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Tomaino M.M.,Care at Hand
Journal of Hand Surgery | Year: 2011

Thumb metacarpal extension osteotomy provides effective treatment for the hypermobile trapeziometacarpal joint consistent with Eaton stage 1 disease. This procedure is a useful alternative to Eaton ligament reconstruction. Clinical outcomes are favorable and, should symptoms persist, the procedure does not jeopardize satisfactory execution of trapezial resection arthroplasty in the future. © 2011 American Society for Surgery of the Hand.

Ozyurekoglu T.,Care at Hand
Journal of Hand Surgery | Year: 2010

A 17-year-old boy who played baseball presented with swelling, pain, and crepitation in the right ring finger proximal interphalangeal joint after a remote trauma. Multiple osteochondral defects were identified on opposing articular surfaces. Cylindrical osteochondral grafts of 2.0, 2.5, and 5.0 mm were applied to the defects and congruency was restored. We confirmed vascularity of the grafts by magnetic resonance. The boy returned to full sports activities. No signs of arthritis were seen at 4-year follow-up radiographs. © 2010.

Ozyurekoglu T.,Care at Hand | Turker T.,Care at Hand
Journal of Hand Surgery | Year: 2012

Purpose: To evaluate the functional and radiographic results of a scaphoid excision and four-corner arthrodesis technique using percutaneous headless compression screws. Methods: A cohort of 33 patients, mean age 51 (range, 20-72) years, was treated for scapholunate advanced collapse (19), scaphoid nonunion advanced collapse (12), midcarpal instability (1), and Preiser disease (1). After scaphoid excision and removal of cartilage and subchondral bone in the midcarpal joint through a limited arthrotomy, capitolunate fixation was achieved with a percutaneous, transmetacarpal Acutrak screw (Acumed LLC, Hillsboro, OR), and triquetrohamate fixation was done with a percutaneous screw. Scaphoid was used as a bone graft. The average follow-up time was 8 months (n = 32; range, 6-64 mo). Results: Union occurred in 31 of 33 wrists (94%). One of the 33 patients had total wrist arthrodesis. Average total active flexion-extension arc was 71° after surgery and 83° before surgery. The postoperative carpal height averaged 0.47 compared to preoperative values of 0.45. The percentage of grip strength significantly improved from 41% before surgery to 80% after surgery. Postoperative mean verbal numerical rating scale pain score was less than 1, statistically better than the preoperative score of 7. Twenty-five of 33 patients were completely pain free. The average postoperative Mayo wrist score was 74, a significant improvement over the preoperative average of 40. Final Disabilities of the Arm, Shoulder, and Hand scores averaged 13 (n = 32; range, 0-49). Conclusions: These results were comparable to or better than the results of previously published techniques in terms of fusion rates, alleviation of pain, grip strength, range of motion; Mayo wrist score; and Disabilities of the Arm, Shoulder, and Hand questionnaire score. The technique exploits the theoretical advantages of strong compression between carpals while avoiding a screw-head sized hole in the lunate articular cartilage and preserving the dorsal capsular ligament attachments to the triquetrum. © 2012 American Society for Surgery of the Hand.

Atasoy E.,Care at Hand
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2013

Although hand surgeons may often see patients with arm and hand pain, numbness and tingling in their practice, the possibility of the presence of thoracic outlet compression syndrome (TOCS) is not often considered. In our practice almost half of newly referred patients have the complaint of upper extremity pain, numbness and tingling. In approximately 50% of these patients detailed history and physical examination are suggestive of TOCS. For this reason it is quite important to recognize the possibility of the existence of this condition. Very often in the past, and occasionally today, this condition has been considered a controversial subject by numerous physicians because of the absence of objective findings in many patients. For several years it has been very well known that the objective findings are present in about 10% of patients and the remaining 90% of patients have subjective complaints. For this reason it has been one of the most commonly underrated, overlooked, and misdiagnosed conditions. During the last 22 years our experience with combined surgical approach for this condition (transaxillary first rib resection with immediate transcervical anterior and middle scalenectomy) has been quite satisfactory. During these years over 850 of these procedures were performed. Between 1989 and 2002 (13 years) 532 patients from a wide geographic area had this combined approach procedure. We were able to locate 358 of these patients for follow-up and of those only 102 responded to our questionnaire. Of the 102 who responded, 95 reported improvement of their symptoms. From 2003 to the middle of 2012, 350 patients from a wide region had this combined procedure. We sent a questionnaire to these patients and had only 57 to respond. Of those who responded, there were 19 bilateral interventions performed a few months apart, with a total of 76 procedures performed. Results based on these 76 procedures revealed 95% improvement of their symptoms. This combined approach for TOCS is the most complete intervention with high rate of improvement and low rate of recurrences.

The descending geniculate artery has received notoriety as the source vessel of the medial femoral condyle vascularized bone flap in recent years. Its size and location enable it to serve as a useful recipient vessel in free flap reconstruction about the knee. It is particularly useful in coverage of unstable below-the-knee amputation stumps when recipient vessels are limited. It provides the ease and convenience of two-team surgery in the supine position and its distal position permits convenient and distal insetting of the transferred flap of choice. A discussion of its use in this setting and exemplary cases are provided. © 2011 by Thieme Medical Publishers, Inc.

Atasoy E.,Care at Hand
Journal of Hand Surgery | Year: 2010

Because hand surgeons frequently see patients with arm and hand pain, numbness, and tingling, it is important for them to recognize the possibility of the presence of thoracic outlet compression syndrome (TOCS). Approximately 40% to 50% of patients with this condition have associated peripheral nerve compression symptoms. Only about 10% of patients with suspected TOCS might show some objective evidence during physical examination and other examination modalities. For this reason, TOCS is one of the most overlooked, misdiagnosed, and underrated conditions. During the past 20 years (19892009) our surgical experience with combined-approach surgery for TOCS, involving transaxillary first rib resection followed by immediate transcervical anterior and middle scalenectomy, has been gratifying. During this period, more than 750 patients had this combined procedure. Between the end of 1989 and 2002 (13 years), 532 patients (many of whom were from out of state) had this kind of intervention. At the end of 2002, we surveyed our patients for the outcome of their surgery. Unfortunately, we were able to locate only 358 patients, and only 102 patients returned a mailed questionnaire. About 95 patients reported improvement of their symptoms. Since the beginning of 2003, more than 230 patients have had the same procedure. It is our impression that the outcome of the surgery in this last group of patients is at least as good as (if not better than) the earlier reported outcome in the first group of patients. The combined surgical approach to TOCS with transaxillary first rib resection and transcervical scalenectomy is the most complete procedure for total decompression of the thoracic outlet, with a much better rate of improvement of symptoms and a lower rate of recurrences. The surgical techniques of these two procedures are described. © 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.

Katz R.D.,Care at Hand
Journal of Hand Surgery | Year: 2013

The value of the human fingertip is incalculable. More than just aesthetic, the fingertip is an instrument through which we navigate our environment and acquire information. All too often, fingertip reconstruction is either not attempted or attempted without adhering to the fundamental principle of "replacing like with like." Through detailed description and case examples, this article highlights the power and utility of the anterograde homodigital neurovascular island flap in fingertip reconstruction. This single-stage flap can reliably resurface large soft tissue defects with sensate glabrous skin. © 2013 American Society for Surgery of the Hand.

Higgins J.P.,Care at Hand | Burger H.K.,Private Hospital Maria Hilf
Journal of Reconstructive Microsurgery | Year: 2014

Background The medial and lateral femur provide a source of convex osteochondral vascularized bone. The medial trochlea has been demonstrated to have similar contour to the proximal scaphoid, lunate, and capitate. Other sites of osteochondral harvest such as the posteromedial femur and the lateral trochlea are similar in morphology to the humeral capitellum and medial talus, respectively. These analogous structures offer potential solutions to difficult articular problems. Patients and Methods Patients who underwent osteochondral reconstruction of the extremities were reviewed. These included 16 medial femoral trochlea (MFT) scaphoid nonunion reconstructions, 16 MFT Kienböck lunate reconstructions, 5 MFT capitate reconstructions, 2 lateral femoral trochlea osteochondral reconstructions of medial tarsal avascular necrosis, and 5 posteromedial femoral osteochondral reconstructions of the humeral capitellum for posttraumatic arthritis. Results Computed tomography (CT) imaging demonstrated 15 of 16 reconstructed scaphoids achieving union. Follow-up wrist motion averaged 46.0 degrees extension and 43.8 degrees flexion, similar to preoperative measurements. CT imaging confirmed healing in 15 of 16 reconstructed lunates. Lichtman staging remained unchanged in 10 patients, improved in 4 patients (3A-2), and worsened in 2 patients (3A-3B). All but one patient experienced improvement in wrist pain. Wrist range of motion at follow-up averaged 50 degrees extension and 38 degrees flexion, similar to preoperative measurements. Capitate, talar, and capitellar reconstructions all resulted in achievement of osseous healing and restoration of joint alignment. Conclusions Vascularized osteochondral flaps provide a useful tool in the treatment of difficult articular problems in the extremities. Clinical experience thus far demonstrates a high rate of achieving union with acceptable range of motion and good pain relief. © 2014 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

In the last 12 years, the Louisville CTA program has screened more than 600 interested hand transplant candidates and has transplanted 6 patients with 7 hand allografts. The program is a collaborative effort between the surgeons and staff of Kleinert, Kutz and Associates, Jewish Hospital and St. Mary's Healthcare, the Christine M. Kleinert Institute, and the University of Louisville. The functional outcome and long-term results of clinical hand transplantation have exceeded initial expectations both within the program and in the community at large. This report summarizes the successes and challenges of the Louisville CTA experience in composite tissue allotransplantation. Copyright © 2011 Elsevier Inc. All rights reserved.

OWINGS MILLS, Md.--(BUSINESS WIRE)--Integra ServiceConnect®, a rapidly growing healthcare services company providing community-based, non-clinical support to underserved individuals who are difficult to reach and engage, is pleased to announce the recent appointment of Michael Ceballos as Senior Vice President, Strategic Development. Mr. Ceballos will be responsible for driving and overseeing the company’s strategic positioning, product development and management, marketing, and strategic relationships. Most recently, Mr. Ceballos served as Vice President, Long-Term Care & Product Development for Buckeye Health Plan, Centene’s Ohio subsidiary. In this role, Mr. Ceballos was responsible for Buckeye’s 15,500 member integrated Medicare-Medicaid dual demonstration business, as well as the product lead for both Buckeye’s Medicare Dual Special Needs Plan and the Health Insurance Marketplace. Prior to Centene, Michael had various strategy and leadership roles at UnitedHealth Group, including serving as Chief of Staff to the Medicare division’s CEO, as an Executive Director for Complex Care Products within UHC’s Medicaid division, International, health care reform and internal consulting. He began his career as an engineer, leading cross-functional teams. “Michael brings an unusually impressive combination of skills and experience in payer- and provider-sponsored service sectors to Integra at a critical time as we sit on the cusp of tremendous growth,” said Michael Yuhas, Integra’s Chief Executive Officer. “Payers and providers are facing steadily increasing pressure from state and federal authorities to go well beyond traditional efforts in finding and engaging hard-to-reach, underserved individuals and Integra’s unique community-based service model is tailored specifically to help them do this. We are thrilled to have Michael join us at such an exciting time.” Mr. Ceballos earned a B.S. and M.S. degree in Civil & Environmental Engineering from Stanford University, and a Master of Business Administration degree from The University of Chicago Booth School of Business. He serves as an Advisor to Care at Hand, a health care technology start-up, and sits on Columbus Early Learning Center’s board of directors. Michael will remain in Ohio where he lives with his wife and two children. Integra ServiceConnect® connects people to services they need to improve their health. With the recognition that 80% of health outcomes are driven by non-clinical social factors, Integra specializes in community-based non-clinical support to address these factors for individuals with healthcare and related social service needs. The Owings Mills, Md.-based company helps health plans, health systems and government organizations find, engage and connect underserved members to services that can preserve and improve their health. To learn more about Integra and its mission to connect underserved members to care that can preserve and improve their health please visit us at and check out our blog at Integra Insights.

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