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Biomedical subjects

T M Sunil

Publications and source records attributed to T M Sunil.

14 recordsLinked to original sources
PubMed2006

A comparative study of ulnar-shortening osteotomy by the freehand technique versus the Rayhack technique.

PURPOSE: To compare the results of ulnar shortening by the traditional freehand method with those achieved by the Rayhack technique. METHODS: A historical cohort of 95 patients (97 ulnas) who had ulnar shortening for the treatment of ulnar-impaction syndrome was evaluated. Forty-three patients (45 ulnas) were treated by the freehand technique and 52 patients (52 ulnas) by the Rayhack technique. Both groups were well matched in terms of age, gender, prior history of trauma, and associated injuries. The following variables were compared: duration of surgery, relief of pain, return to work, postoperative complications, time elapsed between surgery and return to work, union of the osteotomy, collinear alignment of the ulnar shaft, and alignment of the plate against the bone. These variables were compared by using the independent-groups t test, chi-square test, and Fisher exact test, as appropriate. RESULTS: Statistical analysis of the compared parameters: duration of surgery, relief of pain, return to work, postoperative complications, time elapsed between surgery and return to work, and union of the osteotomy, showed that none was significant. There were no cases of malalignment of the ulnar shaft or malalignment of the plate against bone in either group. Our calculations show that one would need a cohort of at least 300 patients in each group to show meaningful differences between the groups provided the same proportions held true. CONCLUSIONS: There was a trend toward a higher incidence of nonunion in patients who had the freehand technique although we were unable to show a statistical difference. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Adolescent↗
PubMed2006

Fashioning a new radial collateral ligament during arthroplasty of the finger metacarpophalangeal joints in rheumatoid arthritis.

We describe a technique for reconstructing the radial collateral ligament of the finger metacarpophalangeal joints in patients with rheumatoid arthritis during arthroplasty. This technique is used in cases where the original collateral ligament is unfit for imbrication. In this method, a new collateral ligament is created using the volar plate of the concerned metacarpophalangeal joint. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory. These advantages make this procedure a useful tool to have in one's surgical armamentarium.

Arthritis, Rheumatoid↗
PubMed2005

Use of volar plate for reconstructing the radial collateral ligament after metacarpophalangeal arthroplasty of fingers in rheumatoid arthritis: surgical technique.

We present a technique for reconstructing the radial collateral ligament using the volar plate after metacarpophalangeal arthroplasty of fingers in rheumatoid arthritis. This technique is indicated when the original collateral ligament is very attenuated and cannot be directly imbricated. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory.

Aged↗
PubMed2005

Multiple unusual complications after extensive chronic sarcoid tenosynovitis of the hand: a case report.

Sarcoidosis is an idiopathic disease characterized by multiple noncaseating granulomatous nodules. Involvement of the hand is extremely uncommon and tenosynovitis of the hand is rare. We present a patient who developed sarcoid tenosynovitis of multiple digits involving both the flexor and extensor tendons. He also developed flexor tendon rupture, subchondral bone erosions, and multiple joint subluxations.

Adult↗
PubMed2005

Salvage of an ischemic "kite" flap by arteriovenous supercharging.

The neurovascular "kite" flap is a well-established procedure for single-stage reconstruction of soft-tissue defects in the thumb. Post-surgical ischemia of the flap due to poor inflow is a rare, but potential, complication. The authors describe a technique of arteriovenous supercharging that was successfully used to salvage such an ischemic flap.

Adult↗
PubMed2004

Clinical indicators of normal thumb length in adults.

PURPOSE: This study was undertaken to obtain clinical indicators of normal relative thumb length in adults. METHODS: Fifty two normal hands in 26 volunteers were analyzed. There were 10 women and 16 men. The average age was 34 years (range, 23-47 years). Eighteen of the volunteers (36 hands) were Chinese and 8 were Caucasian (16 hands). All the subjects were healthy with no history of trauma or disease affecting the hand. The relative distal extent of the tip of the thumb was measured against 2 parameters: the length of the proximal phalanx of the index finger and the distance between the proximal digital crease and proximal interphalangeal crease of the index finger. The obtained values were designated as the thumb-proximal phalanx (TPP) index and the thumb-digital crease (TDC) index, respectively. RESULTS: The TPP index was 0.69 (standard deviation = 0.09) and the TDC index was 0.41 (standard deviation = 0.15). There were no statistically significant differences between the right and left hands nor were there any between male and female hands. It was also noticed that when the thumb was adducted the thenar crease and thumb interphalangeal crease came into contact with one another in 90% of the hands. Consequently, an arc traced along the thenar crease could be extended smoothly into the interphalangeal crease of the thumb. This was termed the thenar arc. Positive or negative variances of the thenar arc correlated statistically with variations of the TPP and TDC indexes. CONCLUSIONS: This study provides 3 simple clinical indicators of normal thumb length: the TPP index, the TDC index, and the thenar arc. Statistical analysis of the TPP and TDC indexes showed that the values are independent of gender, race, or laterality of the hands examined. These 3 indicators may help the clinician determine normal relative thumb length when reconstructing the thumb in adults.

Adult↗
PubMed2004

Intramuscular hemangioma complicated by a Volkmann's like contracture of the forearm muscles.

Intramuscular hemagiomas are rare tumors constituting less than 1% of all hemangiomas. The clinical picture is usually unlike a conventional vascular tumor. Pre-operative diagnosis is very difficult and most often, the condition is recognized only during surgery or after histopathological examination. This is a report of one such rare tumor,which presented as a painful mass in the Flexor Digitorum Superficialis. It was accompanied by the hitherto unreported complication of a Volkmann's like contracture of the deeper forearm muscles. The peculiar feature of this tumor are highlighted and are discussed with a review of relevant literature.

Child↗
PubMed2003

A corrective factor for scoring small finger function using the Littler's line and area under a Gaussian curve method.

PURPOSE: The Littler's line and area under a Gaussian curve method for scoring digital range of motion is an extremely convenient method for evaluating functional return after injury. This method, although being sufficiently accurate for other fingers, leads to a faulty estimation of function in the small finger. METHOD: Twenty-six normal hands in 14 volunteers were scored by using the earlier-described method. The statistical significance of the resulting error in small finger function was determined by using the standard error of difference between means. Corrective methods were determined and their statistical validity was established by using the same test. RESULTS: There was a consistent error in scoring of small finger flexion by about 2.26% using the earlier-described method, which was statistically significant. The error was caused by a radial deviation of the small finger on full flexion. To eliminate the error the proximal reference point of the small finger needs to be shifted radially. The amount of this shift is determined either by using the opposite hand if normal, or by an amount equal to 0.16 times the length of the small finger. CONCLUSIONS: The use of the new reference point for calculating the functional score of the small finger has added to the accuracy of a simple and realistic scoring system for flexion injuries. This eliminates a potential source of error and makes our analysis that much more reliable.

Adult↗
PubMed2001

The Hair-Thread-Tourniquet Syndrome - report of an unusual presentation of this rare condition.

The Hair-Thread-Tourniquet syndrome is a rare disorder with merely 17 cases of finger involvement reported so far. This is a report of one such case of accidental digital constriction, which presented as late as three months after injury. This is the longest reported duration between injury and detection. The constriction band was in the form of an eschar lying in an epithelialised crease. Treatment involved excision of the crease followed by multiple z-plasties to close the resulting defect. This is the first case in English literature to report epithelialisation of the crease and consequently the first case to require excision of the band followed by z-plasty.

Female↗