PubMed Health⌕ Search

Biomedical subjects

J H Dobyns

Publications and source records attributed to J H Dobyns.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of scapholunate dissociation. Rotatory subluxation of the scaphoid.

The treatment of scapholunate dissociation remains controversial. Although good to excellent results have been reported using a variety of surgical techniques, they have often not been confirmed by other authors. Limited wrist mobility and the likelihood that degenerative changes will progress appear to be inherent in most approaches. The ideal treatment is to restore the normal anatomy and, with it, the function of the wrist. Destroying a normal joint by even a limited fusion as a means to provide stability to an abnormal joint is counter to our usual approach to disease. It is for that reason that more reliable soft-tissue reconstructive procedures are necessary. Those interested in arthroscopy are pursuing endoscopic methods of repair, but, at present, little progress is apparent. The physician who solves this problem with an uncomplicated and reliable surgical solution will have indebted us all.

Acute Disease↗
PubMed1992

Digital nerve compression.

A review of the relatively small body of literature about digital nerve compression injuries has been supplemented by the author's experience and interest of over 40 years. The principal lesions involved are of two types: (1) fibrosis about, around, and in the nerve; and (2) reactive hyperplasia of the nerve support elements and sometimes of special end organs, Pacinian corpuscles, and even of the nerve fibers themselves. Nerve signs and symptoms often accompanied by a mass in chronic cases are diagnostic. The most important features of the topic are the recognition by all of the risk elements, embodied in many personal and professional devices and techniques. These risk elements are present in all parts of our society, including home and occupational, avocational, and medical situations. Treatment is best provided by awareness of risk and avoidance of risk activities, particularly repetitive risk activities. Surgery is preferably avoided, but when indicated it is effective. It consists principally of lysis and protective positioning of the damaged nerve or, on occasion, of excision of terminal or end-organ lesions. More information must be gathered about these exceedingly common but notably under-reported problems.

Fingers↗
PubMed1991

Concomitant scapholunate dissociation and Kienböck's disease.

Six men had concurrent scapholunate dissociation and Kienböck's disease, a finding suggestive of a common cause. Five patients attributed the onset of wrist pain to a single traumatic event. Three had x-ray evidence of scapholunate dissociation before the onset of lunate osteonecrosis. Biomechanical factors that may be of significance are ulnar minus variance, lesser compliance of the triangular fibrocartilage, ulnar translation of the carpus at impact with shear fracture through the lunate, and disruption of the scapholunate interosseous membrane occurring under similar stress. Lunate osteonecrosis may depend on a susceptible vascular pattern or intraosseous injury or both. The development of lunatomalacia complicates an already unstable wrist. Treatment options vary according to the clinical stages of each condition, although contrasting treatments have not established optimal care.

Adult↗
PubMed1991

Thumb duplication and contralateral thumb hypoplasia in infant of mother with diabetes.

Uncontrolled maternal diabetes frequently results in congenital anomalies. This report describes an infant of a mother with diabetes born with thumb hypoplasia and contralateral thumb duplication without other associated anomalies. Maternal diabetes should be part of the etiologic differential diagnosis of thumb anomalies. The concomitant occurrence of thumb duplication and hypoplasia, apparently as a result of the same systemic insult, suggests a close relationship between hypoplasia and duplication.

Adult↗
PubMed1991

Preiser's disease.

Nine patients with the diagnosis of unilateral Preiser's disease were seen between 1970 and 1987. The mean age of four male and five female patients was 37 years (range, 20 to 70 years). The diagnosis was based on radiographic evidence of sclerosis, fragmentation, erosion, and collapse of the proximal pole of the scaphoid. Onset was usually insidious but two had a preexisting radial hypoplasia, a third had a modest scaphoid malunion, and a fourth had a recent fall. Treatment consisted of scaphoid excision and silicone rubber prosthetic replacement in three, debridement of necrotic bone fragments in one, and different periods of cast support and observation in the remaining five. No relationship to ulnar variance was seen. Mean follow-up was 6.9 years. Of the scaphoid implants, two had subluxated, but only one was painful. In the more conservatively treated group, pain and function were only modestly limiting in four, who returned to their original occupations as did the one treated by curettage of necrotic bone in the proximal pole. One patient (case 4) was severely incapacitated because of associated severe congenital anomalies of the lower extremities. Polyaxial tomography permitted a better assessment of the degree of involvement and carpal alignment. Preiser's disease is a rare affliction of the carpal scaphoid which may involve the entire bone in avascular changes but primarily leads to fragmentation and collapse of the proximal pole. A conservative approach to treatment is favored based on this experience.

Adult↗
PubMed1991

Anomalies of the fingers and toes associated with Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is a rare congenital malformation characterized by a large angiomatous nevus; hypertrophy of soft tissue or overgrowth of bone, or both; and venous varicosities. The cases of 108 patients who had a diagnosis of this syndrome between 1956 and 1990 were reviewed. One hundred and twenty-six anomalies were found in twenty-nine patients, each of whom had one to thirteen malformations of the fingers or toes, or both. The ratio of female patients to male patients was approximately two to one. Twenty-six patients had macrodactyly affecting one to six digits; nine, syndactyly involving two or more digits; five, metatarsus primus varus; two, clinodacytly; two, polydactyly; one, camptodactyly; and one, a congenital trigger finger. Thirty-three of the 126 anomalies were in extremities that had no nevi, varicose veins, or generalized hypertrophy.

Adolescent↗
PubMed1991

Cumulative trauma disorder of the upper limb.

The current status of cumulative trauma disorder of the upper limb is examined from the standpoint of its long history, its current controversies, and the philosophic basis of the present laws, which control management of the condition. The future needs that should permit cumulative trauma disorders to be better understood, better managed, and better legislated are also addressed.

Arm Injuries↗
PubMed1990

Arthroscopy of the wrist: anatomy and classification of carpal instability.

Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

Arthroscopy↗
PubMed1990

Transcarpal carpometacarpal dislocations, excluding the thumb.

During a 9-year period, we treated 13 patients with major fractures of bones of the distal carpal row creating instability of the corresponding carpometacarpal joints. Diagnosis of the injury was made early in only eight patients whose treatment consisted of open reduction, pin or screw fixation, and immobilization from 6 to 8 weeks. They showed no complications and had an excellent functional recovery. Diagnosis in five (38%) patients was delayed 1 week to 8 months after the accident. At initial presentation, symptoms included pain, loss of grip strength, and mild limitation of finger motion. In three patients an acute carpal tunnel syndrome developed a few days after the accident. Two had established nonunions of the capitate and the hamate. Treatment consisted of open reduction, bone grafting, fixation with multiple pins, and immobilization until fracture consolidation. Results in this group were good in one, moderate in three, and poor in one.

Accidents, Traffic↗
PubMed1990

Gymnast's wrist.

The wrist is a frequent site of symptoms and injury in the gymnast, both acute and chronic. The chronic injuries are due to repetitive loading of the musculoskeletal system, and their incidence rises as participation and level of competition rises. More attention needs to be directed toward prevention, but many of these injuries seem to be inherent to the sport as it transforms the upper extremities into weight-bearing limbs. Evaluation and recognition of wrist injuries in the gymnast will allow appropriate management for these patients; however, the compulsive and intense nature of many gymnasts can lead to recurrent or new injury and continued wrist symptoms. Much more sophisticated and detailed examination of the gymnast's wrist should be done before onset of training, before increase of intensity of training, before competition, and with the onset of any symptoms, including observed guarding. In addition, pretraining and annual follow-up wrist radiographs should be considered for the skeletally immature gymnast. Follow-up evaluation after skeletal maturity and retirement from active participation is needed to elucidate the long-term effect of gymnastics on the wrist.

Chronic Disease↗
PubMed1990

Helping parents to decide what is best for their child.

Helping parents to decide what is best for their child is a necessary portion of medical management for the injured, anomalous, or sick child. It involves collecting information about, consideration of, and giving advice concerning much more than medical details. Certain steps are suggested in offering this help: (1) obtaining comprehensive medical, socioeconomic, and psychologic information; (2) packaging this information to inform fully and satisfy the parents/surrogates of the child; (3) confirming the family's informed participation in the treatment decision; and (4) reinforcing that decision with a very supportive and communicative perioperative period.

Child↗
PubMed1989

Traumatic axial dislocations of the carpus.

Among 1140 patients treated in the last 16 years for any type of carpal fracture, dislocation, or subluxation, 16 (1.4%) patients seen with a traumatic axial disruption of both the carpus and metacarpus were identified. Most of these were crush or blast injuries. According to the direction of instability, the cases were classified into three groups: axial-ulnar disruptions (4 patients), axial-radial disruptions (11 patients), and combined axial-radial-ulnar disruption (1 patient). Treatment consisted of open reduction and percutaneous Kirschner-wire fixation in most cases. The results were less optimistic than suggested in the literature. An average follow-up of 61 months showed that prognosis was determined more by the associated soft tissue injuries than by the carpal derangement itself. Early management of both the skeletal and soft tissue components of the injury seems most effective.

Adolescent↗
PubMed1989

Primary malignant bone tumors of the hand.

Malignant bone tumors of the hand are rare and few centers have extensive experience in the care of patients with these lesions. Eighteen patients with 22 lesions were evaluated at our institution. There were nine chondrosarcomas, four hemangioendothelial sarcomas, two cases each of osteosarcoma and fibrosarcoma, and a single case of Ewing's tumor. The average age of the patients was 39 years. Ten lesions each were located in the metacarpals and phalanges, with two lesions in the carpus. There were nine local recurrences, which appeared at an average of 24.5 months (range, 3 to 74 months). Curettage procedures resulted in the highest rate of local recurrence (85%). Three patients died of metastatic disease. Surgical control of these lesions requires careful preoperative planning and wide surgical margins. Regular oncologic follow-up is necessary.

Adolescent↗
PubMed1989

Congenital anomalies of the upper extremity.

This article has reviewed some of the current methods of management of congenital problems in the upper extremity. Not all problems have been included in this review but some of the landmark advances in this field have been considered. The management of congenital anomalies may change significantly in the future.

Arm↗
PubMed1988

Lipofibromatous hamartoma of nerve.

Seventeen cases of lipofibromatous hamartoma of nerve (14 with histologic confirmation) were treated between 1935 and 1985. One patient had bilateral involvement. Fourteen lesions were located in the upper extremity and four in the lower extremity. Twelve of the 18 lesions were associated with combined soft tissue and skeletal enlargement, or true macrodactyly. Three other lesions had soft tissue enlargement other than that noted intraneurally. Three patients were treated with carpal tunnel release alone and 14 with combined procedures to decrease the size of the affected part. Sensibility in the affected part often appeared unrelated to removal or preservation of hamartomatous nerve tissue. Complications related to nerve surgery included recurrence of carpal tunnel syndrome in one patient, recurrent soft tissue mass in one patient, and painful calcification of the involved tissues 20 years postoperatively in one patient.

Adolescent↗
PubMed1988

Failed distal ulna resections.

Twenty patients with complaints of pain and limitation of activities for more than 1 year after ulnar head resection (Darrach) were studied. Their ages ranged from 18 to 60 years (mean, 38 years). The initial indications for operation were posttraumatic derangement in 18 patients, radial growth anomaly in 1, and a lesion of the ulna in 1. Follow-up ranged from 29 to 135 months (mean, 61 months). The patients had an average of 2.2 additional operations, with up to seven procedures per patient. Radiographs were compared with those from an equal number of successful Darrach resections chosen randomly, and no significant differences were noted. All 20 patients continue to have difficulties despite several years of treatment. The Darrach resection can result in serious disability, especially in the younger patient and the patient with lax ligaments. Reoperation on these patients is rarely successful.

Adolescent↗