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Biomedical subjects

T R Kiefhaber

Publications and source records attributed to T R Kiefhaber.

14 recordsLinked to original sources
PubMed2004

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

Adolescent↗
PubMed2001

Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition.

BACKGROUND: There has been considerable controversy regarding the procedure of choice for treatment of any given stage of osteoarthritis of the thumb carpometacarpal joint. This study was designed to directly compare the clinical results of two common surgical procedures for this condition, trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition, in similar patient populations. METHODS: Between 1988 and 1998, 109 patients (141 thumbs) who were less than sixty years old were treated with one of the two procedures. In a retrospective review, forty-two patients (fifty-eight thumbs) treated with arthrodesis completed an outcome questionnaire and twenty-nine patients (forty-four thumbs) treated with arthrodesis completed the questionnaire and were examined. In the group treated with trapezial excision with ligament reconstruction and tendon interposition, thirty-nine patients (forty-nine thumbs) completed the questionnaire and thirty patients (thirty-eight thumbs) completed the questionnaire and were examined. The average duration of follow-up was sixty-nine months. The groups were similar with regard to age, gender, hand dominance, and duration of follow-up. RESULTS: Subjective evaluation of pain, function, and satisfaction demonstrated no significant difference between the two groups, with >90% of patients satisfied following either procedure. Although grip strength did not differ between the groups, the arthrodesis group had significantly stronger lateral pinch (p < 0.001) and chuck pinch (p < 0.01). The group treated with ligament reconstruction and tendon interposition had a better range of motion with regard to opposition (p < 0.05) and the ability to flatten the hand (p < 0.0001). There was a higher complication rate in the arthrodesis group, with nonunion of the fusion site accounting for the majority of the complications. However, despite a persistent nonunion in six thumbs, those thumbs and the thumbs in which union was obtained did not differ with regard to pain; all of the patients with nonunion had improvement in their pain status compared with preoperatively, and all were very satisfied with the outcome. Peritrapezial arthritis developed in nine patients (fourteen thumbs). This finding was not related to age and did not affect overall pain, function, or satisfaction. CONCLUSIONS: Although traditionally arthrodesis and ligament reconstruction and tendon interposition have been indicated in two different patient populations, we compared them in a homogeneous group and found that the two procedures had similar results with regard to pain, function, and satisfaction despite minimal differences in strength and motion. Although complications were more frequent following arthrodesis, most did not affect the overall outcome.

Arthrodesis↗
PubMed1999

The anconeus muscle flap: its anatomy and clinical application.

The arterial anatomy, coverage area, and potential donor site morbidity of the anconeus muscle flap are described. Using 17 cadaveric upper extremities, we investigated the muscle's arterial anatomy in 12 specimens and defined the coverage area of the anconeus flap in 5 specimens. We also reviewed the records of 9 patients who underwent a pedicle anconeus muscle flap for elbow coverage to assess clinical results of the procedure. The anconeus muscle is supplied from 3 arterial pedicles: the recurrent posterior interosseus artery, the medial collateral artery, and the posterior branch of the radial collateral artery. The recurrent posterior interosseus artery and the medial collateral artery were present in all dissected cadavers and consistently anastomosed with each other underneath the anconeus muscle. By harvesting the muscle on the medial collateral artery, the anconeus muscle flap can be expected to cover a 7.3 cm2 defect over the radiocapitellar joint, a 6.1 cm2 defect over the distal triceps tendon, and a 7.2 cm2 defect over the olecranon. In this series, none of the patients experienced loss of elbow motion, stability, or extension strength. The results of this study indicate that the anconeus can be harvested with minimal risk of morbidity and provides effective coverage for soft tissue defects of the elbow.

Adult↗
PubMed1999

Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.

This retrospective study assessed the short-term complications and long-term subjective and objective results of operative treatment of acute unstable dorsal proximal interphalangeal joint dislocations treated by 2 methods: open reduction internal fixation and volar plate arthroplasty. Fifty-six patients were included in this study. Twenty-three (41%) were treated by volar plate arthroplasty and 33 (59%) were treated by open reduction internal fixation. Postoperative complications occurred in 10 patients (18%). The most frequent complication was redislocation, which occurred in 6 patients (volar plate arthroplasty, 3 patients; open reduction internal fixation, 3 patients) and necessitated salvage surgery in 4 of these 6 cases. In all 6 cases, the fracture of the base of the middle phalanx involved more than 50% of the articular surface. Twenty-four patients (43%) returned for long-term evaluation at an average follow-up period of 46 months (range, 13-125 months). Twenty of these 24 patients (83%) reported little or no pain despite a high incidence (96%) of posttraumatic degenerative changes. Eighteen (75%) reported no difficulty with work activities; 92% continued leisure activities with little or no modification. Proximal interphalangeal joint flexion contractures and extension lag at the distal interphalangeal joint were common. These data indicate that if reduction is maintained, patients may expect few functional deficits despite radiographic degenerative changes and loss of mobility.

Adult↗
PubMed1998

Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation.

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78 degrees and was corrected to a normal 47 degrees at surgery. The average final scapholunate angle was 72 degrees, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.

Adult↗
PubMed1998

Upper-extremity tendinitis and overuse syndromes in the athlete.

Overuse injuries are the result of repetitive microtrauma to the musculotendinous unit. Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response with rest, elevation, and ice is the treatment objective during the inflammatory stage. Prevention of further injury is the primary treatment goal throughout the proliferative phase. Once the inflammatory process has reached the maturation stage, rehabilitation can begin with flexibility exercises, isometric contractions, and a slow return to strength training. Surgical decompression is frequently necessary if chronic inflammation causes fibrosis of the fibro-osseous tendon sheaths. Anomalous muscle bellies and tendinous interconnections can be contributing factors to overuse syndromes. Properly structured training programs and rehabilitation regimens can prevent tendinitis and overuse syndromes.

Arm↗
PubMed1995

Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis.

Seventeen patients were treated with scaphoid excision and four-corner arthrodesis (lunate, capitate, hamate, triquetrum) for scapholunate advanced collapse wrist and followed for a mean of 27 months. Eleven wrists in 10 patients had a proximal row carpectomy for scapholunate advanced collapse wrist and were followed for a mean of 37 months. The total arc of motion averaged 95 degrees in the four-corner arthrodesis patients and 115 degrees in the proximal row carpectomy patients, which was 47% and 64%, respectively, of the range of motion of the opposite wrist. Grip strength averaged 74% of the opposite wrist in the four-corner arthrodesis group and 94% in the proximal row carpectomy group. Three wrists in the four-corner arthrodesis group failed and were successfully converted to a total wrist fusion; two additional patients were awaiting arthrodesis. There were no failures in the proximal row carpectomy group. Proximal row carpectomy showed a high degree of patient satisfaction and is our motion-preserving procedure of choice except in those wrists with advanced capitolunate arthritis.

Adult↗
PubMed1993

Asymptomatic SLAC wrist: does it exist?

Twenty-five patients (30 wrists) had x-ray evidence of scapholunate advanced collapse. Twenty-two wrists had no pain; 12 of these were diagnosed and treated for carpal tunnel syndrome. Eight wrists had mild pain. All patients were reevaluated an average of 2 years later. At that time, 20 wrists were totally free of symptoms and 10 had occasional pain, especially with increased activity (no patients required analgesics). No patient had undergone surgical management for the scapholunate advanced collapse. We believe that there are some patients (especially older and low-demand persons) in whom x-ray evidence of arthritis and clinical findings do not correlate. In these circumstances surgical intervention for treatment of the arthritis may not be warranted.

Adult↗
PubMed1993

Soft tissue reconstruction for rheumatoid swan-neck and boutonniere deformities: long-term results.

Ninety-two fingers with rheumatoid swan-neck deformity were treated with dorsal capsulotomy and lateral band mobilization. An initial increase of 55 degrees of motion into flexion was noted, but this proximal interphalangeal motion deteriorated over time. Of 15 fingers followed at 3 and 12 months, there was a mean loss of 17 degrees of the early postoperative flexion. Nineteen fingers with rheumatoid boutonniere deformity were treated with central slip reconstruction. The results were unpredictable, with only modest improvement in the proximal interphalangeal extension, which deteriorated over time. The authors now recommend arthrodesis for most severe rheumatoid boutonniere deformities.

Adult↗
PubMed1992

Trapeziometacarpal joint arthrodesis: a functional evaluation.

Over a 10-year period, 39 trapeziometacarpal (TM) joint fusions were performed in 37 patients. Pin fixation was used in 27 fusions and staple fixation in 12; all were bone grafted. There were five delayed unions (greater than 3 months) and three nonunions. Twenty-four fusions were evaluated at an average of 4 years. Subjectively, there were 11 excellent, 7 good, 5 fair, and 1 poor result. Grip and pinch strength were symmetrical, and the nine-hole peg test (a measurement of dexterity) was slightly better on the treated side. X-ray films were taken and compared with 25 normal films to assess metacarpal mobility. There was a 72% reduction in the adduction/abduction arc and a 61% reduction in the flexion/extension arc. Despite the marked decrease in motion, subjective functional complaints were minimal. X-ray films were evaluated independently by a radiologist to assess progression of degenerative changes. Only two patients were noted to have changes at the scaphotrapezial joint.

Activities of Daily Living↗
PubMed1992

Upper extremity tendinitis and overuse syndromes in the athlete.

Overuse injuries are the result of repetitive microtrauma to the musculotendinous unit. Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response with rest, elevation, and ice is the treatment objective during the inflammatory stage. Prevention of further injury is the primary treatment goal throughout the proliferative phase. Once the inflammatory process has reached the maturation stage, rehabilitation can begin with flexibility exercises, isometric contractions, and a slow return to strength training. Surgical decompression is frequently necessary if chronic inflammation causes fibrosis of the fibro-osseous tendon sheaths. Anomalous muscle bellies and tendinous interconnections can be contributing factors to overuse syndromes. Properly structured training programs and rehabilitation regimes can prevent tendinitis and overuse syndromes.

Athletic Injuries↗
PubMed1991

Pilon fractures of the proximal interphalangeal joint.

A pilon fracture is an uncommon intraarticular fracture of the proximal interphalangeal (PIP) joint resulting in comminution, central depression, and splay, sagittally and coronally, of the articular surface of the base of the middle phalanx. This study reviews three treatment methods and results in 20 patients. Injury was produced by an axial load and occurred primarily to the ulnar digits. Clinical and radiographic follow-up averaged 25 months. Treatment was divided into three categories: splint (four patients), skeletal traction through the middle phalanx (seven patients), and open reduction with Kirschner pins (nine patients). Anatomic restoration of PIP articular contour was not achieved, regardless of technique. No patient regained full mobility at either interphalangeal joint. Treatment by immobilization is undesirable. Open reduction should be approached cautiously and may result in significant complications. Skeletal traction is safe and gives results that are radiographically and clinically comparable to those achieved with open reduction.

Adult↗
PubMed1986

Lateral stability of the proximal interphalangeal joint.

Current diagnostic criteria and therapeutic guidelines for injuries to the collateral ligaments of the proximal interphalangeal (PIP) joint are imprecise and vague. Laxity determinations, failure analysis, radiographic stress testing, and microscopic dissections were performed on 112 PIP joints. The lateral collateral ligament (LCL) is the primary restraint to varus and valgus angulation of the PIP joint. Its palmar fibers are tight in joint extension and provide the first line of resistance to lateral angulation. Failure of the LCL almost always occurs proximally in a sequential fashion that begins with the palmar fibers and progresses to the more dorsal bundles. Proximal LCL disruption is followed by separation of the accessory collateral-LCL junction and finally by failure of the distal palmar plate. Midsubstance tears of the LCL are rare. If the lateral stress test shows more than 20 degrees of varus or valgus angulation, the LCL can be presumed to be completely disrupted. Angulation of less than 20 degrees is associated with a 53% chance of partial LCL failure and a 47% chance of complete disruption, but the proper position of the LCL will be maintained by the overlying connective tissues. A clinical investigation will be necessary to define the criteria for surgical intervention.

Cadaver↗