A Review on Functional Electrical Stimulation in Tetraplegic Patients to Restore Hand Function.

The purpose of this collective review is to describe a new form of functional electrical stimulation called neuroprosthesis. This unique technology has been devised to produce lateral pinch and palmar grasp in persons with C5 and C6 motor level spinal cord injuries. This neuroprosthesis includes external as well as implanted components.

Interposition arthroplasty with bone-tendon allograft: a technique for treatment of the unstable sternoclavicular joint.

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability.

Changes in radiocarpal loading characteristics after proximal row carpectomy.

Purpose: To document the changes in wrist loading that occur after proximal row carpectomy in a cadaver model.

Methods: The normal radioulnar carpal pressure distributions of 7 cadaver wrists were measured using super-low-pressure-sensitive film. Proximal row carpectomies were performed and the loading characteristics re-evaluated.

Recommendations for postexposure prophylaxis of operating room personnel and patients exposed to bloodborne diseases.

The purpose of this collective review is to discuss management of operating room personnel who have had occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus type I (HTLV-I). HBV postexposure prophylaxis includes starting hepatitis B vaccine series in any susceptible unvaccinated operating room personnel who sustain an exposure to blood or body fluid during surgery. Postexposure prophylaxis with hepatitis B immune globulin (HBIG) is an important consideration after determining the hepatitis B antigen status of the patient.

Functional electrical stimulation in tetraplegic patients to restore hand function.

The purpose of this collective review is to describe a new form of functional electrical stimulation called neuroprosthesis. This unique technology has been devised to produce lateral pinch and palmar grasp in persons with C5 and C6 motor level spinal cord injuries. This neuroprosthesis includes external as well as implanted components.

Biomechanical efficacy of an internal fixator for treatment of distal radius fractures.

Despite the effectiveness of external fixation in the treatment of complex wrist fractures, the complication rate for this modality ranges from 20% to 62%. Common complications are related to the use of percutaneous metal pins and result in an average reoperation rate of 16%. In addition, external fixation is unable to prevent dorsal collapse of the radius or maintain the normal palmar tilt of the radiocarpal joint surface.

An orthopedic surgeon's guide to interpreting electromyography.

Electrodiagnostic tests such as electromyography (EMG) and nerve conduction velocity studies are commonly ordered during the evaluation of patients with suspected peripheral nerve compression. Although these tests are invaluable extensions of the physical examination, many physicians are unable to interpret the test results, and so they base their operative decisions on electromyographers' impressions. A systematic approach to EMG interpretation allows surgeons to determine the nature and location of lesions as well as the degree of involvement and the viability of affected skeletal muscles.

Magnetic resonance imaging of the wrist.

MR imaging of the wrist has the unique capability of simultaneously demonstrating bone and soft tissue structures. Its exquisite sensitivity for detecting bone marrow edema makes it and ideal screening tool for diagnosing radiographically occult osseous injuries and areas of AVN. This, together with its ability to provide a comprehensive, non-invasive assessment of the ligaments, tendons, nerves, and components of the TFC make MRI a very powerful tool for evaluating patients with wrist pain of uncertain etiology.

Postoperative management following carpal tunnel release surgery: principles of rehabilitation.

The patient with an unsatisfactory result following carpal tunnel release is fortunately the exception rather than the rule. The vast majority of appropriately selected and treated patients will recover uneventfully without the need for extensive therapy. Although uncommon, the dissatisfied patient presents an extremely difficult management problem.

Left-hand dominance and hand trauma.

To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%.

Intraosseus ganglia of the wrist.

Purpose: To determine the prevalence of intraosseous ganglion cysts in patients with unexplained wrist pain and evaluate the radiographic methods used for their detection.

Materials And Methods: Four hundred patients with unexplained wrist pain were prospectively examined. All patients underwent standard three-view radiography of the wrist.

Staging and its use in the determination of treatment modalities for Kienböck's disease.

For more than 80 years, surgeons have staged an unsuccessful search for a universally acceptable treatment for Kienböck's disease. It is our contention that no single treatment will be universally successful. Treatment choice must be based on a number of variables, including the experience of the surgeon, the desires and activity level of the patient, the anatomic variation of the ulna, and most importantly, on the stage of the disease.

Facilitating difficult catheter passage.

Passage of a flexible catheter into a septic flexor tendon sheath can be difficult and time consuming because of the catheter's pliability. This article discusses a technique for converting the flexible catheter into a semirigid stylet.

The use of computed tomographic scan to assess femoral malrotation after intramedullary nailing. A case report.

Malrotation complicating intramedullary nailing of the femur must be recognized before healing occurs in the early postoperative period to obtain correction with the least possible effort. A 20-year-old man with more than 40 degrees of excessive external rotation required careful evaluation and demonstrated the value of computed axial tomography (CT scan) followed by derotation.

Evaluation of current extrication orthoses in immobilization of the unstable cervical spine.

An experiment was designed to evaluate the comparative stabilizing efficacy of several widely used semi-rigid orthoses applied to unstable fresh cadaver cervical spines subject to load. Cadaver specimens were surgically destabilized at the C4-5 segment. Lateral radiographs of the destabilized spine were obtained before and after collar placement and after the application of a 5-pound flexion force.

A technique for removing a fractured interlocking tibial nail.

The reported incidence of implant failure following reamed intramedullary tibial fixation is low. When necessary, retrieval of failed tibial nail segments is best performed in a closed fashion in order to avoid the delayed healing and increased risk of infection that may result from exposure of the tibial fracture site. A method to facilitate closed removal of the distal segment of a failed tibial nail is described.