Biomedical subjects

J K Weaver

Publications and source records attributed to J K Weaver.

At least 19 recordsLinked to original sources

PubMed1996

Office carpal tunnel release with wrist block and wrist tourniquet.

Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. Over the past 5 years we have performed carpal tunnel releases in the office setting using wrist block anesthesia and a wrist tourniquet. There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.

Ambulatory Surgical Procedures↗

PubMed1994

Don't forget the Bristow-Latarjet procedure.

The authors have been disturbed by a number of reports appearing in the past 5 years condemning the Bristow procedure because of difficulties with screw failure and misplacement, nerve damage, and tethering of the subscapularis. A retrospective study was performed comparing the Bankart and Bristow procedures as performed by the authors during a 10-year period. Complications, rate of recurrence, presence of subluxation, range of motion, return to activity, strength, pain, and overall satisfaction were evaluated. There were 85 patients in the study, of which 61 had the Bristow operation and 24 were treated with the Bankart procedure. The minimum followup was 2 years. Very little difference was found between the 2 operations in any of the parameters studied, and in the authors' opinion, the Bristow procedure remains a reasonable alternative to the Bankart operation. The range of abduction, external rotation, and strength compared favorably with the Bankart group. The authors have encountered instances wherein capsular deficiency rendered the accomplishment of the Bankart procedure difficult or unreliable. Four such cases are reported. Under these circumstances, the Bristow served as a reliable alternative. Technical recommendations for avoiding the difficulties that have led to the condemnation of the Bristow procedure are described in detail.

Activities of Daily Living↗

PubMed1993

Difficulties with bearing dislocation and breakage using a movable bearing total knee replacement system.

In 1980, the low contact stress, or New Jersey, system was introduced with movable high-density polyethylene bearings between the metallic femoral and tibial components. This system was developed to deal with two principal concerns of conventional knee replacement systems: loosening and wear. A federal Drug Administration review was required, and the study was performed in two phases. From 1981 until 1984, components were cemented in 40 knees, which then were evaluated for an average of seven years after surgery. From 1984 until 1986, 16 knees were selected for cementless fixation and were followed for an average of five years. The cemented group had a failure rate of 10% (four knees), two from tibial component loosening, one from bearing dislocation, and one from infection. Failure was determined by the necessity for revision. The uncemented group had a failure rate of 31% (four knees from bearing fracture and one from knee pain of uncertain source). Bearing failure was attributable to the entrapment of the subluxed lateral bearing. Sacrifice of the anterior cruciate ligament predisposes the system to bearing subluxation and failure.

Aged↗

PubMed1992

Ankle pain following total knee arthroplasty. A case report.

The authors present their experience with four cases of ankle pain occurring in the immediate postoperative period after total knee arthroplasty. In a 40-month period, the authors performed 87 total knee arthroplasties. In the first 28 cases, an extramedullary alignment rod was used and there were no instances of ankle pain (0%). In the next 30 cases, an intramedullary alignment rod was employed and there were three cases of moderate to severe ankle pain (10%). In the last 29 cases, the medullary canal was decompressed, irrigated, and aspirated prior to insertion of the alignment rod. In this group there was only one case of mild ankle discomfort (3.5%). An extensive investigation was made into one of the cases in which the intramedullary alignment rod was used but the canal was not aspirated. Information from this case investigation, observation of the three subsequent cases, and the notation of a decrease in the incidence of ankle pain once aspiration was routinely used are reported. The unproven hypothesis that ankle pain may result from compression of the marrow contents into the bone interstices is presented for consideration. Three of the four cases of ankle pain reported here were spontaneously resolved within 9 months after surgery.

Aged↗

PubMed1991

Patellofemoral arthritis resulting from malalignment. A long-term evaluation of treatment options.

This study examines and compares three treatment options for patellofemoral arthritis resulting from patellofemoral malalignment: longitudinal semipatellectomy, total patellectomy, and a modified Trillat procedure. Patients returned for examination in a 3- to 12-year follow-up period. Results from longitudinal semipatellectomy were unsatisfactory, with a reoperation and failure rate of 70%. Good long-term effects were found with total patellectomy (87% good or excellent). The modified Trillat procedure was effective in preventing recurrent dislocation (94%); however, the procedure was less effective in relieving anterior knee pain (65% good or excellent). A satisfactory solution remains to be found.

Follow-Up Studies↗

PubMed1990

Treatment of comminuted distal radial fractures with preliminary horizontal finger trap traction and a Roger-Anderson external fixation device.

Over a five-year period, 43 patients with comminuted distal radial fractures were treated with a Roger-Anderson external fixation device after the fracture was aligned in Strong's horizontal finger trap traction. Nineteen patients (21 wrists) were available for personal interview and radiographic follow-up. A 0.5-mm loss of radial height and an average loss of 2.4 degrees of palmar angulation presented. Range of motion (ROM) was excellent, stiffness was nonexistent or minimal in 81%, pain was nonexistent or minimal in 86%, and weakness of grasp was nonexistent or minimal in 81%. Complications were minimal; they included three pin tract infections, two of which required pin removal before they resolved. One patient fractured a pin that also required removal. Strong's horizontal finger trap traction and the Roger-Anderson external fixation device simplified the sometimes difficult treatment of this fracture. It seems to be most effective in young athletic individuals who have good bone stock and very comminuted fractures.

Adult↗

PubMed1987

Changing patterns in tibial fractures resulting from skiing.

Of the 734 adult tibial fractures treated in Aspen, Colorado, from 1968-1978, follow-up results were obtained on 527 (72%). The fractures were analyzed with regard to rate of healing, age of patient, and location of fractures. There was a statistically significant increase in healing time with increasing age between ages 16-40. The location of tibial fracture (proximal, middle, distal) had no significant influence on rate of healing. The occurrence of open tibial fracture was low (3% of total) and in most instances wounds were benign (Class I). Compartment syndrome is rarely encountered in skiing fracture because of the relatively low energy involved. All tibial fractures occurring between 1982-1984 were reviewed and compared to the earlier series. This comparison confirmed the continual overall decline in rate of tibial fracture from skiing (from 12.9/100,000 skier days in 1968 to 2.9/100,000 skier days in 1983). This decline was primarily in spiral fractures (from 70% of total in 1968 to 50% in 1983). The percent of transverse fractures was unchanged (+/- 15%) while the percent of short oblique fractures increased from 11% to 33%. Properly adjusted and maintained safety equipment afforded reasonable protection from spiral fractures of the tibia, but a conceptual departure from the current release binding design would be required to protect against the benign moments that produced transverse and short oblique fracture. The current treatment philosophy is based on fracture type and the availability or experience with newer treatment modes.

Adolescent↗

PubMed1987

Skiing-related injuries to the shoulder.

An analysis of 135 consecutive shoulder injuries seen in one clinic during a single ski season revealed anterior dislocation to be the most common ailment, constituting 52% of the total. Rotator cuff tears accounted for 20% of the total, followed by acromioclavicular (AC) separations (18%) and a miscellaneous group of contusions and isolated fractures comprising the other 10%. All of the shoulder dislocations were anterior, most were primary (81%) and men (83%) were involved more frequently. Twenty-four percent of the dislocations were thought to be equipment related. At follow-up examination three to four years after injury, a significant number (41%) were still symptomatic either from a recurrence (18%) or pain and weakness (23%). Patients with rotator cuff tears tended to be about ten years older than the average skier. Their injuries were usually a result of a fall on ipsilateral arm and were not equipment related. Of the 13 patients responding after a three-year follow-up period, most (10/13) were asymptomatic. There were 24 AC separations. All resulted from a direct fall on the shoulder. Sixty percent were first degree, 22% were second degree, and 18% were third degree. About one-third of the respondents with first and second degree injuries were still having significant pain at three-year follow-up examination. The most frequent isolated fracture was a minimally displaced fracture of the greater tuberosity (only three cases in 135 injuries), but this same fracture occurred in 10% of the shoulder dislocations.

Acromioclavicular Joint↗

PubMed1987

Acute surgical repair of the skier's thumb.

Complete ulnar collateral ligament tears incurred during the period fall 1977 through spring 1979 were treated under regional anesthesia by a single group of surgeons in an identical fashion as outpatients. Of 123 thumbs repaired, 69 (59%) were available for follow-up examination. There were 34 women and 35 men with an average age of 34.5 years (range, 16-61 years). The follow-up period averaged 31.6 months (range, 16-46 months). Weakness of pinch was described as none or mild in 66 (96%) and significant in only three (4%). Stiffness was described as none or mild in 66 (96%), moderate in two (3%), and severe in one (1%). Pain was described as none or mild in 68 (99%) and moderate in one (1%). Sixty-two patients (90%) preferred outpatient surgery with regional anesthesia whereas only seven (10%) did not. Forty-five (65%) of the 69 patients who required surgery had used traditional poles with straps, suggesting the pole as the causative factor. However, only 20% of noninjured skiers during the 1981-1982 season were using traditional poles with straps, and the total number of complete ulnar collateral ligament repairs did not decrease with the same number of skiers. Therefore, the change in pole design has not decreased the incidence of total ulnar collateral ligament tears. The results of acute surgical repair as an outpatient with regional anesthesia are excellent; 96% of the patients were pleased with the results. If the lesion is overlooked, the results of secondary construction are not nearly as good.

Adolescent↗

PubMed1985

Primary knee ligament repair--revisited.

There were 4710 knee sprains resulting from skiing in the four Aspen ski areas between 1976 and 1979. Twenty percent of the patients (942) had complete tears. Of these, 302 elected to remain in Aspen for treatment. All were treated by primary ligament repair without augmentation. These cases were evaluated an average of 42 months after injury. Patients with isolated tears of the medial collateral ligament were found to be doing well; virtually all of them had returned to preinjury activity levels. Thirty-six percent of the isolated anterior cruciate repairs were rated failures, and 43% of the combination ACL-MCL injuries had failed because of anterior cruciate deficiency. Twenty-nine percent of the ACL and ACL-MCL injuries had meniscal tears. Cases that included meniscectomy had a failure rate twice as great as those in which the meniscus was preserved. The results following repair of anterior cruciate tears were not acceptable, and augmentation was indicated. Primary repair of medial collateral ligament tears produced excellent results. Meniscal tears were frequent in association with ligament disruption. Ligament repairs were less satisfactory when meniscectomy was performed at the time of the repair.

Athletic Injuries↗

PubMed1975

Total hip replacement: a comparison between the transtrochanteric and posterior surgical approaches.

It can be argued with good justification, that the trochanteric complications which stimulated this study could have been avoided by strict adherence to Charnley's technique regarding trochanteric advancement and re-attachment. Should trochanteric reattachment be required, it should be done with strict attention to the details outlined by Charnley, or by use of some other device such as the Volz bolt. Trochanteric removal is usually unnecessary. The transtrochanteric approach to total hip replacement has inherent technical problems that increase the potential for complications. These problems include: painful trochanteric bursitis, displacement of trochanter, non-union of trochanter, broken wires and, an increase in dislocation rate (12% as compared to 4%). The posterior approach reduces operative time, blood loss, hospitalization, and shortens the period of time to unprotected weight bearing. Should certain conditions such as external rotation contracture, acetabular protrusion, or relative lengthening of the operated limb indicate trochanteric osteotomy, it can be accomplished readily by way of the posterior exposure.

Arthroplasty↗

PubMed1972