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Schreiber JJ, Suh N, Weiland AJ. Spontaneous, isolated rupture of the flexor digitorum superficialis tendon in zone II and annular pulley ruptures. J Hand Surg Eur Vol 2015; 40:316-8. [PMID: 24014517 DOI: 10.1177/1753193413502764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J J Schreiber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - N Suh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A J Weiland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Shindle MK, Burton KJ, Weiland AJ, Domb BG, Wolfe SW. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur Vol 2007; 32:50-3. [PMID: 17049699 DOI: 10.1016/j.jhsb.2006.08.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 08/24/2006] [Accepted: 08/26/2006] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis is an accepted salvage operation for scapholunate advanced collapse and scaphoid non-union advanced collapse. Circular plates were introduced in 1999 and promoted as a rapid and more stable method for this procedure. A retrospective chart review was performed on all patients who were treated with the Spider Limited Wrist Fusion Plate (Kinetikos Medical Inc., San Diego, CA). Sixteen patients were identified and followed clinically and with X-rays for an average of 16 (range 5-38) months. Nine out of the 16 patients (56%) had complications, including non-union (25%), delayed union (6%), dorsal impingement (25%), radial styloid impingement (6%) and broken screws (13%). The purpose of this study was to compare our complication rate using circular plates with published outcomes using traditional methods of fixation: this study identified a significantly higher complication rate and lower union rate using circular plate fixation for four-corner arthrodesis compared with previously published techniques.
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Affiliation(s)
- M K Shindle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
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Affiliation(s)
- A J Weiland
- Editor-in-Chief, Hospital for Special Surgery Cornell, University Medical Center New York, New York, U.S.A
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Affiliation(s)
- A J Weiland
- Editor-in-Chief Hospital for Special Surgery, Cornell University Medical Center, New York, New York, U.S.A
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Affiliation(s)
- A J Weiland
- Editor-in- Chief, Hospital for Special Surgery Cornell University Medical Center New York, New York, U.S.A
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Affiliation(s)
- A J Weiland
- Editor-in-Chief Hospital for Special Surgery Cornell University Medical Center New York, New York, U.S.A
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7
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Abstract
Varicella zoster is a ubiquitous virus which usually affects school-aged children as Chicken Pox. While the initial disease is self-limiting and seldom severe, the virus remains in the body. It lies dormant in the dorsal root ganglia and reactivation may occur years later with variable presentations as Herpes Zoster, or Shingles. While Shingles is common, it rarely presents exclusively in the upper extremity. It is important that hand surgeons recognize the possibility of zoster infection, with or without a rash, when evaluating the onset of neuralgia in a dermatomal distribution in the upper limb. Early diagnosis allows rapid and appropriate treatment, with a lower risk of complications. We report on a case of Herpes Zoster isolated to the ulnar nerve distribution in a young woman.
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Affiliation(s)
- G S Athwal
- Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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Affiliation(s)
- L Kang
- Department of Orthopaedic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence 02903, USA
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Abstract
Treatment of displaced fractures of the distal radius has changed over the course of time. For many years, closed reduction with plaster immobilization was considered the treatment of choice. Subsequent use of pins and plaster, percutaneous pin fixation, and the development of external fixation devices all contributed to improving fracture stability. More recently a new generation of external fixation devices has been developed to permit distraction and palmar translation. In addition, over the past twenty years, we have seen the development of more sophisticated internal fixation devices for the treatment of displaced fractures of the distal radius. The indications for open reduction and internal fixation have been defined largely on the basis of numerous studies which support the concept that articular malreduction is predictive of traumatic arthritis and poor functional result. Knirk and Jupiter have reported poor results for intra-articular fractures of the distal radius having an articular step-off greater than 2 mm. More recently, wrist arthroscopy has been used to improve visualization of articular surfaces and aid fracture reduction. In addition, bone grafting techniques have been employed more frequently to accelerate fracture healing. With improvement in techniques, we are able to provide our patients with better functional results and return them to their activities of daily living and vocation more rapidly.
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Affiliation(s)
- S F Duncan
- Hospital for Special Surgery, New York, NY 10021, USA
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Affiliation(s)
- S H Coleman
- Division of Hand Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York 10021, USA
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Weiland AJ. The challenges of genetic advances. Healthplan 2000; 41:24-30. [PMID: 11185806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A J Weiland
- Kaiser Permanente Northwest, Portland, Ore., USA
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Dugas JR, Weiland AJ. Vascular pathology in the throwing athlete. Hand Clin 2000; 16:477-85, x. [PMID: 10955220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Vascular pathology in the upper extremity of a throwing athlete comprises a spectrum of serious disorders apt to threaten the patient's career and the viability of the involved parts. Such pathology includes digital vessel thrombosis, proximal thrombosis with distal embolization, vessel aneurysm, and vessel compression, such as in thoracic outlet syndrome and quadrilateral space syndrome. This article provides a description of vascular disorders prone to result from sports activities and a review of published data relevant to throwing athletes. Recognition of vascular compromise as a cause for dead arm syndrome or painful digital dysfunction among athletes is essential to prevent the grave consequences of progressive ischemia.
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Affiliation(s)
- J R Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA
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14
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Abstract
Threshold and innervation density tests are common clinical tools used in the evaluation of peripheral nerve injuries and compression syndromes. The purpose of this study is to determine the inter- and intraobserver reliability of Semmes-Weinstein monofilaments and static and moving two-point discrimination in 48 volunteers. Kappa coefficients of inter- and intraexaminer agreement were generated for each test and investigator. The interexaminer reliability for the Semmes-Weinstein monofilaments ranged from fair to moderate in the ulnar and median nerve distributions, and slight to moderate in static and moving two-point discrimination testing. Intraobserver reliability for Semmes-Weinstein monofilaments and static and moving two-point discrimination was slight to fair for both examiners. Our data indicate that Semmes-Weinstein monofilaments and two-point discrimination tests yield unreliable measurements in asymptomatic individuals. Although useful in monitoring neurological function in pathological states, threshold and innervation density measurements from an unaffected digit or extremity may not represent a reliable standard for comparison of abnormal values.
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Affiliation(s)
- T D Rozental
- Department of Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
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Lester B, Jeong GK, Weiland AJ, Wickiewicz TL. Quadrilateral space syndrome: diagnosis, pathology, and treatment. Am J Orthop (Belle Mead NJ) 1999; 28:718-22, 725. [PMID: 10614765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.
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Affiliation(s)
- B Lester
- Department of Orthopaedic Surgery Montefiore Medical Center, Bronx, New York, USA
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Weiland AJ. Useful surgical techniques to treat disorders of the hand and wrist. Tech Hand Up Extrem Surg 1999; 3:221. [PMID: 16609415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- A J Weiland
- Editor-in-Chief, Hospital for Special Surgery Cornell University Medical Center New York, New York, U.S.A
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Affiliation(s)
- A J Weiland
- Department of Orthopaedic Surgery, Cornell University Medical College, New York, New York, USA
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Affiliation(s)
- G López-Graña
- Orthopaedic Surgery Service, Hospital Severo Ochoa, Leganes, Madrid, Spain
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Schneider K, Kasparyan NG, Altchek DW, Fantini GA, Weiland AJ. An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher. A case report and review of the literature. Am J Sports Med 1999; 27:370-5. [PMID: 10352776 DOI: 10.1177/03635465990270031801] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Baseball pitchers appear to be prone to aneurysms of the axillary artery and its branches. The cause is probably related to repetitive compression of or tension on the vessels at the level of the pectoralis minor muscle and the humeral head, which is exacerbated by the pitching motion. The incidence of aneurysms of the axillary artery and its branches among pitchers and other athletes is not known, nor is it clear whether pitchers who are at high risk of vascular injury can be identified before irreversible damage to the vessels has occurred. Perhaps patients who have documented compression or occlusion of the vessel with the arm in the abducted, externally rotated position are at higher risk. Screening pitchers to identify those with axillary artery compression, aneurysm, or thrombosis has also not been shown to be effective. Certainly, many pitchers will have some level of compression of the axillary artery with their arm in the pitching position but will never develop any clinical abnormality requiring treatment. Screening would therefore probably lead to a high false-positive rate. It is clear, however, that pitchers who complain of ischemia-type symptoms such as early fatigue or who have evidence of emboli require a complete evaluation to rule out any abnormality of the axillary artery or one of its branches. Orthopaedic surgeons who see pitchers and other athletes involved in repetitive overhead motions need to be aware of this disorder so that they order the appropriate tests and obtain a vascular consultation--and make a prompt diagnosis. Treatment will vary depending on the type of lesion and on which vessel or vessels are involved, and should be decided on by the team of surgeons treating the patient.
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Affiliation(s)
- K Schneider
- Hospital for Special Surgery, New York, NY 10021, USA
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Weiland AJ. Treatment for congenital differences of the hand and upper extremity. Tech Hand Up Extrem Surg 1999; 3:1. [PMID: 16609449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Abstract
We report a patient with rheumatoid arthritis who developed late catastrophic failure of the hinge mechanism of her trispherical total wrist arthroplasty. This was associated with synovitis secondary to wear debris from Titanium, cement, and polyethylene which produced exuberant flexor and extensor tendon synovitis and median nerve compression.
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Affiliation(s)
- H M O'Flynn
- The Hospital for Special Surgery, Cornell Medical College, New York, NY 10021, USA
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Abstract
Trapeziectomy, ligament reconstruction and tendon interposition arthroplasty is one of the most commonly performed procedures to address pain and instability due to osteoarthritis at the basal joint of the thumb. To determine the effect of stress on first metacarpal subsidence, 15 ligament reconstruction and tendon interposition basal joint arthroplasties were evaluated after a mean follow-up of 32 months. Radiographs were obtained of the arthroplasty at rest and then with maximal effort key pinch stress, which is known to subject the first carpometacarpal joint to considerable axial compression stress. Compared with the preoperative x-rays, the first metacarpal had subsided 21% of the arthroplasty space at rest. Under stress, the first metacarpal was found to subside another 10.5% in height. No subluxation of the metacarpal base could be detected. Key pinch strength improved 17% from the preoperative strength. Tip-to-tip pinch strength improved 17% from the preoperative measurement. Grip strength improved 17% from the preoperative measurement. Grip strength was 9% greater than the preoperative grip strength. There was no statistical association between the amount of first metacarpal subsidence and follow-up key pinch, tip pinch, or grip strength. With axial compressive loading of the arthroplasty, such as in lateral pinch, there is some further proximal migration of the first metacarpal, but this is minimal and does not correlate with functional outcome.
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Affiliation(s)
- S S Yang
- Department of Orthopedic Surgery, The Lenox Hill Hospital, New York, NY 10021, USA
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Affiliation(s)
- A J Weiland
- The Hospital for Special Surgery, New York, NY 10021, USA
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Abstract
A 41-year-old man developed a 3 x 4 cm wound after corrective osteotomies of his distal tibia and fibula. The wound was debrided and covered with a free gracilis muscle flap. Seven days after flap transfer, the arterial pedicle ruptured adjacent to the anastomosis. Attempted repair of the aneurysm failed and the graft was subsequently debrided. Intraoperative wound cultures grew Pseudomonas and Enterobacter cloacae, which were attributed to formation of the aneurysm.
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Affiliation(s)
- D M Kalainov
- Hospital For Special Surgery, New York, New York, USA
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Wright JM, Crockett HC, Weiland AJ. Ulnar collateral ligament tear with concomitant extensor pollicis brevis and extensor pollicis longus disruptions: a case report. J Hand Surg Am 1998; 23:536-40. [PMID: 9620198 DOI: 10.1016/s0363-5023(05)80475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A patient with a tear of the thumb ulnar collateral ligament and simultaneous extensor pollicis brevis and extensor pollicis longus disruptions is reported. No report of a similar constellation of injuries was found in the literature.
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Affiliation(s)
- J M Wright
- The Hand Service, Hospital for Special Surgery, New York, NY, USA
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Affiliation(s)
- S S Yang
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY 10021, USA
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Abstract
A complete assessment of the entire patient along with a clear understanding of the progression of rheumatoid deformities is the key to success when contemplating surgical intervention for rheumatoid arthritis of the hand. The decision to perform surgery must be made following careful evaluation of the patient's signs and symptoms weighed against the potential benefits likely to be gained. The surgical plan will vary from patient to patient and should be tailored accordingly. Early in the disease process, conservative measures including pharmacologic intervention, steroid injections, and hand therapy, including splinting and wrist use modification, are indicated. Surgical intervention, however, should not be avoided for so long that the benefit of successful intervention is diminished. Hand surgery has proven to be effective in correcting deformity and maintaining or increasing function in patients with rheumatoid arthritis. The indications for synovectomy, tenosynovectomy, tendon repair or realignment, arthroplasty, and arthrodesis have been well established. Superior results are possible when surgical reconstruction is performed before tendon rupture, severe fixed contractures, subluxation, or dislocation.
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Affiliation(s)
- A Rosen
- Division of Hand and Microvascular Surgery, Hospital for Special Surgery, Cornell Medical School, New York, New York, USA
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Cole BJ, Bostrom MP, Pritchard TL, Sumner DR, Tomin E, Lane JM, Weiland AJ. Use of bone morphogenetic protein 2 on ectopic porous coated implants in the rat. Clin Orthop Relat Res 1997:219-28. [PMID: 9418644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The ability of recombinant human bone morphogenetic protein 2 to remain osteoinductive and stimulate appositional bone formation on a porous coated implant was tested in a rat quadriceps muscle pouch. Implants with or without hydroxyapatite were used to compare the effects on bone formation of two different does (23 micrograms or 46 micrograms) of recombinant human bone morphogenetic protein 2 against controls as evidenced by contact radiography, histologic examination, and backscatter scanning electron microscopic analysis. Cylindrical plasma sprayed porous titanium implants were placed bilaterally within a muscle pouch surgically created in 48 Lewis rats. Implants treated with recombinant human bone morphogenetic protein 2 formed significantly more bone than did control implants independent of the dose or presence of hydroxyapatite. In all implants with bone formation, osteoinduction via endochondral ossification began within 7 days. By 21 days, cartilage largely was replaced by bone and marrow. The results of this ectopic, nonweightbearing in vivo assay suggest that recombinant human bone morphogenetic protein 2 remains biologically active after application to a titanium implant and may be used to enhance appositional bone formation by direct application to the implant surface.
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Affiliation(s)
- B J Cole
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
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Weiland AJ. New and innovative techniques in hand and upper extremity surgery. Tech Hand Up Extrem Surg 1997; 1:227. [PMID: 16609489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Potter HG, Asnis-Ernberg L, Weiland AJ, Hotchkiss RN, Peterson MG, McCormack RR. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am 1997; 79:1675-84. [PMID: 9384427 DOI: 10.2106/00004623-199711000-00009] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed a prospective study in order to assess the utility of high-resolution magnetic resonance imaging in the detection and specific localization of tears of the triangular fibrocartilage complex. Seventy-seven patients who had pain in the wrist were studied with use of a dedicated surface coil and three-dimensional gradient-recalled techniques with a field of view of eight centimeters and a slice thickness of one millimeter. The patients had pain on the ulnar side of the wrist, ligamentous instability, occult ganglia, or a combination of these. Magnetic resonance images were assessed for radial or ulnar avulsion, or both; central defects; degenerative intrasubstance changes; and complex tears of the triangular fibrocartilage complex. Partial tears were differentiated from complete tears. The findings on the magnetic resonance images were then compared with the arthroscopic findings. Fifty-seven of the fifty-nine tears that were suspected on magnetic resonance images were confirmed with arthroscopy; the two suspected tears that were not confirmed had been interpreted as small partial tears on the magnetic resonance images. With use of arthroscopy as the standard, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-seven of fifty-seven), a specificity of 90 per cent (eighteen of twenty), and an accuracy of 97 per cent (seventy-five of seventy-seven) for the detection of a tear (kappa = 0.93, p < 0.00001). Fifty-three of the fifty-seven tears were localized correctly with use of magnetic resonance imaging. With regard to the location of the tear, magnetic resonance imaging had a sensitivity of 100 per cent (fifty-three of fifty-three), a specificity of 75 per cent (eighteen of twenty-four), and an accuracy of 92 per cent (seventy-one of seventy-seven) (kappa = 0.9, p < 0.0001). We concluded that high-resolution magnetic resonance imaging permits accurate depiction and localization of tears of the triangular fibrocartilage complex. When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist.
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Affiliation(s)
- H G Potter
- Department of Radiology, The Hospital for Special Surgery, New York City, N.Y. 10021, USA.
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Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res 1997:42-5. [PMID: 9308523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed.
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Affiliation(s)
- M Gerwin
- Hospital for Special Surgery, New York, NY 10021, USA
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Weiland AJ. Clinical entities that can be approached and treated in several different ways. Tech Hand Up Extrem Surg 1997; 1:147. [PMID: 16609500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Abstract
PURPOSE To evaluate the efficacy of magnetic resonance (MR) imaging in the assessment of the normal and abnormal ulnar band of the lateral collateral ligament for diagnosis of posterolateral rotatory instability. MATERIALS AND METHODS In nine symptomatic patients and nine asymptomatic subjects, MR imaging was performed with three-dimensional gradient-recalled and fast spin-echo sequences. The nine patients had clinical symptoms suggestive of subtle elbow instability. RESULTS The components of the lateral collateral ligament were identified; tears of the ulnar band were noted in all symptomatic patients. The anterior fibers of the lateral collateral ligament, including the annular ligament, were intact. All symptomatic patients subsequently underwent surgical exploration and reconstruction. Positive clinical findings were demonstrated at examination performed while the patients were under anesthesia. All tears of the ulnar band were confirmed. CONCLUSION With use of appropriate pulse sequences, MR imaging is an effective tool in the preoperative, noninvasive diagnosis of posterolateral rotatory instability.
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Affiliation(s)
- H G Potter
- Department of Radiology, Hospital for Special Surgery-Cornell University Medical Center, New York, NY 10021, USA
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Weiland AJ, Berner SH, Hotchkiss RN, McCormack RR, Gerwin M. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor. J Hand Surg Am 1997; 22:585-91. [PMID: 9260611 DOI: 10.1016/s0363-5023(97)80113-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Thirty-six consecutive patients with 37 complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint were treated with primary repair using a miniature intraosseous suture anchor. Thirty patients were evaluated by clinical examination or by questionnaire at an average of 11 months after repair. Loss of interphalangeal joint motion averaged 15 degrees on the involved side versus the other side, while loss of MP joint motion averaged 10 degrees. There was no significant difference on stress testing measurements between repaired and nonrepaired thumbs. There were no instances of nerve injury, infection, device failure, or reoperation. The authors concluded that this is a safe and effective method for repair of complete tears of the ulnar collateral ligament of the thumb MP joint.
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Affiliation(s)
- A J Weiland
- Division of Hand Surgery, Hospital for Special Surgery, New York, NY 10021, USA
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35
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Weiland AJ. Fractures of the distal radius: significant improvement in the treatment. Tech Hand Up Extrem Surg 1997; 1:69. [PMID: 16609509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Affiliation(s)
- A J Weiland
- Hospital for Special Surgery, New York, NY 10021, USA
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37
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Abstract
An anatomical study was performed to define the course of the radial nerve in the posterior aspect of the arm, with particular reference to its relationship to operative exposures of the posterior aspect of the humeral diaphysis. In ten cadaveric specimens, the radial nerve was found to cross the posterior aspect of the humerus from an average of 20.7 +/- 1.2 centimeters proximal to the medial epicondyle to 14.2 +/- 0.6 centimeters proximal to the lateral epicondyle. As it crossed the posterior aspect of the humerus in each specimen, the nerve had several branches to the lateral head of the triceps; however, no branches were found innervating the medial head of the triceps in the posterior aspect of any of the specimens. At the lateral aspect of the humerus, the nerve trifurcated into a branch to the medial head of the triceps, the lower lateral brachial cutaneous nerve, and the continuation of the radial nerve into the distal part of the upper arm and the forearm. Three operative approaches were performed in each specimen. The posterior triceps-splitting approach exposed an average of 15.4 +/- 0.8 centimeters of the humerus from the lateral epicondyle to the point at which the radial nerve crossed the posterior aspect of the humerus. For the second approach, the radial nerve was mobilized proximally to allow an additional six centimeters of the humeral diaphysis to be visualized. The third approach (the modified posterior approach) involved the identification of the radial nerve distally as it crossed the lateral aspect of the humerus, followed by reflection of both the lateral and the medial heads of the triceps medially. This exposure permitted visualization of 26.2 +/- 0.4 centimeters of the humeral diaphysis from the lateral epicondyle proximally. The results after use of the modified posterior approach in seven patients were also reviewed.
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Affiliation(s)
- M Gerwin
- The Hospital for Special Surgery, New York City, N.Y. 10021, USA
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38
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Abstract
Mirror hand is one of the rarest congenital differences of the upper extremity. Typically, there is absence of the radius, duplication of the ulna, and 7 digits in mirrored symmetry about the middle finger. We report a case of a rarer subset of hand duplication in which there is a normal radius and ulna and a hand with 8 digits. The patient underwent surgery to excise the radial 3 digits and to reconstruct the remaining radial digit to function as an opposable, 2 phalanx thumb. Wrist extension was augmented by transferring the digital extensors from the excised fingers to the radial wrist extensors.
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Affiliation(s)
- S S Yang
- Department of Orthopedic Surgery, Lenox Hill Hospital New York, NY 10021, USA
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39
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Affiliation(s)
- S S Yang
- Hand Surgery Service, Hospital for Special Surgery, New York, NY, USA
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40
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Smith GR, Yang SS, Weiland AJ. Multiple carpometacarpal dislocations. A case report and review of treatment. Am J Orthop (Belle Mead NJ) 1996; 25:502-6. [PMID: 8831895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Carpometacarpal dislocations of the ulnar four joints are rare injuries that are usually associated with high-energy trauma. Given the small number of cases reported, there exists some controversy regarding their optimal management. The case of a 27-year-old man who sustained a dorsal dislocation (without associated fractures) of the ulnar four carpometacarpal joints as a result of a fall from a height is presented. The literature regarding these hand injuries is reviewed, and the need for anatomic reduction and stabilization is discussed.
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Affiliation(s)
- G R Smith
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA
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41
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42
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Kalainov DM, DiCarlo EF, Yang SS, Weiland AJ. Recurrent eccrine acrospiroma of the hand. J Hand Surg Br 1996; 21:280-2. [PMID: 8732420 DOI: 10.1016/s0266-7681(96)80117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A rare case of a recurrent, benign, eccrine acrospiroma of the hand is described.
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43
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Abstract
Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.
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Affiliation(s)
- S S Yang
- Hand Surgery Service, Hospital for Special Surgery, New York, USA
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44
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Abstract
The clinical feasibility of transplantation of a vascularized limb tissue allograft depends upon reducing immunosuppression and its associated toxicity for the graft recipient. Donor or allograft irradiation would eradicate allogeneic marrow and provide a possible alternative or beneficial addition to host immunosuppression. The effect of irradiation on survival of limb tissue allograft was investigated in this study. In a rat model, knee allografts consisting of bone, cartilage, and soft tissues were transplanted across a strong histocompatibility barrier by femoral vascular microanastomoses. The grafts were harvested 1 and 2 weeks postoperatively for histologic and immunologic assays. Gamma irradiation of the graft immediately before transplant decreased graft rejection slightly. However, total body irradiation of the donor followed by a "waiting period" of 2 or more days before transplant significantly delayed rejection. After such a 6-day and a 2-day pretreatment protocol, the host cellular immune responses were not observed 1 and 2 weeks after transplantation and eventual progression toward graft rejection coincided with emergence of host antibody production. Rejection of vascularized limb tissue allografts after donor irradiation thus appeared to be mediated primarily through the humoral pathway. We conclude that donor irradiation is a potentially useful adjunct in prolonging survival of vascularized limb tissue allografts.
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Affiliation(s)
- W P Lee
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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45
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Sowa DT, Hotchkiss RN, Weiland AJ. Symptomatic proximal translation of the radius following radial head resection. Clin Orthop Relat Res 1995:106-13. [PMID: 7671463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eight patients with symptomatic proximal translation of the radius after having radial head resection for trauma were treated with a combination of immediate pinning of the radius to the ulna, silicone radial head replacement, or some form of ulnar shortening, including the Darrach procedure, formal ulnar shortening, or Suave-Kapandji fusion. Despite these techniques, all patients did not maintain effective relative length of the radius, exhibiting 3 mm or greater positive ulnar variance after treatment. Injuries to the central band of the interosseous membrane of the forearm probably do not heal with mechanical integrity. Without this structure, conventional methods of equalization of the radius and ulnar do not appear to be reliable. Current methods of treatment of acute longitudinal dissociation of the radius and ulna are inadequate.
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Affiliation(s)
- D T Sowa
- All Sports Clinic of Delaware, University of Delaware, USA
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46
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Raskin KB, Weiland AJ. Current concepts of replantation. Ann Acad Med Singap 1995; 24:131-4. [PMID: 8572516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The rapidly expanding microsurgical knowledge and technology along with a growing experience in replantation has led the way to new concepts of management that have become essential in the progressive treatment for these complex injuries. Appropriate patient selection, proper modes of limb transportation, injury assessment, surgical technique, and postoperative care are all key components to successful recovery and restoration of function. As the ability to restore vascular flow to amputated digits, hands, and limbs has advanced, critical evaluation of the potential extent of recovery in comparison to amputation revision is imperative. This article discusses the current ideas of the perioperative treatment for replantation with specific attention directed towards these evolving issues.
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Affiliation(s)
- K B Raskin
- Department of Orthopaedic Surgery, New York University Medical Center, New York, New York 10016, USA
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47
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Bednar MS, Weiland AJ, Light TR. Osteoid osteoma of the upper extremity. Hand Clin 1995; 11:211-21. [PMID: 7635883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Osteoid osteomas, relatively rare lesions in the upper extremity, can be a persistent source of hand or wrist pain. Patients under age 40 who have otherwise unexplained pain should be evaluated. Relief of pain with oral nonsteroidal anti-inflammatory drugs should suggest the possibility of osteoid osteoma. Examination may demonstrate localized swelling or joint effusion. Radiographs should be examined for sclerosis in the region of pain. If radiographs are nondiagnostic, a bone scan should be obtained. If the nidus cannot be clearly visualized by radiography and bone scan, a CT scan should be obtained. If the location of the nidus makes excision difficult without removal of a large block of bone, localization with a CT-guided needle or by radioisotope labeling will help to assure removal of the nidus.
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Affiliation(s)
- M S Bednar
- Department of Orthopaedic Surgery, Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois, USA
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48
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Lee WP, Pan YC, Kesmarky S, Randolph MA, Fiala TS, Amarante MT, Weiland AJ, Yaremchuk MJ. Experimental orthotopic transplantation of vascularized skeletal allografts: functional assessment and long-term survival. Plast Reconstr Surg 1995; 95:336-49; discussion 350-3. [PMID: 7824614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vascularized skeletal tissue allografts would greatly expand the domain of reconstructive surgery. Few studies to date have examined the functional aspects of these allografts or their long-term fate. An orthotopic transplant model of rat distal femur and surrounding muscular cuff was developed to assess graft function in fracture healing and weight bearing. Isografts (RT1l to RT1l, n = 40), weak-barrier allografts (RT1l to RT1lv, n = 40), and strong-barrier allografts (RT1l to RT1n, n = 40) were transplanted. As the histocompatibility barrier increased between the donor and recipient animals, the graft viability and performance deteriorated according to radiographic, histologic, and immunologic analyses. Administration of cyclosporine led to survival of strong-barrier allografts similar to that of isografts. A long-term study of these allografts (RT1l to RT1n) was then performed on various immunosuppressive regimens. After an initial 10-week course of cyclosporine to achieve bony union and remodeling, subsequent cessation (n = 20) or intermittent "pulsing" (n = 20) of the immunosuppressant was insufficient in maintaining graft survival. However, graft viability and function were preserved through 1 year on continuous daily cyclosporine (n = 32). There was no evidence of host renal or hepatic toxicity by serum chemistry or histologic sections. Thus long-term survival of functional skeletal allografts was achieved in this orthotopic model without significant host toxicity from immunosuppression.
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Affiliation(s)
- W P Lee
- Department of Surgery, Massachusetts General Hospital, Boston
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49
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Figgie MP, Gerwin M, Weiland AJ. Revision total elbow replacement. Hand Clin 1994; 10:507-20. [PMID: 7962154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Revision total elbow surgery is technically demanding with high complication rates. It requires precise preoperative planning and a surgeon prepared to use any of several surgical options during surgery. Satisfactory results can be achieved in complex cases.
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Affiliation(s)
- M P Figgie
- Hospital for Special Surgery, New York, New York
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50
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Martin SD, Weiland AJ. Missed scapular fracture after trauma. A case report and a 23-year follow-up report. Clin Orthop Relat Res 1994:259-62. [PMID: 8119029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Scapular fractures are important in that they are often associated with high morbidity and mortality. Frequently they are overlooked because of the severity of other associated injuries. Extraarticular scapular fractures are often treated conservatively, even when displaced. There is no significant long-term evaluation on this type of treatment and on the management of scapular malunion. This case report presents a missed scapular fracture and associated rib fractures with subsequent malunion and a 23-year follow-up assessment. Surgical resection of a distorted inferior medial border of the scapula and dorsal rib prominences relieved the patient's symptoms. The case presentation, diagnostic modalities, treatment, and possible long-term sequelae of this complex fracture are reviewed.
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Affiliation(s)
- S D Martin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Cornell Medical Center, New York, New York 10021
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