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Biomedical subjects

T Trumble

Publications and source records attributed to T Trumble.

At least 19 recordsLinked to original sources
PubMed2001

Scaphoid nonunions. Pitfalls and pearls.

Our ability to treat scaphoid nonunions has improved dramatically. The degree of collapse and bone loss can be accurately assessed in waist fractures using sagittal images on CT scans. These nonunions require reduction and bone grafting to re-establish the normal geometry of the scaphoid. Magnetic resonance imaging helps evaluate whether or not avascular necrosis is present in the proximal pole. Because of the poor prognosis of conventional bone grafts, a vascularized bone graft is recommended as the primary treatment when AVN is present. The volar collapse of the humpback deformity is best corrected with a volar approach and the proximal pole nonunion is best approached using a dorsal approach. Nearly all proximal pole nonunions require a vascularized bone graft and all acute proximal pole fractures require open reduction and internal fixation. Using specially designed cannulated screws, the nonunions can be stabilized accurately to decrease the time to resolution of the nonunion and minimize the amount of time in a cast. Stable fixation requires that the screw fixation target the central portion of the scaphoid regardless of the type of screw design used. Using these techniques, the hand surgeon should be able to provide a reasonable prognosis for patients presenting with a scaphoid nonunion, and the treatment should result in functional range of motion, grip strength, and relief of pain.

Bone Screws↗
PubMed1998

Complications associated with administration of detomidine into the caudal epidural space in a horse.

A 364-kg (800-lb) 15-month-old sexually intact cryptorchid male Quarter Horse was admitted to the veterinary teaching hospital for castration. The horse was placed in standing stocks, and a caudal epidural injection of 18 mg of detomidine hydrochloride (50 micrograms/kg [23 micrograms/lb] of body weight) was administered. Fifteen minutes after injection, the horse unexpectedly collapsed to the floor, first into sternal, and then into lateral, recumbency. Because the horse would not get up, the decision was made to perform the surgery with the horse under general anesthesia. The horse required little halothane to maintain a surgical plane of anesthesia for most of the duration of surgery. Recovery from anesthesia was prolonged. Care must be taken when anesthetizing horses that have received large doses of detomidine via caudal epidural injection.

Analgesics↗
PubMed1998

In situ osteotomy for extra-articular malunion of the proximal phalanx.

Eleven patients had correction of extra-articular malunions of the proximal phalanx by in situ osteotomy stabilized with a dorsal plate, which healed within 7 weeks. The patients' average age was 27 years; 8 of the patients were male. After an average follow-up period of 35 months (range, 25-54 months), all the patients had correction of the overlapping or scissoring of the digits during flexion. The rotation deformity improved from 17 degrees to 2 degrees and the angular deformity present in 6 patients improved from 14 degrees to 0 degrees. None of the patients lost motion. On average, the patients improved from 85 degrees to 100 degrees flexion for the proximal interphalangeal joint and from 45 degrees to 55 degrees for the distal interphalangeal joint.

Adolescent↗
PubMed1997

Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures.

To determine if small avulsion fractures of the thumb ulnar collateral ligament (UCL) with minimal (< or = 2.0 mm) displacement can successfully be treated by cast immobilization, the authors reviewed 9 patients with minimally displaced fractures initially treated by casting. Despite immobilization within an average of 2 days of the initial injury (range, 0-6 days), a minimum of 6 weeks of immobilization in a cast, and adequate rehabilitation, all 9 patients had persistent thumb pain, especially with activities requiring strong pinch. After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). Grip strength increased from 77% to 93% (p < .05), but the ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were not significantly altered. Minimally displaced UCL avulsion fractures frequently have significant rotation that prevents successful fracture healing even with prompt cast immobilization.

Adolescent↗
PubMed1993

A comparison of immune response to nerve and skin allografts.

Research in limb reconstruction using peripheral nerve tissue has been hampered by tissue rejection. Not all tissues express major histocompatibility class I and class II antigens to the same extent. Allogenic and isogenic peripheral nerve grafts and split-thickness skin grafts were performed using C57BL/6 and Balb/c mice, which are inbred strains that differ at both major histocompatibility (MHC) class I and class II antigens. The cellular and humoral immune responses of the nerve transplants were compared with studies of skin transplants. Skin allografts represent a "gold standard": they are clearly rejected, with a tissue failure that is easily observed and closely correlated with cellular and humoral projection responses. A significant cellular immune response was noted following both the nerve (p < .04) and skin (p < .03) allografts. The peak response occurred by day 14 following the transplantation. The humoral response with rising antibody titers followed a similar pattern, with peak response at 14 and 21 days post-transplantation. Isogenic transplants did not produce a cellular or humoral immune responses. There was no significant difference between the immune responses produced by the skin transplants, compared to the nerve transplants. Because of the difficulty in producing accurate models of animal function following nerve transplantation, quantitative studies of host immune response to transplantation have not correlated well with the recipient's final functional result. A comparison of the immune responses between clearly rejected skin allografts and nerve allografts suggests that the immune response resulting from nerve allografts could decrease the functional performance of the nerve grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Immunology of peripheral nerves and response to trauma.

Research in limb reconstruction using peripheral nerve tissue has been hampered by tissue rejection. In order to provide more information on the immunology of peripheral nerves, 35 specimens (26 from seven cadavers and nine from surgical biopsies) were analyzed for the presence of human leukocyte antigens (HLA), which are a key component of major histocompatibility complex class II (MHC Class II) antigens. MHC Class II antigens were noted in all human nerve specimens, and the percentage of areas of positive staining by immunohistochemistry was significantly higher (3.82% +/- 1.01%) than that of negative controls (.05% +/- 0.02%) (p less than 0.01). The negative controls consisted of serial sections that were stained in the same manner except that the primary antibody was deleted. There was no significant difference in the presence of MHC Class II antigens between sensory and mixed motor nerves or among the different HLA groups (HLA-DR, HLA-DP, HLA-DQ). A mouse model was used to evaluate the effect of trauma on the presence of MHC Class II antigens. Three weeks after transsection of the sciatic nerve there was a statistically significant increase (p less than 0.05) in the presence of MHC Class II antigens in the distal portion of the nerve (4.49% +/- 0.78%) as compared with samples from animals that had had exposure of the nerve without transsection (1.44% +/- 0.21%) or in nerves from animals that had had no surgery (1.02% +/- 0.21%). The presence of MHC Class II antigens could require more complex cross-matching for tissue transplantation. Nerve grafts that have undergone Wallerian degeneration may actually be more prone to rejection than are other peripheral nerve tissue transplants.

Adult↗
PubMed1990

Scaphoid fractures and Kienbock's disease of the lunate: MR imaging with histopathologic correlation.

Thirteen patients with scaphoid fractures and four patients with Kienbock's disease of the lunate underwent magnetic resonance imaging (MRI) prior to surgery. A total of 28 specimens had MR-histologic correlation. Biopsy specimens obtained by curettage provided pathologic correlation. MRI proved accurate in prospective evaluation of bone viability for both scaphoid fractures and Kienbock's disease. Normal marrow signal was shown to correlate with the presence of osteoid and osteocytes on light microscopy and a surface layer of fluorescence reflecting tetracycline uptake in viable bone. Decreased marrow signal corresponded to non-viable trabeculae with scant osteoid, without osteocytes and no tetracycline labeling. By virtue of its accurate identification of avascular necrosis, MRI may prove valuable in predicting prognosis for patients with scaphoid fractures and Kienbock's disease of the lunate.

Adult↗
PubMed1990

Late posttraumatic carpometacarpal dislocation of the ring and little finger.

A case of late post-traumatic dislocation of the ring and little finger carpometacarpal joints is described. An avulsion fracture from the base of the ring finger metacarpal was noted, but normal alignment was demonstrated by radiographs in the acute postinjury period. However, 3 months repeat radiographs showed a fixed dorsal dislocation. Although late spontaneous carpometacarpal dislocations are rarely encountered, they may develop following an untreated injury that disrupts the ligamentous stability of the joint. Therefore, an index of suspicion should exist for this possibility. The patient described here had pain and decreased grip strength and, therefore, treatment with open reduction and internal fixation was recommended. At the patient's follow-up examination, his pain has resolved and he had normal motion and grip strength. This treatment is advised when the articular cartilage of the carpometacarpal joint surface has been preserved, although sufficient cast immobilization when the avulsion fracture was initially noticed might have prevented the late dislocation.

Adult↗
PubMed1988

Intercarpal arthrodesis for static and dynamic volar intercalated segment instability.

Since 1982 seven patients with volar intercalary segment instability (VISI) have been operated on at the Massachusetts General Hospital. All had preoperative wrist pain and described a painful "clunk" with ulnar deviation. In each case there was palpable evidence of instability when the wrist was deviated ulnarly that produced a "buckling" sensation as the distal and proximal rows rotated with ulnar deviation. Arthrograms in six patients and a cineradiography in one patient confirmed that this buckling correlated with volar rotation of the lunate and triquetrum and dorsal rotation of the capitate and hamate. All the patients had some type of intercarpal arthrodesis including four capitate-lunate-triquetrum hamate (CLTH), one lunate-triquetrum (LT), one lunate-triquetrum-hamate (LTH), and one triquetrum-hamate (TH). Surgical findings included the position of the lunate that had rotated on the capitate so that it was tilting volarly and the major ligament instability was between the proximal and distal rows although ligament tears were also present between lunate and triquetrum. Arthrodesis of the proximal and distal rows provided relief of wrist pain in five of six patients. The one patient with the arthrodesis limited to the proximal row had a poor result. Of the five successful cases, the postoperative range of wrist motion was 81 degrees of extension/flexion arc (63% of the normal contralateral) and 35 degrees of radial and ulnar deviation arc (57% of the normal contralateral wrist). The grip strength postoperatively averaged 58 pounds (74% of the normal contralateral side).

Adolescent↗
PubMed1987

Patency after repair of forearm arterial injuries in animal models.

Repairs of single artery forearm injuries have only a 50% patency rate. The single artery repairs in the forelimbs of the 10 dogs and 42 rabbits studied in this investigation also had patency rates of approximately 50%. The collateral arteries appeared to be a factor causing the low patency rate since ligating them increased the patency of the repaired vessels, and because arteriograms showed dilation of existing collaterals after occlusion of the repaired artery. Pressure and compliance measurements made before the repair were not able to predict patency. Furthermore, attempts to improve the patency rate by temporarily clamping the collateral artery or by denervating the injured artery were not successful.

Angiography↗
PubMed1987

Forearm compartment syndrome secondary to leukemic infiltrates.

A 20-year-old white man with leukemia was recently treated with chemotherapy and was admitted to the Massachusetts General Hospital with a fever and a swollen and painful left forearm that worsened despite intravenous antibiotics. The flexor forearm compartment pressures were elevated; therefore, surgical decompression of the flexor compartments was done. All the wound cultures were negative, and biopsy specimens of tissue showed leukemic infiltrates in the muscle and subcutaneous tissue. Tumor infiltrates may result in increased compartmental pressures, and the treatment of these lesions includes chemotherapy and/or radiation therapy to provide local control of the tumor.

Adult↗
PubMed1987

Forearm force transmission after surgical treatment of distal radioulnar joint disorders.

To evaluate the effect of silicone replacement of the distal ulnar, hemiresection arthroplasty and the Darrach procedure on ulnar support of the carpus, changes in force transmission to the radius and ulnar were measured using load cells in axially loaded cadaver arms. Testing of the intact specimens in neutral position showed that an average of 17% of the axial load was borne by the ulna whereas the load decreased to 3.6% after silicone arthroplasty, to 2.4% after hemiresection arthroplasty, and to 1.0% after the Darrach procedure. Only by placing the silicone cap on the ulna to lengthen it by 4 mm did the ulna load become within 75% of that in the intact specimen. In the intact specimen, ulna loading increased with wrist extension and ulna deviation and decreased with flexion and radial deviation, while after the surgical procedures there was no significant change in ulna loading with wrist position.

Biomechanical Phenomena↗
PubMed1986

A biomechanical comparison of the methods for treating Kienböck's disease.

Reduction of lunate compression is thought to promote revascularization of the lunate in patients with Kienböck's disease. The decompressing abilities of ulnar lengthening, radial shortening, capitate-hamate fusion, and scaphoid-trapezium-trapezoid (STT) fusion were examined in axially loaded, whole arm specimens. Lunate strain was monitored by electronic strain gauges and found to be proportional to the axial load borne by the bone. The STT fusions and the procedures to alter relative radial and ulnar length were successful in relieving lunate loading throughout a functional range of wrist motion and forearm rotation, but the capitate-hamate fusion was ineffective. Only the STT fusion resulted in a significant decrease in wrist range of motion. Incremental ulnar lengthening and radial shortening revealed that approximately 2 mm of length change maximizes lunate decompression without greatly increasing the risk of disorders of the distal radioulnar joint and ulnocarpal impingement.

Biomechanical Phenomena↗
PubMed1985

Effect of femoral stem length on stress raisers associated with revision hip arthroplasty.

The objective of this study was to experimentally determine the optimal length of a femoral component in revision total hip arthroplasty (THA). Embalmed cadaveric femurs were loaded in a physiologic manner, and strains on the lateral cortex were measured. Two kinds of defects were tested to simulate THA after removal of a nail plate and after removal of a loose femoral stem. A drill hole was made in the lateral cortex of the femur to simulate the removal of a nail plate. A reaming defect was made, using flexible reamers to thin the cortex from the lesser trochanter distally to a site corresponding to the tip of a standard femoral component, to simulate THA after removal of a previously inserted femoral stem. Femurs were tested intact, with the defects, and after insertion of femoral components with stem lengths of 100 to 250 mm. The strain increased with the creation of a defect and decreased with the insertion of an implant. For a femur with a defect, the strain was minimized when the stem length extended 1.5 femoral diameters past the defect.

Alloys↗
PubMed1985

Talectomy for equinovarus deformity in myelodysplasia.

Nine patients with myelomeningocele (seventeen involved feet) had talectomy for the correction of equinovarus deformity. The age at surgery ranged from one year and eight months to seven years and four months old. The length of follow-up averaged seven years and four months and ranged from twenty-two months to twelve years. Fifteen feet had a good and two had a poor correction of the deformity of the hind part of the foot, the result being directly related to the intraoperative correction of the equinus deformity. The correction of the fore part of the foot was rated as good in eight, fair in one, and poor in eight feet. Residual deformity of the fore part of the foot compromised the functional result in six feet that had an acceptable correction of the deformity of the hind part.

Child↗
PubMedDate not supplied

A preliminary study of joint surface changes after an intraarticular fracture: a sheep model of a tibia fracture with weight bearing after internal fixation.

OBJECTIVE: To evaluate the changes in the articular cartilage and subchondral bone after an osteotomy designed to simulate an articular fracture. DESIGN: The contribution of the cartilage and subchondral bone was evaluated twelve weeks after creating a 1.0-millimeter step-off in the medial plateau of the tibia of twelve adult domestic sheep. All animals surviving were labeled with fluorescent markers for bone production, oxytetracycline (fifty milligrams per kilogram), and calcein (twelve milligrams per kilogram) nine and 11.5 weeks after surgery. The knees were loaded in compression using an Instron materials tester with pressure-sensitive film to record joint contact pressures above and below the medial meniscus. SETTING: The studies were performed in the research laboratories of the Orthopaedic Laboratory at Harborview Medical Center in Seattle, Washington and the Madigan Army Medical Center in Tacoma, Washington. ANIMALS: Twelve adult domestic sheep. INTERVENTION: An intraarticular osteotomy of the medial tibial plateau with 1.0 millimeter of displacement was performed. The osteotomy was stabilized with 3.5-millimeter lag screws. MAIN OUTCOME MEASURES: The contact pressures of the knee joint and articular histology were evaluated twelve weeks after surgery. Samples of the articular cartilage were analyzed by light microscopy and electron microscopy to evaluate the response of the articular cartilage and subchondral bone of the differential joint loading because of the irregularity in the articular surface caused by the osteotomy. RESULTS: The knees with an intraarticular step-off had two major contact areas with an intervening zone of reduced load corresponding to the edge of the depressed fragment. Coronal histologic sections through the articular surface showed the presence of thinning and fibrillation on the high side of the step-off and some compensatory hypertrophy of the cartilage. The subchondral bone was not responsible for restoring articular congruity because the rate of bone production was similar between the low side of the articular fracture (1.85 micrometers per day) and the high side of the fracture (1.67 micrometers per day). Scanning electron microscopy showed partial cartilage remodeling by deformation of the high side cartilage with bending of the vertical collagen fibrils, even in the unloaded state. CONCLUSIONS: In this model with a small fracture displacement (1.0 millimeter), which was less than the thickness of the articular cartilage (1.5 millimeters), the contour of the joint improved despite residual articular surface incongruency after the fracture healing.

Animals↗
PubMedDate not supplied

Kawasaki disease--a cause of vasculitis in children.

Two cases of Kawasaki disease (mucocutaneous lymph node syndrome) with peripheral vasculitis of the extremities are described. Ischemia began 2-3 weeks after the onset of symptoms and was present for greater than 24 h before hospitalization. Despite supportive therapy, gangrene of the extremities resulted in amputation. The vasculitis causes inflammation and occlusion of vessels, and therefore therapy aimed at arterial dilatation may not be beneficial. Early recognition of ischemia and treatment with correction of hypovolemia, anticoagulation, and hyperbaric therapy may be useful. Steroids may decrease peripheral vasculitis, but there is also an associated increased risk of coronary aneurysms.

Amputation, Surgical↗