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Biomedical subjects

R H Gelberman

Publications and source records attributed to R H Gelberman.

14 recordsLinked to original sources
PubMed1979

Forearm arterial injuries.

The effects of single forearm arterial injuries with and without associated neurological injuries were studied. Fifty subjects were evaluated: seven patients with isolated arterial lacerations, 15 patients with isolated nerve lacerations, 13 patients with combined nerve and arterial injuries, and 15 control subjects. A series of noninvasive peripheral vascular studies were correlated with the symptoms produced by a controlled cold-environment exposure. The hemodynamic alterations associated with symptoms of hand ischemia, and particularly with cold intolerance, were studied. Unrepaired single arterial injuries caused modest, consistent alterations in hand vascularity, but few signs of ischemia or symptoms of cold intolerance. The remaining intact artery demonstrated a consistent increase in flow velocity. Combined nerve and artery injuries caused the most significant alterations in hand vascularity, and median nerve and associated artery injuries caused the most disabling symptoms. Single arterial lacerations had no effect on the rate or completeness of recovery from associated nerve injuries.

Arteries↗
PubMed1979

Fractures at the base of the thumb: treatment with oblique traction.

Oblique traction on the thumb metacarpal, originally described for the treatment of Bennett's fracture, has been applied to comminuted intra-articular fractures of the thumb metacarpal to counter the forces that cause shortening and varus angulation. It also has been applied to fractures of the trapezium to restore congruity of the trapeziometacarpal joint. It was successful in achieving and maintaining a satisfactory reduction in eight patients with these three types of fractures.

Evaluation Studies as Topic↗
PubMed1978

Digital sensibility following replantation.

The amputated digit serves as an excellent model for the examination of digital nerve repair. When amputation is complete, there is no question of cross-over or anomalous innervation. The sensibility of 35 replanted digits in 29 patients was evaluated. Sensory return was related most closely to restored digital vascularity, as measured by Allen test, pulse volume flow, and Doppler. Level of amputation, mechanism of injury, and age of patient also affected ultimate sensation. All patients experienced cold intolerance and some were considerably disabled because of it. The severity of cold intolerance with pain and requiring prolonged rewarming was directly proportional to digital vascularity. When one digital artery thrombosed, ipsilateral digital sensation was not diminished as long as flow through the contralateral vessel was adequate. Two-point discrimation in our series was not as good as that reported for digital nerve repair in the nonamputated digit. Establishing and maintaining adequate digital flow at the time of replantation is essential to obtain good digital sensibility and to avoid symptoms of cold intolerance.

Adolescent↗
PubMed1978

Skeletal metastases of melanoma.

Sixteen hundred and seventy-seven melanoma patients were treated at Duke University Medical Center from 1956 to 1976. Osseous metastases were more common than previously reported and occurred in 116 patients (6.9 per cent), most often in the axial skeleton. Diagnosis was made by roentgenogram, bone scan, or both in the symptomatic patient. Seventy-five patients sustained pathological fractures, most of which were successfully treated conservatively. Nine of the ten patients with neurological symptoms were improved by laminectomy. The grave prognosis for melanoma patients with osseous metastases (mean survival, 3.6 months) led to conservatism even for an impending pathological fracture. Unstable pathological fractures of long bones were treated by internal fixation and irradiation.

Adult↗
PubMed1978

Acute ulnar neuropathy with fractures at the wrist.

Injury to the ulnar nerve associated with or following a fracture at the wrist is unusual. Three cases of this association are presented. Previously reported cases have been reviewed. The associated lesions tend to occur in young adults after higher-energy trauma and more dorsal displacement of the distal radial fragment than are generally seen in patients with Colles fractures. The return of function in the three wrists was related to the promptness and accuracy of reduction of the fracture and to the decompression of the ulnar nerve in Guyon's canal. We present a regimen for treatment of this injury stressing accurate reduction of the fracture and early surgical decompression when necessary.

Adult↗
PubMed1978

Hand metastasis from melanoma: a case study.

Metastases to the hand are rare. Most frequently they result from carcinomas of the lung, breast or kidney. This is a case report of a rare peripheral metastatic lesion in a 24-year-old man with melanoma. There are no previously reported hand metastases from melanoma. Because of the extremely poor prognosis for patients with osseous metastases from melanoma, treatment should be palliative.

Adult↗
PubMed1975

Ulnar variance in Kienböck's disease.

The distal extent of the radius and ulna (ulnar variance) was compared on roentgenograms of normal wrists in randomly selected black and white patients and of fifteen affected wrists in patients with Kienbock's disease. The results establish a statistically significant association between negative ulnar variance and Kienbock's disease. Blacks have more positive ulnar variance and the disease is less likely to develop in them than in whites.

Female↗
PubMed1975

High-pressure injection injuries of the hand.

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.

Amputation, Surgical↗
PubMedDate not supplied

Decompression of forearm compartment syndromes.

The diagnosis of forearm compartment syndrome by clinical findings alone has been difficult and inconsistent. This study was designed to assist in the diagnosis and treatment of forearm compartment syndromes. We evaluated several forearm incisions and determined their effectiveness by measuring compartment pressures using the wick catheter. The wick catheter is a simple, safe, and effective means of determining forearm compartment pressures. Preoperative and intraoperative measurements of the dorsal as well as the volar compartment pressures should be performed. Volar fasciotomy is effective in decompressing the volar compartment and may be effective in lowering the dorsal compartment pressure as well. Dorsal fasciotomy should be performed when that pressure remains elevated following volar decompression. The curvilinear volar and volar-ulnar incisions were equally effective in lowering compartment pressures experimentally, but the curved incision allowed beteer exposure to nerves and vessels and is preferred.

Adult↗