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Biomedical subjects

J H Dobyns

Publications and source records attributed to J H Dobyns.

At least 55 records · Page 3Linked to original sources
PubMed1986

Sports-related extraarticular wrist syndromes.

Extraarticular wrist syndromes are relatively common causes of underperformance or nonparticipation in sports. Many of these conditions may be caused by nonathletic activities. The spectrum of pathologic signs ranges from tendon inflammation, stenosis, and subluxation to neuropathies, vascular conditions, congenital anomalies, cysts, calcarea, and callosities. Appropriate treatment requires an accurate diagnosis and specific measures directed toward the condition. Moreover, many of these problems may be preventable by modification of sports equipment, proper conditioning, alteration of athletic techniques or habits, and various orthoses.

Athletic Injuries↗
PubMed1986

Problems and complications in the management of upper limb anomalies.

Nonsurgical problems and complications of orthotist-prosthetist techniques are not addressed in this article. There are a number of complications, such as decubiti, joint contracture or damage, tendon injury, wound healing, etc., which are not discussed because they are similar in cause, identification, and treatment to the same adult problems. Though it is possible to list the more common complications seen for each congenital anomaly, the tedious repetitiveness of such an approach dissuaded the author. General principles can always be specifically applied when the occasion requires. It is also possible to detail painstakingly the techniques of coping with each complication, but such would require book rather than chapter exegesis, and those who need these details are referred to the bibliography. The theme of this article is that there is no longer much distinction in the mind of the consumer clientele between the problem of the congenital anomaly, the results of treatment, and the complications of those treatments. The provider must therefore be wary, extensively informed, and exceedingly communicative, to the point of suggesting secondary consultation as warranted or desired. Despite this almost adversarial approach, the rewards are still great, for more can be accomplished than ever before, the child will seldom show motivational problems in using what is provided, and gratitude is not lost coinage.

Amniotic Band Syndrome↗
PubMed1985

Distal ulnar recession for disorders of the distal radioulnar joint.

Thirty-six wrists of 35 patients were treated with distal ulnar recession for pain and limitation of motion associated with chondromalacia of the ulnar head, triangular fibrocartilage complex tears, ulnocarpal impingement, and instability of the distal radioulnar joint. Contributing factors were positive ulnar variance in 31 wrists, fracture of the distal radius in five, sprains in 14, premature closure of the distal radial epiphysis in five, and lax ligamentous habitus in five. The ages of the patients averaged 33 years. Clinical findings were local tenderness, crepitus, and instability evident by a positive "piano key" effect. Roentgenographic findings were positive ulnar variance (29 of 36), zero ulnar variance (four), negative ulnar variance (three), positive arthrogram (11 of 19), and "forme fruste" Madelung's deformity (two). The surgical procedure is a modification of the Milch cuff resection with the use of a dynamic compression plate. Recession ranged from 2 to 13 mm (average of 4 mm). Findings at surgery included chondromalacia of the ulnar head (19), tears of the triangular fibrocartilage complex (11), and excessive mobility of the ulnar head (10). At an average follow-up of 24.5 months, results were excellent in 7 wrists, good in 21, fair in four, and poor in four. Poor results in two wrists were upgraded to good after osteosynthesis of a nonunion in one and recessional osteotomy of the radial sigmoid notch in the other. Ulnar recession offers a less destructive alternative to disorders of the distal radioulnar joint than the Darrach resection.

Adolescent↗
PubMed1985

Radiolunate arthrodesis.

The procedure of radiolunate arthrodesis was suggested by spontaneous radiolunate arthrodesis that resulted in painless, satisfactory function. Ulnar translation down the inclined slope of the radius is accelerated by dorsal dislocation of the ulnar head, ulna minus variance, and triangular fibrocartilage resorption and may be an inducement to increased ulnar deviation of the fingers as well as disintegration of the proximal carpal row. Twenty-two radiolunate arthrodeses were performed, 16 by a corticocancellous slotted graft and six by a modified Lauenstein procedure in 17 rheumatoid and five traumatic cases. Nineteen wrists were available for follow-up at an average of 28 months. Average range of motion was 25 degrees of extension, 30 degrees of flexion, 5 degrees of radial deviation, and 15 degrees of ulnar deviation. Subjective evaluation was good in 14 wrist, fair in three, and poor in two. Relief of pain was generally satisfactory, and preoperative grip strength was slightly improved. Progressive degeneration of the midcarpal joint tends to be minimal. If further spontaneous arthrodesis occurs, the wrist remains in satisfactory position. Carpal ulnar translation, midcarpal angulation, and radial angulation are corrected. Loss of carpal height is partially corrected in most instances.

Adolescent↗
PubMed1985

Management of thumb duplication.

Radial polydactyly, a common congenital problem, most often occurs as thumb duplication. It appears in pentadactylous, polydactylous, and hypoplastic hands and is simulated by complex syndactyly. Classically, there are three categories for radial polydactyly: severe hypoplasia, partial duplication, and total duplication (easily confused with pseudoduplication). The common second category is subcategorized by Wassel's seven types. Management techniques vary with these classifications. Until a decade ago, the standard recommendation was simple excision of one of the duplicates. Problems of deformity, instability, and weakness became apparent, and reconstructive options were developed. Review of a series of 54 duplicate thumbs, all surgically treated, reflects the changing pattern of reconstruction. With current techniques, good results are usual, although secondary reconstructive procedures may be required. Simple excision is seldom indicated. Combination procedures, involving core tissues of bone, joint, and tendon or peripheral tissues--neurovascular, subcutaneous, and skin--or sometimes all of these, are preferred for reconstruction. The major current problem is to achieve the maximal good result with a minimal number of surgical operations.

Arthrodesis↗
PubMed1985

Segmental digital transposition in congenital hand deformities.

A review of the current management of congenital digital hypoplasia in the hand has been presented. Techniques for augmenting the size and length of hypoplastic digits have included flap and graft techniques and segmental digital transposition techniques; they now include digital distraction lengthening techniques and free vascularized digital transposition techniques. Since all of these methods are still in use, the relationship between them has been described and some of the lesser known segmental digital transposition techniques have been discussed in greater detail.

Fingers↗
PubMed1985

Athletic injuries of the wrist.

The wrist is at risk for injury in many athletic endeavors, often in acute falls or dorsiflexion injuries and at other times from repetitive stress involved with fitness routines or specific motions called for in the sport. Dorsiflexion accounts for most wrist problems giving rise to compression injuries dorsally such as scaphoid impaction, triquetrohamate impaction, and occult ganglions. These are seen most often in weight lifters, gymnasts, and push-up enthusiasts. Tension injuries occur on the palmar aspect of the wrist with disruption or attenuation of the supporting ligaments or interosseous membranes. This provides scapholunate tears, scapholunate dissociation, lunatotriquetral, midcarpal instability problems, and so forth, which are generally the result of single energetic injuries commonly associated with contact sports. Distal radioulnar injuries include chondromalacia of the ulnar head, ulnar head subluxation, and ulnocarpal impingements with tears of the triangular fibrocartilage. Forceful rotational injuries are generally associated with the former and stressful ulnar deviation with the latter, where tennis players and baseball batters are at risk. Fracture of the hook of the hamate and pisotriquetral chondromalacia are common in sports requiring holding a club, handle, or bat. Precise, early diagnosis affords the best chance for successful treatment.

Adult↗
PubMed1985

Rupture of the distal tendon of the biceps brachii. A biomechanical study.

In biomechanical studies on ten patients who had had a rupture of the distal tendon of the biceps brachii, we compared the results of immediate anatomical reattachment, delayed reattachment, and conservative treatment. When the tendon was simply attached to the brachialis muscle (one patient), there was nearly normal strength in elbow flexion but about 50 per cent loss of forearm supination. Late reinsertion (one patient) improved strength of both flexion and supination, but not to normal. Immediate reattachment (four patients) restored normal strength in flexion and supination at one year but not at four months (one patient). With conservative treatment (three patients) there was a mean loss of 40 per cent of supination strength and variable loss of flexion strength, averaging 30 per cent. These data suggest that immediate surgical reinsertion of the biceps tendon into the radial tuberosity, compared with other modes of treatment, restores more strength of flexion and supination.

Adult↗
PubMed1984

Lunotriquetral sprains.

Injuries to the ulnar side of the carpus have not been well defined. Lunotriquetral (LT) sprains have only recently been described and are often unrecognized. They usually occur from hyperextension: and twisting of the wrist. Symptoms include pain, weakness, limitation of motion, and a "click" with lateral motions. The sprain may be associated with dorsal subluxation of the ulnar head and supination of the carpus. Physical examination discloses point tenderness, laxity, and often a snap over the LT joint. Dorsopalmar manipulation of the triquetrum on the lunate demonstrates crepitus and laxity. A radiocarpal arthrogram is helpful in confirming the diagnosis. Palmar-flexion instability patterns represent a more extensive continuation of this injury, which then may be termed an LT dissociation. Treatment with adequate immobilization for acute injuries appears to be useful if the diagnosis is established early. Chronic sprains may require stabilization of the LT joint by ligament repair, reconstruction, or LT fusion. Associated injuries, such as carpometacarpal (CMC) or hamulus fractures, have been noted. Results of treatment have varied considerably and depend in part on the severity and chronicity of the condition at the time of recognition.

Adolescent↗
PubMed1984

The unified concept of carpal injuries.

The classification of injuries to the wrist using a unified concept of mechanism of injury based on a hyperextension mechanism provides a means of understanding the spectrum of wrist injuries. The compressive forces acting after injury induce collapse deformities which if unrecognized, result in permanent weakness and limitation of motion. Careful examination and awareness of the spectrum of wrist injuries allows consideration of optimal treatment.

Biomechanical Phenomena↗
PubMed1984

Trispiral tomography in the evaluation of wrist injury.

The value of trispiral tomography in diagnosing, evaluating, and treating wrist trauma is reviewed, with emphasis on the special categories in which it has been found useful. Some typical examples are given. Trispiral tomography is currently the preferred tomographic technique for wrist evaluation at the Mayo Clinic.

Adult↗
PubMed1983

Intra-articular metacarpal head fractures.

One hundred and three intra-articular metacarpal head fractures in 100 patients are presented and classified by anatomical involvement on roentgenographic examination. The fractures were epiphyseal (Salter-Harris type III, n = 4), ligament avulsions from metacarpal head (n = 17), osteochondral (n = 8), oblique (sagittal, n = 22), vertical (coronal, n = 4), horizontal (transverse, n = 4), comminuted (n = 31), boxer's fractures with extension into the joint (n = 3), loss of substance (n = 6), and occult compression with avascular necrosis (n = 4). Experience with fractures involving large intra-articular defects suggests that they should be reconstructed to give a congruous metacarpal head; the digit should then be mobilized as early as technically feasible.

Adolescent↗
PubMed1983

Instability patterns of the wrist.

Carpal instabilities are generally the result of a hyperextension injury. The deformities are mediated through the internal compressive force supplied by the musculotendinous units and are dependent on the extent of injury as well as the precise structures that are disrupted. The scaphoid inherently tends to palmar flex. It will pull the lunate with it if the lunotriquetral integrity has been interrupted, and conversely the lunate and triquetrum will dorsiflex if the scapholunate integrity is disrupted. If the integrity of the oblique external ligaments, particularly the volar (palmar) radiolunate, is disrupted, the entire carpus has a tendency to translate ulnarly. Carpal instabilities are invariably associated with weakness, limitation of motion, and pain.

Carpal Bones↗
PubMed1982

Quantitative wound cultures in upper extremity trauma.

In a prospective study, 64 traumatic wounds to the hand and forearm were examined for infection by quantitative smear (Gram stain) and culture to determine whether significant wound contamination had occurred and to help in making the decisions regarding use of antibiotics and immediate or delayed closure. Sepsis developed in 23 of the 64 patients. The smears, available in 25 to 30 minutes, gave correct indications regarding development or absence of sepsis in 54 patients (84%); and the cultures, available in 24 to 36 hours, did so in 57 (89%). Prophylactic treatment with antibiotics in 36 patients was deemed unnecessary or inappropriate in 24 (smear and culture both negative, or organisms resistant to the agent). Quantitative smears and cultures, undertaken immediately by the techniques used in this study, are of practical value in management of traumatic wounds to the hand and forearm.

Adult↗
PubMed1982

Ulnar lengthening in the treatment of Kienböck's disease.

Twenty patients with Kienböck's disease were treated with a modification of the Persson ulnar-lengthening procedure to remove compressive stress from the damaged lunate. After an average follow-up of thirty-seven months, relief of pain was satisfactory in eighteen patients who had returned to work (nine of whom had strenuous occupations), and two patients were dissatisfied because they had persistent pain and were not able to return to their previous occupations. Non-union at the site of the ulnar osteotomy occurred in three patients who were treated early in the series and was the result of inadequate internal fixation or insufficient duration of protective splinting. All three of the patients had satisfactory results after replating and bone-grafting. The procedure appears to help to maintain carpal height, prevent further collapse of the lunate, encourage consolidation of the fragmented lunate, and increase grip strength. Except for ulnar deviation, which the procedure may further diminish, the postoperative motions of the wrist were moderately improved.

Adolescent↗