Cooney, William P.

Free skin flap transfer for foot salvage and reconstruction was done in 10 patients whose follow-up exceeded 1 year. Nine of the 10 had successful results, and generally all achieved the desired reconstructive goal in one stage, with a minimum of hospitalization and disability time. In using a free skin flap transfer in weightbearing locations, the need for cutaneous innervation of the flap should be considered, but such innervation is not necessary for success.

Total joint arthroplasty (TJA) is implemented primarily for the relief of pain, and secondarily for achieving better function by increasing the joint’s strength and motion. In order to keep health costs low, it is desirable that the TJA achieves and maintains a long-term and secure fixation of the implanted components. Unfortunately, clinical follow-up shows that the prosthetic finger implant components have long-term complications including bone resorption, wear, loosening, and failure of the implant components. Although the mechanism of complications is not fully understood, it is well known that the wear and failure of prostheses are highly related to the mechanical forces or stresses of implant components. It is therefore desirable that reliable 3-D computational finite element analysis (FEA) models can be developed and used for the stress analysis of implants. In this study, the finger proximal interphalangeal (PIP) prosthetic components were analyzed using a nonlinear finite element method. Implant components under different joint flexion angles as well as different forces were studied. The stress distribution on the contact surface of the implant component was obtained. The developed FEA models can be used to examine the contact situations (contact stress, contact region, and stress distribution), which are critical to the wear and potential failure of the implant components. Based on FEA results, the design of the current finger PIP implants can be improved for optimum performance and a long-term fixation.

Golf is an activity generally stressful to the hands and wrists and particularly can produce increasing symp toms in players with underlying problems such as hand and wrist arthritis or tendinitis. The purpose of this study was to quantitate wrist motion and club head/ ball impact force in subjects with pathologic conditions of the hand, wrist, or forearm, within a laboratory environment. A regular straight-handled golf club was compared to a new BioCurve handle design that has a 19° ulnar bend. We measured and compared the effect of the two grips on wrist motion, club head velocity, ball impact force, ball impact location, and isometric torsional strength in 20 subjects who had a variety of upper extremity disorders. This data was then com pared to data collected in an identical fashion from golfers without such conditions. The results of our study show that there were no differences related to club handle design on impact force or impact location, club head velocity, or club head path and face angle. Wrist kinematic differences were minimal between handle designs. The differences that were significant (P < 0.05) centered around the decreased ulnar deviation of the left hand that resulted when subjects used the BioCurve handle design, which also allowed greater resistance to torque than the straight grip club. In addition to collecting objective data, we asked subjects for their opinions of the two grips. As a whole, the normal group and the group with pathologic conditions noted more comfort, improved grip, and less shock transmission with the BioCurve handle.

Despite the use of wrist guards during skate- and snowboard activities, fractures still occur at the wrist or at further proximal locations of the forearm. The main objectives of this study were to conduct a human subject testing under simulated falling conditions for measurement of the impact force on the hand, to model wrist guards as a shock isolator, to construct a linear mass-spring-damper model for quantification of the impact force attenuation (Q-ratio) and energy absorption (S-ratio), and to determine whether wrist guards play a role of an efficient shock isolator. While the falling direction (forward and backward) significantly influenced the impact responses, use of wrist guards provided minimal improvements in the Q- and S-ratios. It was suggested based on the results under the submaximal loading conditions that protective functions of the common wrist guard design could be enhanced with substantial increase in the damping ratio so as to maximize the energy absorption. This would bring forth minor deterioration in the impact force attenuation but significant increase in the energy absorption by 19%, which would help better protection against fall-related injuries of the upper extremity.

Abstract A modified approach to endoscopic carpal tunnel release has been developed and tested in 60 cadaveric specimens by three surgeons using the Agee endoscopic carpal tunnel release system. The modified approach, which includes specific localization of the hook of the hamate, flexor retinaculum, and the superficial palmar arch utilizing topographical landmarks, avoids entry into Guyon's canal and injury to the ulnar artery and nerve, median nerve, and common digital nerves. Use of the anatomic approach resulted in significantly superior results. There were fewer incomplete releases, and fewer surgical passes were required, for the inexperienced surgeons. When these anatomic considerations were not included, the learning curve was much steeper. For surgeons planning endoscopie surgical release of the transverse carpal ligament, the described topographical approach improves the technical competence with the procedure and reduces the number of complications and learning curve associated with new procedures. We recommend the use of topographical landmarks and other anatomic considerations during endoscopic carpal tunnel release.

Thumb motion and stability were examined after sequential division of support ligaments of the trapeziometacarpal (TMC) to simulate the pathologic condition of ligament laxity. The motion obtained with passive circumduction was measured with a magnetic tracking system. The lengths of the TMC joint ligaments were approximated by measuring the distance between origin and insertion of each ligament. The change in this apparent interorigin distance of the ligaments was measured before and after ligament sectioning. The anterior oblique ligament (AOL) and the ulnar collateral ligament (UCL) had the greatest effect on TMC joint stability during circumduction of the thumb. Division of the first intermetacarpal ligament (IML) did not produce a change in apparent length of other ligaments. We conclude that small changes in ligament length affect thumb stability and alter the path of circumduction. Neither the IML or posterior oblique ligaments were major stabilizers of the TMC joint during circumduction, prehensile grasp, or tip pinch. Reconstruction of the AOL and UCL ligaments should be considered for treatment of the initial stages of TMC instability.