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Biomedical subjects

R H Gelberman

Publications and source records attributed to R H Gelberman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Quantification of the radial torsion angle with computerized tomography in cadaver specimens.

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).

Aged↗
PubMed1997

Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation.

The purpose of this retrospective study was to determine the long-term functional and radiographic outcomes in a series of young adults (less than forty-five years old) in whom an acute displaced intra-articular fracture of the distal aspect of the radius had been treated with operative reduction and stabilization. Twenty-six fractures in twenty-six patients met the initial inclusion criteria for the study. Twenty-one patients returned for a physical examination, imaging (plain radiographs and computerized tomography scans), and completion of a validated musculoskeletal function assessment questionnaire at a minimum of 5.5 years. The physical examinations were performed by the same observer, who was not involved in the initial care of the patients. The plain radiographs and computerized tomography scans were assessed in a blinded fashion by two independent observers who measured the radiographic parameters with standardized methods. At an average of 7.1 years, osteoarthrosis of the radiocarpal joint was evident on the plain radiographs and computerized tomography scans of sixteen (76 per cent) of the twenty-one wrists. A strong association was found between the development of osteoarthrosis of the radiocarpal joint and residual displacement of articular fragments at the time of osseous union (p < 0.01). However, the functional status at the time of the most recent follow-up, as determined by physical examination and on the basis of the responses on the questionnaire, did not correlate with the magnitude of the residual step and gap displacement at the time of fracture-healing. All patients had a good or excellent functional outcome irrespective of radiographic evidence of osteoarthrosis of the radiocarpal or the distal radio-ulnar joint or non-union of the ulnar styloid process. It appears prudent therefore to base the indications for salvage operative procedures on the presence of severe symptoms or a loss of function rather than on radiographic evidence of osteoarthrosis of the radiocarpal joint.

Adolescent↗
PubMed1997

The extraosseous and intraosseous arterial anatomy of the adult elbow.

UNLABELLED: We investigated the extraosseous and intraosseous arterial anatomy of the human adult elbow. Twenty-two fresh adult cadaveric upper extremities were studied with a technique of combined India-ink and latex injection followed by chemical débridement. The intraosseous vascularity of twelve extremities was then evaluated with a rapid Spalteholz clearing technique. Our findings demonstrated consistent patterns of extraosseous and intraosseous vascular anatomy, which were organized into three vascular arcades: medial, lateral, and posterior. The medial arcade was formed by the superior and inferior ulnar collateral arteries and the posterior ulnar recurrent artery. The lateral arcade was formed by the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The posterior arcade was formed by the medial and lateral arcades and the middle collateral artery. The intraosseous circulation of the elbow, which was segmental in organization, appeared to be dependent on the local blood supply. The capitellum and the lateral aspect of the trochlea were supplied by posterior perforating vessels arising from the radial recurrent, radial collateral, and interosseous recurrent arteries. The medial aspect of the trochlea was supplied by a circumferential vascular ring originating from the inferior ulnar collateral artery. Watershed areas were apparent between the blood supplies to the medial and lateral aspects of the distal end of the humerus. The olecranon was richly supplied by vessels coursing along its medial aspect from the posterior ulnar recurrent artery and along its lateral aspect from the interosseous recurrent artery. The radial head had a dual extraosseous blood supply from a single branch of the radial recurrent artery, which supplied the head directly, and from additional vessels from both the radial and the interosseous recurrent artery, which penetrated the capsular insertion at the neck of the radius. CLINICAL RELEVANCE: Our findings demonstrate that arterial contributions to the intraosseous circulation of the elbow are more specific than previously appreciated. The intraosseous circulation of the elbow is derived mainly from perforating vessels that arise from neighboring extraosseous arteries. These perforating arteries may be damaged by trauma or by extensile dissection during reconstruction of the elbow. An understanding of the extraosseous and intraosseous circulation of the elbow may help to avoid iatrogenic injury to the intraosseous circulation.

Adult↗
PubMed1997

The Marshall R. Urist Young Investigator Award. Autogenous flexor tendon grafts. Biologic mechanisms for incorporation.

To examine the hypothesis that different types of dense regular connective tissue may have different repair mechanisms within the synovial space, intrasynovial and extrasynovial autogenous donor flexor tendon grafts were placed within the synovial sheaths of the medial and lateral forepaw digits of dogs. Histologic, ultrastructural, biochemical, and biomechanical analyses were done between 10 days and 6 weeks after tendon grafting. Intrasynovial tendon grafts remained viable when transferred to the synovial space and appeared to heal through an intrinsic process with preservation of the gliding surface and improved functional characteristics. Extrasynovial tendon grafts functioned as a scaffolding for the early ingrowth of new vessels and cells. Early cellular necrosis consistently was followed by the ingrowth of fibrovascular adhesions from the periphery. The formation of dense peripheral adhesions, obliterating the gliding surface of the tendon, led to diminished tendon excursion and proximal interphalangeal joint rotation.

Animals↗
PubMed1996

Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty.

A radiographic method was developed, the trapezial space ratio, for assessing the space occupied by the trapezium (a space defined by the distal scaphoid and thumb metacarpal base divided by the thumb proximal phalanx). This method was applied to 100 normal thumb radiographs and to the radiographs of 15 patients with symptomatic degenerative arthrosis of the thumb basal joint before and after operative treatment with ligamentous reconstruction and tendon interposition arthroplasty. The trapezial space ratio averaged 0.476 +/- 0.033 for radiographs of normal thumbs, 0.372 +/- 0.084 for the pre-operative radiographs of thumbs with symptomatic basal joint arthrosis, and 0.270 +/- 0.078 for the radiographs of thumbs following basal joint arthroplasty. A significant reduction in the trapezial space ratio was noted when values from arthritic thumbs were compared to those of normal thumbs (22%; P < 0.0001). A further reduction in the trapezial space ratio was noted when post-operative values were compared to pre-operative ones (27%; P < 0.0002). Comparing post-operative trapezial space ratio values to values obtained in normal thumbs, a reduction of 43% was found in those thumbs treated operatively. These finding indicate that the trapezial space is reduced significantly in thumbs with severe degenerative arthrosis compared to normal thumbs and that ligament construction tendon interposition arthroplasty is not entirely successful in either restoring or maintaining the length of the thumb ray.

Adult↗
PubMed1996

Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty.

This article provides a qualitative and quantitative outcomes assessment of a consecutive series of 27 patients (30 thumbs) with basal joint arthritis of the thumb undergoing ligament reconstruction and tendon interposition arthroplasty. Outcome analysis revealed that 24 (89%) patients were satisfied with the relief of pain provided by the arthroplasty and 23 (87%) would undergo surgery again. Eighteen (67%) thumbs were noted to have improvement in the ability to perform activities of daily living. Significant improvements were noted in web space measurements and in grip and pinch strength determination. X-ray film assessment using the trapezial space ratio averaged 0.33 +/- 0.08 in preoperative x-ray films of thumbs with stage III and IV degenerative arthritis and 0.23 +/- 0.07 in thumbs following basal joint arthroplasty. This represents a total decrease of 51% in the trapezial space ratio following arthroplasty compared to the normal values obtained in previous studies and 33% compared to the preoperative values obtained in this study. Outcomes assessment at a mean of 42 months after surgery showed that there was no significant correlation between maintenance of trapezial height and both objective and subjective clinical outcomes. Although ligament reconstruction consistently failed to restore trapezial height, primary and secondary clinical outcomes following basal joint arthritis were almost uniformly satisfactory.

Activities of Daily Living↗
PubMed1996

Relationship between joint motion and flexor tendon force in the canine forelimb.

To increase in vivo tendon force and gliding after flexor tendon repair, a variety of modifications to the methods by which protective passive motion is administered have been advocated. To determine the relationship between the prime variables, wrist and digital position, muscle activation, and in vivo tendon force, a clinically relevant canine model was developed. Force was measured in the flexor tendon during several joint manipulation paradigms: single-finger flexion-extension with the wrist flexed (group 1F), single-finger flexion-extension with the wrist extended (group 1E), four-finger flexion-extension with the wrist flexed (group 4F), four-finger flexion-extension with the wrist extended (group 4E), and synergistic wrist and finger motion where wrist extension and finger flexion were performed simultaneously, followed by wrist flexion and finger extension (group SYN). In addition, tendon force was measured during electric stimulation of the proximal flexor muscle mass. Passive tendon force with the wrist extended (groups 1E and 4E) was two to three times greater than that measured with the wrist flexed, independent of the number of digits moved. With the wrist extended, peak tendon force reached 1,997 g +/- 194 g during single-digit manipulation (group 1E), compared to only 853 g +/- 104 g with the wrist flexed during the same maneuver (group 1F). Statistical comparison between means revealed that groups 1E and 4E were significantly different from groups 1F, 4F, and SYN (p < .005). There were no significant differences between groups 1E and 4E or between groups 1F, 4F, and SYN (p > .200). Active muscle force elicited by electrical stimulation and passive force varied dramatically as the wrist was flexed from full extension 3460 g +/- 766 g to full flexion 427 g +/- 239 g (p < .001). Simultaneously, passive tension decreased from 940 g +/- 143 g with wrist extended to 76 g +/- 37 g with the wrist flexed. These data indicate that wrist position has the greatest effect on flexor tendon force during motions that are commonly used to rehabilitate flexor tendon repairs. Thus, if force is to be controlled during passive motion, wrist-joint angle will have the dominant effect, while the number of digits manipulated will have much less of an effect. If the clinical goal is to minimize tendon force, rehabilitation could be carried out with the wrist flexed, whereas if the goal is to increase tendon force, rehabilitation could include exercise programs that use a greater degree of wrist extension.

Animals↗
PubMed1996

Carpal tunnel release. Correlations with preoperative symptomatology.

Fifty patients (54 hands) who underwent carpal tunnel release for carpal tunnel syndrome were evaluated to determine the relationship between the prominence of specific clinical symptoms and the early results of carpal tunnel release. Patients were evaluated preoperatively, 3 weeks after surgery, and 3 months after surgery by questionnaire, physical examination, and Semmes-Weinstein monofilament pressure testing. The symptoms evaluated included hand/wrist/forearm pain, night pain/paresthesias, intermittent paresthesias, hand clumsiness, hand weakness, constant numbness, and difficulty with work related tasks. All symptoms showed significant improvements at 3 months after surgery. Overall symptom reduction at 3 months after surgery was 49% +/- 73%. Overall satisfaction at 3 months after surgery was 7.8 +/- 2.8 (0 to 10 scale). the severity of preoperative subjective hand weakness was significantly associated with surgery and with less improvement of function at 3 months after surgery and with less satisfaction with overall symptom relief at 3 months after surgery. Although subjective outcomes in this study were markedly improved after carpal tunnel release regardless of preoperative symptomatology, patients with more preoperative night symptoms and intermittent paresthesias and less preoperative hand/wrist pain, numbness, weakness, clumsiness, and difficulty with work related tasks were the most satisfied with their surgery.

Adult↗
PubMed1995

Autogenous flexor tendon grafts: fibroblast activity and matrix remodeling in dogs.

To investigate rates of cellular proliferation and matrix turnover in autogenous flexor tendon grafts, hindlimb intrasynovial (flexor digitorum profundus) and extrasynovial (peroneus longus) tendons were placed within the synovial sheaths of the medial and lateral forepaw digits of 18 dogs and treated with controlled early passive motion. After the dogs had been killed, short-term culture and labeling in vitro were utilized to determine rates of DNA, proteoglycan, collagen, and noncollagen protein synthesis. Schiff base covalent collagen crosslink concentrations and total collagen and protein content also were evaluated at intervals through 6 weeks. Tendon grafts of extrasynovial origin showed greater rates of DNA synthesis and significantly elevated levels of proteoglycan, collagen, and noncollagen protein synthesis and Schiff base covalent collagen crosslink concentrations (dihydroxylysinonorleucine) compared with intrasynovial tendon grafts. It was not clear to what extent the increased activity in the extrasynovial graft was due to actual differences between the intrasynovial and extrasynovial tendons or to the responses of the connective tissue surrounding the extrasynovial tendon graft. Since both types of grafts demonstrated similar unaltered levels of collagen and protein content over time, these data suggest greater rates of matrix turnover in tendon grafts of extrasynovial origin than in those of intrasynovial origin. Coupled with previous findings showing increased cellular proliferation in extrasynovial tendon grafts, these data indicate that the process of translation to an intrasynovial environment necessitates a more active process of soft-tissue repair and remodeling when extrasynovial donor tendons are used.

Animals↗
PubMed1995

Autogenous intrasynovial and extrasynovial tendon grafts: an experimental study of pro alpha 1(I) collagen mRNA expression in dogs.

On the basis of recent evidence that the healing processes of tendon grafts are donor-tissue specific, in situ hybridization, using a 372 bp cDNA fragment complementary to a portion of pro alpha 1(I) collagen mRNA, was utilized to compare the cellular responses to transplantation exhibited by autogenous intrasynovial and extrasynovial flexor tendon grafts. Intrasynovial and extrasynovial tendons from the hindpaw were transferred to synovial sheaths in the forepaw of 12 mongrel dogs (24 tendons) and treated with immediate controlled passive motion. The tendon grafts were harvested at 2, 4, and 6 weeks, and each was divided into a proximal, central (8 mm), and distal portion. Sections from the central portion were embedded in paraffin and subjected to in situ hybridization, autoradiography, and staining; levels of procollagen mRNA then were assessed by microscopic examination. The two types of tendon grafts exhibited different levels of pro alpha 1(I) collagen mRNA expression at all three time points. Intrasynovial tendon grafts displayed no areas of increased type-I procollagen mRNA at 2, 4, and 6 weeks. The extrasynovial tendon grafts displayed increased surface levels of type-I procollagen mRNA at 2 and 4 weeks; the levels decreased to background levels by 6 weeks. The high levels of procollagen mRNA exhibited by the extrasynovial grafts suggest increased collagen synthetic activity, indicative of a cellular response to injury, whereas the preservation of low levels of expression in the intrasynovial grafts may signify a less inflammatory cellular response.

Animals↗
PubMed1995

Aneurysmal bone cyst involving the lunate.

Aneurysmal bone cysts are rare lesions which even more rarely involve the bones of the hand. We report a case of a cyst involving the lunate which was initially mistaken for interosseous ganglion. Due to delay in diagnosis, marked destruction of the lunate occurred, necessitating excision and scapho-capitate arthrodesis. Although rare, aneurysmal bone cysts should be included in the differential diagnosis and ruled out prior to embarking on a course of treatment.

Bone Cysts, Aneurysmal↗
PubMed1995

The flexor digitorum longus: an anatomic and microscopic study for use as a tendon graft.

Recent experimental studies have shown that intrasynovial donor tendons have the capacity to heal with minimal alteration in the gliding surface when grafted to an intrasynovial location. In order to evaluate the flexor digitorum longus of the foot as a potential matched donor tendon for use in flexor tendon grafting, we dissected 15 feet (75 toes) and 10 hands (50 fingers) to determine the intrasynovial lengths of the flexor digitorum longus and flexor digitorum profundus and to determine a method of tendon graft harvest. Specimens were taken from the intrasynovial portion of each tendon for evaluation by light and electron microscopy. The intrasynovial tendons of the hand and foot were similar in vascularity, cellularity, gliding surface, and ultrastructure. The flexor digitorum longus tendon of the foot was a mean length of 12 cm to the area of tendon confluence in the midfoot, which will usually provide enough tendon length for grafting from the distal phalanx to the palm of the hand. Because of the difference in length of the synovial sheaths of the fingers and toes, some extrasynovial tendon will be transferred to the synovial space when a flexor digitorum longus tendon is used.

Cadaver↗
PubMed1995

Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis.

Nineteen patients underwent 20 dorsal capsulodesis for dynamic scapholunate instability. Seventeen patients (18 wrists) were evaluated by a questionnaire and physical examination after a mean postoperative follow-up period of 34 months (range, 12-65). The diagnosis was based on a combination of characteristic symptoms of scapholunate instability and physical findings consisting of dorsal wrist tenderness at the scapholunate interval and a positive scaphoid shift test. Following surgery, a significant decrease was noted in symptoms of pain and clunking. Functional status was improved postoperatively; the most significant gains were seen in opening jars, sweeping, shoveling, and throwing. Fifteen of 17 patients returned to their original occupations, although 7 of those who returned to their original occupations did so with some restrictions. Objective evaluation by physical examination revealed a significant improvement in wrist stability as determined by the scaphoid shift test, and an average loss of 12 degrees of flexion. Fifteen of 17 patients (16 of 18 wrists) stated that they would undergo the surgery again if faced with the same choice. Our data demonstrate that dorsal radioscaphoid capsulodesis of the wrist in patients with dynamic scapholunate instability provides substantial improvement over preoperative status.

Adolescent↗
PubMed1995

Growth factors and canine flexor tendon healing: initial studies in uninjured and repair models.

The role of growth factors in a variety of bone and soft tissue healing processes has been studied extensively in numerous recent models, yet little is known about the specific growth factors that may be playing a role in flexor tendon healing. We used a number of established protein purification techniques and bioassays to isolate and partially characterize a heparin-binding growth factor from unoperated canine tendons. Our data provide evidence that basic fibroblast growth factor, a potent angiogenic growth factor, is present in normal canine intrasynovial flexor tendons. We then studied repaired canine flexor tendons to further elucidate the role of growth factors in the tendon healing process. Heparin-sepharose elution profiles from three repair intervals (3, 10, and 17 days) were graphed and compared to known profiles of isolated growth factors. The three repair intervals demonstrated two elution profile peaks, consistent with varying amounts of platelet-derived growth factor and epidermal growth factor. Although additional experimentation is required to identify definitively the various protein isolates, these data provide compelling evidence that a variety of growth factors are present in uninjured and healing digital flexor tendons.

3T3 Cells↗
PubMed1994

Predictors of neurovascular displacement in hands with Dupuytren's contracture.

A prospective study of hands with Dupuytren's contracture was designed to test the association of three variables, the presence of an interdigital soft tissue mass, the presence of flexion contractures at each digital joint, and the duration of contracture, with the formation of spiral nerves. 66 digits in 37 hands affected by Dupuytren's disease were examined intra-operatively. Of the 34 digits (52%) with spiral nerves, 28 had soft tissue masses (42%). The sensitivity of a soft tissue mass alone as a predictor of a spiral nerve was 59% and the specificity 75%. The presence of a flexion contracture at the PIP joint had a sensitivity of 88% and a specificity of 62% for the presence of a spiral nerve. The combination of a soft tissue mass and a PIP joint contracture was a very specific (94%) but not a particularly sensitive (50%) test for spiral nerve formation. The formation of a spiral nerve is progressive, occurring most often in hands with significant PIP joint contractures with or without soft tissue interdigital masses.

Dupuytren Contracture↗
PubMed1994

Cellular survival and proliferation in autogenous flexor tendon grafts.

In order to investigate fibroblast survival and proliferation in autogenous flexor tendon grafts, hindlimb intrasynovial and extrasynovial donor tendons were placed within the synovial sheaths of the medial and lateral forepaw digits of 21 dogs (42 tendons) and treated with controlled early passive motion. Intravital histologic evaluations with confocal microscopy and biochemical determinations of total DNA content and DNA synthesis were carried out at 10 days, 3 weeks, and 6 weeks. Intravital staining of the extrasynovial tendon grafts demonstrated variable degrees of cellular necrosis at the earliest intervals followed by cellular repopulation with fibroblasts and neovascularization from surface vessels. In contrast, intrasynovial tendon grafts were populated predominantly by viable cells at each interval, with occasional patches of cell necrosis and fibroblast ingrowth. Total DNA content and DNA synthesis values in the intrasynovial donor tendons were significantly lower than those seen in the extrasynovial tendon grafts at each interval. Extrasynovial tendons appear to act as scaffolds, undergoing extensive cellular death followed by a rapid repair response. Findings that intrasynovial tendon fibroblasts survive the tendon grafting process suggest that the nutritional supplies and metabolic requirements of intrasynovial and extrasynovial donor tendons differ largely.

Animals↗
PubMed1994

Variations in cellular proliferation and matrix synthesis in intrasynovial and extrasynovial tendons: an in vitro study in dogs.

Intrasynovial and extrasynovial flexor tendon grafts recently have been shown to have dissimilar patterns of cellular survival and host integration within the digital sheath. In an effort to determine if fundamental differences exist between these two types of tendons, we investigated the biochemical composition and cellular activity of intrasynovial and extrasynovial tendon segments of 12 adult mongrel dogs in short-term explant culture in MCDB 105 and in DMEM media. Proteoglycan, collagen and noncollagen protein synthesis and content and DNA synthesis were determined following culture in both media. Intrasynovial tendon segments cultured in MCDB 105 medium synthesized significantly less collagen, noncollagen protein, and DNA and had similar amounts of proteoglycans compared to extrasynovial tendons. Comparison of intrasynovial and extrasynovial tendon segment responses in DMEM medium showed that intrasynovial tendons synthesized more proteoglycan, protein, and DNA than they did in MCDB 105. Extrasynovial tendons had similar rates of matrix component and DNA synthesis in both media. Findings that the synthesis of matrix components and DNA between intrasynovial flexor and extrasynovial peroneal tendon segments differ significantly indicate that intrasynovial flexor tendons may be specially adapted to the nutritional milieu provided by an intrasynovial environment. These data are supported by the selective successful stimulation of fibrocartilaginous segments within intrasynovial flexor tendons in media favored for the culture of cartilaginous tissue.

Animals↗