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Biomedical subjects

J H Dobyns

Publications and source records attributed to J H Dobyns.

At least 73 records · Page 4Linked to original sources
PubMed1982

Capitate fractures: a long-term follow-up.

Capitate fractures are serious carpal injuries that sould be treated as aggressively as scaphoid fractures, with anatomic reduction obtained by open techniques if necessary and by immobilization until the fracture has united. Thus treated, even a capitate proximal pole, free of soft tissue attachments will heal. Anatomic reduction is required for restoration of carpal kinematics. Even with optimal treatment, some posttraumatic carpal arthrosis may be found with long-term follow-up investigations.

Adolescent↗
PubMed1982

Krukenberg's kineplasty and rehabilitation in a blind, bilateral full-hand amputee.

In blind persons, perception from the remaining sensory mechanisms is of utmost importance in maintaining contact with their surrounds. Absence of visual input in bilateral hand amputees would render the use of prosthetic devices unsuccessful. Krukenberg's kineplasty, which transforms the forearm stump into a forceps and provides retention of tactile, pain, temperature, and proprioceptive inputs, can increase the patient's functional abilities substantially. In the case reported, a 12-year-old boy who became blind and a bilateral hand amputee as a result of an explosion had significantly improved functional ability, independence, and life-style after this procedure. Active physical and occupational therapy and muscle re-education, begun two to three weeks after the Krukenberg procedure, were very important in aiding the patient to achieve independent function.

Adolescent↗
PubMed1981

Chronic, complex volar dislocation of the metacarpophalangeal joint.

Three cases of traumatic volar dislocation of the metacarpophalangeal (MP) joint of a finger had a common pathologic condition, interposition of the dorsal capsule within the joint space. Late treatment included open reduction. MP joints arthrodesis, or arthroplasty. We reproduced volar dislocation of the MP joint in cadaver specimens by a hyperflexion, proximal translational force applied to the dorsum of the proximal phalanx. In all dislocations, the dorsal capsule of the joint was avulsed proximally and drawn into the joint. Dorsal capsule entrapment may be an important pathologic feature militating against successful closed management in a significant percentage of these injuries. A dorsal surgical approach with reduction and repair is recommended when the injury is seen before onset of gross degenerative changes within the MP joint.

Adolescent↗
PubMed1981

Chronic sprains of the carpometacarpal joints.

The relatively rigid second and third carpometacarpal joints provide stability for the cantilevered metacarpals of the index and middle fingers, about which the thumb and ulnar metacarpals move, providing spatial adaptation for grasping objects. Although seldom recognized, sprains of the carpometacarpal joints as part of a range of injury which includes subluxations, dislocations, and fractures are apparently common. The entity known as carpe bossu also may be related. The second and third carpometacarpal joints are more susceptible to injury in palmar flexion than in dorsiflexion. The sprain may be acute or chronic. Severe swelling over the carpometacarpal area, with tenderness and weakness without significant roentgenographic findings, is suggestive of the acute sprain, which generally responds to immobilization. The chronic sprain is often overlooked or misdiagnosed. Point tenderness of one or more carpometacarpal joints, a palpable laxity, and crepitus with manipulation are seen as physical findings, in decreasing order of frequency. Lidocaine, 0.5 ml, injected directly into the joint offers dramatic relief. If conservative measures are insufficient, arthrodesis of the joint is relatively simple, symptomatically reliable, and functionally uncompromising, especially of the second and third rays.

Adolescent↗
PubMed1981

Total elbow arthroplasty. A five-year experience at the Mayo Clinic.

During the five years from 1973 through 1977, eighty Mayo and Coonrad total elbow arthroplasties were performed in seventy-two patients at the Mayo Clinic. Follow-up after at least two years (average, four years) revealed that the results were good in 60 per cent, fair in 16 per cent, and poor in 24 per cent. Pain was a major symptom in 80 per cent of the elbows preoperatively but in only 3 per cent postoperatively. At follow-up, motion had increased: extension-flexion by 10 degrees (average range, 29 to 131 degrees of flexion) and forearm rotation by 26 degrees (average range, 61 degrees of pronation to 59 degrees of supination). Excluding eleven prostheses with loosening for which revision was necessary, there were forty-four complications (55 per cent) after eighty procedures. Of these forty-four complications, eleven were ulnar neuropathies (two permanent and nine transient); four were wound-healing problems; ten, significant triceps weakness; eleven, intraoperative fractures of the medial or lateral supracondylar bone column; seven, deep infections; and one was an ulnar fracture. Although the complication rate was very high, most of the complications occurred during the early years of the study. Follow-up revealed twenty-nine elbows with radiolucency around the components: in twenty-five about the humeral and in four about the ulnar component. Revisions were performed in nineteen (24 per cent) of the eighty elbows: in eleven because of loosening, in seven because of deep infection, and in one because of ankylosis. Intraoperative supracondylar fracture and defective cementing of the prosthesis were important factors contributing to prosthetic loosening. When the arthroplasty was successful, the relief of pain was dramatic, stability was excellent, and the range of motion was superior to that provided by any other procedure currently available.

Arthritis↗
PubMed1980

Nonunion of the scaphoid: analysis of the results from bone grafting.

Scaphoid nonunion was treated by bone-grafting techniques in 86 patients with 90 fractures. The volar inlay (Russe) technique had union in 38 of 44 fractures (86%); the dorsal inlay (Matti) technique in 20 of 22 fractures (91%); the dorsal peg graft (Murray) in nine of 18 fractures (50%); and compression screw osteosynthesis in one of six cases (17%). Fourteen patients had secondary arthritis associated with fracture union. Union was more frequent (85%) in 54 undisplaced nonunions than in 36 displaced nonunions (65%). Complications included avascular necrosis, secondary arthrosis, and persistent nonunion. Avascular necrosis in 13 nonunions was treated successfully by inlay grafts in 11, and postoperative avascular necrosis (four nonunions) was resolved after fracture healing in two. The four patients with failed results had the dorsal peg grafting technique. Of 22 persistent nonunions, 16 had secondary arthritis and four had avascular necrosis. The rate of union was increased when Kirschner wire fixation of unstable nonunions was performed. The dorsal and volar inlay techniques had consistently higher rates of union with fewer complications than did the dorsal peg grafting technique.

Adolescent↗
PubMed1980

Complications of Colles' fractures.

Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications.

Arthritis↗
PubMed1980

Fractures of the scaphoid: a rational approach to management.

Fractures of the scaphoid can be classified into either undisplaced, stable fractures or displaced, unstable fractures by their roentgenographic appearance. When there is greater than 1 mm of fracture offset or an instability collapse pattern (dorsal lunate rotation) on the lateral view, an unstable, displaced fracture is present. When doubt exists after reviewing routine films, special X-rays, such as radial-ulnar deviation stress views, traction oblique views, or trispiral tomography should be obtained. In acute scaphoid fractures, where no displacement of the fracture fragments or lunate dorsal tilting can be seen, a short-arm thumb spica cast provides satisfactory support for fracture union. A wrist position of volar flexion-radial deviation is preferred to the more traditional positions of wrist extension with radial deviation or wrist extension with ulnar deviation with 100% union rate and no malunions. In displaced scaphoid fractures, a long-arm cast is recommended, with reduction of the fracture by wrist flexion and radial deviation. If accurate reduction is not obtained or is lost during the course of treatment, open reduction and internal fixation should be strongly considered. In scaphoid nonunions, undisplaced fractures can be treated satisfactorily by an inlay bone graft, using either a dorsal or a volar approach. For displaced scaphoid nonunions, either a dorsal approach with internal fixation should be done (particularly if there is evidence of radioscaphoid arthrosis), or a volar approach with internal fixation can be performed. Peg graft techniques had a higher rate of nonunion and secondary arthritis. Nonunions should be immobilized a minimum of 4 months or until roentgenographic union is present.

Bone Transplantation↗
PubMed1980

Fractures of the carpal bones other than lunate and navicular.

Injuries to the carpals and their ligaments are difficult to diagnose unless one utilizes special X-ray techniques based upon a careful history of the injury and examination for tender points and painful joints. Use of only standard X-rays and cursory examinations caused many injuries to be missed in earlier years. Many fractures resolve with simple splinting or casting, but many do not, and late sequelae are now being diagnosed more commonly than in the past. Localization of pathologic conditions by diagnostic injections of local anesthesia or arthrography (or both) is very helpful. Salvage may require excision of fragments, exostoses, reconstruction of ligaments, or local arthrodesis.

Adult↗
PubMed1980

Kienböck's disease: the natural history of Kienböck's disease and consideration of lunate fractures.

Forty-six patients with Kienböck's disease were evaluated over a 2- to 27-year period; 72% had a history of wrist injury prior to diagnosis; 67% had evidence of fracture or fragmentation of the lunate. Documented fractures of the lunate were identified followed by both the presence and absence of subsequent Kienböck's disease and this may be explained by the variable blood supply of the lunate. Ten patients were not treated; 36 patients were treated surgically. Patients were relieved of pain and had functional wrists whether they were treated or not and regardless of the type of surgical treatment.

Adolescent↗
PubMed1979

Total joint arthroplasty. The hand.

Joint replacement in the hand has developed on the basis of improved understanding of the pathophysiologic and the biomechanical factors involved in normal and diseased joints. Compromises are required in prosthetic design and surgical reconstruction, but function and appearance in deformed hands are susceptible to surgical improvement.

Arthritis, Rheumatoid↗
PubMed1979

External pin fixation for unstable Colles' fractures.

During a five-year period, a double-pin Roger Anderson apparatus, with pins perpendicularly placed in the second and third metacarpals and in the distal part of the radius, was applied in 130 patients with an unstable Colles fracture. Sixty of the 130 were followed for two years. Shortening was limited to a median of two millimeters and dorsal angulation, to a median of 3 degrees. Wrist dorsiflexion averaged 58 degrees, and volar flexion averaged 50 degrees. Pronation and supination had an average loss of 5 degrees when compared with the uninjured side. Repeat reduction was required in only three patients. Patient assessment revealed that 85 per cent of the patients had good results; 12 per cent, fair; and 3 per cent, unsatisfactory. Objective analysis (McBride system) revealed that 90 per cent had good to excellent results; 8 per cent, fair; and 2 per cent, poor. Ninety-two per cent had no pain, 89 per cent had no deformity, and the mean grip strength was twenty kilograms. Sixteen patients had complications; seven of the sixteen had pin loosening, which occurred most frequently late during the course of treatment and without adverse sequelae.

Colles' Fracture↗
PubMed1978

Management of post-traumatic instability of the wrist secondary to ligament rupture.

A retrospective review of 55 patients with post-traumatic radioscapholunate ligament disruption suggests that rupture of this ligament can be treated successfully if certain guidelines are followed. If the rupture is seen within 4 weeks, an anatomic reduction maintained in plaster for 8 weeks leads to good results. Ligament ruptures that cannot be held in reduction or that are diagnosed after 4 weeks do poorly with immobilization only. Results after ligament reconstruction have ranged from good to fair but appear to have been sufficiently successful to warrant continued trial rather than resort to arthrodesis, proximal row carpectomy, or similar reconstructive procedures. Patients with degenerative joint disease associated with radioscapholunate rupture are not candidates for ligament reconstruction. Radial styloidectomy or some variety of wrist arthrodesis or wrist arthoplasty should be considered in these instances.

Adult↗
PubMed1978

Scaphotrapezial trapezoidal arthrosis.

Scaphotrapezial trapezoidal degenerative arthritis as an isolated entity or as a preponderant part of a pantrapezial degenerative process was seen in 49 hands of 34 patients. Pain and weakness were the primary complaints. Point tenderness was present in all but two hands. Significant loss of grasp and pinch strength was noted in 18 hands, and loss of wrist motion occurred in 16 hands. Roentgenographic findings included narrowing of the scaphotrapezial trapezoidal joint space, subarticular cortical sclerosis, and cyst formation. A dorsiflexed position of the scaphoid, with a scapholunate angle of less than 45 degrees, was noted in 38 of the 45 hands. Late collapse of the intercarpal joint with dorsiflexion instability of the lunate also was noted. Twenty-nine hands were treated conservatively by protective splints, corticosteroid injections, and avoidance of exacerbating activities. Surgical treatments consisted of fibrous arthroplasty (four), silicone interposition arthroplasty (six), trapezial replacement arthroplasty (three), arthrodesis (five), joint debridement (one), and trapezial excision (one). Late results were more encouraging than were early results and were moderately satisfactory for each method. Improvement in grasp and pinch strength was most predictable for arthrodesis, although wrist motion was diminished.

Adult↗
PubMed1977

Bacterial colonization of mutilating hand injuries and its treatment.

A total of 120 hand injuries were reviewed. Sixty-seven occurred between 1965 and 1972 and were analyzed retrospectively, and 53 occurred between 1972 and 1974 and were analyzed prospectively. The bacterial colonization was determined in 86 injuries. Injuries sustained while handling farm implements tended to be colonized by mixed gram-negative and gram-positive isolates. The gram-negative isolates usually were resistant to all antibiotics, with the exception of gentamicin. However, nine bacterial isolates were resistant to all agents tested. Injuries sustained in the home or industry were colonized by gram-positive organisms. Most were susceptible to semisynthetic penicillinase-resistant penicillins such as methicillin and its congeners. The use of parenteral prophylactic antimicrobial agents in the treatment of mutilating hand injuries was not significant in preventing infection, and their use does not seem to be indicated in farm implement-related injuries. Antimicrobials are of value in home- and industrial-related injuries only when the status of the wound so indicates.

Anti-Bacterial Agents↗
PubMed1977

Surgical treatment of calcinosis cutis in the upper extremity.

Recent surgical experience with 11 cases of calcinosis cutis has given the authors an opportunity to define the role of surgery in the management of this condition. In scleroderma associated with dermatomyositis, when complications or disability arise from one or more areas of calcinosis, surgery may give significant palliation. Wound healing, although a potential problem, does not constitute a contraindication to operative treatment. Damage to deep structures usually is avoidable, but in some instances is a reasonable trade-off for the benefits obtained. Follow-up has confirmed that surgery is beneficial to patient comfort and function, even in the few patients in whom some calcinosis recurred.

Aged↗