Treatment of chronic post-traumatic dorsal subluxation of the distal ulna by hemiresection-interposition arthroplasty.

Twenty-four patients were evaluated for complaints of pain in the area of the distal radioulnar joint, decreased forearm rotation, and weakness of grip. All patients had a history of trauma to the involved wrist an average of 40 months prior to presentation. Six patients had undergone previous surgery that was unsuccessful. Twenty-three patients were available for follow-up evaluation at an average of 36 months following hemiresection-interposition arthroplasty. At that time, results were excellent in 13 patients, good in 4 patients, fair in 3, and poor in 3. Two patients developed symptoms of styloidcarpal abutment (poor results), one of whom was upgraded to an excellent result after undergoing a shortening osteotomy of the ulna.

Adult↗
PubMed1991

Symptomatic congenital coalition of the pisiform and hamate.

Recent reports have shown that carpal coalition, previously regarded as an asymptomatic congenital anomaly, may be an unusual occult cause of wrist pain. Two cases are presented as the first reported examples of congenital piso-hamate fusion creating symptoms due to associated arthritis or occult fracture.

Adult↗
PubMed1991

Radioulnar joint fusion for distal radioulnar joint instability.

Each one of this small group of patients illustrates a rare indication for the radioulnar joint fusion procedure in distal radioulnar joint instability. The case histories tell of a last ditch effort to salvage function in an extremity crippled by painful radioulnar instability after excision of the distal ulna. The fusions healed slowly and two required repeat surgery to achieve union. Today we would routinely add iliac bone graft to the fusion area to hasten healing. Rarely indicated, this is a salvage procedure that is done after failure of other procedures geared to preserve the rotation of the forearm. These patients all had successful salvage of their extremities for activities of daily living, but only one returned to his labor job. All were worker's compensation cases in physical jobs. Two patients had had prior radiocarpal fusions, making them even more restricted in function. This procedure should be kept in mind to be used in the rare cases of painful instability of the distal radioulnar joint when traditional motion-preserving procedures have failed.

Adult↗
PubMed1990

Proximal row carpectomy: clinical evaluation.

Proximal row carpectomy as a treatment of disorders of the radiocarpal joint remains controversial despite numerous reports documenting clinically successful outcomes. Criticism includes postoperative loss of grip strength, unsatisfactory range of motion, prolonged rehabilitation time, and the potential for progressive painful arthritis. Twenty-seven patients were studied to address these concerns. The average length of follow-up was 4 years. Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery. In all cases, range of motion matched or surpassed preoperative values. Grip strength improved to an average of 80% of the contralateral side. A detailed radiographic analysis of the radii of curvature of the lunate fossa and the capitate showed that the radius of curvature of the capitate is approximately two thirds of the corresponding value of the lunate. Motion between the capitate and the radius is translational with a moving center of motion, which may dissipate load on the radius and explain the relative success of the procedure.

Adult↗
PubMed1989

Secondary flexor tendon reconstruction.

Staged flexor tendon reconstruction using silicone rods is a technique that can be successfully used to salvage severely injured digits. Refinements in the technique have led to the development of an active tendon prosthesis which is under clinical investigation. Attention to technical details and a well-supervised rehabilitation program are necessary to obtain satisfactory results.

Adolescent↗
PubMed1987

Surgery for scleroderma of the hand.

The role of hand surgery in systemic sclerosis (scleroderma) has been documented infrequently. Out of a series of 813 consecutive patients with scleroderma, 31 have had one or more surgical procedures on their involved hands--a total of 52 operations. Raynaud's phenomenon and digital tip ulcerations have been controlled medically by vasodilators and meticulous local wound care. Most digital ulcerations progressing to frank gangrene have been allowed to autoamputate to maximize the length of the salvaged finger, but 23 digital amputations have been performed when conservative measures failed. Digital sympathectomy and microsurgical revascularization have produced relief of symptoms in several patients. Severe flexion contractures of the proximal interphalangeal (PIP) joints, with secondary hyperextension of the metacarpophalangeal (MP) joints, have been effectively treated by arthrodesis of the PIP joints in 44 to 55 degrees of flexion. This has allowed both improved hand function and primary healing of dorsal ulcers in 53 PIP joints in 12 patients.

Adolescent↗
PubMed1987

Intratendinous ruptures of the flexor digitorum profundus tendon of the small finger.

Ten patients had spontaneous ruptures of the flexor digitorum profundus tendon involving the small finger. All ruptures occurred at work with the hand engaged in resisted flexion. Seven patients were treated by surgical means, four patients by direct repair, two by tendon transfer, and one by tendon graft. The ruptures were intratendinous occurring just distal to the A2 pulley in two patients, in the palm in four, and in the carpal canal in one. A pathologic condition to explain the tendon ruptures was not found on gross inspection or subsequent histologic examination. The seven patients treated by surgical means achieved satisfactory results. Follow-up averaged 52 months. Three patients did not have surgical repair and they have been followed-up for an average of 16 months. The results of direct repair within 1 week of rupture were superior to the results of late reconstruction.

Accidents, Occupational↗
PubMed1987

Proliferative fasciitis of the hand in a child.

Proliferative fasciitis is unusual in the hand and is particularly unusual in young children. The histology of this benign process can be confusing, and it may be differentiated from a sarcoma. The proper treatment is local excision.

Child↗
PubMed1986

Fibrous hamartoma of the wrist in infancy.

Fibrous hamartoma of infancy (FHI) is a rare, self-limiting, benign tumor that occurs in the early years of life. The vast majority of reported cases occur in the proximal upper extremity and torso. A case of FHI that occurred in the wrist of a 9-month-old girl is presented. Diagnostic features of FHI are discussed and emphasized. Surgical treatment is highly successful and is the method of choice.

Female↗
PubMed1986

Erosion of the triquetrum and pisiform bones caused by a foreign body granuloma.

A 16-year-old boy had pain and swelling in the left wrist 6 months after he had fallen on a twig. Erosion of the triquetrum and pisiform was seen on x-ray films. A granulomatous process was identified at operation. Despite numerous cultures and special stains, no organisms were identified. Wood debris was seen under high-power magnification. A wooden foreign body may cause bone and joint destruction through a granulomatous process. In this case, surgical debridement and excision stopped the destructive process.

Adolescent↗
PubMed1985

Immunostaining for carcinoembryonic antigen does not discriminate for early recurrence in breast cancer. The ECOG experience.

Carcinoembryonic antigen (CEA) immunohistochemistry was evaluated by 11 surgical pathologists with sections from 147 postmenopausal women with node-positive breast cancer. Carcinoembryonic antigen staining in breast cancer tissues has been correlated with a worse prognosis. This association was studied with a clinically characterized population of Eastern Cooperative Oncology Group (ECOG) patients using precisely the peroxidase-antiperoxidase methodology which had been employed in another published study. In 50% of the cases, the study pathologists were uncertain whether CEA was or was not present in the cancers. Various groupings of the pathologists' interpretation were compared with the observed disease-free intervals in the patients. These analyses suggested no association of perceived CEA staining with the biological course of the cancers. Two reference pathologists who examined the sections in a similar way also gave non-prognostic interpretations. There is no convincing evidence that pathologists can reliably interpret the CEA content in the same breast cancer tissue sections. There is no observed correlation between immunohistochemical evidence of CEA in a breast cancer tissue section and the biological behavior of that cancer.

Aged↗