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Biomedical subjects

J M Agee

Publications and source records attributed to J M Agee.

13 recordsLinked to original sources
PubMed1996

Carpal tunnel syndrome: unusual contraindications to endoscopic release.

Endoscopic carpal tunnel release has become an increasingly popular method of surgical treatment of carpal tunnel syndrome. Consequently, the contraindications to this technically challenging procedure continue to evolve. We describe two patients with carpal tunnel syndrome and unusual anomalies and pathology of the hook of the hamate that we believe represent relative or absolute contraindications to endoscopic carpal tunnel release.

Carpal Bones↗
PubMed1995

Endoscopic carpal tunnel release: a prospective study of complications and surgical experience.

A 63-center prospective study of endoscopic carpal tunnel release using the Agee Carpal Tunnel Release System was conducted in 1049 procedures in 988 patients. Prior experience with endoscopic release varied significantly among surgeon participants. Surgeons evaluated the newly redesigned system for blade visibility, blade height, and mechanical function. Data on patient complications were collected at the time of surgery and 3-4 weeks postoperative. The results indicated minimal complications and no confirmed injuries to vessels or nerves; the symptoms from one possible digital nerve injury eventually resolved completely. Surgeons were able to observe the point of entry of the blade into the transverse carpal ligament in 97.5% of procedures. Introduction of the blade assembly into the carpal tunnel was rated easy or adequate in 90.6% of procedures, and blade height was rated adequate in 97.4% of procedures.

Arthroscopes↗
PubMed1994

Treatment of comminuted distal radius fractures: an approach based on pathomechanics.

Following dorsally displaced fractures of the distal radius, the classic position of immobilization is with the wrist flexed and in ulnar deviation. This is not the position of function and entails morbidity in the form of finger stiffness, which may require prolonged rehabilitation. We treated 20 consecutive, comminuted, intraarticular distal radial fractures using a new external fixation system with the wrist in a neutral to extended position, thereby promoting metacarpophalangeal joint flexion by relatively relaxing the finger extensor tendons. Supplemental pin fixation was used in eight cases. Most patients were performing active digital motion on the day of surgery and 95% maintained functional finger motion during treatment. All fractures healed uneventfully. Palmar tilt was restored in 55% of patients in spite of a wrist neutral or extended position. This method of fixing distal radial fractures allows restoration of anatomy while avoiding hand stiffness.

Adult↗
PubMed1994

Endoscopic carpal tunnel release using the single proximal incision technique.

The goal of the single incision endoscopic technique is to avoid an incision on the palmar surface of the hand. As compared with open release and the two-portal endoscopic technique for release of the carpal tunnel, this single incision technique permits the patient to return earlier to work and activities of daily living as a result of less tenderness and earlier return of strength. Safe performance of the technique requires that the surgeon have both a thorough knowledge of the anatomy of the hand and a commitment to master the technical details of the surgical approach. Because the technique is of value strictly to view and divide the TCL, patient selection requires careful preoperative evaluation to exclude those carpal tunnels with pathology that requires direct inspection or surgical treatment. In a prospective study with the redesigned point of entry blade assembly that allows a view of the blade's entry into the ligament, no device-related complications occurred. In considering a surgical approach for endoscopic carpal tunnel release, the authors feel that it is important to recognize the value of an "open" proximal surgical incision designed to directly view the plane between the finger flexor synovium and the deep surface of the TCL. Stab wound "portals" that are widely used in arthroscopic surgery are inadequate for endoscopic carpal tunnel releases. The device and the procedure are designed to obtain an unobstructed view of the underside of the TCL and divide it completely. Additional long-term prospective studies are needed to define the comparative recurrence rates of open versus single incision endoscopic carpal tunnel release surgeries.

Arthroscopy↗
PubMed1993

The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint.

Our experience with the Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint is reported. Twenty-one wrists in 17 patients were followed for an average of 39 months postoperatively. Average range of motion at follow-up evaluation was pronation to 78 degrees and supination to 86 degrees. X-ray films demonstrated that significant ulnarward and palmarward translocation of the carpus was prevented. The Sauve-Kapandji procedure provides a stable ulnar side support in the rheumatoid wrist with distal radioulnar degeneration.

Adult↗
PubMed1993

Distal radius fractures. Multiplanar ligamentotaxis.

Ligamentotaxis is the principle of molding fracture fragments into alignment as a result of tension applied across a fracture by the surrounding intact soft tissues. Uniplanar ligamentotaxis obtained by longitudinal traction does not always restore palmar tilt to the distal radius. Multiplanar ligamentotaxis extends the principle of uniplanar ligamentotaxis to include translation of the hand in the dorsal-palmar and the radial-ulnar planes to effect appositional and tilting alignment of the distal fragment(s) of a fractured radius. Use of an external fixator that allows adjustments in multiple planes helps restore anatomic alignment and maintain fracture reduction during healing.

Bone Lengthening↗
PubMed1993

External fixation. Technical advances based upon multiplanar ligamentotaxis.

The principle of ligamentotaxis obtained by longitudinal traction is useful in restoring skeletal length to distal radial fractures. Using external skeletal fixation to translate the hand in radial-ulnar and dorsal-palmar directions, ligamentotaxis in two additional planes aligns and tilts the distal radial fragment and its articular surface. Following restoration of palmar tilt by palmar translation, wrist position can be adjusted into neutral or extension to help avoid finger stiffness and carpal tunnel syndrome without compromising fracture reduction.

Biomechanical Phenomena↗
PubMed1992

Endoscopic release of the carpal tunnel: a randomized prospective multicenter study.

A 10-center randomized prospective multicenter study of endoscopic release of the carpal tunnel was carried out. Surgery was performed with a new device for transecting the transverse carpal ligament while control hands were treated with conventional open surgery. There were 122 patients in the study; 25 had carpal tunnel surgery on both hands and 97 had surgery on one hand. Of the surgical procedures, 65 were in the control group and 82 were in the device group. The endoscopic device was coupled to a fiberoptic light and a video camera. A trigger-activated blade was used to incise the transverse carpal ligament. After surgery, the best predictors of return to work and to activities of daily living were strength and tenderness variables. For patients in the device group with one affected hand, the median time for return to work was 21 1/2 days less than that for the control group. Two patients treated with the endoscopic device required reoperation by open surgical decompression; only one of these had incomplete release with the device. Two patients in the device group experienced transient ulnar neurapraxia.

Activities of Daily Living↗
PubMed1991

Reducing postischemic paraplegia using conjugated superoxide dismutase.

Paraplegia after thoracic aortic aneurysm repair has an incidence of 2.2% to 24%. Oxygen-derived free radicals after reperfusion of an ischemic spinal cord may be partly responsible for neuronal destruction. We studied the effects of polyethylene glycol-conjugated superoxide dismutase (PEG-SOD), a free radical scavenger, as a way of increasing spinal cord tolerance to ischemia. Thirty rabbits underwent 40 minutes of aortic occlusion (a known model of paraplegia). Ten of these animals received 25,000 U/kg of PEG-SOD 24 hours before aortic occlusion and two additional doses of 10,000 U/kg, one before and one subsequent to spinal ischemia. Ten animals received superoxide dismutase in the same dosages as those receiving PEG-SOD. Ten control animals received placebo. All animals were studied for 96 hours, at which time a final neurological examination was performed and the results were recorded. Of the 10 animals treated with PEG-SOD, 2 were completely paralyzed whereas 8 had less (7) or no (1) neurological impairment. Eight of the 10 control animals and 9 of the 10 animals receiving superoxide dismutase were completely paralyzed. None of the control animals or animals receiving superoxide dismutase had a normal neurological examination (p less than or equal to 0.05). Treatment with PEG-SOD before and during occlusion increased the rabbit spinal cord tolerance to a 40-minute ischemic insult. Scavenging free radicals may lessen experimental spinal cord injury.

Animals↗
PubMed1991

The risk of axillofemoral bypass grafting for acute vascular occlusion.

The hypothesis of the present study is that axillofemoral bypass grafting for acute vascular occlusion has results significantly inferior to an elective procedure. We reviewed 53 patients undergoing primary axillofemoral bypass grafting at the University of Virginia from 1984 to 1989. We found that patients who were admitted with acute vascular occlusion had a higher incidence of perioperative complications (63% vs 26%, p = 0.001), perioperative mortality (26% vs 3%, p less than 0.05), lower graft patency at 1 year (60% vs 90%, p less than 0.05), lower rate of freedom from reoperation in first year (50% vs 82%, p less than 0.01), and lower rates of limb salvage (76% vs 94%, p less than 0.05) than patients undergoing axillofemoral bypass grafting for chronic symptoms or conditions. These two groups did not differ in any of the other risk factors or perioperative characteristics examined. We conclude axillofemoral bypass grafting performed for indications other than acute vascular occlusion is associated with acceptable morbidity, mortality, graft patency, and limb salvage rates.

Acute Disease↗
PubMed1987

Unstable fracture dislocations of the proximal interphalangeal joint. Treatment with the force couple splint.

The force couple splint maintains concentric joint reduction while allowing early active range of motion exercises. Sixteen cases were treated with a force couple created across the proximal interphalangeal (PIP) joint, levering the dislocated base of the middle phalanx palmarly, while simultaneously lifting the distal end of the proximal phalanx dorsally to restore joint reduction. The splint is constructed from three Kirschner wires and is activated by a single rubber band. The effect of this force couple is present through a complete range of joint motion, thereby allowing active flexion and extension of the joint during bone and soft tissue healing. The force couple splint is capable of producing good to excellent results in patients with unstable acute fracture dislocations of the PIP joint.

Adolescent↗
PubMed1978

Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique.

A linkage of Kirschner wires activated by a single rubber band creates a force couple across a fracture-dislocated proximal interphalangeal joint. The method dynamically achieves concentric joint reduction, which is maintained through a full active range-of-joint flexion and extension. Two case reports accompany a description of the technique.

Adolescent↗