Non-osseous complications following distal radius fractures.
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Colles' Fracture↗
Biomedical subjects
P J Stern
Publications and source records attributed to P J Stern.
Trapeziometacarpal joint arthrodesis: a functional evaluation.
Over a 10-year period, 39 trapeziometacarpal (TM) joint fusions were performed in 37 patients. Pin fixation was used in 27 fusions and staple fixation in 12; all were bone grafted. There were five delayed unions (greater than 3 months) and three nonunions. Twenty-four fusions were evaluated at an average of 4 years. Subjectively, there were 11 excellent, 7 good, 5 fair, and 1 poor result. Grip and pinch strength were symmetrical, and the nine-hole peg test (a measurement of dexterity) was slightly better on the treated side. X-ray films were taken and compared with 25 normal films to assess metacarpal mobility. There was a 72% reduction in the adduction/abduction arc and a 61% reduction in the flexion/extension arc. Despite the marked decrease in motion, subjective functional complaints were minimal. X-ray films were evaluated independently by a radiologist to assess progression of degenerative changes. Only two patients were noted to have changes at the scaphotrapezial joint.
Activities of Daily Living↗
Distal interphalangeal joint arthrodesis: an analysis of complications.
One hundred thirty-nine patients underwent 181 arthrodeses of finger distal interphalangeal joints (144) and/or thumb interphalangeal joints (37). Techniques included (1) crossed Kirschner pins (111 joints), (2) interfragmentary wire and longitudinal Kirschner pin (43 joints), and (3) Herbert screw (27 joints). Each technique had a similar nonunion rate. There were 21 nonunions: 13 were pain free, 6 were successfully fused on the second attempt, 1 was painful (but the patient refused further surgery), and 1 was amputated. Inadequate bone stock, inadequate bone resection, premature pin removal, and infection appear to complicate the attainment of bony union. Twenty percent of the fusions had major complications (nonunion, malunion, deep infection, and osteomyelitis). Minor complications (dorsal skin necrosis, cold intolerance, proximal interphalangeal joint stiffness, paresthesias, superficial wound infection, and prominent hardware) occurred in 16% of the joints fused.
Arthrodesis↗
Secondary nerve reconstruction.
Presented is a review of nerve grafting, including the indications, technique, and results. Alternative techniques, including vascularized nerve grafts, tubulization, nerve elongation, and direct muscle neurotization are also discussed.
Humans↗
Upper extremity tendinitis and overuse syndromes in the athlete.
Overuse injuries are the result of repetitive microtrauma to the musculotendinous unit. Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response with rest, elevation, and ice is the treatment objective during the inflammatory stage. Prevention of further injury is the primary treatment goal throughout the proliferative phase. Once the inflammatory process has reached the maturation stage, rehabilitation can begin with flexibility exercises, isometric contractions, and a slow return to strength training. Surgical decompression is frequently necessary if chronic inflammation causes fibrosis of the fibro-osseous tendon sheaths. Anomalous muscle bellies and tendinous interconnections can be contributing factors to overuse syndromes. Properly structured training programs and rehabilitation regimes can prevent tendinitis and overuse syndromes.
Athletic Injuries↗
Reconstruction of the burned thumb.
The thumb accounts for 40 to 50% of hand function. Reconstruction of soft-tissue contractures include release and coverage with skin grafts or various local, regional, distant, or free flaps. Thumb length, so important for prehension and opposition, can be restored by phalangealization, pollicization, or toe-to-thumb transfer. Secondary techniques such as metacarpal distraction-lengthening or osteoplastic reconstruction are rarely indicated.
Burns↗
Acute management of thermal and electrical burns of the upper extremity.
Acute management of upper extremity thermal and electrical injuries requires an aggressive treatment protocol which combines meticulous wound care, intensive hand therapy, and early stable wound coverage to salvage upper extremity function. Electrical injuries inflict severe deep-tissue destruction that frequently results in major limb amputation.
Arm Injuries↗
Digital ischemia in clandestine intravenous drug users.
Five young adults were seen initially with digital ischemia without a history of trauma or underlying systemic illness. After careful evaluation and treatment, inadvertent intraarterial drug injection was found to be the cause of the ischemia. The diagnosis was initially overlooked because the patients did not offer a history of drug abuse and did not appear like the stereotypical drug user. These patients may be seen early or several months after their accidental intraarterial injection. With the increase in drug abuse today, all segments of society can be affected. This diagnosis should be considered in any patient with unexplained digital ischemia.
Adolescent↗
The abductor digiti minimi muscle flap: an adjunct in the treatment of metacarpal osteomyelitis.
The abductor digiti minimi muscle has a constant 1 to 1.5 cm neurovascular pedicle that arises from the ulnar artery and nerve within Guyon's canal. We have successfully used the abductor digiti minimi as a pedicle transfer as an adjunct in the treatment of chronic osteomyelitis of the small and ring finger metacarpal shafts.
Adult↗
Pilon fractures of the proximal interphalangeal joint.
A pilon fracture is an uncommon intraarticular fracture of the proximal interphalangeal (PIP) joint resulting in comminution, central depression, and splay, sagittally and coronally, of the articular surface of the base of the middle phalanx. This study reviews three treatment methods and results in 20 patients. Injury was produced by an axial load and occurred primarily to the ulnar digits. Clinical and radiographic follow-up averaged 25 months. Treatment was divided into three categories: splint (four patients), skeletal traction through the middle phalanx (seven patients), and open reduction with Kirschner pins (nine patients). Anatomic restoration of PIP articular contour was not achieved, regardless of technique. No patient regained full mobility at either interphalangeal joint. Treatment by immobilization is undesirable. Open reduction should be approached cautiously and may result in significant complications. Skeletal traction is safe and gives results that are radiographically and clinically comparable to those achieved with open reduction.
Adult↗
The distal radioulnar joint complex in rheumatoid arthritis: an overview.
Rheumatoid arthritis frequently involves the distal radioulnar joint region and is progressive. Early recognition of involvement is paramount to offering patients appropriate and timely treatment. Early operative intervention should be considered preventative. Synovectomy, hemiresection interposition technique, matched distal ulna resection and distal radioulnar fusion with creation of a pseudarthrosis through the distal ulnar shaft have been advocated for patients with early involvement. Distal ulnar resection remains the most commonly used procedure for advanced disease. No soft tissue reconstructive procedure to stabilize the ulnar stump offers distinct advantages. They should be considered modifiers and augmentations to distal ulna resection. Judicious resection of the ulnar head minimizes instability of the ulnar stump. The use of an ulnar cap is not recommended for routine use.
Arthritis, Rheumatoid↗
Technical successes and functional failures after free tissue transfer to the tibia.
A retrospective study evaluated functional outcome in 59 patients with 61 successful free tissue transfers performed after open tibial fractures. Twenty-one patients had transfers done within 7 days, 13 between 7 and 21 days, and 25 were done greater than 3 weeks after injury. All 59 patients had Type III injuries as classified by Gustilo and Anderson. Nineteen patients (32%) were identified as late functional failures. Each of these patients underwent as average of 10 procedures. In this group chronic osteomyelitis was noted in 13 of 19 patients and chronic venous insufficiency with skin ulceration in 9 of 19 patients. Fracture nonunion was seen in 8 of 19. Degenerative joint problems and foot deformities were identified in 7 or 19 patients. Seven patients (12%) ultimately required below-knee amputation. Functional failure did not correlate with the timing of flap application, but rather with the severity of the initial injury. Free tissue transfer is not a panacea. It is but one step in the overall reconstruction of complex tibial wounds.
Adult↗
Classification and treatment of postburn metacarpophalangeal joint extension contractures in children.
Two hundred and seventy-eight surgically treated postburn metacarpophalangeal joint extension contractures in children were reviewed. A classification system based on the limitation of passive metacarpophalangeal flexion was devised to direct surgical intervention and assess postoperative results. Type I (47%) digits demonstrated greater than 30 degrees of metacarpophalangeal flexion with the wrist fully extended, and scarring was generally limited to the dorsal skin. Type II (34%) digits demonstrated less than 30 degrees of metacarpophalangeal flexion with the wrist maximally extended, and scarring typically involved skin, dorsal apparatus, and metacarpophalangeal capsule. Type III (19%) digits were fixed in greater than 30 degrees of metacarpophalangeal hyperextension and often demonstrated incongruity or dorsal subluxation of the metacarpophalangeal joint. Improvement after reconstruction was seen in 95% of type I digits, 73% of type II digits, and 47% of type III digits. Failure to improve usually resulted from inadequate scar release/excision or from failure to release deep soft tissues (dorsal apparatus or metacarpophalangeal capsule). Thirty secondary procedures were done to improve an unsatisfactory result after the initial reconstruction. These included deep releases, metacarpophalangeal joint arthrodeses, and amputations. The ring and small fingers accounted for 65% of the digits in this study, 68% of the failures, and all seven amputations.
Adolescent↗
Upper extremity burn contractures.
Upper extremity burn contractures are a major challenge to the reconstructive surgeon. Despite increasing sophistication in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in the hand. Reconstructive options for axillary, antecubital, wrist, metacarpophalangeal joint, and interdigital web contractures are discussed, with special emphasis on the techniques and advantages of local flap reconstruction.
Arm↗
Selected acute infections.
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Acute Disease↗
Tendinitis, overuse syndromes, and tendon injuries.
Tendinitis and overuse syndromes plague athletes and performing artists. Although rarely career ending, both may impair performance for significant periods of time. This article emphasizes the distinction between these two entities and discusses proper diagnosis and treatment.
Cumulative Trauma Disorders↗
Transection of radial digital nerve of the thumb during trigger release.
Iatrogenic laceration of the radial digital nerve of the thumb during trigger release occurred in four patients. Histologic cross sections through the thumb in cadaveric specimens at the level of the metacarpophalangeal crease showed the radial digital nerve to be 2.19 mm beneath the dermis and 1.15 mm directly anterior to the radial sesamoid bone. In this position the nerve is vulnerable to transection when it is trapped between the sesamoid and the knife blade.
Adult↗
Digital nerve calcification in CREST syndrome.
A patient with the CREST variant of scleroderma with painful digital nerve calcification is presented. Surgical removal of the calcification provided pain relief; however, there was no return in sensibility.
Aged↗