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Biomedical subjects

J M Failla

Publications and source records attributed to J M Failla.

At least 19 recordsLinked to original sources
PubMed1999

Ultrasound diagnosis and surgical pathology of the torn interosseous membrane in forearm fractures/dislocations.

Ultrasound was used to effectively diagnose and precisely locate a torn interosseous membrane in 2 forearm fracture/dislocations. The ultrasound appearance of the torn interosseous membrane in cadavers and in the fractures/dislocations shows disruption of the anterior and posterior layers in midsubstance or adjacent to the radius or ulna. The surgical pathology in 3 forearm fractures/dislocations (2 Galeazzi injuries and 1 Essex-Lopresti injury) shows a longitudinal oblique tear of the interosseous membrane, parallel to its major palmar fibers, oriented from proximal radial to the distal ulnar. After ultrasound diagnosis, we demonstrated the feasibility of direct primary repair of the torn interosseous membrane associated with the Essex-Lopresti injury in a clinical case.

Adult↗
PubMed1999

Scaphoid fracture displacement with forearm rotation in a short-arm thumb spica cast.

Three-dimensional motion between the fragments of an experimental scaphoid waist fracture was measured during dynamic forearm pronation and supination in a short-arm thumb spica cast with and without applied tendon loads. Metal markers placed in each fragment were tracked using high-speed biplane radiographic image sequences and stereophotogrammetric analysis. Peak displacements (from the intact state) exceeded 1 mm in all specimens, with the largest movements occurring in the radial direction during pronation (mean: 2.1 mm unloaded, 2.5 mm loaded). Total range of displacement motion between fragments exceeded 3 mm (mean ulnar/radial direction: 3.4 mm unloaded, 4.1 mm loaded). Dorsal/palmar and proximal/distal displacements were minimal except at the extremes of forearm pronation/supination. Rotations between fragments were small (within +/- 6 degrees) and varied considerably across specimens. No significant differences were found between loaded and unloaded trials. Thus, in the absence of long-arm thumb spica casting to limit forearm rotation, significant motion between the fragments of a scaphoid waist fracture is likely.

Biomechanical Phenomena↗
PubMed1999

Hand infections in the trauma patient.

Infections are a frequent, unfortunate complication seen in orthopedic trauma patients. The specific anatomy of the upper extremity makes it an easy target for opportunistic organisms, especially after an acute traumatic event. In addition, pathogenic factors and host factors can contribute to the severity of the infection. Meticulous wound management, identification of the offending organism(s), and tailoring of care to the special needs of the very sick trauma patient limit complications.

Animals↗
PubMed1998

Injection accuracy and clinical relief of de Quervain's tendinitis.

In a controlled, prospective, double-blind study, the incidence of accurate injection of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon compartments was defined and correlated with clinical relief of de Quervain's tendinitis. X-ray dye was included with steroid and lidocaine injections for 19 patients; dye location was immediately checked by 1 radiologist blinded to the clinical results. Dye was confirmed to be within the first dorsal compartment in 16 of 19 cases. There was relief of symptoms in 11 of 19 patients. Four of 5 patients with dye in both the APL and EPB tendon compartments, experienced relief of symptoms, while all 3 with dye in neither compartment experienced no relief. This suggests that accurate injection of steroids is required for relief of de Quervain's tendinitis. The EPB compartment was often missed (13/19 cases), possibly because it was separate or of small size and deep location. This may be a factor in failed injections, just as surgery can fail if a separate EPB compartment is not released.

Adult↗
PubMed1998

The anatomy of the radial side of the thumb: static restraints in preventing subluxation and rotation after injury.

This study sought to define the anatomic variations of the radial side of the thumb metacarpophalangeal joint and to assess the contributions of the radial structures to stability. In Part I, the radial side of the thumb metacarpophalangeal joint was studied in 31 cadavers, showing that the extensor pollicis brevis insertion was variable. In Part II, 13 additional hands were studied to evaluate the static restraints to rotation and subluxation, showing that variability in the amount of volar subluxation and pronation was possible in the intact thumb. This study showed that the radial collateral ligament and extensor pollicis brevis capsule collectively contribute to stability against rotation and volar subluxation. We found roentgenograms with a pure volar displacement force to be more helpful than pronation stress roentgenograms in showing metacarpophalangeal instability after injury. This instability may require surgery to repair the injured structures and restore the stability to varus stress and volar subluxation.

Biomechanical Phenomena↗
PubMed1997

The acute pathologic changes of paint-injection injury and correlation to surgical treatment: a report of two cases.

The early histologic changes of digital tissues after paint-injection injury support the urgent need to remove all contaminated tissue. Paint causes immediate tissue necrosis on contact and then incites an immediate necrotizing inflammatory reaction that persists if the tissues are not completely debrided. Early histopathologic changes include vessel thrombosis, tissue necrosis, and acute necrotizing inflammatory infiltrate, all occurring only hours after injection injury. In light of these histologic changes, if paint cannot be completely removed from digital arteries in an attempt to salvage the finger, then the wound should be left open and the finger monitored for further necrosis in response to the retained paint.

Acute Disease↗
PubMed1997

The interosseous membrane affects load distribution in the forearm.

The role of the interosseous membrane in load sharing was defined by simultaneously quantitating loads in the distal radius and ulna and in the proximal radius and ulna with an axial load to the wrist, before and after transecting the interosseous membrane. With the interosseous membrane intact, the load at the proximal ulna was greater than at the distal ulna and the load at the proximal radius was less than at the distal radius, suggesting that force was transferred from the radius distally to the ulna proximally. The average percentage of the total load in each bone in supination was as follows: distal radius, 68%; distal ulna, 32%; proximal radius, 51%; proximal ulna, 49%. After interosseous membrane division, the proximal and distal load values became equal in each bone, in all forearm positions, demonstrating that without the membrane there was no load transfer between the radius and ulna. The interosseous membrane transfers load from the wrist to the proximal forearm, via fibers that run from the proximal radius to the distal ulna and exert a proximally directed pull on the ulnar shaft.

Biomechanical Phenomena↗
PubMed1995

Steroid versus placebo injection for trigger finger.

The ability of a single injection of steroid and lidocaine to bring about cure of primary trigger finger was determined and compared with a control placebo injection of only lidocaine. Twenty-four patients were randomized to the therapeutic or control group and were followed prospectively. One physician administered the injection, another the clinical examination after injection, and a third evaluated the results blindly. Patients were not told to which group they were assigned. Nine of the 14 patients in the steroid group versus two of the ten patients in the placebo group were cured of trigger finger at final follow-up examination. After injection, seven patients had immediate but temporary relief of triggering because of flexor sheath distention. One injection cured 64% [corrected] of patients with primary trigger finger with no side effect and is the recommended nonsurgical treatment.

Administration, Topical↗
PubMed1993

Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases.

Rupture of the extensor pollicis longus tendon at the tip of a prominent fixation screw occurred in two cases after fixation of fractures of the radial shaft and in one case after fixation of a fracture of the scaphoid. Patients were referred because of their inability to extend the thumb. Active thumb extension was restored in two patients by screw removal and tendon transfer. The third patient elected nonoperative care. Close scrutiny of good-quality intraoperative x-ray films after internal fixation about the wrist may detect screws that are too prominent and thereby prevent rupture of the extensor pollicis longus tendon.

Adult↗
PubMed1993

Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion.

A clinical impression of avascular changes in the hook of the hamate after fracture led to this study of the pattern and size of the hamate hook vascular foramina. It appears that vessels enter the hamate hook at primarily two sites. The radial base foramina are large and always present, while the ulnar tip foramina are small and absent in 29% of specimens. In these hamates, fracture at the hook base could potentially compromise blood supply to the hook fragment, and this may be a factor in hamate hook nonunion.

Blood Vessels↗