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Biomedical subjects

R I Burton

Publications and source records attributed to R I Burton.

At least 19 recordsLinked to original sources
PubMed1992

The prevalence of carpal tunnel syndrome in patients with basal joint arthritis of the thumb.

Basal joint arthritis of the thumb and carpal tunnel syndrome are common conditions with an acknowledged coexistence. This article attempts to quantify the prevalence of carpal tunnel syndrome in patients with basal joint arthritis and to examine some of the etiologic factors that affect the coexistence of the two disorders. Of 246 patients who had surgery about the basal joint, 95 patients (39%) were identified by chart review as having carpal tunnel syndrome. Eleven of 122 remaining patients contacted had symptomatic carpal tunnel syndrome confirmed by nerve-conduction studies, bringing the total to 106 (43%). The prevalence was higher in worker's compensation patients and those with diabetes mellitus. The prevalence was lower in men than in women, and patients with inflammatory joint disease were at less risk than those with osteoarthritis. Given this high association, great care should be taken to diagnose or exclude coexistent carpal tunnel syndrome in patients scheduled for basal joint surgery so that, if present, it can be treated at the same time, diminishing the risk of postoperative morbidity and delayed symptoms.

Arthritis↗
PubMed1990

Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion?

Forty-three procedures on the proximal interphalangeal joint in 24 patients are retrospectively reviewed. A diagnosis of erosive osteoarthritis accounted for 83% of the joints that had operation. Flexible silicone interposition, cemented Biomeric arthroplasty, or arthrodesis were done based on the individual functional needs of each patient and involved digit. All cemented Biomeric devices, preferentially implanted in the radial digits for optimal lateral stability, failed through the elastomer hinge at an average of 2.25 years after operation. Arthrodesis of the proximal interphalangeal joint in the radial digits provided greatest improvement in lateral pinch strength. Flexible silicone interposition arthroplasty in the ulnar digits provided an average flexion arc of 56 degrees with satisfactory pain relief. Although none required revision, radiographically evident bone resorption adjacent to the silicone implant was progressive over time; 35% of implants followed-up longer than 2 years demonstrated periarticular erosion and 20% followed-up beyond 4 years had extensive endosteal resorption along the intramedullary prosthetic stems. Surgical treatment of the osteoarthritic proximal interphalangeal joint remains an unsolved problem.

Adult↗
PubMed1990

Credentialing for international fellowships.

The common market may provide a unique opportunity to develop certification models between countries as some of the economic, social, and language barriers begin to soften. International fellowships must be encouraged, especially those from the third world, but with the understanding that the purpose of such international education is for the fellow to return to the country of origin and improve the health care delivery there, not to improve the personal finances of the fellow in an adopted country. The autocratic dogmatic certification by the decreed blessing of the department chair must give way to objective examination by impartial boards. There are too many differences now to establish an international certifying process, but everyone must encourage and work toward common professional, educational, political, national, and economic goals so that eventually such certifying might be possible. Dialogue between boards in the United States and analogous bodies in other countries (such as colleges of surgeons) to nurture the definition of necessary core knowledge, standardize examination design and technique, and eventually develop reciprocity for requirements to take examinations should also be encouraged.

Certification↗
PubMed1988

Small joint injuries of the hand. Dynamic and functional implications.

An injury to one of the small joints of the hand may have a major impact on hand function and thus have major implications for career and avocation. Proper treatment demands a knowledge of hand anatomy and dynamic function. Proper primary treatment usually yields better results than attempted late reconstruction; however, even with the best of primary care, long-range significant disability may result.

Hand Injuries↗
PubMed1987

Basal joint implant arthroplasty in osteoarthritis. Indications, techniques, pitfalls, and problems.

Implant arthroplasty is a valuable surgical procedure for some patients with basal joint arthritis of the thumb. Those patients for whom it seems to be the most useful are the low-demand osteoarthritic and the rheumatoid. Should this type of arthroplasty be selected, the associated soft tissue reconstruction is of paramount importance in determining the success of the surgical effort.

Arthroplasty↗
PubMed1986

Small-joint arthrodesis in the hand.

Arthrodesis of selected small joints of the hand is often indicated; however, in previously reported series nonunion is not uncommon. There were 171 consecutive arthrodeses of small joints performed on 134 patients. The operative method employed was essentially the method described by Littler. Emphasis was placed on the accurate coaptation of bone surfaces, the use of cancellous bone graft when needed, maintenance of the coaptation with Kirschner wires, and the need for postoperative immobilization. This technique resulted in union of 170 out of 171 arthrodeses (a nonunion rate of 0.6%). There were no infections. There were four delayed unions.

Arthritis, Rheumatoid↗
PubMed1986

Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty.

Seventy-two procedures in 53 patients with advanced basal joint arthritis are retrospectively evaluated with follow-up ranging from 12 months to 8 years. Follow-up of a subset of 32 silicone implant arthroplasties in osteoarthritic thumbs averaged 3.9 years with a 25% failure rate. Despite providing early symptomatic relief, silicone implants lost nearly 50% of vertical height at the ulnar margin secondary to cold flow and wear and subluxed 35% of the width of the prosthesis during the study period. Dynamic tendon transfers did not prevent implant subluxation and had no effect on the magnitude or pattern of implant wear. Ligamentous reconstruction reduced implant instability, but was accompanied by an increase in silicone wear and cold flow. Reactive giant cell synovitis with silicone particulates and adjacent bone resorption was seen in some cases of implant arthroplasty failure. Forces across the osteoarthritic basal joint would seem to preclude a stable silicone implant arthroplasty in the absence of eventual wear and symptomatic foreign body synovitis. Because of this unresolved conflict between implant stability and wear, at the present time we seldom use silicone in the osteoarthritic basal joint, but continue to utilize the silicone hemitrapezium or the cannulated trapezium replacement with satisfactory results in the low-demand rheumatoid thumb.

Adult↗
PubMed1986

Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty.

Palmar oblique ligament reconstruction combined with tendon interposition (LRTI) arthroplasty with part of the flexor carpi radialis tendon was developed for advanced osteoarthritis of the thumb basal joint. Twenty-five procedures are reviewed with an average follow-up of 2 years, ranging from 1 to 4 1/2 years. LRTI arthroplasty more consistently improved pinch strength, increased grip strength endurance, and restored thumb web space than did silicone implant arthroplasty. Proximal metacarpal migration averaged only 11% of the initial arthroplasty space versus nearly 50% loss of height with silicone implants. Subluxation averaged only 7% of the width of the thumb metacarpal base relative to the scaphoid versus subluxation of 35% of the base of the implant with silicone arthroplasty. Excellent results were achieved in 23 thumbs or 92% of cases. No deterioration of function or stability has been noted over time, and no revisional procedures have been necessary. On the basis of these encouraging early results, LRTI arthroplasty has become our preferred surgical treatment for advanced basal joint osteoarthritis of the thumb.

Arthroplasty↗
PubMed1986

Surgical management of the rheumatoid wrist--fusion or arthroplasty.

Forty-eight patients with 33 wrist fusions and 37 silicone wrist arthroplasties were reviewed and compared. Of those who had arthrodesis 97% showed a good or excellent result. Follow-up time averaged 82 months. All patients had a decrease in pain. Most patients had stronger wrists but complained of decreased dexterity. There were no pseudarthroses. The complication rate was 18%. Of patients in the arthroplasty group, 78% had a good or excellent result. Follow-up time averaged 51 months. Most patients in the arthroplasty group had improved dexterity and adequate wrist strength. Average flexion/extension was 32 degrees/29 degrees. The complication rate was 25%, which included four revisions. Of patients who had arthroplasties, 14% had bone resorption about the stem, and 11% of the patients with arthroplasties had x-ray evidence of settling. Factors that did not influence the result of the arthroplasty were patient age, duration of disease before surgery, finger extensor tendon rupture, preoperative motion, and hand dominance. Factors that were associated with failure and/or a fair result in arthroplasty patients were the use of ambulatory aids, the older and narrower prosthetic design, dislocated wrist preoperatively, and the chronic use of steroids.

Adult↗
PubMed1986

Complications following surgery on the basal joint of the thumb.

Basal joint arthritis of the thumb is common and can be disabling. Effective surgical treatment is realistic, and most patients will obtain predictably gratifying results. With attention to detail, most problems can be prevented. Occasionally, however, in spite of excellent care, complications do occur. Fortunately, such complications will usually respond to prompt recognition and treatment.

Arthritis↗
PubMed1977

Malignant fibrous histiocytoma of the forearm: report of a case and review of the literature.

The tissue histiocyte can give rise to a variety of lesions, either benign or malignant, and the latter often is confused with other sarcomas. The multipotential nature of the histiocyte results in the presence of at least five different cell types in these tumors, and all may be derived from a common precursor cell. The anaplasia of elements which differentiate as fibroblasts appears to correlate with survival. The tumors may be highly malignant, and the 10 year survival rate approximates 40%. Aggressive surgical management of these tumors is mandatory, with either wide en bloc resection or primary amputation of the involved extremity. Should the tumor recur locally after a wide resection and there be no detectable metastases, prompt amputation is indicated.

Female↗
PubMed1977

Multiple chondrosarcomas in a hand: a case report.

In a patient with multiple enchondromas limited to the ring finger and the fifth ray of the left hand, four of the enchondromas underwent simultaneous malignant degeneration during a 7 year observation period. Roentgenograms showed the initial cortical expansion changing to cortical destruction and soft tissue invasion. Ray resection of the involved digits was performed with a good functional result.

Adult↗
PubMed1976

Skeletal alterations following irradiation for Wilms' tumor: with particular reference to scoliosis and kyphosis.

The roentgenographic changes in the axial skeleton after irradiation for Wilms' tumor were studied in eighty-one patients. In addition to the initial alterations found in the individual vertebrae within the field of irradiation, spinal deformity subsequently developed in fifty-nine patients (pure scoliosis in thirty-eight, kyphoscoliosis in nineteen, and pure kyphosis in two). Unitl the adolescent growth spurt these deformities tended to remain slight, but some progression did occur. In seven patients the scoliosis became severe enough to require spine fusion. A Milwaukee brace used in three patients failed to correct the curve. The trapezoidal shape of the vertebrae and scarring of the soft tissues within the concavity made correction difficult. Recognizable roentgenographic alterations failed to develop in twenty-two patients who, in general, were older and had received less irradiation. There appeared to be a correlation between the amount of irradiation and the severity of the spinal deformity (p is less than 0.05) and between the age of irradiation and the amount of deformity (p is less than 0.02).

Adolescent↗