Biomedical subjects

Michael R Hausman

Publications and source records attributed to Michael R Hausman.

7 recordsLinked to original sources

PubMed2006

Arthroscopic reduction-association of the scapholunate.

The reduction-association scapholunate (RASL) procedure for stabilization of the scapholunate joint is an alternative to soft-tissue procedures that do not maintain normal carpal alignment, despite reports of good symptomatic relief. The RASL procedure--indicated for patients with scapholunate instability or scapholunate dissociation without arthritis and, in selected cases, with stage 1 scapholunate advanced collapse of the wrist--can be performed arthroscopically. Radial midcarpal and 3-4 radiocarpal portals are used to excoriate and prepare the scapholunate joint surfaces. By use of 0.62'' K-wire joysticks in the lunate and distal pole of the scaphoid, the scaphoid undergoes dorsiflexion and supination while the lunate undergoes palmarflexion to achieve reduction. A .35'' guidewire is advanced through the scaphoid waist, across the scapholunate joint to the proximomedial corner of the lunate. Supplemental K-wire fixation, from the scaphoid to the capitatum and lunate to the radius, stabilizes the reduction for placement of a cannulated HBS screw (Orthosurgical Implants, Miami, FL) through a 1-2 portal, while reduction and positioning are confirmed arthroscopically. Arthroscopy facilitates anatomic reduction of the joint, as well as the critically important, precise placement of the cannulated HBS screw, by use of 3 portals rather than the traditional 2-incision approach.

Arthroscopy↗

PubMed2006

Wrist arthrofibrosis.

Wrist arthrofibrosis is a condition of decreased range of wrist motion due to intrinsic adhesions and extrinsic contracture. It is clinically characterized by restricted wrist range of motion, pain, swelling, and a plateau in improvement after at least 6 months of intensive physiotherapy. Other conditions must be excluded, such as articular incongruity, arthritis, spasticity, skin and subcutaneous scarring, and loose bodies. We have devised a classification system based on pathologic anatomic location, where Type I represents intrinsic adhesions, and Type II represents extrinsic contracture. The types are subdivided according to where the pathology is present. The operative approach should be wrist arthroscopy for Types IA (radiocarpal adhesions) and IB (midcarpal adhesions) where intraarticular adhesions are present. Types IC (distal radioulnar joint adhesions) and II C (distal radioulnar joint capsular contracture) are best approached in an open manner where dorsal and palmar capsulectomies of the distal radioulnar joint are performed. For Types IIA, B, and D (dorsal, palmar, and combination extrinsic contracture, respectively), both open and arthroscopic methods are described.

Adult↗

PubMed2005

Management of the distal radioulnar joint in rheumatoid arthritis.

The DRUJ frequently is involved in RA and can be a source of major disability. Nonoperative treatment consists of adequate hand/occupational therapy, judicious splinting, and pharmacologic management. If unacceptable pain and dysfunction persists or if there is tendon rupture, surgery is indicated. Surgical treatment ranges from debridement and soft tissue balancing if the joint is preserved to osseous procedures ranging from Darrach resection, Sauve-Kapandji procedure, hemiresection, to distal ulna replacement. Tendon ruptures usually require tendon transfers. If an osseous procedure is required, the authors prefer the Sauve-Kapandji procedure in the younger, active adult. Darrach distal ulna resection is recommended for the older, sedentary patient. For either procedure, if there is evidence of pre-existing radiocarpal instability, partial or total wrist arthrodesis or arthroplasty should bea concomitant procedure.

Arthritis, Rheumatoid↗

PubMed2004

Intractable wounds and infections: the role of impaired vascularity and advanced surgical methods for treatment.

Fracture nonunion, delayed union, and osteomyelitis remain serious problems with substantial morbidity and mortality rates. Healing promoters, including bone morphogenic proteins, fibroblast growth factors, and transforming growth factor-beta, regulate bone growth in experimental models, such as those employing a "critical gap" to establish nonunion, but have not been effective in clinical situations. This paradox may relate to the fact that such agents target cells, yet in the setting of a clinical nonunion or osteomyelitis, the affected area is frequently hypovascular and therefore deficient in target precursor cells. Wound healing is dependent on local tissue vascularity. Surgical procedures, such as local and remote tissue transfer, which are designed to modify this cell-deficient, poorly vascularized environment, have proved very successful but are often complex and costly. No simple pharmacologic means of upregulating such angiogenesis currently exists.

Fractures, Ununited↗

PubMed2004

Interposition elbow arthroplasty.

Pain and loss of motion associated with elbow arthritis is poorly tolerated and constitutes a major functional impairment. While total elbow arthroplasty reliably alleviates pain and improves motion, durability issues mandate restricted indications and light use. Interposition arthroplasty, combined with hinged external fixation, is an alternative and may be preferred in younger, more active patients anticipating heavier use.

Journal Article↗

PubMed2003

Hand transplantation: current status.

The hand is a very special organ, with unique functions and versatility in the human body. Our hands are pivotal in manipulating our environment, receiving feedback from our surroundings and communicating our unspoken words by gestures. Thus, the loss of a hand is a tragic, disfiguring event with profound personal, vocational, financial and social implications. Transplantation of life-saving solid organs is now widely accepted in both the medical and lay communities. The technical skills and prerequisites for hand transplantation have been honed over recent decades, culminating in the recent commencement of hand transplantation in several centers around the world. However, unlike life-saving solid organ transplantation, hand transplantation has been greeted with less enthusiasm in the professional community because it is not yet clear what the long-term risks-to-benefits ratio is. The scientific background, and the potential risks, benefits, and ethical aspects of this procedure are discussed. Successful transplantation to amputees of fully integrated and functional hands is a worthy goal. Hopefully, at some point in the future, hand transplantation will become another safe and viable option for amputees to consider.

Amputation, Traumatic↗

PubMedDate not supplied

Implanted neuroprostheses for restoration of hand function in tetraplegic patients.

Restoration of hand function through functional electrical stimulation allows tetraplegic patients to use existing abilities to control paralyzed muscles. In patients with C5 or C6 spinal cord injuries, implanted upper extremity neuroprostheses use functional electrical stimulation technology to power hand and arm muscles. A variety of devices, often using contralateral shoulder motion, sends signals via a small external controller and transmitting coil to an implanted stimulator. The stimulator powers designated upper extremity muscles via implanted electrodes. The surgical procedure is minimally invasive and easily reversed. Palmar and lateral grasp, among other functions, can be reliably restored, leading to significant improvements in functional capacity. High user satisfaction, low complication rates, and recent advances in technology and control systems contribute to the success of this technology in the treatment of devastating spinal cord injuries.

Electric Stimulation↗