An agenda for plastic surgery in the twenty-first century.
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Career Choice↗
Biomedical subjects
P M Weeks
Publications and source records attributed to P M Weeks.
Fascicular topography of the median nerve: a computer based study to identify branching patterns.
This study was undertaken to definitively describe the internal anatomy of the median nerve. Thirty median nerves were dissected in the distal forearm and hand. Sixteen nerves were sectioned every 250 to 1000 microns along their length. Computer programs were developed in our laboratory to digitize and store the data. Analysis of our data has shown the following consistent findings: (1) the number of fascicles remains relatively constant over the centimeter lengths of the nerve; (2) over 75% of the sections contain zero to one fascicular branching; (3) fascicular groups destined for the same endpoint remain localized within the nerve for long distances; and (4) calculation of Wilks' lambda demonstrates a high degree of group fascicular regionality.
Humans↗
Coincident rupture of the scapholunate and lunotriquetral ligaments without perilunate dislocation: pathomechanics and management.
Wrist injuries causing coincident disruptions of the scapholunate and lunotriquetral ligaments commonly result in perilunate dislocations. This article (1) describes our management of eight patients with wrist pain after coincident scapholunate and lunotriquetral ligament disruptions in the absence of perilunate dislocation; and (2) reports the results of biomechanical testing of some of the extrinsic and intrinsic wrist ligament and interprets these data to explain the injury seen clinically. The diagnosis of ligament failure was made on the basis of history, physical examination, arthrography and surgical exploration. Surgical treatment of seven patients consisted of concomitant scapho-trapezio-trapezoid fusion and lunotriquetral fusion. Three of seven patients were free of pain, two had pain only at the extremes of motion, and two required additional surgery. Biomechanical analysis of the scapholunate and lunotriquetral ligaments and two extrinsic wrist ligaments, the radiolunotriquetral and the radioscaphocapitate, confirmed the clinical suspicion that the intrinsic ligaments could be completely disrupted while the extrinsics are only partially injured. Such a scenario could account for the residual stability that prevents the development of perilunate dislocations. Coincident disruption of the scapholunate and lunotriquetral ligaments in the absence of perilunate dislocation is an unusual injury. Treatment with lunotriquetral fusion and scapho-trapezio-trapezoid fusion restored functional use in five of seven wrists while maintaining wrist motion.
Adult↗
Wrist pain: a systematic approach to diagnosis.
Numerous radiographic procedures are now available to help determine the cause of wrist pain. This paper presents a wrist-pain algorithm that defines the relative roles of various radiographic techniques in the evaluation of patients with wrist pain. Practical application of the algorithm is demonstrated through illustrative cases.
Adult↗
Management of chronic lunotriquetral ligament tears.
Treatment of chronic disruptions of the lunotriquetral (LT) ligament is not well-defined. Eleven patients treated by LT fusion with use of a compression screw are reported. The injury frequently resulted from hyperextension of the wrist. Pain on the ulnar side of the wrist, limited motion, and tenderness over the LT joint exacerbated by ballottement were present. Standard radiographs were normal. Arthrography showed the ligamentous tear in all cases. After operation, immobilization was continued until fusion was apparent radiographically. Fusion was achieved in all cases between 2 and 5 months. Four patients were free of pain, four patients had pain only at the extremes of motion, and three patients had persistent pain. Mean wrist motion was as follows (preoperative/postoperative): flexion (53 degrees/45 degrees), extension (60 degrees/49 degrees), radial deviation (17 degrees/21 degrees), and ulnar deviation (25 degrees/18 degrees). Maximum grip strength as a percentage of the uninjured side was 73% preoperatively and 59% postoperatively. LT tears can exist de novo or as part of the ulnar impaction syndrome; a method for differentiation is presented.
Adult↗
Management of synovial sarcoma of the median nerve at the elbow.
Synovial sarcoma is a high-grade malignancy with a marked propensity for local recurrence and a moderate rate of regional lymph node involvement. It usually causes death from massive pulmonary metastases. Despite its aggressive biologic behavior, en bloc wide local resection of small extremity tumors rather than amputation may be indicated if removal of all gross disease is possible. Extremity morbidity from resection of vessels, nerves, and soft-tissue bulk can be minimized by the use of composite reconstruction techniques currently available. A case report is presented to illustrate aggressive limb-sparing surgical therapy of a small, favorably located synovial sarcoma with immediate neurovascular and soft-tissue reconstruction. The literature is reviewed to aid subsequent surgeons faced with management of this uncommon tumor.
Abdominal Muscles↗
Identification of the collagen-producing cells in healing flexor tendons.
A monoclonal antibody to procollagen type I (anti-pC) which specifically stains cells synthesizing collagen was used to study the healing of chicken flexor tendons in vivo. Healing was assessed using routine hematoxylin and eosin histology and immunoperoxidase staining with anti-pC. Studies showed that epitenon cells proliferate 3 days after injury and are producing collagen by 7 days after injury. Tenocytes do not begin producing collagen until 14 to 21 days after injury. From 3 to 5 weeks, the entire substance of the tendon becomes filled with collagen-synthesizing cells. These cells may have originated from the tendon sheath, the epitenon, or the endotenon; however, the evidence presented in this study suggests that the epitenon is a major source of these cells.
Animals↗
Role of radionuclide imaging in the evaluation of wrist pain.
The cause of hand and wrist pain can be difficult to determine, especially when standard radiographs are normal or show only nonspecific changes. This study reports the effectiveness of radionuclide imaging in the evaluation of patients with hand and wrist pain of uncertain cause. Eighty-eight patients with hand and wrist pain and initially normal standard radiographs were evaluated prospectively by additional radiographic methods including the following: routine tomography, wrist arthrography, computerized tomography, or magnetic resonance imaging. Each patient also had bone scintigraphy. The diagnosis established by clinical assessment and by other imaging methods was then compared with the scintigraphic findings. The presence or absence of focal scintigraphic abnormalities correlated with the presence or absence of focal pathology definable by the conventional methods in 88% of patients. As expected, scintigraphy was chiefly of value in defining the locus of an injury or other process in the wrist, rather than the nature of an abnormality. The scintigrams were abnormal in 95% of cases involving complete intrinsic ligament ruptures and fractures and were normal in 96% of patients with no definable injury. Scintigraphic findings correlated poorly with partial intrinsic ligament injuries and in cases of synovitis. Radionuclide imaging is a sensitive means of detecting focal lesions in patients with hand and wrist pain of unknown cause.
Adult↗
Arthrographic surface anatomy of the carpal triangular fibrocartilage complex.
In a review of 364 radiocarpal and 123 distal radioulnar joint arthrograms we identified 44 (12%) patients with contrast defects at either the proximal or distal surface of the carpal triangular fibrocartilage complex (TFCC). Differences in their arthrographic characteristics distinguished two separate groups of patients; one with similar and another with dissimilar appearing TFCC surface contrast collections. Thirty-one of our 44 patients had similar appearing, isolated radial-sided collections at either the proximal or distal TFCC surfaces. Our arthrographic, demographic, and historical study of these patients suggests that the collections are not caused by traumatic partial TFCC tears but represent a normal anatomic variant, probably a synovial recess at the radial TFCC attachment. Arthrography and dissection of a limited number of cadaveric specimens confirmed this conclusion. The second group included the remaining 13 patients. This group had contrast collections at either the proximal or distal TFCC surface, which varied in location and appearance. This smaller group is more likely to represent those uncommon patients with partial TFCC defects caused by tears.
Adolescent↗
Multiple nerve dysfunction after carpal tunnel release.
A case is reported of the delayed onset of multiple nerve dysfunction after simple carpal tunnel release. The patient received a local anesthetic with the use of an arm tourniquet. The multiple dysfunctions included radial sensory and motor dysfunction at 5 days, anterior interosseous nerve syndrome at 33 days, and ulna intrinsic motor loss between 33 and 77 days after operation. There was no recovery in the radial or anterior interosseous nerves after 5 months of conservative management. At operation the radial nerve was compressed by the intermuscular septum, and the anterior interosseous nerve was compressed by the superficialis arcade. Decompression was followed by complete recovery.
Adult↗
Fracture of the dorsoulnar tubercle of the trapezium.
The dorsoulnar tubercle of the trapezium may fracture, and this fracture may be missed without precise physical examination and correct radiographic studies. If there is persistent localized pain and tenderness in this region and the results of routine wrist radiographic examination are normal, a bone scan should be performed. If there is localized uptake in the area of the trapezium, additional radiographic studies may be necessary to confirm or exclude this fracture. Four patients with this previously unreported fracture and a method for its detection are presented.
Adult↗
Autonomous healing of chicken flexor tendons in vitro.
A monoclonal antibody to procollagen type I, which specifically stains cells actively secreting collagen, was used to study the healing of chicken flexor tendons in vitro. Healing was assessed with histology, immunohistologic staining, and autoradiography. Studies showed that epitenon cells proliferate 2 days after injury and are producing collagen 4 days after injury. Endotenocytes remain dormant during this time period. Tendons in vitro demonstrate active collagen synthesis and thus the capacity for autonomous repair.
Animals↗
Digital ischemia of the upper extremity: a systematic approach for evaluation and treatment.
Symptomatic upper extremity digital ischemia is an uncommon disorder reflecting diverse etiologies. Herein we present an algorithm to aid in evaluation and treatment of digital ischemia. This approach seeks to establish the diagnosis and lead to appropriate treatment while minimizing testing and therapy. Practical application of the algorithm is demonstrated through illustrative cases.
Adult↗
Characteristics and management of flexor tendon graft disruption.
In order to define the proper management of patients with disruption of a flexor tendon graft, 220 consecutive flexor tendon grafts were reviewed. Patients were divided into two groups--those who did not require a silastic rod prior to tendon grafting (89 grafts) and those who did require a silastic rod prior to tendon grafting (131 grafts). The incidence of tendon graft disruption for these two groups was 1.1% and 7.6%, respectively. Based on an analysis of these 11 graft disruptions, a method of management was devised. The literature is reviewed regarding the incidence and method of management of disrupted flexor tendon grafts.
Adolescent↗
Carpal avascular necrosis: MR imaging.
The authors evaluated the use of magnetic resonance (MR) imaging in diagnosis of avascular necrosis (AVN) of carpal bones by examining 21 patients with wrist pain and two healthy volunteers. MR images were compared with conventional radiographs in every case and with bone scintigrams in 18 cases. MR imaging was slightly less sensitive than bone scintigraphy in depicting AVN, but in patients who were imaged with long repetition time (TR)/long echo time (TE) sequences in addition to short TR/short TE sequences, MR imaging was found to be more specific. While the authors believe that bone scintigraphy remains the screening test of choice for patients with wrist pain and normal plain radiographs, MR imaging promises to add significant diagnostic information in cases in which bone scans are abnormal.
Adult↗
Biomechanical behavior of the scapholunate ligament.
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Aged↗
Three-dimensional wrist imaging: evaluation of functional and pathologic anatomy by computer.
The wrist has been studied morphologically and functionally using advanced technology. The osseous morphology of the wrist was investigated by computed tomography and surface reconstruction software. The functional behavior of the wrist in motion was studied using electromagnetic tracker technology. Three-dimensional imaging from CT scans is emerging as a research tool for the study of gross surface morphology, especially for osseous structures. One of the most demanding applications of this technology lies in the human wrist, because of its small size and inherent complexity. We have demonstrated some of the potential of computer graphics and three-dimensional surface reconstructions in the wrist for patients with osseous abnormalities. Acquisition of six-degree-of-freedom kinematic data to describe carpal motion has been made possible by new electromagnetic tracker technology. Analysis of these data in human wrist experiments revealed that the instantaneous center of rotation was not fixed in the head of the capitate, as was previously thought.
Adult↗
Disseminated histoplasmosis presenting as an acute tenosynovitis.
Disseminated histoplasmosis is usually a multifocal process with a wide variety of clinical presentations. Despite frequent bone marrow involvement, overt bone and joint disease is uncommon and isolated synovial involvement is extremely rare. We describe in this report an unusual case of disseminated histoplasmosis presenting as acute tenosynovitis. To our knowledge, this is only the second reported case of synovial involvement by H. capsulatum without a concomitant osseous lesion.
Acute Disease↗