Carpal tunnel volume changes of the wrist under distraction.

This study attempts to determine changes in carpal canal volume with distraction across the wrist. Uniform longitudinal distraction was maintained with two external fixators on the radial and ulnar aspects of the forearm axis of five cadaver specimens. After CT scanning, volume determinations were made at 5 mm increments beginning at the lunocapitate joint to a point 1.5 cm distal to the middle finger carpometacarpal joint. There was a statistically significant decrease of the mean total carpal canal volume from 0 to 4.54 kg of distraction, with no statistically significant decrease from 0 to 2.27 kg or 2.27 to 4.54 kg. The largest decrease occurred at 15 and 20 mm distal to the proximal edge of the transverse carpal ligament corresponding to the level of the hamate hook. Reduction in mean carpal canal volume was 10.2% and 7.5% at these distances, respectively, from 0 to 4.54 kg of distraction. Progressive distraction across the wrist causes a decrease in total carpal canal volume.

Digital neurorrhaphy after the age of 60 years.

Fifteen patients over the age of 60 years (average age: 65 years), with 19 digital nerve lacerations, were evaluated more than 1 year after injury. Two-point discrimination, Semmes-Weinstein evaluation, and subjective return of sensibility were examined by a certified hand therapist before and after local anesthetic block of the uninjured digital nerve. Sixty-three percent of the patients regained moving two-point discrimination less than 15 mm; 100 percent regained Semmes-Weinstein values of less than 4.56; and 84 percent of the patients subjectively noted greater than half of their normal sensation. Crossover innervation was a factor in four of 14 repairs. Based on the data, useful sensation can be regained by repairing a digital nerve in the majority of patients older than 60 years of age.

Reconstruction of an ulnar-sided thumb in central deficiency: a case report.

The thumb, which is normally located on the radial border of the hand, requires adequate sensibility to perceive its environment and adequate mobility to oppose to the other digits. We present a case in which the most ulnar digit of the hand was surgically augmented to function as a thumb.

Analysis of digital pulse-volume recordings with radial and ulnar artery compression.

The vascular noninvasive studies of 289 consecutive cardiac surgery patients were reviewed to better understand hand blood-flow physiology in an older population with vascular disease. The radial artery was found to be more important to pulsatile digital blood flow than the ulnar artery. In more than 20 percent of hands, the thumb and the index and fifth fingers lost pulsatile blood flow with radial artery compression at the wrist compared with only 5 percent with ulnar artery compression. The maintenance of pulsatile digital blood flow did not follow anatomic patterns of blood vessels previously presumed to be of paramount importance. The hand acts more like a single vascular bed than it does like two separate systems with a connecting arch.

Un-united fractures of the distal radius: a report of 12 cases.

The treatment of 12 distal radius nonunions in 11 patients over a 24-year period is presented. The average age of the patients was 55 years (range, 35-72 years). The comorbid medical conditions in the patients with these fractures included diabetes mellitus, peripheral vascular disease, psychiatric disorders, alcoholism, peripheral neuropathy, scleroderma, and morbid obesity. Nine of the un-united fractures in 8 patients had insufficient metaphyseal bone to allow internal fixation; 6 of these fractures were treated with a wrist arthrodesis. Three un-united fractures in 3 patients had sufficient supporting bone to permit correction of the nonunion and preservation of the radiocarpal joint. Three nonunions in 3 patients were treated without further surgery. Bony union was achieved in all 9 nonunions managed operatively (6 wrist arthrodeses and 3 open reductions).

Radial artery use in bypass grafting does not change digital blood flow or hand function.

BACKGROUND: Patient selection criteria have not been clearly established for use of the radial artery as a bypass conduit. To help establish such criteria, we measured changes in digital blood flow and hand function after radial artery removal. METHODS: Ninety-eight patients of the first 122 consecutive patients considered for radial artery harvest met predetermined criteria by vascular noninvasive studies to undergo removal of the radial artery. In 42 of these 98 patients, the radial artery was actually used as a bypass conduit; 28 of these 42 patients returned for noninvasive vascular studies, a critical review of hand function, and a hand symptom questionnaire. RESULTS: There were no significant differences between the operated and nonoperated hands for digital-brachial indices, cold response, grip or pinch strength, digital two-point discrimination, or nine-hole peg tests. The patients had an increased incidence of a small amount of forearm numbness and tingling, but no increase of pain or cold intolerance. CONCLUSIONS: For properly selected patients, there are minimal changes in hand function after radial artery removal.

Successful treatment of primary cutaneous Aspergillus flavus infection of the hand with oral itraconazole.

Primary cutaneous Aspergillus flavus infections of the hand are exceedingly rare. Usually, these infections are present in severely immunocompromised patients suffering from lymphoreticular malignancies. The majority of cases result in invasive systemic infections and often culminate in death. We report a case of primary cutaneous A. flavus infection in the hand of a patient immunocompromised only by non-insulin-dependent diabetes, who ultimately was cured of this infection with oral itraconazole.

Malignant fibrous histiocytoma of the distal fibula: a case report.

A 25-year-old female with primary malignant fibrous histiocytoma of the distal fibula is presented. Malignant fibrous histiocytoma of bone is a rare primary bone tumor in this anatomic location. Careful preoperative staging studies and neoadjunct chemotherapy permitted an unusual resection to be performed resulting in successful limb salvage for the patient.

Mechanisms of fatty acid effects on sarcoplasmic reticulum. II. Structural changes induced by oleic and palmitic acids.

The interaction of micromolar concentrations of palmitic and oleic acids with the sarcoplasmic reticulum membrane was studied by electron microscopic techniques in an attempt to define their different effects on ATP-induced calcium sequestration in sarcoplasmic reticulum vesicles. Oleic acid had a concentration-dependent effect on the morphology of sarcoplasmic reticulum vesicles, promoting vesicle fusion and eventual solubilization. Palmitic acid did not alter the morphology of sarcoplasmic reticulum, but its probable site(s) of interaction could be determined. In the presence of palmitic acid, large lamellar structures that formed external to sarcoplasmic reticulum vesicles are probably composed of pure palmitic acid and/or palmitic acid/phospholipid mixed "micelles," but internalization of palmitic acid into sarcoplasmic reticulum vesicles was not detected. Palmitic acid reduced the phospholipid content of sarcoplasmic reticulum membranes with a preservation of the average interparticle protein spacing as observed in freeze-fracture electron micrographs. Thus, palmitic acid appears to be incorporated into the sarcoplasmic reticulum lipid bi-layer. Oleic acid inhibition of ATP-induced calcium sequestration by sarcoplasmic reticulum vesicles is probably caused by net permeability changes of the membrane. A structural mechanism for palmitic acid stimulation of ATP-induced calcium sequestration is proposed in light of the probable insertion of palmitic acid into the sarcoplasmic reticulum lipid bilayer.

Organization of calcium pump protein dimers in the isolated sarcoplasmic reticulum membrane.

The arrangement of the calcium pump protein in the isolated sarcoplasmic reticulum (SR) membrane was examined by optical diffraction of freeze-fracture electron micrographs. Several states of protein particle organization were observed: random, hexagonal and tetragonal packing, and a mixture of hexagonal and tetragonal packing. This suggests that the time-averaged positions of protein particles in the plane of the SR membrane are weakly defined. In addition, there appears to be a greater degree of local or short-range order compared to long-range order within the field of freeze-fracture particles. We utilized measurements from tetragonally or hexagonally packed arrays to determine a unit cell area occupied by each freeze-fracture particle and its associated lipid matrix. When these unit cell areas and the stereologically determined area per freeze-fracture particle were compared to the cross-sectional area occupied by a single calcium pump protein and its associated lipid, obtained by x-ray and neutron diffraction methods, we concluded that each freeze-fracture particle probably represents a dimer of pump protein molecules in the plane of the SR membrane.