Arthroscopic ankle surgery. Overcoming anatomic difficulties with improved techniques.
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Ankle Joint↗
Biomedical subjects
P T Hergenroeder
Publications and source records attributed to P T Hergenroeder.
Osteochondritis dissecans of the femoral condyles.
Because the results of treatment of osteochondritis dissecans of the femoral condyles are still not consistently satisfactory, we reviewed the cases of eighty-three patients (ninety-five knees) with osteochondritis dissecans who were followed for two to thirty-one years to identify factors that may influence treatment and long-term prognosis. Of the eighty-three patients, sixteen had only non-surgical treatment, sixty-five had only surgical treatment, and two had non-surgical treatment of one knee and surgical treatment of the other. Of the twenty-two knees (eighteen patients) that were treated non-surgically, fifteen were treated before and seven were treated after distal femoral epiphyseal closure. Of the seventy-three knees (in sixty-seven patients) that were treated surgically because of persisting symptoms, twenty-three were treated before epiphyseal closure and fifty, after closure. At follow-up, each knee was given a rating of excellent, good, fair, poor, or failure, and a corresponding point score. Seventy-seven per cent of the knees in the surgical group and 82 per cent of those in the conservatively treated group were rated either excellent or good. The average scores in both groups were higher in knees in which the osteochondritic defect was small and was treated before epiphyseal closure, and in knees in which the fragment healed as compared with the ones from which the fragment was removed. We found that knees with osteochondritis dissecans of the femoral condyles that had no other abnormal physical findings or functional disability responded well to conservative treatment before epiphyseal closure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Wound complications in the surgical management of Dupuytren's contracture: a comparison of operative incisions.
A prospective study was carried out comparing the z-plasty, volar zig-zag and open-palm incisions in eighty-two patients undergoing partial selective fasciectomy for Dupuytren's disease. Flap necrosis, haematoma, and postoperative pain were greatest following the z-plasty and zig-zag incisions. While healing was somewhat delayed and a digital nerve was lacerated in the transverse open-palm group, the complication rate was lower overall and we now prefer this technique for partial selective fasciectomy for Dupuytren's disease.
Dupuytren Contracture↗
The results of radial and ulnar arterial repair in the forearm. Experience in three medical centers.
Sixty-two patients with ninety injuries to the radial or the ulnar artery, or to both of these arteries, had arterial repairs using microvascular techniques in three medical centers. Twenty-six of the twenty-eight patients who had an ischemic hand secondary to injuries to both arteries and a successful operative repair had at least on patent vessel at follow-up. Of the other two patients, one had an amputation through the forearm for ischemia of the hand and the other had a viable hand supplied by collateral vessels, although both the radial and the ulnar arteries were thrombosed. The over-all success rate for all repairs was 54 per cent. After 47 per cent of the one-artery and 57 per cent of the two-artery lacerations, the vessels were patent at follow-up. Repairs of acute sharp transections of the radial artery within thirty-six hours of injury were most successful. Of the factors other than operative technique that strongly influence vessel patency after repair, back pressure in the distal arterial stump and the extent of the ischemia of the hand relative to its normal blood supply (a function of the completeness of the palmar arch) appear to be the most important.
Adolescent↗
The carpal tunnel syndrome. A study of carpal canal pressures.
We measured intracarpal canal pressures with the wick catheter in fifteen patients with carpal tunnel syndrome and in twelve control subjects. The mean pressure in the carpal canal was elevated significantly in the patients. When the wrist was in neutral position, the mean pressure was thirty-two millimeters of mercury. With 90 degrees of wrist flexion the pressure increased to ninety-four millimeters of mercury, while with 90 degrees of wrist extension the mean pressure was 110 millimeters of mercury. The pressure in the control subjects with the wrist in neutral position was 2.5 millimeters of mercury; with wrist flexion the pressure rose to thirty-one millimeters of mercury, and with wrist extension it increased to thirty millimeters of mercury. Carpal tunnel release brought about an immediate and sustained reduction in pressure.
Adult↗
The vascularity of the flexor pollicis longus tendon.
The vascularity of ten human flexor pollicis longus tendons was studied by injection and clearing techniques. Four separate vascular systems supply the tendon from the musculotendinous junction to the osseous insertion. The proximal two systems and the distal two systems are separated by an avascular zone over the metacarpophalangeal joint. While there are differences in the vascularity of the flexor pollicis longus tendon and the other digital flexor tendons, the intrinsic vascularization is similar. Differences in vascularity alone would not account for good recovery of function following repair of flexor pollicis longus.
Humans↗
Compartment syndromes of the forearm: diagnosis and treatment.
Twenty-six patients with suspected forearm compartment syndromes were evaluated clinically and by intracompartmental pressure determinations. The most reliable physical findings indicating a forearm compartment syndrome were marked pain on passive digital extension and reduced hand sensibility or paresthesias. Pressure determinations were most helpful in evaluating comatose patients and patients with equivocal physical findings. A curvilinear volar incision and, when indicated, a straight dorsal incision provided adequate decompression in the ten operatively treated patients. Postfasciotomy pressure determinations were helpful in assessing the adequacy of volar and dorsal decompression.
Adult↗