PubMed Health⌕ Search

Biomedical subjects

Martin I Boyer

Publications and source records attributed to Martin I Boyer.

At least 19 recordsLinked to original sources
PubMed2007

Microvascular transplantation of epiphyseal plates: studies utilizing allograft donor material.

Compromised function of an epiphyseal plate caused by trauma, tumor, infection, or congenital malformation can result in significant musculoskeletal deformity. Techniques used to correct or minimize the extent of these deformities include autogenous or allogeneic cancellous bone grafts, nonvascularized cortical allografts, vascularized bone and composite tissue transfers, and distraction osteogenesis. These solutions are not ideal for children because they do not adequately address the actively growing nature of the extremity. Microvascular techniques have enabled the experimental transplantation of vascularized epiphyseal plates with high levels of postoperative viability and subsequent growth and offer a potential advantage over conventional treatments.

Animals↗
PubMed2006

Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment.

PURPOSE: To evaluate objective functional and radiographic outcomes after internal fixation of acute, displaced, and unstable fractures of the distal aspect of the radius in adults by using a low-profile dorsal plating system. Our hypothesis was that the low-profile dorsal plating system would allow for a reduction of extensor tendon irritation and pain and provide stable osseous fixation. METHODS: Sixty consecutive unstable fractures in 59 patients were treated by open reduction internal fixation using a low-profile dorsal plating system. There were 29 type A, 14 type B, and 8 type C fractures (AO classification system). Fifty patients with 51 fractures returned for outcomes assessment by physical examination, plain radiographs, and completion of a validated musculoskeletal function assessment questionnaire. The minimum follow-up period was 1 year; the mean follow-up period was 24 months. Clinical evaluation was performed and plain radiographs were assessed for maintenance of immediate postoperative reduction and implant position. Objective functional assessment was obtained through the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Outcomes analysis showed no cases of extensor tendon irritation or rupture. Hardware removal was performed in 1 patient but no extensor tendon irritation or rupture was evidenced. The mean Disabilities of the Arm, Shoulder, and Hand score was 11.9; implant-related discomfort was minimal. All patients had an excellent (31 patients) or good (19 patients) result according to the scoring system of Gartland and Werley. The mean active range of motion was greater than 80% of that of the contralateral wrist in flexion/extension, pronation/supination, and ulnar/radial deviation. Extensor tendon function was unimpaired in all patients. Grip and pinch strength averaged 90% and 94% of the contralateral sides, respectively. Radiographic evaluation showed no change in fracture reduction or implant position. CONCLUSIONS: The treatment of distal radius fractures with a low-profile stainless steel dorsal plating system is a safe and effective method that provides stable internal fixation and allows for full extensor tendon glide and full metacarpophalangeal joint motion. Objective outcome testing showed uniformly good to excellent recovery of wrist and hand function in all patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2006

Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series.

PURPOSE: To report our experience using a fixed-angle volar plate in conjunction with a corrective osteotomy and cancellous bone graft for the treatment of distal radius malunions with dorsal angulation in 4 patients. METHODS: Four consecutive patients had a volarly based opening wedge osteotomy with a fixed angle volar plate and cancellous bone grafting for the treatment of a dorsally angulated distal radius malunion. Data collected retrospectively included a visual analog pain scale, grip strength, range of motion, radiographic parameters, and each patient's subjective functional outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand questionnaire. Motion, strength, and radiographic values were compared with the contralateral arm for each patient. RESULTS: The average time from initial fracture to corrective osteotomy was 346 days. The average length of follow-up evaluation was 13.5 months. The flexion-extension arc of motion increased an average of 21 degrees to a value of 84% of the contralateral side; the pronation-supination arc of motion increased an average of 20 degrees to a value of 98% of the contralateral side. The average tilt of the radius improved from 26 degrees extension to 2 degrees extension; the average radial inclination improved from 22 degrees to 24 degrees; the average ulnar variance excluding the 1 patient who had a distal ulna resection improved from 5 mm to 1 mm. The average retrospective Disabilities of the Arm, Shoulder, and Hand score improved from 30 to 7; the average retrospective visual analog pain scale score improved from 4.5 to 1. The average grip strength increased from 20 to 29 kg, which corresponded to 73% of the contralateral extremity. CONCLUSIONS: The rigid characteristics of fixed angle volar plates can provide an alternative to the traditional techniques of distal radius osteotomy including structural bone grafting and dorsal plate fixation or external fixation. In addition these plates are strong enough to allow for early postoperative motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗
PubMed2006

Use of routine histologic evaluation of carpal ganglions.

PURPOSE: Although histologic evaluation is performed routinely on tissue removed during the excision of carpal ganglions, the necessity of this evaluation is uncertain. We evaluated the use of routine histologic evaluation of excised carpal ganglions and performed a cost-benefit analysis. METHODS: A retrospective review identified 160 consecutive carpal ganglion (102 dorsal, 58 volar) excisions performed over the past 7 years by 2 surgeons. The preoperative evaluation, surgical findings, and results of the pathologic assessment were evaluated for patients treated with a typical carpal ganglion excision. RESULTS: In 156 of 160 patients the preoperative and intraoperative data were highly suggestive of a carpal ganglion; the pathology reports confirmed the diagnosis in all of these patients. No new information was provided by pathologic assessment. In 4 patients the preoperative and intraoperative assessments were less certain; the pathologic assessments in these patients also were equivocal. No malignancy or condition requiring additional treatment was identified. At our institution the total cost of pathologic evaluation for a carpal ganglion including processing and interpretation fees is $352. CONCLUSIONS: Routine histologic examination of excised dorsal and volar carpal ganglions may be unnecessary if the preoperative and intraoperative evaluations are consistent with a diagnosis of carpal ganglion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Biopsy↗
PubMed2006

Pyrolytic carbon arthroplasty for posttraumatic arthritis of the proximal interphalangeal joint.

PURPOSE: To prospectively evaluate the subjective and objective functional outcome of patients treated with a pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty for posttraumatic arthritis. METHODS: Five patients (7 joints) with traumatic injuries to the PIP joint were followed up for more than 1 year after pyrolytic carbon arthroplasty. All patients were treated with surgical reduction and stabilization at the time of the initial injury, but at a minimum of 6 months after the initial injury they had persistent pain, loss of motion, and functional limitations. All patients had a stable PIP joint with a satisfactory extensor mechanism but had radiographic evidence of posttraumatic arthritis. Patients were evaluated before and after arthroplasty with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and visual analog scale and by radiographic and physical examination. RESULTS: At an average of 17 months, the mean DASH questionnaire score was unchanged. The pain rating on the visual analog scale was 6 out of 10 before surgery and 4 out of 10 after surgery; this change was not statistically significant. The average range of motion of the PIP joint decreased by 10 degrees at the last evaluation. Grip strength improved from an average of 47 lb to 63 lb after surgery. CONCLUSIONS: The subjective and objective functional outcomes in 5 patients more than 1 year after pyrolytic carbon PIP joint arthroplasty for PIP joint trauma were disappointing. For posttraumatic patients, we no longer use pyrolytic carbon PIP joint arthroplasty.

Adult↗
PubMed2005

Flexor tendon biology.

Significant advances in the understanding of intrasynovial flexor tendon repair and rehabilitation have been made since the early 1970s. The concept of adhesion-free, or primary tendon healing--that tendons could heal intrinsically without the ingrowth of fibrous adhesions from the surrounding sheath has been validated both experimentally and clinically in studies over the past 25 years. Recent attempts to understand and improve the results of intrasynovial flexor tendon repair have focused upon restoration of the gliding surface, augmentation of early post-operative repair site biomechanical strength and on the elucidation of the molecular biology of early post-operative tendon healing. The goals of the surgical treatment of patients with intrasynovial flexor tendon lacerations remain unchanged: to achieve a primary tendon repair of sufficient tensile strength to allow application of a post-operative mobilization rehabilitation protocol. This program should inhibit the formation of intrasynovial adhesions and restore the gliding surface, while facilitating the healing of the repair site.

Biomechanical Phenomena↗
PubMed2005

Nerve decompression for complex regional pain syndrome type II following upper extremity surgery.

PURPOSE: To evaluate the results of nerve decompression for the symptoms of complex regional pain syndrome that developed after upper-extremity surgery. METHODS: Eight patients (5 men, 3 women) developed worsening severe pain, swelling, and loss of range of motion after an upper-extremity surgery. The diagnosis of complex regional pain syndrome was made at an average of 6 weeks (range, 1-10 weeks) after the surgical procedure. A clinical diagnosis of either median or combined median and ulnar nerve compression at the wrist was confirmed in all patients with electrophysiologic testing. Nerve decompression was performed at a mean of 13 weeks after the procedure. Subjective (Disabilities of the Arm, Shoulder, and Hand questionnaire; visual analog pain scale) and objective (forearm, wrist, and finger range of motion; grip strength) data from before and after nerve decompression were reviewed. RESULTS: The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire decreased from 71 to 30 (p < .05). The mean visual analog pain score decreased from 7.5 to 1.8. (p < .05) There was immediate and near-complete resolution of all somatic complaints including hypersensitivity to touch, hyperhydrosis, swelling, and cold sensitivity. Range of motion and grip strength improved. CONCLUSIONS: Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients.

Aged↗
PubMed2005

Ulnar-sided wrist pain: diagnosis and treatment.

Ulnar-sided wrist pain has often been equated with low back pain because of its insidious onset, vague and chronic nature, intermittent symptoms, and frustration that it induces in patients. Chronic ulnar-sided wrist pain may be accompanied by a history of workers' compensation claims and unrelenting and irresolvable pain, and it may occur in patients with dfficult personalities. Despite these issues, many patients with ulnar-sided wrist pain have pathologic lesions that may be amenable to surgical treatment.

Arthralgia↗
PubMed2004

Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation.

PURPOSE: To compare anatomic tilt radiographs with standard posteroanterior (PA) and lateral radiographs for their efficacy in detecting screw penetration of the distal radius articular surface. METHODS: Twenty-four cadaveric human forearm specimens had fixation with a dorsal distal radius plate and screws. Three groups were evaluated: (1) no articular surface screw penetration, (2) radial-sided articular screw penetration, and (3) ulnar-sided articular screw penetration. Standard PA and lateral views and anatomic tilt PA and lateral views were taken of each specimen. Three observers reviewed both individual (PA or lateral) and paired (PA and lateral) radiographs. These radiographs were evaluated based on whether or not articular penetration had occurred. A number between 1 and 5 was assigned to represent the degree of certainty of their assessment. The accuracy of the observers was calculated to determine if screw penetration of the articular surface had occurred and, if so, which screw had penetrated the joint. The sensitivity and specificity of each view, interobserver reliability, and the reviewers' confidence in evaluating presence or absence of screw penetration were calculated. RESULTS: The use of anatomic tilt lateral views significantly improved the overall accuracy, (0.93 vs 0.64), sensitivity (0.98 vs 0.77), and specificity (0.83 vs 0.38) of the detection of articular screw penetration when compared with standard lateral views. PA and lateral anatomic tilt views, when viewed together, significantly improved (p <.001) the accuracy of each observer's determination of the position of the penetrated screw (0.90 vs 0.67). In addition, anatomic tilt views significantly improved the confidence of the reviewers in their more accurate observations (4.7 vs 3.3, p <.05). CONCLUSIONS: Anatomic tilt PA and lateral radiographs of the distal radius are an accurate and clinically useful tool for the evaluation of both presence and location of screw penetration of the articular surface after dorsal plating.

Bone Plates↗
PubMed2004

Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting.

PURPOSE: There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation. METHODS: Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers. RESULTS: At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment. CONCLUSIONS: Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.

Adult↗
PubMed2004

The accuracy of high-resolution ultrasound for evaluating focal lesions of the hand and wrist.

PURPOSE: Although several articles have described the sonographic features of solid and cystic lesions of the hand and wrist, few have investigated its accuracy for diagnosing such lesions. The purposes of this retrospective study were to determine the accuracy of sonography for diagnosing focal lesions of the hand and wrist against the standard of histologic examination of the resected specimen and to compare the accuracy of sonography against the recorded initial clinical impression. METHODS: A medical record search for all sonographic studies of the hand and wrist at our institution was performed. Eighty-four patients had correlative surgery and made up the study group. All sonogram reports were reviewed for the absence or presence of focal lesions and specific diagnoses and all medical records were reviewed for the initial clinical impression. Both were compared with histologic findings and tested for agreement with the kappa statistic and for significant differences with the McNemar test RESULTS: Seventy-six of the 84 patients had focal lesions of the hand and wrist and 8 had normal sonograms. Overall, ultrasound correctly diagnosed 83% of the lesions and the initial clinical impression was correct in 54%. Of the 76 lesions ultrasound correctly diagnosed 87% of cystic lesions, 73% of solid lesions, 75% of tenosynovitis cases and the single-vessel thrombosis. The initial clinical impression was correct in 67% of cystic lesions and 75% of tenosynovitis cases. The solid or cystic nature of the 15 solid lesions and the single-vessel thrombosis could not be determined by history or physical examination alone. Of the 35 cases in which the recorded clinical impression was incorrect or not recorded ultrasound provided the correct diagnoses in 71% of these cases. Agreement with the kappa statistical analysis was only fair and the recorded initial clinical impression was less accurate than ultrasound. CONCLUSIONS: Ultrasound was statistically more accurate than the initial clinical impression for distinguishing solid from cystic lesions of the hand and wrist. Ultrasound was very accurate for specifically diagnosing ganglions and slightly less for solid lesions and tenosynovitis.

Adolescent↗
PubMed2004

Tendon injury response: assessment of biomechanical properties, tissue morphology and viability following flexor digitorum profundus tendon transection.

Insertion site injuries of the flexor digitorum profundus (FDP) tendon often present for delayed treatment. Apart from gross observations made at the time of surgery, the changes that occur in the flexor tendon stump during the interval from injury to repair are unknown. These changes may include tendon softening and loss of viability, which may contribute to the poor outcomes observed clinically and experimentally. Thirty-eight FDP tendons from 23 adult dogs were transected sharply from their insertions on the distal phalanges and were not repaired. Dogs were allowed full weight bearing and were euthanized 7 or 21 days after injury. Biomechanical testing indicated that the resistance of injured tendons to pullout of a Kessler-type suture was not different from control tendons at 7 days and was increased at 21 days by 25% (p<0.05). Morphologically, at 7 and 21 days the cut surface had a smooth appearance and the end of the injured tendon was increased in thickness by 30% and 50%, respectively (p<0.05). Histologically, we observed increased cellularity and dramatic fibroblast proliferation within the injured tendon stump; there was no evidence of decreased cell viability. We conclude that during the interval from 0 to 21 days after FDP insertion-site injury, tendons cells are viable, proliferative and synthesizing new matrix. This leads to increased tendon size and enhanced resistance to suture pullout. These findings offer a scientific rationale supporting the clinical practice of surgical re-attachment within the first 3 weeks after injury.

Animals↗
PubMed2004

Survival of microvascular physeal allograft transplants following withdrawal of short-term postoperative immunosuppression.

BACKGROUND: Physeal necrosis following vascularized allograft transplantation occurs because of vascular rejection. The effect of immunosuppression withdrawal on physeal viability after bone-healing to the recipient site was investigated with use of a validated model for heterotopic microvascular transplantation of rabbit tibial physeal allografts. Our hypothesis was that an allograft survives after withdrawal of immunosuppression only if bone-healing, and therefore epiphyseal and metaphyseal vascular continuity, occurs between the transplanted physis and the recipient bone. METHODS: Physeal grafts with adjacent exposed epiphyseal and metaphyseal bone were transplanted to allogeneic recipients. Graft circulation was restored microsurgically. The immunosuppression regimen consisted of cyclosporine, administered for six weeks, followed by withdrawal of immunosuppression for four weeks. The animals were killed at ten weeks postoperatively. Group I consisted of twelve allografts that were transferred with bone contact between the transplanted graft and the iliac crest recipient site, whereas group II consisted of twelve allografts transplanted without bone contact. Control groups had identical surgical procedures without immunosuppression. Longitudinal growth was assessed by fine-detail radiography, and osseous union was evaluated histologically. Transplanted physes were evaluated histologically, and cellular viability was quantified by bromodeoxyuridine uptake. Two-way analysis of variance was used to compare physeal viability between groups. RESULTS: Following immunosuppression withdrawal, the physeal grafts with bone contact had significantly greater viability indices (16.0 +/- 2.9 compared with 0.0 +/- 0.0, p < 0.005) and decreased longitudinal growth (5.1 +/- 1.9 mm compared with 10.3 +/- 3.5 mm, p < 0.05), and they demonstrated histological features that were consistent with continued viability associated with mild rejection compared with grafts transplanted without bone contact. Abnormalities of physeal architecture, however, were seen routinely. All control physes transferred without immunosuppression were nonviable and did not grow. CONCLUSIONS: The viability of physeal allograft transplants is preserved following the withdrawal of immunosuppression, provided that the graft design and recipient site preparation allow for epiphyseal and metaphyseal neovascularization mediated by bone-healing between graft and recipient.

Animals↗
PubMed2004

Giant cell tumors of the tendon sheath: analysis of sonographic findings.

OBJECTIVE: The purpose of this study was to analyze the sonographic characteristics of giant cell tumors of the tendon sheath. CONCLUSION: Giant cell tumors of the hand typically appear as solid, homogeneous hypoechoic masses with detectable internal vascularity that are associated with the flexor tendons of the fingers.

Adolescent↗
PubMed2003

Development and validation of new model for microvascular transplantation of epiphyseal plate allografts with minimal adjoining epiphyseal and metaphyseal bone.

A model for the free allograft microvascular transplantation of rabbit proximal tibial epiphyseal plate allografts was developed, validated, and tested in an in vivo animal model. Transplants contained the minimum amount of adjacent epiphyseal and metaphyseal bone compatible with preservation of the epiphyseal-plate vascular supply, as determined by corrosion casting. Perfusion to this graft was evaluated quantitatively using radioactive microspheres, and qualitatively using India-ink injection. Female New Zealand White rabbits at 12 weeks of age were utilized. Vascularized transplantation of epiphyseal plate allografts was performed either into a defect of matched size in the iliac crest or into a soft-tissue pocket without bone contact. Cyclosporine A immunosuppression (CSA) was administered daily for 6 weeks. Two control groups underwent identical surgical procedures, but had no postoperative immunosuppression. Epiphyseal plates both with and without bone contact, in rabbits immunosuppressed postoperatively with CSA, demonstrated longitudinal growth and preserved viability as determined by positive bromodeoxyuridine uptake. Control epiphyseal plates transferred without postoperative immunosuppression were uniformly nonviable. This new model has value as a basis for further studies into the clinical applicability of isolated epiphyseal-plate transplants.

Animals↗
PubMed2003

Bone loss following tendon laceration, repair and passive mobilization.

Little is known about the localized changes in bone mass that occur following tendon or ligament injury. Interruption of normal load transfer at the insertion site will presumably lead to a localized loss of bone, although few data exist to support this claim. To test this hypothesis, we transected the canine flexor digitorum profundus (FDP) tendon from its insertion, and either repaired it using a trans-osseous suture technique or left it unrepaired (laceration only). Post-operatively, forelimbs in the repair group were cast immobilized except for 10 min of daily passive mobilization rehabilitation, whereas in the laceration only group dogs were allowed full weight bearing. At 5-42 days post-injury, we assessed bone mineral density (BMD) using pQCT and osteoclast surface by histomorphometry. We measured significant bone loss in the distal phalanx after combined FDP tendon laceration, repair, and post-operative passive mobilization, with BMD decreases of 20%, 40%, and 41% at 10, 21, and 42 days (p<0.01). Moreover, we observed that passive mobilization and tendon laceration each contributed independently to the observed bone loss. At 42 days, BMD was reduced by 21% in bones that were not injured but were subjected to the post-operative passive mobilization protocol, while BMD was reduced by 28% in bones subjected to tendon laceration and full weight bearing (p<0.01). In both the passive mobilization and laceration specimens, we counted significantly increased osteoclasts after only 7-10 days, and these increases persisted through 42 days (p<0.05). We conclude that rapid and sustained bone resorption leads to significant bone loss in the 6-week period following flexor tendon injury and repair. This bone loss may impact healing by impeding the restoration of a strong tendon-bone interface.

Animals↗
PubMed2003

Neovascularization of the flexor digitorum profundus tendon after avulsion injury: an in vivo canine study.

PURPOSE: The changes in matrix material properties and intrinsic vascularization that have been noted in intrasynovial tendon stumps after avulsion injury may be of considerable clinical relevance with regard to the results of surgical repair. Our objective was to determine both the time course and the source of neovascularization of the tendon stump in an in vivo canine model of flexor digitorum profundus (FDP) avulsion after a clinically relevant delay in diagnosis. METHOD: The FDP tendon was released from bone directly by sharp dissection and the vinculum brevis profundus was lacerated, simulating an avulsion injury with interruption of the vascular supply to the tendon stump. After death at 7 and 21 days, tendon vascularity was evaluated with India ink injection and clearing using a modified Spalteholtz technique. RESULTS: All 7-day specimens showed an absence of vascularity compared with the controls. In all 21-day specimens a direct vascular supply originated from local fibrovascular adhesions contacted the stump on its surface and blood vessels penetrated the tendon stump circumferentially. Progressive vascularization of the avulsed tendon stump occurred between 7 and 21 days after injury, originating from fibrovascular adhesions to the surrounding synovial sheath. CONCLUSIONS: Whereas previous studies of intrasynovial flexor tendon laceration and repair have shown a progressive proximal to distal neovascularization of the FDP during the early postoperative period, longitudinal proximal to distal growth from the proximal blood supply of the FDP was not observed toward the unrepaired tendon stump.

Animals↗