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Biomedical subjects

M Garcia-Elias

Publications and source records attributed to M Garcia-Elias.

At least 19 recordsLinked to original sources
PubMed2003

Relationship between joint laxity and radio-ulno-carpal joint morphology.

The relationships between wrist laxity, ulnar variance, sigmoid notch inclination, and lunotriquetral motion were analysed in 60 normal volunteers. A strong correlation between ulnar length and sigmoid notch inclination was found for the entire group. Joint laxity was found to correlate with ulnar variance and lunotriquetral mobility in women, but not in men. The greater the laxity, the shorter the ulna and the greater the lunotriquetral motion during radial to ulnar deviation. These results support the concept that laxity increases the vulnerability of the wrist to injury.

Adult↗
PubMed2002

Failed ulnar head resection: prevention and treatment.

Distal ulnar head resections may cause a painful impingement of the distal ulnar stump against the radius during loaded forearm rotation. Different soft-tissue procedures have been suggested to solve this difficult problem, but none has demonstrated clear superiority over the others. The introduction of a variety of ulnar head and total radio-ulnar joint prostheses has provided a new method of addressing this problem, but there is presently no evidence that these implants produce long-lasting results. This paper critically reviews these different options, and emphasizes techniques which may help to minimize the risk of complications when excision of the ulnar head is unavoidable.

Humans↗
PubMed2001

Partial excision of scaphoid: is it ever indicated?

The carpal scaphoid cannot be partially or totally excised without paying a functional penalty, usually in the form of carpal instability. In selected conditions, however, a partial scaphoidectomy may be preferred over other less reliable alternatives. These include excision of a small fragment of a fractured proximal pole when there is no injury to the scapholunate ligaments; excision of the distal fragment of a nonunited, arthritic distal-third scaphoid fracture; resection-arthroplasty of isolated STT osteoarthritis; and distal scaphoid excision to improve midcarpal function after a radioscapholunate fusion. In this article, both the pathomechanics and clinical results of such techniques are discussed.

Arthrodesis↗
PubMed2000

Dynamic radial translation instability of the carpus.

We report a case of a dynamic radial translation instability of the carpus, secondary to avulsion of the ulnocarpal ligaments and attenuation of the short radiolunate ligament. In addition, there was a peripheral detachment of the distal radioulnar ligaments causing distal radioulnar instability. Reattachment of the avulsed ligaments combined with a Sauvé-Kapandji procedure resulted in an excellent function, which was maintained 10 years after surgery.

Accidents, Occupational↗
PubMed1999

Prognostic factors in the treatment of carpal scaphoid nonunions.

The aim of this multicenter study of 138 patients with scaphoid nonunions was to assess the prognostic factors of bone healing or failure after curative surgical treatment options: isolated bone grafting (30%), internal fixation (23%), or combined bone grafting and internal fixation (47%). Bone healing occurred in 75% of cases. Persistent nonunion was evident in 20% of cases; it was possible in 6%. The clinical and radiologic results were worse in the group of failures. Stepwise multiple logistic regression analysis was conducted to identify the factors of prognosis toward bone healing or failure. In univariate analysis, professional heavy work, age of the nonunion of over 5 years, associated radial styloidectomy, and duration of postoperative immobilization were associated with a significantly decreased likelihood of healing of the scaphoid nonunion. In multivariate analysis, the only remaining predictor was the delay between the initial trauma and the treatment of the nonunion. Among the cases of internal fixation (with or without bone grafting), the only predictor in multivariate analysis was the importance of bone resorption. The dorsal approach resulted in a more pronounced loss of wrist flexion and extension amplitudes. If the time elapsed between the initial fracture and the treatment of the nonunion exceeds 5 years, the chances of healing of the nonunion are decreased.

Adult↗
PubMed1999

Resection of the distal scaphoid for scaphotrapeziotrapezoid osteoarthritis.

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119 degrees. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.

Adult↗
PubMed1998

Ulnar dislocation of the trapeziometacarpal joint: a case report.

An ulnar dislocation of the trapeziometacarpal joint is reported. On the posteroanterior radiograph of the wrist, the boney alignment appeared normal, and the only sign indicating a dislocation was a slight widening of the joint. By contrast, a true posteroanterior view of the trapezium clearly demonstrated the metacarpal ulnarly displaced. A late tendon reconstruction of the damaged palmar and medial ligaments produced a satisfactory result.

Adult↗
PubMed1998

Lateral closing wedge osteotomy for treatment of Kienböck's disease. A clinical and biomechanical study of the optimum correcting angle.

A retrospective clinical analysis of 20 patients who underwent a lateral closing wedge osteotomy of the radius as an adjuvant procedure to a radial recession in the treatment of Kienböck's disease is reported. The functional outcome is compared to the results of a simplified two-dimensional articulating force analysis (Rigid Body Spring Model) based on radiographs of the wrist of the same patients taken before and after surgery. At an average follow-up of 39 months, wrist function was excellent in 4 patients, good in 9, moderate in 6, and poor in one patient. A significant positive correlation between functional improvement and percent reduction of the calculated peak pressure at the radiolunate interval was found. This was maximal in patients with wedge osteotomies between 5 and 10 degrees.

Adolescent↗
PubMed1998

Soft-tissue anatomy and relationships about the distal ulna.

The author investigates the complex anatomic relationship between the ulnar head and adjacent osseous structures (radius and carpus). Special attention is directed to the orientation and shape of the articular surfaces the constraining effects of specific membranes and ligaments (radio-ulnar and ulnocarpal), the shock-absorbing function of the triangular fibrocartilage, and the dynamic action of specific muscles (pronator quadratus and extensor carpi ulnaris) The anatomy of other nonstabilizing structures (meniscus homologue and prestyloid recess) is also discussed.

Biomechanical Phenomena↗
PubMed1997

Kinetic analysis of carpal stability during grip.

When the wrist is grasping an object, at least four mechanisms of carpal stabilization are involved-one for each carpal row (proximal and distal), one for the midcarpal joint, and one for the radiocarpal joint. These mechanisms are based on the general principle that, under load-bearing conditions, any bone tends to rotate into a specific direction depending upon several factors, including the position of the wrist at the time of loading, the direction of the forces being transferred, and the inclination and shape of the articular surfaces on which the bone stands. Such an attempted displacement is initially guided and later neutralized by appropriately oriented ligaments, with which a new equilibrium is achieved. An injury or disease affecting any one of these mechanisms results in a specific type of carpal instability, depending upon which mechanism(s) has been violated. Only through a thorough understanding of these mechanisms of wrist stabilization will our ability to successfully treat these problems be enhanced.

Biomechanical Phenomena↗
PubMed1996

Combined fracture of the hook of the hamate and palmar dislocation of the fifth carpometacarpal joint.

A case of fracture of the hook of the hamate associated with a palmar dislocation of the fifth carpometacarpal joint is described. Surgical exploration revealed that the different elements of the flexor carpi ulnaris musculotendinous unit, which includes the pisiform, the pisohamate and pisometacarpal ligaments, were displaced proximally together with the avulsed fragment of the hook of the hamate and the fifth metacarpal. These findings suggest that such an injury results from a sudden, violent contraction of the flexor carpi ulnaris against the fixed wrist. It was successfully treated by open reduction and fixation of the hook of the hamate fracture and stabilization of the carpometacarpal joint.

Accidents, Traffic↗
PubMed1995

Influence of joint laxity on scaphoid kinematics.

Excessively lax wrists more frequently become symptomatic if overloaded or injured than normal joints. Whether this is the consequence of biological or mechanical factors or both remains unknown. This study evaluates the relationship between the degree of joint laxity and scaphoid kinematic behaviour during radio-ulnar deviation of the wrist in 60 normal volunteers. There is a significant linear relationship between the direction of scaphoid rotation and the amount of wrist joint laxity. During lateral deviation of the wrist, joints that are more lax have a scaphoid rotating mainly along the sagittal plane of flexion and extension, with little lateral deviation. In contrast, the scaphoid of volunteers with decreased laxity rotate mostly along the frontal plane of radioulnar deviation with minimal flexion extension. These results support the concept of increased out-of-plane scaphoid rotation as a factor of increased vulnerability during over-work or injury.

Adult↗
PubMed1993

Bennett's fracture combined with fracture of the trapezium. A report of three cases.

Three cases are reported in which open reduction and internal fixation were required to stabilize an unstable first carpometacarpal joint with simultaneous fracture of the trapezium and Bennett's fracture. The results were good in terms of range of movement and radiological appearance, all of them returning to normal activities, including heavy manual work.

Adult↗
PubMed1992

Flexor tendon forces: in vivo measurements.

S-shaped force transducers were developed for measurement of the forces along intact tendons. After calibration, the transducers were applied to the flexor pollicis longus and flexor digitorum superficialis and profundus tendons of the index finger in five patients operated on for treatment of carpal tunnel syndrome. The tendon forces generated during passive and active motion of the wrist and fingers were recorded. For pinch function, the amount of the applied load was measured with a special pinch meter. Tendon forces in the range of 0.1 to 0.6 kgf were measured during passive mobilization of the wrist. Tendon forces up to 0.9 kgf were present during passive mobilization of the fingers. Tendon forces up to 3.5 kgf were present during active unresisted finger motion. Tendon forces up to 12.0 kgf were recorded during tip pinch, with a mean applied pinch force of 3.5 kgf. These results have potential application in determining the amount of force that a tendon repair would have to resist during passive as well as active postsurgical mobilizations.

Carpal Tunnel Syndrome↗
PubMed1992

Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of sectioning the transverse carpal ligament.

The width of the carpal arch, represented in this study by the distance between the tips of two Kirschner wires--one inserted into the trapezium and another into the hook of the hamate--was measured with precision calipers in 21 patients with carpal tunnel syndrome, both before and after sectioning of the transverse carpal ligament and in different wrist positions. With the ligament intact, most of the wrists showed a decrease in the distance in both flexion and extension. The distance increased an average of 11% after sectioning of the transverse carpal ligament. The dynamic behavior of the carpal arch, however, was not substantially modified by this procedure.

Adult↗