Biomedical subjects

Steven E R Hovius

Publications and source records attributed to Steven E R Hovius.

At least 19 recordsLinked to original sources

PubMed2007

Impairment and disability after severe hand injuries with multiple phalangeal fractures.

PURPOSE: Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. METHODS: The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. RESULTS: Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. CONCLUSIONS: The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.

Activities of Daily Living↗

PubMed2006

The effect of the epiphyseal growth plate on the length of the first metacarpal in triphalangeal thumb.

PURPOSE: Triphalangeal thumb is characterized as a congenital difference of the thumb with an extra phalanx. Additional thumb length is attributed mostly to the extra phalanx. The influence of the epiphyseal plate positions on growth in congenital hand anomalies is unclear. The purpose of this article was to compare the length of the first metacarpal in triphalangeal thumbs with the length of the same bone in normal thumbs and to investigate the influence of the often aberrant metacarpal epiphyseal plates on the length of the triphalangeal thumb metacarpal during growth. METHODS: The positions of the epiphyseal plate and the relative length of the first metacarpal were examined retrospectively in 37 patients with triphalangeal thumb. Ratios of the measurements were calculated (metacarpal II/metacarpal I) and compared with a normal population. Subjects were divided into 3 groups based on the position of the epiphyseal plate (double, proximal, distal). RESULTS: The distally placed growth plate was the most common variety, present in 22 of patients, followed by the proximal position in 14, and double epiphyseal plates in 6. All ratios of patients with triphalangeal thumb were significantly smaller than those of a normal population, indicating a longer first metacarpal in this condition. First metacarpals in triphalangeal thumb with double epiphyses grew disproportionately more than those of a normal population, whereas those with distal epiphyses grew disproportionately less than normal. First metacarpals with proximal epiphyses grew at the same rate as normal first metacarpals. CONCLUSIONS: In this study population the most common growth plate location was distal whereas the most common location in the normal population is proximal. The different positions of the epiphyseal plates correlate with growth differences in patients with triphalangeal thumb.

Adolescent↗

PubMed2006

Fibroblasts accelerate culturing of mucosal substitutes.

Reconstruction of large mucosal defects of the floor of the mouth is typically performed with keratinizing skin. Drawbacks include donor site defects and hair bearing of the flaps. Cultured mucosal substitutes (CMSs) have been developed for clinical use to replace keratinizing skin. Acellular dermis is often used as a dermal carrier for autologous cells, because it reduces wound contraction and is easier for the surgeon to handle than, for example, collagen gels. A major problem of CMSs using acellular dermis is variation in epidermal quality. To improve the quality of the CMSs, human fibroblasts were incorporated into the acellular dermis and seeded with human keratinocytes. To study the role of the fibroblasts in epidermal morphology and basement membrane formation, CMSs were stained for differentiation markers beta1 integrin, cytokeratin 10, and involucrin after 1 and 2 weeks in culture. Basement membrane formation was analyzed using laminin 5 and collagen IV and VII staining; proliferation was analyzed using Ki-67 staining. The epidermises of fibroblast-containing CMSs matured faster into a well-organized epithelium than did those that did not contain CMSs. A 52.7% increase in basal cells, a 53.5% increase in mitosis index, and a 78.0% increase in keratinocyte cell layers were observed. Addition of fibroblasts reduced culturing time and enhanced proliferation, maturation, and quality of the epidermis.

Cells, Cultured↗

PubMed2006

Recovery of neurophysiological features with time after rat sciatic nerve repair: a magneto-neurographic study.

Experimental assessment of peripheral nerve regeneration in rats by electrophysiology is controversial due to low reproducibility of electrophysiological indicators and diminished quantitative evaluation in conventional experimental set-ups. Magnetoneurography (MNG) counteracts these drawbacks by magnetically recording electrophysiological signals ex vivo, thereby providing accurate and quantitative data. In 50 rats, sciatic nerve transection was followed by direct repair. MNG outcome parameters, footprints [static toe spread factor (TSF); function] and muscle weight (MW) were studied for their recovery pattern from 2 to 24 weeks. By using MNG, we showed that the regeneration process still continues when functional recovery (static TSF) becomes stagnant. With regression analysis, MNG parameters amplitude, amplitude area and conduction velocity (CV) demonstrated moderate significant correlation with MW, whereas CV was not significantly associated with static TSF. No significant association exists between MW and static TSF. A Kaplan-Meier survival curve revealed that autotomy/contracture of rat hind paws was not related to decreased MNG outcome values. In conclusion, this study highlights and discusses the dissimilarities between direct (MNG) and indirect (static TSF and MW) assessment techniques of the regeneration process. We emphasise the significance of MNG as a direct derivative of axon regeneration in experimental rat studies. Additionally, we stress the must for right-left ratios, as neurophysiological indicators vary with age, and we confute possible bias in footprint analysis caused by exclusion of autotomy/contracture animals.

Age Factors↗

PubMed2005

Functional outcome after surgical treatment of phalangeal fractures in severely injured hands.

We assessed functional results after treatment of phalangeal fractures in severely injured hands. Our aim was to quantify digital functional loss with (combinations of) risk factors of unsatisfactory function. Patients who had multiple phalangeal fractures necessitating operation in a 10-year time period were tested, using measurements of total active movement. Seventy-eight patients with 228 phalangeal fractures were available for follow-up. In 88 fingers, the fractures ended in amputation and were excluded from the study. In the resulting 140 fractures, 74 (53%) had a good result (movement >180degrees for fingers 2-5, and >98degrees for the thumb), and 66 (47%) in an unsatisfactory result. Associated soft tissue injury, level of injury, and arthrodesis were risk factors for diminished function. Intra-articular fractures and multiple fractures within the same finger predisposed to arthrodesis. Despite the extensive and severe injuries more than half had good results, which is comparable with reports describing hand injuries with less extensive trauma.

Adolescent↗

PubMed2005

Spaghetti wrist trauma: functional recovery, return to work, and psychological effects.

BACKGROUND: Few studies on spaghetti wrist trauma have been published. The study populations have all consisted of small numbers of patients, and most studies have focused on functional recovery. In addition, different definitions of this injury have been used. The objective of this study was to assess outcome for a larger group of patients in terms of functional recovery, return to work potential, and psychological distress, and to compare outcomes between the two most commonly used definitions for spaghetti wrist injury. METHODS: The initial study-population consisted of 67 patients. Fifty patients completed a questionnaire package consisting of the Disabilities of Arm, Shoulder, and Hand questionnaire, including the Functional Symptom Score (range, 0 to 100), a questionnaire to evaluate return to work and time off work (range, 0 to 52), and the Impact of Event Scale (range, 0 to 75). Motor recovery and sensory recovery were assessed in an outpatient setting, on average, 10 years (range, 2 to 18) after the operation (n = 43). RESULTS: The mean Functional Symptom Score was 15.1 (SD, 16.1; range, 0 to 74) after a mean follow-up of 10.0 years (SD, 4.4; range, 2 to 18). Mean time off work was 34.7 weeks (SD, 17.9; range, 4 to 52), and 45.2 percent of the patients could not return to work within 1 year after the injury. Mean score on the Impact of Event Scale was 26.2 (SD, 19.7; range, 2 to 69). Compared with the unaffected hand, grip and tip pinch strength were decreased with means of 23.5 percent (SD, 22.4; range, 0 to 93) and 33.9 percent (SD, 23.7; range 0 to 83), respectively. Regarding sensory recovery, 12 patients (27.9 percent) had no protective sensation. No statistical differences were found between the two different definitions. CONCLUSIONS: This study demonstrated that spaghetti wrist injury can be placed among the severe disabling injuries. Comparison of the two definitions did not reveal any differences in outcome. To complete the evaluation of long-term outcome, a patient-derived assessment of function can be added to the clinical examination, and attention should be paid to psychological distress following the injury.

Adolescent↗

PubMed2005

Clinical and genetic analysis of patients with Saethre-Chotzen syndrome.

BACKGROUND: Saethre-Chotzen syndrome is a craniosynostosis syndrome further characterized by distinctive facial and limb abnormalities. It shows complete penetrance and variable expressivity and has been linked to the TWIST gene on chromosome 7p21; more than 80 different intragenic mutations and, recently, large deletions have been detected in Saethre-Chotzen patients. The aim of this study was to genetically and phenotypically characterize patients with a clinical diagnosis of Saethre-Chotzen syndrome. METHODS: Patients with a clinical diagnosis as well as those with a genetic diagnosis of Saethre-Chotzen syndrome (n = 34) were included in the study. RESULTS: The study showed that the important features of Saethre-Chotzen syndrome are brachycephaly (occurring in 74 percent of patients), a broad, depressed nasal bridge (65 percent), a high forehead (56 percent), ptosis (53 percent), and prominent auricular crura (56 percent). Furthermore, using different molecular techniques, pathogenic mutations in the TWIST gene were identified in 71 percent of patients. CONCLUSIONS: Patients with deletions of the TWIST gene did not differ from those with intragenic TWIST mutations in frequency or severity of craniofacial abnormalities. However, they did distinguish themselves by the presence of many additional anomalies and diseases and--most importantly--the high frequency of mental retardation, which was borderline significant. The authors conclude that when using stringent inclusion criteria for studies of Saethre-Chotzen syndrome, patients who have a pathogenic mutation of the TWIST gene should be excluded.

Acrocephalosyndactylia↗

PubMed2005

Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair.

BACKGROUND: The aim of this study was to quantify variables that influence outcome after median and ulnar nerve transection injuries. The authors present a meta-analysis based on individual patient data on motor and sensory recovery after microsurgical nerve repair. METHODS: From 130 studies found after literature review, 23 articles were ultimately included, giving individual data for 623 median or ulnar nerve injuries. The variables age, sex, nerve, site of injury, type of repair, use of grafts, delay between injury and repair, follow-up period, and outcome were extracted. Satisfactory motor recovery was defined as British Medical Research Council motor scale grade 4 and 5, and satisfactory sensory recovery was defined as British Medical Research Council grade 3+ and 4. For motor and sensory recovery, complete data were available for 281 and 380 nerve injuries, respectively. RESULTS: Motor and sensory recovery were significantly associated (Spearman r = 0.62, p < 0.001). Multivariate logistic regression analysis showed that age (< 16 years versus > 40 years: odds ratio, 4.3; 95 percent confidence interval, 1.6 to 11.2), site (proximal versus distal: odds ratio, 0.46; 95 percent confidence interval, 0.20 to 1.10), and delay (per month: odds ratio, 0.94; 95 percent confidence interval, 0.90 to 0.98) were significant predictors of successful motor recovery. In ulnar nerve injuries, the chance of motor recovery was 71 percent lower than in median nerve injuries (odds ratio, 0.29; 95 percent confidence interval, 0.15 to 0.55). For sensory recovery, age (odds ratio, 27.0; 95 percent confidence interval, 9.4 to 77.6) and delay (per month: odds ratio, 0.92; 95 percent confidence interval, 0.87 to 0.98) were found to be significant predictors. CONCLUSIONS: In this individual patient data meta-analysis, age, site, injured nerve, and delay significantly influenced prognosis after microsurgical repair of median and ulnar nerve injuries.

Adult↗

PubMed2004

Mechanical functioning of peripheral nerves: linkage with the "mushrooming" effect.

Biomechanical properties of nerve have been studied extensively. All neural matrix tissues have been suggested to be the main load-bearing component. Based on the ultrastructure it has been proposed that the architecture of the epineurium allows some degree of extensibility of the nerve. A role of the perineurium could be to withstand the positive endoneurial pressure. The hypothesis is that the mechanical behaviour of nerves is dependent on an interaction between the core swelling pressure and restraint by the outer sheath. Loss of this balance will alter that behaviour. To test this, rat sciatic nerves were subjected to mechanical loading at in vivo and ex vivo tension. Retraction of nerve segments was measured after excision and after incubation at 37 degrees C or freezing. Swelling properties of the nerve were measured by immersion in water or PBS (phosphate buffer solution) with intact or opened epineurium. Results showed a significant decrease in strength and stiffness with an increase in strain of the nerve after excision, compared to in vivo. Retraction was on average 11%. Freezing or incubation at 37 degrees C did not alter retraction. The swelling properties of the nerve demonstrated a significant difference between intact and opened epineurium and similar results for water and PBS, indicating that epineurium is a constraint and that the nerves are underhydrated. The proposed model for the intact nerve is a continuous connective tissue tube surrounding and constraining an inner swelling pressure of the neural core. Loss of integrity of the nerve has detrimental effects on its biomechanical properties.

Animals↗

PubMed2004

Measuring the strength of the intrinsic muscles of the hand in patients with ulnar and median nerve injuries: reliability of the Rotterdam Intrinsic Hand Myometer (RIHM).

PURPOSE: To determine the reliability and measurement error of measurements of intrinsic muscle strength of a new hand-held dynamometer (the Rotterdam Intrinsic Hand Myometer [RIHM]). METHODS: With the RIHM we obtained repeated measurements of the intrinsic muscle strength of the hand in 27 patients with peripheral nerve injury of the ulnar and/or median nerve in different stages of rehabilitation. The average time period after injury was 4.4 years (range, 99 days-11 years). RESULTS: Differences between 2 measurements greater than 6.3 N were interpreted as a real change in assessing the strength of the abduction of the little and index finger; for the median innervated muscles of the thumb this value was 16 N. CONCLUSIONS: In patients with nerve injuries the muscle strength is usually assessed with manual muscle strength testing and grip- and pinch-strength dynamometers. Preferably the intrinsic muscle strength should be measured in isolation and quantitatively. The RIHM is a new dynamometer that allows for measurements of the intrinsic muscle strength in isolation with reliability comparable to grip and pinch measurements.

Adolescent↗

PubMed2004

Reliability of tendon excursion measurements in patients using a color Doppler imaging system.

PURPOSE: The purpose of this study was to assess the test-retest reliability of tendon excursion measurements with color Doppler imaging in patients with flexor tendon injuries following a modified Kleinert protocol. METHODS: One observer performed repeated measurements at 3 different time periods in 13 patients with flexor tendon injuries, following a modified Kleinert protocol. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and related indices of measurement error were calculated. RESULTS: Measurements at 10 day after surgery had an ICC of.88 and an SEM of 1.1 mm. Measurements at 6 weeks after surgery had an ICC of.58 and an SEM of 2.0 mm. The measurements after 3 months had an ICC of.94 and an SEM of 1.2 mm. CONCLUSION: Measurements at 10 days and more than 3 months after surgery were reliable and were as reliable as the measurements performed on healthy subjects. At 6 weeks after surgery the measurements were less reliable. Color Doppler imaging is a reliable and noninvasive method to assess tendon excursion, even in patients with small tendon excursion movements.

Female↗

PubMed2004

Non-invasive measurement of tendon excursion with a colour Doppler imaging system: a reliability study in healthy subjects.

The excursion of the flexor digitorum profundus tendon during active flexion of the third finger was measured with colour Doppler imaging in 10 healthy volunteers. Repeated measurements were made by one observer in three sessions to assess the test-retest reliability. An analysis of variance (ANOVA) was done to find out the multiple sources of measurement error. The intraclass correlation coefficient was 0.81. For single measurements, the standard error of measurement was not more than 0.17 cm. The smallest detectable difference between two consecutive measurements was 0.48 cm. The test-retest reliability of colour Doppler measurements of excursion of the flexor digitorum profundus III tendon (FDP III) in healthy subjects is good. With series of 25 flexion movements, colour Doppler imaging is applicable in the assessment of tendon excursions in patients.

Adult↗

PubMed2004

Static footprint analysis: a time-saving functional evaluation of nerve repair in rats.

Walking track analysis is a widely accepted technique for functional evaluation after sciatic nerve repair in rats, but it is labour-intensive. In 2000, Bervar described a time-saving digitised static footprint analysis. In that study there were good correlations between the traditional sciatic function index (SFI) and the newly-developed static sciatic index (SSI) and static toe spread factor (TSF), respectively. Despite promising results, static footprint analysis is still not widely used. The present study was designed to validate it. After transection of the sciatic nerve, end-to-end repair was assessed using video recorded dynamic and static footprints in 45 Wistar rats. We found an even better correlation between the SFI and both the SSI and the static TSF. In conclusion, static footprint analysis is a time-saving and easy technique for accurate functional assessment of peripheral nerve regeneration in rats.

Animals↗

PubMed2004

Long-term outcome of muscle strength in ulnar and median nerve injury: comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer.

OBJECTIVE: To compare the outcome of muscle strength with manual muscle strength testing grip and pinch strength measurements and a dynamometer which allows for measurements of the intrinsic muscles of the hand in isolation (the Rotterdam Intrinsic Hand Myometer, RIHM). METHODS: Thirty-four patients more than 2 years after ulnar and/or median nerve injury. Muscle strength was evaluated using manual muscle strength testing (MMST), grip, pinch and intrinsic muscle strength measurements. RESULTS: Manual muscle strength testing showed that most muscles recover to grade 3 or 4. Average grip strength recovery, as percentage of the uninjured hand, was 83%. Pinch strength recovery was 75%, 58% and 39% in patients with ulnar, median and combined nerve injuries, respectively. The RIHM measurements revealed a poor recovery of the ulnar nerve innervated muscles in particular (26-37%). No significant correlation (Pearson) was found between the measurements of the RIHM and grip strength. Pinch strength was significantly correlated with strength of the abduction of thumb and opposition of the thumb strength (r 0.55 and 0.72, p = 0.026, 0.002) as measured with the RIHM. CONCLUSION: While manual muscle strength testing and grip strength measurements show a reasonable to good recovery, measurements of the intrinsic muscles by means of the RIHM showed poor recovery of intrinsic muscle strength after peripheral nerve injury. No correlation was found between the recovery of intrinsic muscle strength and grip strength measurements.

Adolescent↗

PubMed2004

Treatment of the triphalangeal thumb.

Triphalangeal thumb is a thumb with 3 phalanges and has an estimated incidence of 1 in 25,000 live births. Clinical presentation of triphalangeal thumb can vary considerably. Most strikingly is the long finger-like thumb with clinodactyly, in the same plane as the fingers and may or may not present with an extra thumb. Anatomically, the extra phalanx can have different shapes, from wedge to rectangular. Furthermore, the involved joints, ligaments, muscles, and tendons of the first ray, from distal interphalangeal joint to radiocarpal joint, can be hypoplastic, malformed, or absent with varying degrees of stiffness or instability. Also, the first web can be insufficient, and radial polydactyly as well as other hand deformities can be present. The aim of surgical treatment is to try to reconstruct or correct the anatomic difference and at the same time provide a more acceptable appearance. In our series, depending on the malformation, operations varied from removal of the delta phalanx with ligament reconstruction to multiple osteotomies and rebalancing as well as pollicization. Complications are mostly related to structures that have not been reconstructed or corrected during operation. Results in these often complex cases can be rewarding if the surgeon has sufficient knowledge of the underlying anatomic differences.

Journal Article↗

PubMed2004

Reduction of neural adhesions by biodegradable autocrosslinked hyaluronic acid gel after injury of peripheral nerves: an experimental study.

OBJECT: Adhesion formation is a serious problem in peripheral nerve surgery, frequently causing dysfunction and pain. The authors aimed to develop an objective biomechanical method of quantifying nerve adhesions and to use this technique for the evaluation of the efficacy of an autocrosslinked hyaluronic acid (HA) gel as an antiadhesion therapy. METHODS: Thirty-three female Wistar rats underwent dissection, crush injury, or transection plus repair of the sciatic nerve. The nerves were or were not treated with the HA gel. Six weeks after surgery, the adhesions formed were assessed by measuring the peak force required to break the adhesions over a standardized area. Results of biomechanical measurements demonstrated that the peak force significantly increased as the severity of the injury increased. After using the HA gel to treat the nerve, the peak force was significantly reduced in rats with any of the three types of injuries; peak force decreased by 26% in the animals in the dissection group, 29% in the crush injury group, and 38% in the transection and repair group, compared with the untreated animals. CONCLUSIONS: The biomechanical method described is an objective, quantitative technique for the assessment of nerve adherence to surrounding tissue. It will be a valuable tool in future studies on antiadhesion therapies. Furthermore, HA gel significantly reduces nerve adhesions after different types of nerve injuries.

Adjuvants, Immunologic↗

PubMed2003

Magnetoneurography: recording biomagnetic fields for quantitative evaluation of isolated rat sciatic nerves.

Magnetoneurography (MNG) is a technique to record the biomagnetic action fields of peripheral nerves. The benefits of MNG in contrast to electroneurography include the decreased signal disturbance caused by surrounding biological tissues and the use of a calibration pulse, both of which contribute to high reproducibility. MNG has proven to be a valuable tool to quantitate peripheral nerve regeneration in rabbits. However, the most commonly used model to study the peripheral nervous system is the rat sciatic nerve. Until now, the small size of the nerve impeded accurate MNG measurements in rat. This report describes a custom made recording chamber that allows accurate control of conduction distances and temperature and enables adequate MNG measurements of isolated sciatic nerves of Wistar rats. We applied biphasic stimulation with optimized grounding to reduce the stimulus artefact. A high reproducibility of signals was demonstrated. 'Ex vivo' nerve viability was assured for at least 2 h after dissection. In conclusion, MNG is a powerful tool to quantitatively evaluate the function of rat sciatic nerves and will be used for the early assessment of nerve regeneration.

Animals↗

PubMed2003

Difficulties in conducting a prospective outcome study.

The success of an outcome study depends largely on the number of recruited patients, the loss of followup, and the response rate to postal questionnaires. In this article, different strategies were proposed to increase the aforementioned items. Most presented strategies were developed because of failure of measures used earlier. In the authors' study concerning hand surgery, this resulted in missed inclusions and loss of followup. It is hoped that by reading and using the strategies discussed, future researchers will start at the end of the learning curve and will shed a bright light on the obscurity of recovery after hand injury.

Hand Injuries↗