Biomedical subjects
Publications and source records attributed to K H Duncan.
Three cases of intraarticular osteotomy of malunited intraarticular fractures of the metacarpal head are described. The patients, all young males, had significant improvement in the articular anatomy and function. Rigid internal fixation was used in each case.
An operative technique for the construction of a supple and broad commissure in syndactyly and web contracture release is introduced. The technique is based on a M-V flap framework. Sixty-three flaps were done in 33 patients who were followed-up for an average of 19 months. Excellent results were obtained in 90% of the cases. There were no neurologic or vascular complications in any of these cases. The versatility of this method has allowed its use in the majority of our cases that necessitated web release or web space reconstruction.
The use of an expandable intramedullary device for internal fixation of metacarpal or phalangeal bones is described. The device is applicable to transverse fractures, short oblique fractures, or transverse osteotomies. The device consists of a cylindrical apparatus made of titanium that allows collapse in the circumferential diameter. It is introduced into the medullary canal in its collapsed state, and on release expands to its normal diameter in the canal with the fracture reduced over it. A biomechanical evaluation compared the stability of this device with other commonly employed fixation methods. A retrospective review is presented of the first 43 patients in whom the device was implanted.
Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48- to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 81% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.
Complications following ganglion cyst excision include a 3%-50% recurrence rate, wrist stiffness, infection, neuroma formation, and keloid formation. Scapholunate instability is almost never seen as a complication of ganglion excision. Scapholunate instability occurred following excision of a dorsal ganglion in the wrist of a 38-year-old man.
Carpal tunnel syndrome is one of the most common problems seen by the hand surgeon. In spite of its frequent occurrence there are several aspects of its treatment that remain controversial. A survey of the members of the American Society for Surgery of the Hand determined whether a consensus exists concerning the treatment of carpal tunnel syndrome among surgeons who regularly treat hand problems.
The concept of time-energy displacement is based on the hypothesis that unrefined complex carbohydrates of low energy density will prolong eating time and induce satiety at a low energy intake. The present study compared the effects of diets low in energy density and high in energy density on satiety, energy intake, and eating time among 20 obese and nonobese subjects. Each diet was served over a 5-day period, and subjects were allowed to eat to satiety. With equal acceptance ratings of the diets, satiety was reached on the diet low in energy density at a mean daily energy intake one-half that of the diet high in energy density (1570 versus 3000 kcal). Eating time was significantly longer on the diet low in energy density by an average of 33%/day. Obese and nonobese subjects were comparable in their satiety ratings, energy consumption, eating time, and food acceptance. These data support the concept of time-energy displacement, which should therefore have applicability to the treatment and prevention of obesity.
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