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Biomedical subjects

R C Lewis

Publications and source records attributed to R C Lewis.

At least 37 records · Page 2Linked to original sources
PubMed1988

Biomechanical and clinical evaluation of the expandable intramedullary fixation device.

The use of an expandable intramedullary device for internal fixation of metacarpal or phalangeal bones is described. The device is applicable to transverse fractures, short oblique fractures, or transverse osteotomies. The device consists of a cylindrical apparatus made of titanium that allows collapse in the circumferential diameter. It is introduced into the medullary canal in its collapsed state, and on release expands to its normal diameter in the canal with the fracture reduced over it. A biomechanical evaluation compared the stability of this device with other commonly employed fixation methods. A retrospective review is presented of the first 43 patients in whom the device was implanted.

Adult↗
PubMed1988

Treatment of upper extremity reflex sympathetic dystrophy with joint stiffness using sympatholytic Bier blocks and manipulation.

Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48- to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 81% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.

Arm↗
PubMed1988

Scapholunate instability following ganglion cyst excision. A case report.

Complications following ganglion cyst excision include a 3%-50% recurrence rate, wrist stiffness, infection, neuroma formation, and keloid formation. Scapholunate instability is almost never seen as a complication of ganglion excision. Scapholunate instability occurred following excision of a dorsal ganglion in the wrist of a 38-year-old man.

Adult↗
PubMed1987

Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire.

Carpal tunnel syndrome is one of the most common problems seen by the hand surgeon. In spite of its frequent occurrence there are several aspects of its treatment that remain controversial. A survey of the members of the American Society for Surgery of the Hand determined whether a consensus exists concerning the treatment of carpal tunnel syndrome among surgeons who regularly treat hand problems.

Carpal Tunnel Syndrome↗
PubMed1987

Expandable intramedullary device for treatment of fractures in the hand.

Because the hand tolerates disuse so poorly, the beginning of early motion following fractures is important in achieving early restoration of function. This report concerns the use of a unique, expandable intramedullary device for internal fixation of metacarpal or phalangeal shaft fractures that renders enough intrinsic stability that motion may be started early without fear of loss of reduction. The device is applicable for transverse or short oblique fractures and consists of a cylindrical apparatus made of titanium that allows for collapse in the circumferential diameter. It is introduced into the medullary canal in its collapsed state, and then is released to allow reexpansion into its normal diameter in the canal with the fracture reduced over it. This gives excellent fixation and affords stability approaching that of normal bone. Minimal postoperative immobilization is needed and early restoration of motion is possible. The device may also be used to immobilize metacarpal bones or phalanges following osteotomies, and it appears to be excellent for fixation of the bone in digits to be replanted. No complications have occurred in the reported series.

Finger Injuries↗
PubMed1986

The tenon method of small joint arthrodesis in the hand.

A technique for arthrodesis of small joints of the hand is described that uses a tenon to secure apposition that has good intrinsic stability as well as a large surface area of cancellous bony contact. A minimum of postoperative immobilization is required. The tenon arthrodesis method has been employed in 85 joints. The literature shows pseudoarthrosis rates of 0 to 33%. This technique had a 2.3% failure rate that compares favorably with those in other published series.

Arthrodesis↗
PubMed1986

Median nerve compression caused by a synovial cyst.

A case of median nerve compression at the wrist by a synovial cyst is described. Precise localization of the source of the synovial cyst was determined by surgical exploration and visualization of the carpal tunnel space.

Carpal Tunnel Syndrome↗
PubMed1986

Undesirable neighbors.

Explore the source record for details and available documents.

Community Mental Health Centers↗
PubMed1985

Injuries of the cervical spine in high school wrestling.

Severe injuries to the cervical spine and spinal cord have been widely reported from many causes: automobile accidents, diving mishaps, falls, and contact sports. This paper concerns three young men who sustained severe trauma to the cervical spine and spinal cord during high school wrestling. Certain head-holds are prone to cause such injuries. Their tetraparesis and tetraplegia were reversed by reducing the fracture-dislocation and internal stabilization, in one case by decompressive laminectomy when no bony disruption was encountered. Their recoveries were satisfactory, but prevention of these cervical injuries may be accomplished by elimination of the more dangerous holds in wrestling.

Adolescent↗
PubMed1985

Infections of the hand.

The unique anatomic arrangements in the hand make possible rapid extension of infections through synovial-lined spaces if abscesses are not drained and pressure is allowed to build up. Adequate knowledge of these anatomic features and of routes for surgical drainage is mandatory if one is to give adequate management of hand infections. Localized processes, such as paronychia, felon, and human bite infections also require special insight for adequate treatment.

Abscess↗
PubMed1985

High-compression injection injuries to the hand.

The importance of a specific effect of various agents injected into the hand cannot be overemphasized, since the outpouring of inflammatory edema fluid as a response to the more sclerotic solutions leads to tamponade and occlusion of digital vessels. Moreover, it has been shown that the vascular insufficiency is further increased by actual necrosis of small vessel walls caused by these solutions, which coagulate the protein of the arteriolar and arterial wall. The pathologic physiology is described, which indicates that the usual case of high-compression injection of foreign material into the hand develops severe and sometimes catastrophic consequences related to the tamponade effect occurring from the compression force, the quantity of material injected, and the subsequent outpouring of inflammatory edema fluid occasioned by the chemical irritation of these substances within the tissues. Based upon these findings, it has been pointed out that early treatment of these injuries is mandatory, with adequate incision along diagonal lines on the palmar surface of the hand made with the idea of decompressing the tamponade effect on the digital vessels as well as evacuation of the foreign material. Careful cleansing of the surrounding tissues to remove extensions of the material from the central mass is important. Finally, the postoperative measures, the late treatment procedures, and the rehabilitative surgical procedures have been described.

Accidents, Occupational↗
PubMed1984

The restoration of sensibility by nerve translocation.

A unique method is described for restoring sensibility to the completely anesthetic digits occurring as a result of irreparable segmental loss of median or ulnar nerves. Functioning proximal nerve ends are translocated into distal nonfunctional digital nerves. In all five cases presented, protective or better sensation was restored to the anesthetic digits.

Adolescent↗
PubMed1984

Digital nerve-grafting for traumatic defects. Use of the lateral antebrachial cutaneous nerve.

We used segments of the lateral antebrachial cutaneous nerve to graft defects in forty-two digital nerves in thirty-five patients. Age was a more important prognostic indicator for functional sensibility than either the length of the nerve graft or the time-interval from injury to grafting. The younger patients did better. A battery of eight tests was used to determine functional sensibility scores. All patients improved and 40 per cent had completely normal sensibility.

Adolescent↗
PubMed1983

The lateral antebrachial cutaneous nerve as a highly suitable autograft donor for the digital nerve.

The lateral antebrachial cutaneous and digital nerves were compared by a histomorphometric method in each patient from a series of patients in whom a digital nerve was grafted with the lateral antebrachial cutaneous nerve as donor. Statistical analysis by the paired Student's test of paired data sets from all patients showed that there was no significant difference between the two nerves in regard to the following parameters: fascicular area, area of the entire nerve bundle, and percent of the nerve bundle occupied by the actual nerve fascicles. These data, together with other observations reported here, strongly support the hypothesis that the lateral antebrachial cutaneous nerve closely resembles the original fascicular pattern of the digital nerve and is, therefore, a highly suitable donor for the digital nerve.

Adult↗