Biomedical subjects

Steven Z Glickel

Publications and source records attributed to Steven Z Glickel.

10 recordsLinked to original sources

PubMed2006

Ligament reconstruction.

Volar ligament reconstruction is an effective technique for treating symptomatic laxity of the CMC joint of the thumb. The laxity may bea manifestation of generalized ligament laxity,post-traumatic, or metabolic (Ehler-Danlos). There construction reduces the shear forces on the joint that contribute to the development and persistence of inflammation. Although there have been only a few reports of the results of volar ligament reconstruction, the use of the procedure to treat Stage I and Stage II disease gives good to excellent results consistently. More advanced stages of disease are best treated by trapeziectomy, with or without ligament reconstruction.

Arthroplasty↗

PubMed2006

Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint.

PURPOSE: Radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint are much less common than ulnar collateral ligament injuries. Cast or splint immobilization is recommended for treating grade I and grade II tears; however, there is no consensus for treating grade III (complete) tears of the RCL. The purpose of this study was to assess the results of repair of acute grade III tears of the RCL and evaluate the efficacy of late reconstruction for chronic instability. METHODS: From 1986 to 2001 there were 26 patients (16 in the repair group, 10 in the reconstruction group) who were reviewed retrospectively and examined clinically after either repair or reconstruction of the RCL of the thumb. The repair group had surgery at a mean of 2.5 weeks after injury and was evaluated at a mean follow-up time of 4.6 years. The reconstruction group had surgery at a mean of 6.8 months after injury and was evaluated at a mean follow-up time of 5.0 years. RESULTS: At an average follow-up of 59 months, there were no statistically significant differences in MCP or interphalangeal joint motion, grip or pinch strength, or MCP joint stability between the 2 groups. Based on a newly developed grading system there were 12 excellent and 3 good results in the repair group and 8 excellent and 2 good results in the reconstruction group. Overall satisfaction was excellent for both groups. CONCLUSIONS: We recommend the repair of acute grade III RCL injuries and reconstruction of chronic grade III RCL tears of the thumb MCP joint to prevent the development of a painful unstable thumb and possibly to prevent the development of MCP joint arthritis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Acute Disease↗

PubMed2006

Closed treatment of nonrheumatoid extensor tendon dislocations at the metacarpophalangeal joint.

PURPOSE: Acute sagittal band injuries at the metacarpophalangeal (MCP) joint resulting in subluxation or dislocation of the extensor tendons may cause pain and swelling at the MCP joint and limit active extension of the MCP joint. These injuries often are treated with surgical repair or reconstruction. This article outlines a nonsurgical treatment protocol that uses a customized splint for acute, nonrheumatoid extensor tendon dislocations caused by injury to the sagittal bands. METHODS: We retrospectively reviewed 10 patients with 11 acute sagittal band injuries who were treated with a splint of thermally molded plastic that differentially holds the injured MCP joint in 25 degrees to 35 degrees of hyperextension relative to the adjacent MCP joints. All the sagittal band ruptures resulted in complete dislocation of the extensor digitorum communis (EDC) tendon-Rayan and Murray type III injuries. Active proximal interphalangeal and distal interphalangeal motion was begun immediately at the time of initial splinting. The average follow-up period was 14 months. RESULTS: At the time of final evaluation all patients had full range of motion in flexion and extension. Eight patients had no pain and 3 had moderate pain. Four patients (5 digits) had no extensor tendon subluxations and 3 had barely discernable subluxations. Three patients had moderate subluxation of the EDC tendon and their treatments were considered failures. One of these patients had subsequent sagittal band reconstruction. CONCLUSIONS: Our results show acute sagittal band injuries in nonrheumatoid patients resulting in dislocation of the EDC tendon can be managed nonsurgically in many patients with a customized splint called the sagittal band bridge. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗

PubMed2006

Surgical exposures of the humerus.

The neurovascular and muscular anatomy about the humerus precludes the use of a truly "safe" fully extensile approach. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a triceps-avoiding paramuscular technique. To gain maximal exposure, the radial nerve must be mobilized at the spiral groove. For exposure of only the proximal humeral shaft, many surgeons prefer the anterolateral approach because it uses the internervous plane between the axillary and deltoid nerves proximally and the radial and musculocutaneous nerves distally. Proximally, the deltopectoral approach to the shoulder continues to be the most widely used. However, the lateral deltoid-splitting approach is a viable, less invasive approach for both rotator cuff repair and fixation of valgus-impacted proximal humeral fractures. Distally, intra-articular exposure is dependent on triceps mobilization, either by olecranon osteotomy or triceps release; this exposure can be coupled with either a triceps-splitting or a paratricipital approach for proximal extension.

Arthroplasty↗

PubMed2004

Limited, protected postsurgical motion does not affect the results of digital nerve repair.

PURPOSE: Casting for 3 to 4 weeks has been the accepted protocol after primary repair of digital nerve lacerations. In contrast, combined digital nerve and flexor tendon repairs are rehabilitated with immediate postsurgical range of motion. The purpose of this study was to compare the results of primary nerve repair in isolated digital nerve lacerations immobilized after surgery with nerve repairs combined with flexor tendon repairs that are mobilized in a limited, protected fashion immediately after surgery. METHODS: We reviewed retrospectively patients who had had surgical repair of isolated digital nerve lacerations or combined digital nerve and flexor tendon lacerations. Demographics recorded included age, hand dominance, injured digit, and time to mobilization. Follow-up data included range of motion at the metacarpophalangeal, proximal interphalangeal, distal interphalangeal, and wrist joints; static 2-point discrimination; and Semmes-Weinstein monofilament testing. Between-group comparisons were based on t-tests for continuous measures and chi-square tests for categoric measures. Paired t-tests were used for within-group comparisons. All comparisons were based on 2-tailed.05-level tests. RESULTS: Fourteen patients (16 digits) with isolated nerve repairs (group 1) and 12 patients (14 digits) with combined nerve and tendon repairs (group 2) were evaluated. The average age and duration at follow-up evaluation were similar in the 2 groups. The average time to mobilization, however, was 21 days in group 1 and 4 days in group 2. Injuries occurred equally in dominant and nondominant hands. Good range of motion returned in all digits. In addition there was no significant difference in final 2-point discrimination and Semmes-Weinstein testing between groups 1 and 2. CONCLUSIONS: Our data showed a decrease in sensibility between the injured and uninjured digits in each of the 2 groups studied, as has been shown previously. The difference in sensibility between the 2 groups, however, was not statistically significant. These data challenge the long-held belief that digital nerve repairs should be completely immobilized after surgery.

Adult↗

PubMed2004

A history of hand surgery in New York City.

The origins of Hand Surgery in New York City are temporally centered around World War II. Arthur J. Barsky, MD, Condict W. Cutler, Jr, MD and Emanuel B. Kaplan, MD laid the groundwork for our regional specialty prior to the War. J. William Littler, MD, Robert E. Carroll, MD, served in the Armed Forces and were instrumental in the development of the specialty in the second half of the 20th century. Hand services evolved in each of the major academic centers in New York including those led by Lee Ramsey Straub, MD, at the Hospital for Special Surgery, Richard J. Smith, MD at the Hospital for Joint Disease, Robert W. Beasley, MD at New York University and Berish Strauch, MD, and Morton Spinner, MD, at Albert Einstein and Montefiore. Several surgeons who worked with or were trained by these masters formed the nucleus of the next generation of leaders including Richard G. Eaton, MD, Martin A. Posner, MD, Harold M. Dick, MD, and Charles Melone, MD. Their proteges and a relatively small number of surgeons trained elsewhere, like Andrew J. Weiland, MD, and Robert Hotchkiss, MD, make up the current leadership of Hand Surgery in New York City.

General Surgery↗

PubMed2004

Assessment of articular displacement of distal radius fractures.

Intraarticular step and gap displacements represent the most common indication for surgical treatment of distal radius fractures. Most often, treatment decision making relies only on good-quality plain radiographs taken before and after reduction with measurement accuracy maximized by using the longitudinal axis method. When plain radiographs alone prove insufficient, CT scans or tomograms will significantly improve interobserver and intraobserver reliability of measurements, especially when evaluated using the arc method. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intraarticular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. Intraoperatively, we use fluoroscopy to obtain 30 degrees cephalad posteroanterior views and as 22 degrees lateral views to best observe articular surface reduction. Our current operative indications include fractures with radiocarpal or distal radioulnar joint step or gap deformities greater than 1-2 mm, gross distal radioulnar joint instability, or those with extensive metaphyseal comminution rendering them particularly unstable after closed reduction. In general, we tend to lean toward operative fixation in younger, more active patients.

Arthroscopy↗

PubMed2003

Treatment of chronic, traumatic hyperextension deformities of the proximal interphalangeal joint with flexor digitorum superficialis tenodesis.

PURPOSE: To our knowledge, there are no reports in the literature regarding treatment of chronic, posttraumatic proximal interphalangeal (PIP) joint hyperextension deformities with flexor digitorum superficialis tenodesis. The purpose of this study was to describe the surgical treatment and results of flexor digitorum superficialis tenodesis for the treatment of chronic, posttraumatic PIP joint hyperextension deformities. METHODS: Twelve patients were reviewed retrospectively and re-examined at a mean follow-up period of 35 months (range, 6-108 mo). Evaluation included completion of a Disabilities of the Arm, Shoulder, and Hand questionnaire and range of motion (ROM) measurements. RESULTS: There were 5 excellent, 5 good, and 2 fair results. Five patients had a residual flexion contracture at the PIP joint of 5 degrees to 15 degrees, although this did not create any functional impairment as determined by responses to the Disabilities of the Arm, Shoulder, and Hand questionnaire at follow-up evaluation. The 2 patients with fair results had postoperative PIP flexion contractures of 30 degrees and 60 degrees. All 12 patients returned to their previous occupations and recreational activities. CONCLUSIONS: Flexor digitorum superficialis tenodesis is an effective method with predictable results for the treatment of chronic, traumatic hyperextension deformities of the PIP joint.

Adult↗

PubMed2002

The extensor pollicis brevis entrapment test in the treatment of de Quervain's disease.

Isolation of the extensor pollicis brevis (EPB) tendon in a separate compartment has been reported to contribute to the pathogenesis of de Quervain's disease and affect the patient's response to nonsurgical treatment. The EPB entrapment test was developed to evaluate the patient with de Quervain's disease. The purpose of this study was to compare the results from this preoperative test with the anatomic findings at surgery in patients who failed nonsurgical treatment. One hundred seventy-eight patients who were treated for de Quervain's disease (200 wrists) were asked to compare the amount of pain elicited by firm resistance with thumb metacarpophalangeal joint extension with that from resistance to palmar abduction. Twenty-six wrists (13%) had surgical release after failure of nonsurgical treatment. Of those having surgery the proportion of wrists with a positive EPB entrapment test was significantly higher among those with 2 compartments (18 of 22) than among those with 1 compartment (0 of 4) (Fisher's exact test). In the surgical group the EPB entrapment test showed 81% sensitivity and 50% specificity in identifying wrists with a separate EPB compartment.

Compartment Syndromes↗

PubMed2002

Thumb metacarpophalangeal joint ulnar collateral ligament reconstruction using a tendon graft.

Chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb can cause significant functional disability due to pain and weakness of pinch and grasp. In the absence of adequate ligament to repair, stability of the joint can be restored by reconstruction using a free tendon graft. The technique described here routes the tendon graft through two holes in the proximal phalangeal base and one hole in the metacarpal neck in a triangular configuration, which recapitulates the normal anatomy of the ulnar collateral ligament. The results of reconstruction are good. Stability and strength are restored without sacrificing significant range of motion and with minimal donor site morbidity.

Journal Article↗