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Lewis H Millender: Influence Statistics

One hundred fifteen flexor tendon ruptures were reviewed in 43 hands with rheumatoid arthritis, one hand with psoriatic arthritis, and one hand with lupus erythematosis. Ninety-one tendons were ruptured at the wrist, four ruptures occurred at the palm, and 20 ruptures occurred within the digits. At the wrist level, 61 ruptures were caused by attrition on a bone spur and 30 were caused by direct invasion of the tendon by tenosynovium. All ruptures distal to the wrist were caused by ...

Decompression of the ulnar nerve at the elbow with medial epicondylectomy was done in 43 patients and reviewed with an average follow-up of 2.3 years. Eight were graded as excellent, 23 as good, 9 as fair, and 3 as poor results. A special emphasis was placed on analysis of the potential disadvantages of medial epicondylectomy including bone tenderness at the osteotomy site, vulnerability of the ulnar nerve, ulnar collateral ligament instability, and weakness from disruption of the flexor ...

This is a retrospective review of 29 patients (33 hands) who underwent a palmaris longus transfer because of severe thenar atrophy secondary to median nerve entrapment at the wrist. The mean follow-up was 17 months. Ninety-four percent of our patients were satisfied because their thumb function improved. Twenty-six of the patients had the transfer at the time of initial release of the carpal tunnel, and three patients had the transfer when the carpal tunnel was released a second time. ...

A rare complication of rheumatoid arthritis is presented. A patient developed simultaneous extensor paralysis of all 5 digits of one hand due to compression of the posterior interosseous branch of the radial nerve by rheumatoid synovium of the elbow joint. By the technics of dye-contrast tendon radiography and electromyography, the extensor paralysis of tendinous origin could be separated from that of a neural defect. Operative decompression was necessary to restore extension. It should ...

Six cases of aneurysm and thrombosis of the ulnar artery in the hand occurred. Based on a review of the clinical history and examination, surgical findings, and pathology, it appears that the initiating event in the development of aneurysms and thromboses of the ulnar artery was intimal injury associated with trauma. In addition to a description of the pathophysiology, three clinical groups are defined; hypothenar mass with or without Raynaud's phenomena, and Raynaud's phenomena without ...

A comparison study was done for 25 consecutive trapeziectomies in 21 women with silicone replacements and 25 consecutive trapeziectomies in 24 women without silicone replacements who were reviewed from 1 to 9 years postoperatively. The patients, who ranged from 35 to 75 years of age, were housewives and clerical workers. All had trapeziometacarpal osteoarthritis. Among the patients with silicone replacement of the trapezium, 90% reported pain relief; mean thumb abduction was 42.5 ...

A review of the results of 37 arthroplasties of the wrist with flexible silicone, done at least 6 months before, in patients with rheumatoid arthritis showed six (16%) to have residual discomfort and two (5%) to have recurrent deformity. Pain was the primary indication for treatment in 31 and deformity in six. Three of 37 wrists had prosthetic fractures (8%). Ten patients who had the opposite wrist fused before the arthroplasty felt the movable wrist was more functional. ...

Metacarpophalangeal joint arthroplasty using flexible silicone rubber prostheses is a reliable and effective method for the treatment of various painful and deforming conditions affecting the metacarpophalangeal joint. Although it is used primarily for the treatment of rheumatoid hand deformities, the prosthesis has been found helpful in the treatment of various traumatic conditions affecting the metacarpophalangeal joints. This paper discusses the principles of arthroplasty and ...

The goal of preventative rheumatoid hand surgery is the eradication of the diseased synovium or tenosynovium before irreparable joint or tendon destruction occurs. Although there is general agreement that both dorsal and flexor tenosynovectomy are reliable and effective procedures to prevent the complications of tenosynovitis, the case for synovectomy is less well established. We have discussed the indications for both tenosynovectomy and synovectomy and described the surgical techniques ...

Most rheumatoid patients will present with one or more thumb deformities at some stage of their clinical history. The goal of treatment is restoration and maintenance of stable and painless motion. Treatment is based on the type and stage of the deformity. The boutonniere thumb is the most common deformity. Metacarpophalangeal arthrodesis is preferred for isolated metacarpophalangeal involvement. For advanced cases in a low-demand patient, metacarpophalangeal arthroplasty with ...

Of 71 silicone rubber wrist arthroplasties performed between 1976 and 1983, 20% were found to have fractured, and an additional 5% required revision for deformity and pain. In most cases, no specific cause for the failure could be identified. However, excessive wrist motion, overuse, and inadequate surgical technique appear to be contributory. Prosthetic fracture is associated with increasing wrist pain, instability, and deformity with decreasing strength and function. Twelve of 14 ...

The rheumatoid boutonniere deformity does not limit hand function significantly until it becomes severe. For this reason the surgical procedures used should not risk or sacrifice existing function. For the mild cases one can improve the digital balance by a simple extensor tenotomy combined with dynamic splinting. In more advanced stages with passive correction possible, the deformity can be improved by reconstruction of the extensor mechanism. With fixed deformities one can choose ...

In six patients rupture of the radial collateral ligament of the metacarpophalangeal joint of one of the three ulnar fingers, surgical reconstruction was successful using local tissues in five and a tendon graft in one. Operative treatment of this injury is indicated only when significant instability is present.

Two cases of a fracture of the hook of the hamate are described in which the diagnosis was clinically missed even though a fracture of the hook was considered. In one patient, the clinical diagnosis was thought to be ulnar wrist instability, and in the other, a pisiotriquetral injury. In one case, the diagnosis was confirmed only by a computerized tomography scan even though lateral tomograms were negative.