Awards & Distinctions ?

Associations
American Board of Internal Medicine

Publications & Research

Dr. Bowers has contributed to 36 publications.
Title Ulnar Head Implant Arthroplasty: an Intermediate Term Review of 1 Surgeon's Experience.
Date December 2009
Journal Techniques in Hand & Upper Extremity Surgery
Excerpt

Ulnar head arthroplasty has been an emerging alternative for salvage of resection arthroplasty at the distal radioulnar joint (DRUJ) since the early 1990s. Recently, it has been offered for initially treating painful arthrosis or instability of the DRUJ. This follow-up study reports a surgeon's experience treating DRUJ disorders with ulnar head arthroplasty. Twenty-two wrists in 20 patients (11 females, 9 males), 6 with no prior wrist procedures were treated between 1995 and 2006 for painful DRUJ disorders with either Herbert-Martin (Martin Medizin-Technik, Tuttingen, Germany) or Avanta (Small Bone Innovations, New York, NY) head prosthesis. Follow-up averaged 54.3 months. A standardized telephone survey determined preoperative /postoperative verbal analog pain scores and a modified Mayo Wrist Score (delineating poor, fair, good, or excellent outcomes). Data suggest that ulnar head implant arthroplasty is a reasonable treatment option for DRUJ-related pain, loss of function, or salvage of failed distal ulna resection procedures. The analog pain score statistically significant decreased by 1.68 points when comparing preoperative to postoperative scores. Average Modified Mayo Wrist Scores were good, independent of whether the procedure was primary or salvaged. No significant difference was seen between the primary or salvage group modified Mayo Wrist Scores. Whereas averaged modified Mayo scores for both the primary and salvage groups were in the good category, prostheses used as primary procedures may be associated with fewer poor or fair outcomes. Two good and 1 excellent outcome of 3 wrists requiring revision procedures suggest that even with revision of the implant arthroplasty, satisfactory results may be expected.

Title Range of Motion Effects of Distal Pole Scaphoid Excision and Triquetral Excision After Radioscapholunate Fusion: a Cadaver Study.
Date July 2009
Journal The Journal of Hand Surgery
Excerpt

Radioscapholunate (RSL) fusion is an effective surgical procedure for the treatment of isolated radiocarpal arthritis. Although functional wrist motion is typically preserved through the midcarpal joint, many patients are still frustrated by postoperative limitations. The purpose of this study was to evaluate motion of cadaver wrists after simulated RSL fusion with excision of the distal pole of the scaphoid and the triquetrum.

Title Limited-incision Carpal Tunnel Release.
Date May 2006
Journal Techniques in Hand & Upper Extremity Surgery
Title Salvage of Failed Resection Arthroplasties of the Distal Radioulnar Joint Using a New Ulnar Head Prosthesis.
Date August 2000
Journal The Journal of Hand Surgery
Excerpt

Twenty-three patients with painful instability following total or partial resection of the ulnar head were treated using a new ulnar head prosthesis combined with a simple soft tissue repair. Stability and marked symptomatic improvement were achieved in all patients. With a mean follow-up period of 27 months, this improvement has been maintained in all but 1 patient, whose prosthesis had to be removed because of a low-grade infection. These results suggest that the use of a prosthesis is a satisfactory way to restore stability and relieve secondary symptoms that may be associated with partial or total excision of the ulnar head.

Title Arthroscopy of the Distal Radioulnar Joint.
Date November 1999
Journal Hand Clinics
Excerpt

Arthroscopy of the distal radioulnar joint is a natural extension of radiocarpal arthroscopy and can be a useful tool for certain conditions that affect this small joint. Arthroscopy provides a minimally invasive means of evaluating the distal radioulnar joint and enables visualization of the articular surfaces, synovium, and undersurface of the triangular fibrocartilage. In this article, indications, surgical techniques, and potential pitfalls of this technically demanding procedure are presented.

Title Arthroscopy of the Distal Radioulnar Joint.
Date November 1995
Journal The Orthopedic Clinics of North America
Excerpt

Arthroscopy of the distal radioulnar joint is challenging. Its indications are evolving. When the experienced hand surgeon believes that the procedure is justified, unusual discoveries may be made. Patients with distal radioulnar joint pain who remain a diagnostic challenge before arthroscopy may sometimes be helped by the results of arthroscopy of this small joint.

Title Closed Traumatic Rupture of Finger Flexor Pulleys.
Date February 1995
Journal The Journal of Hand Surgery
Excerpt

Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

Title Anatomy of the Proximal Interphalangeal Joint.
Date August 1994
Journal Hand Clinics
Excerpt

The proximal interphalangeal joints (PIPs) of the fingers are crucial for normal digital and hand function. Studies of their anatomy reveal subtle bony differences that dictate the precise planes of motion allowed in the constrained joint. Soft tissue restraints guide the cartilaginous surfaces through permissible ranges of motion. Understanding these restraints and the precise orientation of other joint structures assists treatment of conditions affecting the PIP joint.

Title Long-term Outcome of Volz Total Wrist Arthroplasties.
Date May 1994
Journal The Journal of Arthroplasty
Excerpt

The authors determined the outcomes of 18 consecutive Volz total wrist arthroplasties that were followed for an average of 8.6 years. Nine of these wrists were followed for 10 or more years. Fourteen wrists were replaced for rheumatoid arthritis and four for post-traumatic degenerative joint disease. Forty-nine degrees of combined flexion and extension and 25 degrees of combined ulnar and radial deviation were maintained. The balance of wrist motion was dependent upon the design and location of the metacarpal prosthesis. A 24% loss in carpal height (subsidence) occurred during the study period. Four metacarpal components were loose (22%), three of which were placed in patients with degenerative joint disease. One radial component (6%) was loose. Fifteen of 18 wrists (83%) had little or no pain. The three wrists with moderate or severe pain were in patients with degenerative joint disease. There were five (28%) complications. One revision was performed and another was recommended. Overall, the long-term outcome of total wrist arthroplasty was favorable in patients with rheumatoid arthritis.

Title Antibiotic Prophylaxis in Experimental Bone Infections.
Date May 1992
Journal The Journal of Bone and Joint Surgery. American Volume
Title Distal Radioulnar Joint Arthroplasty. Current Concepts.
Date March 1992
Journal Clinical Orthopaedics and Related Research
Excerpt

Arthroplasty techniques for the distal radioulnar joint can be grouped into several categories. These are resectional or excisional arthroplasty, hemiresection or partial resectional arthroplasty, ulnar shortening, or replacement arthroplasty. These techniques are used in varying conditions and situations. Once the function of the radioulnar joint is understood, the choice of arthroplasty technique is simplified. This article presents the theoretical basis for selecting a particular type of arthroplasty technique in any patient. The author's hemiresection interposition technique of arthroplasty developed in the mid 1970s. Sufficient results have now been published that an assessment of the efficacy of the procedure is available. The author's current concept is that detailed and increasing experience with the procedure has uncovered some problems and some modifications. The major indications for the hemiresections arthroplasty and its alternatives must be in the armamentarium of those dealing with this joint.

Title Instability of the Distal Radioulnar Articulation.
Date September 1991
Journal Hand Clinics
Excerpt

This complex issue is addressed by a discussion of a classification of clinically observed instabilities. Experimental data and clinical observations are combined to provide a theoretical rationale for understanding the subject. Clinical usefulness is described.

Title Nerve Suture and Grafting.
Date September 1989
Journal Hand Clinics
Excerpt

Nerve anatomy, terminology, and techniques for nerve restoration are reviewed in sufficient detail to allow the reader to quickly update his or her knowledge in this area. Ideas for future directions of study are presented.

Title Sprains and Joint Injuries in the Hand.
Date October 1986
Journal Hand Clinics
Excerpt

Several specific injuries are discussed in detail, including acute collateral ligament injury, ulnar collateral ligament injuries of the thumb MP joint, volar plate injuries, volar PIP joint dislocations, pseudoboutonniere deformity, and dorsal MP joint dislocations.

Title Flexible Fiberoptic Sigmoidoscopy.
Date July 1986
Journal Alaska Medicine
Title Chondromyxoid Fibroma of the Proximal Phalanx. A Tumour That May Be Confused with Chondrosarcoma.
Date May 1986
Journal Journal of Hand Surgery (edinburgh, Scotland)
Excerpt

Chondromyxoid fibroma is a rare benign tumour of chondral origin. The diagnosis is difficult, but as Jaffe emphasized, "its recognition is of some importance in that pathologically it may be mistaken for sarcoma and, as such, treated more radically than is necessary" (Jaffe, 1948). Salzer (1965) found only 136 cases in the world literature since 1948 when Jaffe defined the criteria for their histological diagnosis. Only six cases of chondromyxoid fibroma have been reported involving the hand (Frank, Rockwood, 1969; Zatyepin, Klimova, Lipkin, Perety, 1979).

Title Congenital Absence of the Triquetrum: a Case Report.
Date November 1985
Journal The Journal of Hand Surgery
Excerpt

A case of congenital absence of the triquetrum in a 47-year-old man is reported. The etiology could be related to deficient chondrification or ossification. Conservative treatment relieved his symptoms of pain and weak grasp.

Title Distal Radioulnar Joint Arthroplasty: the Hemiresection-interposition Technique.
Date May 1985
Journal The Journal of Hand Surgery
Excerpt

The hemiresection-interposition technique for distal radioulnar joint arthroplasty was developed from anatomic studies that indicated the importance of preserving the functional elements of the ulnocarpal ligament complex. The technique has been previously described. My experience with 38 patients who were followed for an average of 2 1/2 years shows that the procedure is most valuable for patients with rheumatoid arthritis (85% had stable, painless pronation averaging 84 degrees and supination of 77 degrees, while 15% had mild pain and pronation of 70 degrees and supination of 75 degrees). It is also valuable for patients with degenerative or trauma-induced arthritis (100% had painless rotation-pronation averaging 80 degrees and supination of 80 degrees). A modified procedure is useful for patients with ulnocarpal impingement syndrome where the Milch shortening osteotomy may not succeed because of radioulnar incongruity.

Title Capitate-radius Arthrodesis: an Alternative Method of Radiocarpal Arthrodesis.
Date June 1984
Journal The Journal of Hand Surgery
Excerpt

Arthrodesis of the wrist may be indicated for a variety of conditions and can be achieved by many techniques. We have had experience with radiocarpal arthrodesis by fusion of the capitate to the radius after a modified proximal row carpectomy . The common feature in our 10 patients was a flexion deformity of the wrist. In five of the patients it was the result of spastic posturing. Five of the patients had a variety of other conditions. Primary arthrodesis occurred in all patients and the cosmetic improvement was appreciated by all patients. Functional improvement seemed to be most related to the preoperative condition. The follow-up evaluation averaged 5.4 years with a range from 6 months to 11 years.

Title Management of Small Joint Injuries in the Hand.
Date December 1983
Journal The Orthopedic Clinics of North America
Excerpt

The principles of management of small joint injuries of the fingers are discussed. Particular attention is paid to acute capsular injuries, fractures, and chronic capsular problems.

Title Aortoduodenal Fistula: Case Report of Massive Gastrointestinal Bleed.
Date August 1983
Journal Alaska Medicine
Title Scaphoid Impression Fracture: a Case Report.
Date May 1983
Journal The Journal of Hand Surgery
Title Ulnar Variance--the Effect of Wrist Positioning and Roentgen Filming Technique.
Date August 1982
Journal The Journal of Hand Surgery
Excerpt

Ulnar variance--the roentgenographic distance between contiguous articular surfaces of the distal radiocarpal and ulnocarpal joints--changes with wrist and forearm position. Supination increases the measurement of negative ulnar variance. Pronation decreases the measurement of negative ulnar variance. Wrist deviation and alterations of the x-ray beam in the longitudinal plane also influence the measurement. A standardized wrist roentgenogram has been developed to allow accurate and reproducible measurements of ulnar variance. Internal landmarks for recognizing the standard views are introduced. The use of standard wrist roentgenographic techniques for all wrist films is recommended.

Title Hepato-veno-occlusive Disease: Case Report.
Date June 1981
Journal Alaska Medicine
Title The Proximal Interphalangeal Joint Volar Plate. Ii: a Clinical Study of Hyperextension Injury.
Date May 1981
Journal The Journal of Hand Surgery
Excerpt

The surgical anatomy and clinical course of the pure hyperextension injury of the proximal interphalangeal (PIP) joint is described based on observations in 12 patients coupled with 15 cases from the literature and vascular injection study of the volar plate. The conclusions are (1) virtually all pure hyperextension injuries produce a rupture of the volar plate at the distal end and (2) such a rupture, when not associated with a marginal metaphyseal avulsion fracture, is not easily diagnosed and is likely to eventuate in a chronic posttraumatic hyperextension deformity because relatively avascular injured tissue is insufficiently immobilized.

Title The Proximal Interphalangeal Joint Volar Plate. I. An Anatomical and Biomechanical Study.
Date June 1980
Journal The Journal of Hand Surgery
Excerpt

The anatomy and biomechanics of the volar plate are reviewed. From a study of 60 fresh adult specimens, the authors present a consolidated anatomic concept of this structure, emphasizing the distinctiveness of the proximal attachments, the variable nature of the distal attachments, and the complex relationships to the flexor sheaths, the vincula, and the collateral ligaments. Experimental biomechanical data suggest that the nature and site of injury to this structure is dependent on the rate of application of force: rapid rates produce rupture at the distal attachment, slow rates attenuate the proximal check ligaments.

Title An Intraarticular-intraosseous Carpal Ganglion.
Date October 1979
Journal The Journal of Hand Surgery
Title Compression of the Deep Branch of the Ulnar Nerve by an Intraneural Cyst. Case Report.
Date July 1979
Journal The Journal of Bone and Joint Surgery. American Volume
Title Closed Rupture of the Volar Plate of the Distal Interphalangeal Joint.
Date March 1979
Journal The Journal of Bone and Joint Surgery. American Volume
Title Chronic Mallet Finger: The Use of Fowler's Central Slip Release.
Date October 1978
Journal The Journal of Hand Surgery
Excerpt

The use of Fowler's central slip release is reported in five patients considered to be failures of closed management in a personal series of 100 consecutive "mallet fingers" seen over a period of 3 years. Fracture-subluxation of the distal interphalangeal joint, avulsion fractures of the extensor tendon, and distal phalangeal epiphyseal injuries are excluded to regidly control the data interpretation. In all five the central slip release was employed as a salvage procedure-as Fowler recommended. In four cases the result was rated as excellent; the remaining case was rated as good, with minimum follow-up of 1 year.

Title The Post-traumatic "swan-neck" Finger--two Common Causes.
Date May 1978
Journal North Carolina Medical Journal
Title Gamekeeper's Thumb. Evaluation by Arthrography and Stress Roentgenography.
Date July 1977
Journal The Journal of Bone and Joint Surgery. American Volume
Excerpt

We reviewed 197 previously reported cases of acute rupture of the ulnar collateral ligament of the metacarpophalangeal joint with respect to anatomy, diagnosis, surgical findings, and management. A standardized roentgenographic technique in stress abduction of the thumb was developed from thirty normal patients. The correlation between the abduction arc as recorded by our technique, the arthogram, and surgical pathology in twenty patients is reported.

Title Mallet Deformity of a Finger After Phalangeal Fracture. Case Report of Treatment by the Fowler Procedure.
Date July 1977
Journal The Journal of Bone and Joint Surgery. American Volume
Title Congenital Deficiency of the Ulna.
Date July 1977
Journal The Journal of Hand Surgery
Excerpt

Twenty-three patients with ulnar ray deficiency were studied and the deformities described by combining Kummel's and Swanson's classifications. An individualized, functionally oriented management program is recommended with early resection of the fibrocartilaginous remnant to prevent shortening, radial bowing, and possible malrotation. Rotational deformity can be corrected by wedge osteotomy, rotation osteotomy, or proximal radial ulnar synostosis. Improved motion at the elbow can be obtained by release of contractures or resection of the radial head. Wrist deformity may require resection of the ulnar remnant and a wedge osteotomy of the radius.

Title Brachial-artery Rupture in Ehlers-danlos Syndrome: an Unusual Cause of High Median-nerve Palsy. A Case Report.
Date December 1976
Journal The Journal of Bone and Joint Surgery. American Volume
Title Keratoacanthoma: an Unusual Hand Tumor.
Date October 1976
Journal Clinical Orthopaedics and Related Research
Excerpt

Keratoacanthoma is a common skin lesion of the head and neck, and is well described in the literature. It seldom presents to the Orthopedic surgeon as a hand tumor. The lesion does not require radical approach, but mimics squamous cell carcinoma which usually does. The clinical behavior and pathology, as well as the biological behavior of the tumor, are discussed. Fifteen cases treated by the authors are reported and their clinical and pathological course and treatment are discussed. Serious errors in treatment may arise from reliance on the histologic characteristics alone. Conservative treatment of keratoacanthoma should be avoided but radical excision of the part is unnecessary. Prompt and total excision is the treatment of choice, with closure either primarily or with split skin graft.


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