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Biomedical subjects

L H Millender

Publications and source records attributed to L H Millender.

At least 37 records · Page 2Linked to original sources
PubMed1985

Tenosynovial osteochondroma of the hand. A case report and brief review.

A 61-year-old man presented with a slowly growing, painless mass over the dorsum of his right hand. Roentgenography, computed tomography, and a radionuclide bone scan revealed a soft-tissue mass with mineralization but no bone or joint involvement. Routine laboratory tests and a chest roentgenogram were negative. A biopsy was inconclusive. The mass was removed en bloc and was diagnosed as synovial osteochondroma arising from the extensor tendon sheaths. The patient has been symptom-free 16 months postoperation. The literature indicates that these tumors occur almost exclusively in the hands or feet and are thought to develop by metaplasia from the mesenchymal cells of the synovial membrane; mineralization and ossification of the tumor are secondary. The actively growing tumor is often cellular and may show atypical cytologic features. Such microscopic characteristics should not be interpreted as evidence of a low-grade chondrosarcoma. A review of the literature failed to disclose a case with malignant transformation, although several lesions had recurred, some more than once. For this reason, complete removal of the involved synovia is of great importance.

Chondroma↗
PubMed1984

Ligamentous reconstruction for chronic intercarpal instability.

Twenty-one patients with chronic intercarpal instability were operated on an average of 13.2 months after injury or onset of symptoms. Fourteen had reconstruction via dorsal approaches by use of radial wrist extensor or other tendon graft. Seven patients were approached dorsally and palmarly, three had ligament repair, and four had reconstructions. The average follow-up was 25.4 months. Pain decreased in 85.7% of patients, although only two were pain free. Range of motion (ROM) generally decreased, and grip strength increased slightly. Radiologically, there was significant improvement on the initial postoperative roentgenograms, much of which was lost by the time the final roentgenograms were obtained. A clinical and radiologic grading system was devised to evaluate results. The average clinical grade improved from poor (26.5%) preoperatively to fair (44.4%) postoperatively. The radiologic grade remained in the poor range postoperatively, although there was some improvement from 40.4% to 45.6%.

Adult↗
PubMed1982

Hand involvement in psoriatic arthritis.

From a population of 105 patients with confirmed psoriatic arthritis, 25 patients required hand surgery. These 25 surgical patients were evaluated retrospectively both clinically and radiographically. The patterns of hand and wrist involvement as well as the results of surgery differed from those typically seen in rheumatoid disease. Spontaneous fusion of the wrist in a functional position, severe proximal interphalangeal involvement often with marked flexion contractures, severe erosion of the distal interphalangeal joint with spontaneous fusions, and generalized stiffness characterize these hands. Minimal improvement in motion and a significantly increased incidence of infection following arthroplasty were noted.

Arthritis↗
PubMed1982

Silicone spacer or tendon spacer for trapezium resection arthroplasty--comparison of results.

A comparison study was done for 25 consecutive trapeziectomies in 21 women with silicone replacements and 25 consecutive trapeziectomies in 24 women without silicone replacements who were reviewed from 1 to 9 years postoperatively. The patients, who ranged from 35 to 75 years of age, were housewives and clerical workers. All had trapeziometacarpal osteoarthritis. Among the patients with silicone replacement of the trapezium, 90% reported pain relief; mean thumb abduction was 42.5 degrees, pronation was 37.5 degrees, and pinch strength averaged 5 kg. Among the patients without silicone replacement after trapeziectomy, 95% reported pain relief; mean thumb abduction was 46.8 degrees, pronation was 41.4 degrees, and pinch strength averaged 4.6 kg. For those patients with only one hand operated upon, pinch strength in that hand averaged 85% that of the opposite hand in patients with silicone trapezial replacement and 82% for those without silicone trapezial replacement. In this patient population, trapeziectomies with or without silicone replacement as treatment for trapeziometacarpal osteoarthritis appear to give similar results.

Adult↗
PubMed1981

The surgical treatment of hand deformities in systemic lupus erythematosis.

Ten patients with systemic lupus erythematosis hand deformities were studied. Wrist involvement included distal ulnar subluxation in 14 wrists (with four requiring excision) and various degrees of carpal instability in 12 wrists (usually asymptomatic). Metacarpophalangeal (MP) joint subluxation treated by soft tissue procedures for passively correctable deformities in 30 joints had a failure rate of 70%. MP joint arthroplasties performed in 33 joints gave fair results in 16 joints with fixed deformities and good results in 17 joints with passively correctable deformities. Thumb deformities always involved all three joints, and maintenance of carpometacarpal (CMC) joint stability was the key to thumb reconstruction. CMC joint stabilization with ligamentous reconstruction gave good results in three of four thumbs. Four CMC joint fusions and two CMC joint implant arthroplasties gave good results. Each was accompanied by appropriate procedures on the MP joint or interphalangeal joint.

Finger Joint↗
PubMed1980

Arthroplasty of the rheumatoid wrist with silicone rubber: an early evaluation.

A review of the results of 37 arthroplasties of the wrist with flexible silicone, done at least 6 months before, in patients with rheumatoid arthritis showed six (16%) to have residual discomfort and two (5%) to have recurrent deformity. Pain was the primary indication for treatment in 31 and deformity in six. Three of 37 wrists had prosthetic fractures (8%). Ten patients who had the opposite wrist fused before the arthroplasty felt the movable wrist was more functional. Contraindications are marked deformity, significant instability, excessive bone loss, and multiple tendon ruptures.

Adult↗
PubMed1978

Interpositional arthroplasty for rheumatoid carpometacarpal joint disease.

Over the past 3 years the Swanson great toe prosthesis was used in an interpositional arthroplasty at the carpometacarpal joint in 21 thumbs of 19 patients with rheumatoid arthritis and three thumbs of two patients with lumpus arthritis. In selected patients with advanced disease, this prosthesis has the advantage of allowing for correction of deformity while preserving carpal stock which may be important if a surgical procedure is required at the wrist. Stable capsular closure does not require reinforcement by adjacent tendon. Twenty-two thumbs of 19 patients were improved, although in three the prosthesis was malpositioned. Two patients required reoperation and removal of the prosthesis: one for infection, and one for failure to correct deformity. Overall functional results often were affected by the status of disease in other joints, but in general were acceptable.

Adult↗
PubMed1978

Chronic fracture-subluxation of the proximal interphalangeal joint.

Reported methods of treatment of chronic fracture-subluxations of the proximal interphalangeal joint require wide dissection and prolonged immobilization and often result in limited motion. Open reduction with minimal dissection, immobilization for 11 days to allow soft-tissue healing, and the early institution of active flexion exercises protected by an extension block splint was done in four patients. The long-term results demonstrate restoration of a stable joint with satisfactory motion and minimal subjective complaints.

Adult↗
PubMed1976

Stiffness of the proximal interphalangeal joints in rheumatoid arthritis. The role of flexor tenosynovitis.

In nineteen hands (seventy-four fingers) of eleven women and one man with rheumatoid arthritis there was restriction of active and passive motion of the proximal interphalangeal joints, with signs of flexor tenosynovitis but no clinical or roentgenographic evidence of involvement of the joint. The nineteen hands were treated by flexor tenosynovectomy (palm only in nine, palm and carpal tunnel in five, both palm and digits in four, and digit, palm, and wrist in one) combined with manipulation of the joint under regional anesthesia. After an average follow-up of twenty-one months (range, six to thirty-six months), the average range of active motion had increased from 40 to 84 degrees and the average range of passive motions, from 57 to 87 degrees. Only three patients had unsatisfactory results, one because of persistent unexplained swelling and two because of recurrence of the tenosynovitis.

Adolescent↗
PubMed1975

Surgical treatment of the swan-neck deformity in rheumatoid arthritis.

Swan-neck deformities vary not only in origin but also in the extent of functional loss. Careful examination used to determine the degree of flexion in all positions as well as x-ray examination of the joint has allowed us to group these patients into four types. Various surgical procedures are recommended according to this classification, which has made the treatment of these patients more orderly and rewarding.

Arthritis, Rheumatoid↗
PubMed1975

Surgical treatment of the boutonniere deformity in rheumatoid arthritis.

The rheumatoid boutonniere deformity does not limit hand function significantly until it becomes severe. For this reason the surgical procedures used should not risk or sacrifice existing function. For the mild cases one can improve the digital balance by a simple extensor tenotomy combined with dynamic splinting. In more advanced stages with passive correction possible, the deformity can be improved by reconstruction of the extensor mechanism. With fixed deformities one can choose between proximal interphalangeal joint fusion and arthroplasty. The decision is influenced by several factors, including the digit involved and the status of adjacent joints. After a careful evaluation of the patient's capabilities and needs, it is possible to improve these deformities by the methods discussed.

Arthritis, Rheumatoid↗
PubMed1975

Preventive surgery - tenosynovectomy and synovectomy.

The goal of preventative rheumatoid hand surgery is the eradication of the diseased synovium or tenosynovium before irreparable joint or tendon destruction occurs. Although there is general agreement that both dorsal and flexor tenosynovectomy are reliable and effective procedures to prevent the complications of tenosynovitis, the case for synovectomy is less well established. We have discussed the indications for both tenosynovectomy and synovectomy and described the surgical techniques used for dorsal tenosynovectomy and flexor tenosynovectomy in the wrist, palm, and digits. In addition, the treatment of both extensor and flexor tendon ruptures has been presented.

Arthritis, Rheumatoid↗
PubMed1975

Infection after silicone prosthetic arthroplasty in the hand.

After 2105 silicone prosthetic arthroplasties in the hands of 631 patients, infections occurred in ten. The average time from operation to onset of signs and symptoms of infection was seventeen days, and in seven of the ten patients the infecting organism was Staphylococcus aureus. Seven patients ultimately were treated by removal of the prosthesis, intravenous antibiotics for about five days, and oral antibiotics for about two weeks. At follow-up, twelve to fifty-six months after operation, nearly all of the patients had stable, somewhat stiff but pain-free joints, the results being similar to those after resection arthroplasty.

Adult↗