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Biomedical subjects

J L Goldner

Publications and source records attributed to J L Goldner.

At least 19 recordsLinked to original sources
PubMed1991

Psoriatic arthritis of the foot and ankle: analysis of joint involvement and diagnostic errors.

Forty-two patients with psoriatic arthritis arthritis who were referred to a tertiary medical center from 1983 to 1987 were reviewed. The foot and/or ankle was the most common site of joint or bone involvement, (N = 36, 86%). Twenty-six of these patients demonstrated bilateral involvement. The foot and ankle was the most common site of initial arthritis (N = 23, 55%). Errors in patient diagnosis were noted and analyzed. Eight patients with foot and ankle involvement were diagnosed and treated for either gout or compression of a digital nerve. Major causes for misdiagnosis included failure to identify psoriatic skin lesions and failure to associate foot and ankle symptoms with psoriatic arthritis.

Adolescent↗
PubMed1991

Growing pains.

Explore the source record for details and available documents.

Bone Diseases↗
PubMed1991

Revision arthrodesis for tibiotalar pseudarthrosis with fibular onlay-inlay graft and internal screw fixation.

Pseudarthrosis after failed tibiotalar arthrodesis was successfully treated surgically in nine of 11 patients between 1980 and 1987. The indication for the initial attempted arthrodesis was traumatic arthrosis in seven patients, traumatic arthrosis with osteonecrosis of the talus in two patients, degenerative arthrosis in one patient with cavovarus foot (Charcot-Marie-Tooth), and myelodysplasia with progressive valgus deformity of the foot and ankle in one. The surgical technique planned for revision arthrodesis provided firm coaptation of tibia to talus with internal fixation that maintained the foot at right angles to the tibia with the forefoot in neutral position. Seven feet in 11 patients were treated using a transfibular approach that allowed excision of fibrous tissue and sclerotic bone, decortication of the media malleolus, fixation of the tibia to the talus with cancellous screws, and onlay/inlay fibular graft. Of the remaining four patients, one was treated with medial compression plate, a second was treated using an anteromedial cortical graft, a third was treated by a combination of sliding anteromedial corticocancellous graft and tibiotalar compression screw, and a fourth was treated with tibiotalar compression screw. Clinical and roentgenographic union occurred in nine of 11 patients. One patient developed a painless, fibrous union and one patient with persistent pseudarthrosis had myelodysplasia and severe valgus deformity and required amputation. Adequate exposure was possible through the transfibular approach to provide cancellous bone opposition, to excise the pseudarthrosis membrane and sclerotic bone, and to remove necrotic segments of the talus. In addition, supplemental bone graft, internal fixation, and postoperative cast immobilization were also helpful in obtaining union.

Adolescent↗
PubMed1990

Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries.

Despite technical advances, the ability to restore motor function following a brachial plexus avulsion is limited. Twenty patients who suffered the loss of elbow flexion following a brachial plexus avulsion injury underwent a neurotization procedure in an attempt to restore that lost function. Of 16 patients who underwent intercostal to musculocutaneous nerve anastomosis, seven obtained good elbow flexion. Four patients who no longer had a viable biceps brachialis muscle underwent an anastomosis between transposed intercostal nerves and a free vascularized gracilis muscle grafted to the position of the biceps. Two of these patients obtained good elbow flexion. Although synkinesis between the biceps brachialis and the inspiratory muscles can be demonstrated during coughing and deep inspiration, the patients learn to flex their reinnervated biceps brachialis muscle and maintain flexion independent of respiration.

Adolescent↗
PubMed1990

Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults. Adjunctive treatment of thumb-in-palm deformity in cerebral palsy.

A hypermobile hyperextension or hyperflexion deformity of the metacarpophalangeal (MCP) joint associated with thumb-in-palm deformity in 90 patients affected by cerebral palsy was treated by arthrodesis with or without soft-tissue procedures. Twenty-two of these patients were adults with closed physes, and 68 were children or adolescents with open growth plates. The MCP joint fusion was usually accompanied by intrinsic muscle lengthening and/or extrinsic tendon transfer, but occasionally it was the only procedure performed to diminish the thumb-in-palm position. Even in four-year-olds, joint fusion was a predictable procedure to establish stability of that joint without disturbing longitudinal or circumferential growth. Measurable function was improved to a mild or moderate degree in 44 of the 50 children who were followed to maturity. Eighteen of the 68 children were unavailable for follow-up evaluation. Six of the 50 followed patients showed no functional improvement, although arthrodesis of the MCP joint occurred in four of the six. The other two patients were operated on when they were 12 years of age and developed a fibrous union that was painless and stable when they were adults. Even those patients who had no functional improvement did have improved appearance and easier control of the affected hand when it was manipulated by the opposite hand. The children were followed to maturity with age-matched cerebral palsy control patients. There was no significant disturbance in growth of those thumbs that had MCP joint fusion when the physes were open.

Adolescent↗
PubMed1989

Chronic peroneal tendon subluxation produced by an anomalous peroneus brevis: case report and literature review.

Although congenital anomalies of the peroneal muscles have been well documented from anatomical studies, only a single clinically symptomatic case has been previously reported. In the present report, a previously unreported variation of the peroneus brevis, a bifid peroneus brevis, is described. This variation contributed to chronic subluxation of the peroneal tendons. Diagnosis was made at the time of operation, and resection of the duplicated tendon and reinforcement of the peroneal retinaculum relieved the symptoms of the patient.

Ankle Joint↗
PubMed1989

Neuralgic amyotrophy.

Neuralgic amyotrophy is an infrequent neuromuscular anomaly involving the shoulder girdle and upper extremity. Its course is highlighted by the sudden onset of severe pain followed by sensory deficits, muscle weakness, and severe atrophy. The diagnosis is based on the history and physical findings and is corroborated with electromyography. The prognosis is excellent. Treatment is supportive, using analgesics and physical therapy.

Analgesics↗
PubMed1988

Immediate and delayed neurorrhaphy in a rabbit model: a functional, histologic, and biochemical comparison.

The effect of timing of neurorrhaphy on neuromuscular function was studied. The extensor digitorum longus neuromuscular units of 51 rabbits were used, with repairs performed immediately, 3 weeks, 3 months, and 6 months after nerve transection. Neuromuscular function was assessed 3 months after nerve repair, as was histology, histochemistry, and muscle hydroxyproline content. Force generated by immediately repaired units was 93% of unoperated controls. All functional delayed repairs produced approximately 50% of control force. Mild endomysial and perimysial fibrosis was present in the immediate neurorrhaphy group. Fibrosis was mild to moderate in the functional delayed repairs and moderate to severe in the nonfunctional repairs. Total and regional hydroxyproline content correlated to both function and timing of nerve repair. The data demonstrate that immediate repair of peripheral nerve lacerations gives the best functional recovery in this rabbit model. If immediate repairs are not performed in the rabbit, approximately 50% to 75% of normal function can be obtained when repairs are delayed for periods of 3 weeks to 6 months.

Animals↗
PubMed1988

Surgical reconstruction of the upper extremity in cerebral palsy.

This article discusses surgical treatment of the upper extremity in cerebral palsy. Such treatment should provide a balanced grasp and release, a reasonable range of pronation and supination of the forearm, and should maintain sufficient strength for hand function.

Arm↗
PubMed1988

Strengthening of the partially paralyzed shoulder girdle by multiple muscle-tendon transfers.

Strength and stability of the shoulder girdle affect function of the entire upper extremity. Isolated muscle weakness may be compensated for by adjacent muscles; however, profound weakness of the deltoid muscle, for example, affects not only placement of the extremity, but also strength and endurance of the forearm and hand. Orthotic substitutes for weakened muscles are not successful. If the muscle weakness is nonprogressive and stable, then surgical treatment will improve glenohumeral stability, increase endurance, and provide more uniform strength for many activities of daily living.

Brachial Plexus↗
PubMed1987

Neurorrhaphy, nerve grafting, and neurotization: a functional comparison of nerve reconstruction techniques.

This study examines the efficacy of three methods of peripheral nerve reconstruction: neurorrhaphy, nerve grafting, and neurotization. The extensor digitorum longus (EDL) neuromuscular unit of 63 New Zealand rabbits was used as the experimental model. Neuromuscular function was examined after 2, 4, and 6-month recovery periods. Variable recovery was seen after 2 months of recovery. At 6 months postoperatively, nerve grafting and neurorrhaphy were not statistically different from the unoperated control neuromuscular units. Neurotization grafting demonstrated a recovery of function of no greater than 50% at 6 months.

Animals↗
PubMed1987

Traumatic horizontal deviation of the second toe: mechanism of deformity, diagnosis, and treatment.

Two patients with a deviated overlapping second toe due to rupture of the dorsal lateral metatarsophalangeal (MTP) collateral ligament and the lateral interosseous tendon were diagnosed, analyzed, and treated. Athletic activities were responsible for the tendon-ligament ruptures and the ensuing medial deviation of the second toe. Pain occurred in the second MTP joint, and a dorsal corn formed over the proximal interphalangeal joint (PIP). Reconstructive procedures included lengthening of the interosseous-lumbrical tendons and the collateral ligament on the medial side of the joint; a dorsal capsule incision; repair of the lateral collateral ligament and interosseous tendon; transfer of the flexor digitorum longus to the extensor digitorum longus; and shortening of the proximal phalanx in one patient. These soft tissue reconstructive procedures and realignment joint congruity are essential to relieve pain and prevent traumatic arthrosis. The treatment completed on the two patients resulted in relief of pain, satisfactory function, and alignment of the digits involved.

Adult↗
PubMed1986

Computerized tomographic analysis of acute calcaneal fractures.

Computerized tomography (CT) of the hindfoot is introduced as an effective technique in the evaluation of acute, intra-articular calcaneal fractures. Thirty-two fractures in 30 patients have been reviewed, and common fracture characteristics identified. These included the presence of a sustentacular fragment, displacement and comminution of the lateral weightbearing surface, and lateral spread with loss of calcaneal height. Based on the improved understanding of fracture anatomy provided by the CT scan, treatment often can be determined more accurately.

Adult↗
PubMed1986

Computerized tomography of talocalcaneal tarsal coalition: a clinical and anatomic study.

Consistently accurate radiographic diagnosis of talocalcaneal tarsal coalitions is difficult because of the complex anatomy of the subtalar articulations. Standard techniques that include special radiographic views and plain tomography are useful but often inconclusive. In this study, computerized tomography (CT) was used to evaluate suspected talocalcaneal coalitions in patients with the clinical diagnosis of peroneal spastic flatfoot. CT demonstrated bony and nonbony coalitions in 14 of 22 patients studied. In the remaining eight patients, CT effectively ruled out the diagnosis of subtalar coalitions. If the coalition is obvious, CT will confirm it; if the clinical syndrome exists but standard radiographic procedures do not document the lesion, CT scan will be helpful in establishing a diagnosis. Anatomic studies of fresh cadaver feet compared CT, plain tomography, and plain radiographs for efficacy in visualizing the three subtalar facet joints. CT was superior to the other modalities for clearly identifying all aspects of the subtalar joint and talocalcaneal coalitions in patients and cadavers.

Adolescent↗
PubMed1986

Bilateral nontraumatic anterior acromioclavicular joint dislocation. A case report.

An incidental finding of bilateral nontraumatic anterior acromioclavicular joint dislocation was made in a 14-year-old boy with spastic hemiparesis. Acromial processes were dislocated anterior to the distal clavicles, with characteristic radiographic findings. The dislocation is termed "anterior" because the clavicle is anatomically more proximal than the acromion. Anterior acromioclavicular joint dislocation usually is associated with significant trauma. There was no history of trauma in this case. Localized laxity of the acromioclavicular and coracoclavicular ligaments was the presumed cause of this condition, because there was no visible osseous abnormality. Since the patient was asymptomatic, no treatment was indicated.

Acromioclavicular Joint↗