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Biomedical subjects

T L Greene

Publications and source records attributed to T L Greene.

At least 19 recordsLinked to original sources
PubMed1991

Computed analyses of the pathomechanics of scaphoid waist nonunions.

The computed tomography scans of both the injured and the normal wrists of nine patients with a scaphoid nonunion of 5 to 120 months' duration were used to create three-dimensional computer models. When the computer images of the normal and the contralateral fractured scaphoids were superimposed, it was possible to calculate the volume of bone that was lost as a result of the injury and its failure to heal, as well as the angular relationship of the fracture components to one another. The amount of the scaphoid bone that was lost varied from 6% to 15% of bone volume and did not show a linear correlation with the duration of the nonunion. The configuration of the missing bone was consistent and exhibited a prismatic shape whose base is quadrilateral and faces palmarly. The proximal scaphoid fracture component is extended, radially deviated, and supinated in relation to its distal fracture component. The consistent fracture deformity and the configuration of the bony defect in the scaphoid waist nonunions should be helpful in the understanding and treatment of the condition.

Adult↗
PubMed1990

Digital subtraction arthrography of the wrist.

Digital subtraction arthrography of the wrist was used to identify abnormalities in eighty-six (60 per cent) of 139 patients during a fifteen-month period. Multiple abnormalities were noted in thirty-four (25 per cent) of the wrists. The clinical signs and symptoms in the eighty-six wrists did not always correlate with the defects that were seen on the arthrograms. Three of five patients who had an isolated tear of the scapholunate ligament, six of thirteen who had an isolated tear of the lunotriquetral ligament, and seven of nineteen who had an isolated tear of the triangular fibrocartilage complex also had signs and symptoms on the opposite side of the wrist. Many of the lesions that were seen on arthrography may have been serendipitous, degenerative, or unrelated to a specific injury. There was a high prevalence of positive ulnar variance in patients who had at least one ulnar abnormality. Capsular tears, most often seen on the radiovolar aspect of the wrist, were best outlined by contrast medium injected into the radiocarpal joint. The arthroscopic findings differed from the arthrographic findings in five of the twenty patients in whom both studies were done. The three-compartment technique of injection is a valuable diagnostic tool. Injections of contrast medium into the distal radio-ulnar joint outlined five of thirteen tears of the triangular fibrocartilage complex that were not seen after injection into the radiocarpal joint. Of the eleven tears that were seen after injection into the radiocarpal joint, five were not seen when contrast medium was injected into the distal radio-ulnar joint.

Adolescent↗
PubMed1989

Work in progress: postarthrography computed tomography of the wrist: evaluation of the triangular fibrocartilage complex.

This report reviews a work in progress evaluating the use of postarthrography computed tomography (CT) of the wrist in assessing triangular fibrocartilage complex abnormalities. Twenty-two triangular fibrocartilage complex perforations in 119 patients were identified with both multiple compartment arthrography and postarthrography CT. To obtain a double contrast image of the triangular fibrocartilage complex, the postarthrography CT examinations were performed after multiple compartment arthrography and the injection of air into the radiocarpal compartment. The site of triangular fibrocartilage complex perforation could be identified (radial versus peripheral) as could degenerative changes and internal derangements such as chondrocalcinosis. We did not, however, find any information not provided by arthrography that would have changed the course of management. At this time there is no clinical role for postarthrography CT in the evaluation of triangular fibrocartilage complex derangements.

Arthrography↗
PubMed1989

Composite wiring of metacarpal and phalangeal fractures.

Composite wiring techniques using various configurations of Kirschner pins and stainless steel wire sutures have been applied to the treatment of 63 fractures of the long bones of the hand. The secure fixation achieved allowed active motion within 1 week of operation. Thirty-three metacarpal fractures achieved a final mean total active motion of 256 degrees (standard deviation 13.4) (normal total active motion -260 degrees). Twenty-one phalangeal fractures achieved a mean total active motion of 215 degrees (standard deviation, 46 degrees). There were no instances of infection, malunion, nonunion, loss of reduction, or tendon rupture in the 63 fractures that were treated.

Adolescent↗
PubMed1989

Advanced imaging of the wrist.

In an effort to improve the radiologist's contribution to the evaluation of the painful wrist, the authors have studied the usefulness of a variety of imaging techniques. Preliminary results of these studies, including: 173 conventional CT, 80 3-D CT, 119 postarthrography CT, 138 multiple compartment digital subtraction arthrography and 55 MRI examinations, are reported, and technical aspects of the examinations are described.

Diagnostic Imaging↗
PubMed1989

CT of the wrist for the evaluation of traumatic injuries.

Computed tomography (CT) of the wrist can help evaluate many types of posttraumatic injuries, particularly bony trauma. Most wrist fractures can be diagnosed with routine radiography, but problematic cases and complicated healing fractures can be difficult to evaluate with conventional radiography. CT provides improved contrast resolution and multiplanar imaging. The results of complex healing fractures and fusion procedures can be facilitated with CT. Even in the face of advanced osteoporosis CT can delineate bone edges and detect small areas of bony fusion. The degree of bone graft assimilation can be determined with CT. Unlike conventional radiography, metal fixation pins and cast material do not obviate diagnostic exams with CT. Certain posttraumatic complications such as distal radioulnar joint incongruity and hypertrophy of Lister's tubercle can be detected with axial CT images. Complicated cases of retained foreign bodies can be evaluated with CT. The high-contrast resolution of CT allows precise localization of foreign bodies and can define anatomic relationships to adjacent vital structures such as joints, tendons, and carpal tunnel. Postarthrography CT of the wrist is an investigational tool that permits direct visualization of the triangular fibrocartilage complex (TFCC). Complete and partial tears of the TFCC can be evaluated with postarthrography CT. Ulnar capsular tears and disruptions of interosseous ligaments can also be evaluated with this technique. The exact role of postarthrography CT of the wrist, however, is uncertain at this point. Three-dimensional CT is receiving increasing interest and may eventually help the understanding of wrist pathomechanics and kinematics. In summary, CT of the wrist can be instrumental in evaluating complicated posttraumatic injuries of the wrist and has certain advantages over routine radiography.

Humans↗
PubMed1988

Mathematical analysis of computed carpal models.

The computed carpal models from digital computed tomography (CT) data obtained in this study compare favorably to natural anatomy. A new application of algebraic analysis of this data provides mathematical markers from which to calculate the position and orientation of each carpal bone. When the origin of the spatial coordinates of a carpal bone is transferred to the centroid of the bone, the data can be treated as three-dimensional pattern vectors describing its surface. It is then possible to calculate vectors that are the principal axes of the geometry. These axes provided references that were used to calculate position and orientation of the carpal bones in three wrist specimens. Comparisons of volumes, surface areas, and sizes and proportions of five computed images of each carpal bone from two of these wrists demonstrate the reliability of the technique. The analysis of CT scans of ceramics with known boundaries allows an estimation of its accuracy. The technique is well suited to the future study of normal wrist kinematics and pathological conditions.

Carpal Bones↗
PubMed1988

Fractures of the body of the trapezium.

Fractures of the body of the trapezium are uncommon. Ten such cases are reported. They may be associated with other carpal or metacarpal fractures and may require special radiographic views for diagnosis. There does not appear to be a consistent mechanism of injury. A classification system is proposed based on the five fracture configurations identified. Open reduction with internal fixation of the displaced articular surface is preferred.

Adolescent↗
PubMed1987

Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap.

A patient with extensive loss of bone and soft tissue from the right heel is presented. The defect was reconstructed using an osteocutaneous flap based on the deep circumflex iliac vessels. Indications for this procedure include extensive loss of bone and soft tissue precluding the use of local flaps. A 30-month period has elapsed since her reconstruction. A single ulcer developed 13 months postoperatively that healed after flap revision. We feel that tailoring the flap to minimize redundancy at the initial operation, subsequent tissue excision if necessary, and reinnervation augment durability of the flap.

Child↗
PubMed1987

Treatment of unstable metacarpal and phalangeal fractures with tension band wiring techniques.

The techniques of tension band fixation are applied in the treatment of metacarpal and phalangeal fractures. The technique uses standard, readily available materials. The variability of the fixation techniques allows for secure fixation of virtually any long bone fracture in the hand, even when other methods are not applicable. Nonunion, malunion, loss of fixation, infection, or tendon rupture have not occurred. The technique allows for early active motion and return to full activity usually within for to six weeks. Most patients achieve full painless motion in that time.

Adult↗
PubMed1986

Scaphoid-trapezium-trapezoid fusion in the treatment of chronic scapholunate instability.

Limited intercarpal arthrodesis for chronic scapholunate instability has been the subject of several recent publications. We have followed nine patients, who had scapho-trapezio-trapezoidal (S-T-T) fusion for scapholunate instability. All nine patients were re-examined recently after an average follow-up period of 19 months (range, 12 to 25 months). Six of the nine patients believed that their symptoms were significantly improved. The postoperative range of wrist motion (ROM) was decreased in all directions of motion. The pinch strength averaged 86% on the treated side and the grip strength averaged 74% of the unoperated side. Review of follow-up x-ray films showed radiographic evidence of union in eight of nine patients. We conclude that, with careful patient selection and close attention to operative detail, S-T-T fusion can be an effective treatment for scapholunate instability. However, the results are not uniformly predictable, and neither range of motion nor strength is normal after the procedure.

Adolescent↗
PubMed1985

Digital nerve grafting using the dorsal sensory branch of the ulnar nerve.

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

Adolescent↗
PubMed1985

Carpal tunnel release: analysis of suboptimal results.

The results of carpal tunnel release are generally good, but not all patients obtain complete and long lasting relief. Persistence of signs and symptoms after adequate decompression of the median nerve is uncommon. Forty-seven suboptimal results in thirty-four patients have been evaluated to determine the reasons for failure. Thirty-eight of the suboptimal results (81%) were associated with the persistent neck pain and/or abnormal cervical radiographs (typically narrowing of C5-6 and/or C6-7 disc spaces). This retrospective review supports a "double crush" phenomenon that influences both the manifestations of carpal tunnel syndrome and the outcome of its treatment.

Adult↗
PubMed1985

Lipofibromas of the median nerve: long-term follow-up of four cases.

Four cases of lipofibromatous infiltration of the median nerve with long-term follow-up (average 11 years) are reported. Progressive compromise of median nerve function has been noted. Initial treatment considerations should be directed toward biopsy and alleviation of the compression neuropathy. The role of microsurgical debulking procedures remains unclear at this time.

Adolescent↗