Pit bull attack: case report and literature review.
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Aged↗
Biomedical subjects
S F Viegas
Publications and source records attributed to S F Viegas.
Load transfer characteristics of the wrist. Part I. The normal joint.
A static positioning frame allows the positioning of unembalmed human upper extremities in any combination of wrist flexion/extension, radio/ulnar deviation, and pronation/supination. Pressure-sensitive film (Fuji) was used to study the contact areas, scaphoid-lunate area ratios, average high pressures, centroid positions, and intercentroid distances of five wrist joints under a uniform load of 103 Newtons (N) in 36 different positions. The contact areas accounted for only 20.6% of the available joint surface. They shift from a primarily palmar location to a primarily dorsal location when the wrist changes from flexion to extension. Overall the scaphoid contact area was 1.47 times that of the lunate and was generally greatest with the wrist in ulnar deviation. The scapho-lunate contact area ratio increased as wrist position changed from radial to ulnar deviation and/or from flexion to extension. For the constant load of 103 Newtons the high pressure averaged 3.17 megapascals (MPa). The scaphoid and lunate high pressure centroids shifted palmar when wrist position changed from 20 degrees of flexion to 20 degrees of extension and then shifted dorsal with further extension of the wrist. The intercentroid distance averaged 14.91 mm and ranged from 10 to 20 mm.
Biomechanical Phenomena↗
Load transfer characteristics of the wrist. Part II. Perilunate instability.
An experimental model with a static positioning frame, pressure-sensitive film (Fuji), and a microcomputer-based video digitizing system, previously developed by the two senior authors, was used in this study to examine the effects of increasing perilunate instability on the load transfer characteristics of the wrist. These effects included a significant dorsal ulnar shift of the scaphoid centroid with increasing perilunate instability together with a less dramatic palmar ulnar shift of the lunate centroid. Overall, the scaphoid contact area was found to decrease as the stage of perilunate instability increased, even in ulnar deviation and/or extension, which in the normal wrist was found to be the positions that had the greatest scaphoid contact area. Average pressures in the high pressure zones were found to significantly increase in wrists with a stage III instability compared with normal wrists. An increase in the intercentroid (scaphoid/lunate) distance was most evident with the wrist in 20 degrees extension, neutral radioulnar deviation, and 90 degrees supination.
Biomechanical Phenomena↗
Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation.
Six cases of dorsal transscaphoid perilunate fracture/dislocations and two cases of palmar transscaphoid lunate fracture/dislocations were treated by open reduction and internal fixation of the scaphoid with a Herbert screw. Supplemental Kirschner wire stabilization of the carpus was also used in the two cases of palmar transscaphoid lunate fracture/dislocation. All patients were male, with an average age of 23.6 years. The follow-up averaged 18.9 months. A clinical evaluation scoring system assessing pain, ability to function in an occupation, range of motion, grip strength, and radiographic appearance of the wrist was used. Based on this system the scoring of the six cases of dorsal transscaphoid perilunate fracture/dislocations that were treated was three excellent, one good, and one fair result, while the scoring of both palmar transscaphoid lunate fracture/dislocations showed poor results.
Adolescent↗
Attritional lesions of the wrist joint.
One hundred anatomic specimens of wrists were dissected to assess the incidence of perforations in the ligaments and triangular fibrocartilage of the wrist. The age of the specimen appeared to have a positive correlation with the incidence of perforations. There were no identifiable lesions in the wrists of specimens that were 45 years of age or younger. The incidence of perforations increased in specimens 60 years of age or older to 33% for the scapholunate interosseous ligaments, 27.6% for the lunotriquetral interosseous ligaments, and 27.6% for the disk of the triangular fibrocartilage of the wrist.
Adolescent↗
Osteochondritis dissecans of the lunate.
Osteochondritis dissecans of the lunate has not been previously reported in the English-language literature. A case of osteochondritis dissecans of the lunate and an ulnar positive variance in a 16-year-old girl is presented. Several possible causes of the lesion and its surgical treatment are discussed.
Adolescent↗
Functional bracing of fractures of the second through fifth metacarpals.
A simple new brace aids in the reduction and immobilization of fractures of the second, third, fourth, and fifth metacarpals. This brace incorporates an adjustable strap and pads made of radiolucent materials. It provides 3-point fixation while allowing full range of motion of the wrist and digits. It has been preferred by patients to an ulnar gutter splint, and its use resulted in less residual angulation of the fracture than occurred with other methods.
Braces↗
Atypical causes of hand pain.
The history and physical examination allow early identification of the cause of hand pain in most patients. In some cases, however, the etiology of the pain is not obvious and a diagnostic problem arises. The less common causes of hand pain include atypical mycobacterial infection, occult fractures, bone fragments, incomplete carpal coalitions, carpal ligament injuries and several uncommon forms of tendinitis.
Female↗
Lead poisoning from a gunshot wound to the hand.
Lead intoxication from retained bullets is uncommon but potentially fatal. A 45-year-old man was shot in the left wrist with a .32-caliber rifle. He was first seen 16 months later with symptoms, signs, and laboratory values that were consistent with the diagnosis of plumbism. The factors leading to plumbism, its evaluation, and treatment are reviewed.
Humans↗
Trigger thumb of de Quervain's disease.
Triggering of the thumb due to de Quervain's Disease has not been reported in an adult, and only one case in a child has been documented in the literature. Two cases of trigger thumb that were due to stenosing tenosynovitis in which the extensor pollicis brevis tendon triggered in a separate fibro-osseous tunnel within the first dorsal compartment are cited.
Adult↗
Intraarticular ganglion of the dorsal interosseous scapholunate ligament: a case for arthroscopy.
A rare case of an intraarticular ganglion within the dorsal interosseous scapholunate ligament is presented, including preoperative work-up and intraoperative findings. Wrist arthroscopy was crucial in its diagnosis.
Adult↗
Hand injuries from shrimp boat winches.
Shrimp boat winch injury to the upper extremity was identified in three patients. The injury occurred when the individual's hand became entrapped in the cable and the upper extremity was drawn into the winch mechanism. This resulted in midshaft fractures of one or both bones of the forearm and amputation of a portion of the fourth and fifth fingers. This injury emphasizes the importance of safeguards on the cable system. However, in the absence of safety regulations in the shrimping industry, more of these injuries can be expected.
Accidents, Occupational↗
Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study.
We studied 300 wrists from cadavera and the wrists of forty patients with de Quervain disease to determine the variation in the pattern of the tendons and septa in the first extensor compartment. In 75 per cent of the wrists from cadavera, we found that the number of tendons within the compartment differed from what is considered standard; there was complete or partial septation in 40 per cent. In about a third of the specimens from cadavera, the first extensor compartment was divided by a septum and two tendons or more were present within the major subcompartment. These features might readily result in inadequate decompression of the compartment in the treatment of de Quervain disease. In our prospective study of forty patients with de Quervain disease, septation was found in twenty-seven. There was no significant difference between the number of patients and the number of specimens from cadavera that had no, one, or two accessory abductor tendons.
Cadaver↗
Tumoral calcinosis: a case report and review of the literature.
Tumoral calcinosis rarely occurs in the hand. It is an uncommon familial disease suggesting an autosomal recessive gene pattern, often with laboratory findings of hyperphosphatemia and normocalcemia. Our patient had bilateral hand involvement, including local calcinosis cutis of the skin and bone changes not previously reported in the literature. At a 2-year follow-up after two lesions were excised from her left hand, one lesion had completely resolved and the other recurred. Two large symptomatic lesions and one area of local calcinosis cutis in her right hand have recently been excised.
Adolescent↗
Location and geometric description of carpal bones in CT images.
The carpal regions of ten cadaver extremities were imaged by CT. The images were combined into a 3-dimensional model of the carpus using a technique based on a dynamic programming algorithm to find an optimal estimate of the location of the bone boundaries in the CT images. The resulting set of surface points on each bone was used to compute volumes and principal and antipodal axes for the bones. A spatial coordinate system was established based on the positions of the centroids of three bones in the distal carpal row. The angular orientations of all carpal bones were determined with respect to this system. The principal axes for the same bone among ten wrist specimens proved to be more widely dispersed than the antipodal axes for the same bones. The antipodal axes also correspond more closely to an intuitive notion of the "longest axis" of the bones. We conclude that the antipodal axis is a more reliable and useful measure of bone orientation than the principal axis.
Adult↗
Effects of fingernail length on finger and hand performance.
The purpose of this study was to investigate effects of fingernail length on active range of motion (AROM) of the fingers, speed of finger manipulation, number of words typed, and grip strength. Fifteen normal women (mean age, 30 years) performed measurements under four conditions--with no attached fingernails and with fingernails extending 2, 1, and 0.5 cm beyond the tip of the finger. Analyses of variance showed that: 1) with fingernails of all extended lengths, grip strength measured on the first setting of the Jamar hand dynamometer decreased; 2) with fingernails 1 and 2 cm in length, AROM, grip strength on the second dynamometer setting, and finger manipulation decreased; and 3) with fingernails 2 cm in length, typing speed decreased (p < 0.05). Long fingernails limit flexion of the finger joints, particularly the metacarpophalangeal joints. Lack of finger flexion will limit excursion of long flexors and extensors in patients. It is recommended that patients cut their fingernails to a length of 0.5 cm to achieve optimal functional outcomes.
Activities of Daily Living↗
Biomechanics of the wrist.
This article summarizes six years of studies with an experimental model, which uses a static positioning frame, pressure-sensitive film, and a microcomputer-based videodigitizing system, to characterize the biomechanics of the human cadaver wrist by measuring the contact areas and pressures in a variety of normal, simulated traumatic, and surgically treated conditions. The results of these studies have provided clinically relevant information about the normal anatomy and functional mechanics of the wrist, as well as guidelines for the treatment for a number of different fractures and ligament injuries. The results of studies of radial carpal instabilities and fractures have demonstrated an increased load in the areas where degenerative arthritis is seen in these clinical conditions, and have furnished a means by which the biomechanical efficacy of certain surgical treatments can be measured.
Biomechanical Phenomena↗
A comparison of double-plate fixation methods for complex distal humerus fractures.
A modified method of fracture fixation of complex distal humeral fractures with medial and lateral plates and bolts was biomechanically tested and compared with previously described fixation techniques. Compressive stiffness coefficients were determined for three classes of fixation before and after fatigue cycling. This procedure was followed with compressive loading to failure. The results show that in the most unstable fracture type tested this new fixation method provides increased strength and stability. Early clinical follow-up examinations of patients treated with this technique show that this method is a reasonable fixation alternative for the complex distal humerus intercondylar fracture.
Adult↗