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Papers by stephen sundberg

PubMed, 2017

Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to giv... more Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to give an account of commonly used eponymous instruments in orthopaedic surgery, focusing on the original intent of their designers in order to inform how we use them today. We searched PubMed, the archives of longstanding medical journals, Google, the Internet Archive, and the HathiTrust Digital Library for information regarding the inventors and the developments of 7 instruments: the Steinmann pin, Bovie electrocautery, Metzenbaum scissors, Freer elevator, Cobb periosteal elevator, Kocher clamp, and Verbrugge bone holding forceps. A combination of ingenuity, necessity, circumstance and collaboration produced the inventions of the surgical tools numbered in our review. In some cases, surgical instruments were improvements of already existing technologies. The indications and applications of the orthopaedic devices have changed little. Meanwhile, instruments originally developed for other specialties have been adapted for our use. Although some argue for a transition from eponymous to descriptive terms in medicine, there is value in recognizing those who revolutionized surgical techniques and instrumentation. Through history, we have an opportunity to be inspired and to better understand our tools.

PubMed, Jul 1, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

Journal of Pediatric Orthopaedics, Jul 1, 1986

Foot & ankle, Nov 1, 1982

A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ... more A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ankle. She described a twisting injury to that region 2 months earlier which had been treated by a short leg cast and crutches for a 1-week period. Examination disclosed moderate swelling with tenderness over the anterolateral aspect of the hindfoot but no instability and a full range of motion. Four years previously, she had been treated with a sigmoid colon resection for a Dukes B2, grade 3 adenocarcinoma. Only 3 months before her present visit, a repeat abdominal exploration revealed extensive metastatic involvement. Routine roentgenograms showed a lytic lesion of the anterolateral calcaneus (Fig. 1). Tomography further delineated the location and destructive nature of the lesion (Fig. 2). A technetium bone scan revealed intense hindfoot uptake but no other skeletal involvement (Fig. 3). An open biopsy specimen showed a colonic-type grade 2 adenocarcinoma (Fig. 4). Treatment consisted of local radiation and immobilization in a short leg walking cast for 8 weeks, followed by progressive weightbearing with crutches. When last seen in follow-up, the patient was still using crutches but was experiencing decreased pain, and there was roentgenographic evidence of early healing.

Clinical Orthopaedics and Related Research, Jul 1, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's dis... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

Pediatric Clinics of North America, Oct 1, 1996

Unintentional injuries, or injuries that occur without specific intent of harm, are the leading c... more Unintentional injuries, or injuries that occur without specific intent of harm, are the leading cause of death and disability among children in the United States. Each year, approximately 20,000 children become permanently disabled, 550,000 children are hospitalized, and 15 million children visit the emergency department because of unintentional injuries. Trauma to the musculoskeletal system account for one third of injury-related hospital admissions and half of injury-related emergency department visits. The incidence rate for musculoskeletal injuries requiring hospitalization is 26 per 10,000 children-years, whereas the incidence of emergency department visits is 1068 per 10,000.7 Pediatric musculoskeletal injury poses significant social and economic costs. In 1987, the annual cost in the United States for initial medical care of musculoskeletal injuries for patients 0 to 19 years of age was approximately 2.09billion?Theannualcostofinitialhospitalcare(2.09 billion? The annual cost of initial hospital care (2.09billion?Theannualcostofinitialhospitalcare(827 million) was two thirds of the cost of injuries requiring treatment in the emergency department ($1.26 billion). These estimates do not include the social and economic burdens these injuries place on families. These burdens include time lost from school, decreased ability of the injured child to participate in normal activities, and disruption of parental work schedules. The pediatrician is usually the first physician to examine an injured child. Pediatricians should be familiar with the basics of patient assess-From the

Pediatric Clinics of North America, 1996

Unintentional injuries, or injuries that occur without specific intent of harm, are the leading c... more Unintentional injuries, or injuries that occur without specific intent of harm, are the leading cause of death and disability among children in the United States. Each year, approximately 20,000 children become permanently disabled, 550,000 children are hospitalized, and 15 million children visit the emergency department because of unintentional injuries. Trauma to the musculoskeletal system account for one third of injury-related hospital admissions and half of injury-related emergency department visits. The incidence rate for musculoskeletal injuries requiring hospitalization is 26 per 10,000 children-years, whereas the incidence of emergency department visits is 1068 per 10,000.7 Pediatric musculoskeletal injury poses significant social and economic costs. In 1987, the annual cost in the United States for initial medical care of musculoskeletal injuries for patients 0 to 19 years of age was approximately 2.09billion?Theannualcostofinitialhospitalcare(2.09 billion? The annual cost of initial hospital care (2.09billion?Theannualcostofinitialhospitalcare(827 million) was two thirds of the cost of injuries requiring treatment in the emergency department ($1.26 billion). These estimates do not include the social and economic burdens these injuries place on families. These burdens include time lost from school, decreased ability of the injured child to participate in normal activities, and disruption of parental work schedules. The pediatrician is usually the first physician to examine an injured child. Pediatricians should be familiar with the basics of patient assess-From the

Journal of Pediatric Orthopaedics, 2004

Cartilaginous dysplasias (multiple hereditary osteochondromatosis [MHO] and Ollier&am... more Cartilaginous dysplasias (multiple hereditary osteochondromatosis [MHO] and Ollier's enchondromatosis [OE]) are common pediatric orthopaedic conditions. Long bone growth deformities commonly develop in children with MHO and OE. The timing of procedures frequently used to treat these deformities is often dependent upon the bone age. It was the purpose of this study to investigate bone ages in a series of 40 children with MHO and OE. There were 6 girls and 9 boys with OE, and 9 girls and 16 boys with MHO. Each child's age, gender, race, and diagnosis were recorded. Hand-wrist radiographs obtained during routine evaluation of hand-wrist deformities or scanograms were identified, randomly numbered, and blinded regarding the identity and age of the child. Each radiograph was reviewed by five different observers at two different times separated by a minimum of 3 weeks. Statistical analyses were performed, looking at differences between bone and chronological age; inter- and intraobserver variability in bone age assessment; and differences by observer. The average chronological age (n = 40) was 7.8 +/- 3.6 years, average bone age (n = 400) was 7.2 +/- 3.7 years, and average difference between chronological and bone age (n = 400) was 0.6 +/- 1.3 years (P < 10-6). Intra- and interobserver variability was +/-1.5 and +/-1.6 years. There were no differences between observers in the average chronological/bone age difference (P = 0.63). Clinicians should be aware of this average 0.6-year delay in bone age when planning an epiphysiodesis for limb length equalization in children with cartilaginous dysplasias.

Foot & Ankle, 1982

A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ... more A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ankle. She described a twisting injury to that region 2 months earlier which had been treated by a short leg cast and crutches for a 1-week period. Examination disclosed moderate swelling with tenderness over the anterolateral aspect of the hindfoot but no instability and a full range of motion. Four years previously, she had been treated with a sigmoid colon resection for a Dukes B2, grade 3 adenocarcinoma. Only 3 months before her present visit, a repeat abdominal exploration revealed extensive metastatic involvement. Routine roentgenograms showed a lytic lesion of the anterolateral calcaneus (Fig. 1). Tomography further delineated the location and destructive nature of the lesion (Fig. 2). A technetium bone scan revealed intense hindfoot uptake but no other skeletal involvement (Fig. 3). An open biopsy specimen showed a colonic-type grade 2 adenocarcinoma (Fig. 4). Treatment consisted of local radiation and immobilization in a short leg walking cast for 8 weeks, followed by progressive weightbearing with crutches. When last seen in follow-up, the patient was still using crutches but was experiencing decreased pain, and there was roentgenographic evidence of early healing.

Clinical Orthopaedics and Related Research, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's dis... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

The Iowa orthopaedic journal, 2017

Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to giv... more Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to give an account of commonly used eponymous instruments in orthopaedic surgery, focusing on the original intent of their designers in order to inform how we use them today. We searched PubMed, the archives of longstanding medical journals, Google, the Internet Archive, and the HathiTrust Digital Library for information regarding the inventors and the developments of 7 instruments: the Steinmann pin, Bovie electrocautery, Metzenbaum scissors, Freer elevator, Cobb periosteal elevator, Kocher clamp, and Verbrugge bone holding forceps. A combination of ingenuity, necessity, circumstance and collaboration produced the inventions of the surgical tools numbered in our review. In some cases, surgical instruments were improvements of already existing technologies. The indications and applications of the orthopaedic devices have changed little. Meanwhile, instruments originally developed for other spe...

Journal of Pediatric Orthopaedics, 1989

PubMed, 2017

Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to giv... more Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to give an account of commonly used eponymous instruments in orthopaedic surgery, focusing on the original intent of their designers in order to inform how we use them today. We searched PubMed, the archives of longstanding medical journals, Google, the Internet Archive, and the HathiTrust Digital Library for information regarding the inventors and the developments of 7 instruments: the Steinmann pin, Bovie electrocautery, Metzenbaum scissors, Freer elevator, Cobb periosteal elevator, Kocher clamp, and Verbrugge bone holding forceps. A combination of ingenuity, necessity, circumstance and collaboration produced the inventions of the surgical tools numbered in our review. In some cases, surgical instruments were improvements of already existing technologies. The indications and applications of the orthopaedic devices have changed little. Meanwhile, instruments originally developed for other specialties have been adapted for our use. Although some argue for a transition from eponymous to descriptive terms in medicine, there is value in recognizing those who revolutionized surgical techniques and instrumentation. Through history, we have an opportunity to be inspired and to better understand our tools.

PubMed, Jul 1, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

Journal of Pediatric Orthopaedics, Jul 1, 1986

Foot & ankle, Nov 1, 1982

A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ... more A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ankle. She described a twisting injury to that region 2 months earlier which had been treated by a short leg cast and crutches for a 1-week period. Examination disclosed moderate swelling with tenderness over the anterolateral aspect of the hindfoot but no instability and a full range of motion. Four years previously, she had been treated with a sigmoid colon resection for a Dukes B2, grade 3 adenocarcinoma. Only 3 months before her present visit, a repeat abdominal exploration revealed extensive metastatic involvement. Routine roentgenograms showed a lytic lesion of the anterolateral calcaneus (Fig. 1). Tomography further delineated the location and destructive nature of the lesion (Fig. 2). A technetium bone scan revealed intense hindfoot uptake but no other skeletal involvement (Fig. 3). An open biopsy specimen showed a colonic-type grade 2 adenocarcinoma (Fig. 4). Treatment consisted of local radiation and immobilization in a short leg walking cast for 8 weeks, followed by progressive weightbearing with crutches. When last seen in follow-up, the patient was still using crutches but was experiencing decreased pain, and there was roentgenographic evidence of early healing.

Clinical Orthopaedics and Related Research, Jul 1, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's dis... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

Pediatric Clinics of North America, Oct 1, 1996

Unintentional injuries, or injuries that occur without specific intent of harm, are the leading c... more Unintentional injuries, or injuries that occur without specific intent of harm, are the leading cause of death and disability among children in the United States. Each year, approximately 20,000 children become permanently disabled, 550,000 children are hospitalized, and 15 million children visit the emergency department because of unintentional injuries. Trauma to the musculoskeletal system account for one third of injury-related hospital admissions and half of injury-related emergency department visits. The incidence rate for musculoskeletal injuries requiring hospitalization is 26 per 10,000 children-years, whereas the incidence of emergency department visits is 1068 per 10,000.7 Pediatric musculoskeletal injury poses significant social and economic costs. In 1987, the annual cost in the United States for initial medical care of musculoskeletal injuries for patients 0 to 19 years of age was approximately 2.09billion?Theannualcostofinitialhospitalcare(2.09 billion? The annual cost of initial hospital care (2.09billion?Theannualcostofinitialhospitalcare(827 million) was two thirds of the cost of injuries requiring treatment in the emergency department ($1.26 billion). These estimates do not include the social and economic burdens these injuries place on families. These burdens include time lost from school, decreased ability of the injured child to participate in normal activities, and disruption of parental work schedules. The pediatrician is usually the first physician to examine an injured child. Pediatricians should be familiar with the basics of patient assess-From the

Pediatric Clinics of North America, 1996

Unintentional injuries, or injuries that occur without specific intent of harm, are the leading c... more Unintentional injuries, or injuries that occur without specific intent of harm, are the leading cause of death and disability among children in the United States. Each year, approximately 20,000 children become permanently disabled, 550,000 children are hospitalized, and 15 million children visit the emergency department because of unintentional injuries. Trauma to the musculoskeletal system account for one third of injury-related hospital admissions and half of injury-related emergency department visits. The incidence rate for musculoskeletal injuries requiring hospitalization is 26 per 10,000 children-years, whereas the incidence of emergency department visits is 1068 per 10,000.7 Pediatric musculoskeletal injury poses significant social and economic costs. In 1987, the annual cost in the United States for initial medical care of musculoskeletal injuries for patients 0 to 19 years of age was approximately 2.09billion?Theannualcostofinitialhospitalcare(2.09 billion? The annual cost of initial hospital care (2.09billion?Theannualcostofinitialhospitalcare(827 million) was two thirds of the cost of injuries requiring treatment in the emergency department ($1.26 billion). These estimates do not include the social and economic burdens these injuries place on families. These burdens include time lost from school, decreased ability of the injured child to participate in normal activities, and disruption of parental work schedules. The pediatrician is usually the first physician to examine an injured child. Pediatricians should be familiar with the basics of patient assess-From the

Journal of Pediatric Orthopaedics, 2004

Cartilaginous dysplasias (multiple hereditary osteochondromatosis [MHO] and Ollier&am... more Cartilaginous dysplasias (multiple hereditary osteochondromatosis [MHO] and Ollier's enchondromatosis [OE]) are common pediatric orthopaedic conditions. Long bone growth deformities commonly develop in children with MHO and OE. The timing of procedures frequently used to treat these deformities is often dependent upon the bone age. It was the purpose of this study to investigate bone ages in a series of 40 children with MHO and OE. There were 6 girls and 9 boys with OE, and 9 girls and 16 boys with MHO. Each child's age, gender, race, and diagnosis were recorded. Hand-wrist radiographs obtained during routine evaluation of hand-wrist deformities or scanograms were identified, randomly numbered, and blinded regarding the identity and age of the child. Each radiograph was reviewed by five different observers at two different times separated by a minimum of 3 weeks. Statistical analyses were performed, looking at differences between bone and chronological age; inter- and intraobserver variability in bone age assessment; and differences by observer. The average chronological age (n = 40) was 7.8 +/- 3.6 years, average bone age (n = 400) was 7.2 +/- 3.7 years, and average difference between chronological and bone age (n = 400) was 0.6 +/- 1.3 years (P < 10-6). Intra- and interobserver variability was +/-1.5 and +/-1.6 years. There were no differences between observers in the average chronological/bone age difference (P = 0.63). Clinicians should be aware of this average 0.6-year delay in bone age when planning an epiphysiodesis for limb length equalization in children with cartilaginous dysplasias.

Foot & Ankle, 1982

A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ... more A 61-year-old woman was evaluated for pain, swelling, and a feeling of instability involving her ankle. She described a twisting injury to that region 2 months earlier which had been treated by a short leg cast and crutches for a 1-week period. Examination disclosed moderate swelling with tenderness over the anterolateral aspect of the hindfoot but no instability and a full range of motion. Four years previously, she had been treated with a sigmoid colon resection for a Dukes B2, grade 3 adenocarcinoma. Only 3 months before her present visit, a repeat abdominal exploration revealed extensive metastatic involvement. Routine roentgenograms showed a lytic lesion of the anterolateral calcaneus (Fig. 1). Tomography further delineated the location and destructive nature of the lesion (Fig. 2). A technetium bone scan revealed intense hindfoot uptake but no other skeletal involvement (Fig. 3). An open biopsy specimen showed a colonic-type grade 2 adenocarcinoma (Fig. 4). Treatment consisted of local radiation and immobilization in a short leg walking cast for 8 weeks, followed by progressive weightbearing with crutches. When last seen in follow-up, the patient was still using crutches but was experiencing decreased pain, and there was roentgenographic evidence of early healing.

Clinical Orthopaedics and Related Research, 1984

Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's dis... more Further experience with ulnar lengthening in the treatment of 22 patients with Kienböck's disease confirms the efficacy of this procedure as observed in a previous series of 20 patients. In this procedure, the joint compressive force is removed from the trabeculae of the convex portion of the body of the lunate that is weakened by avascular necrosis. Subchondral fractures were present in at least 13 of the 22 patients. The technique of ulnar osteotomy, with interposition bone graft supported by a slotted bone plate applied prior to completion of the osteotomy, seems well established. Three patients were lost to follow-up and one required a secondary lunate excision for continuing pain. The remainder of the patients were well satisfied with the procedure.

The Iowa orthopaedic journal, 2017

Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to giv... more Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to give an account of commonly used eponymous instruments in orthopaedic surgery, focusing on the original intent of their designers in order to inform how we use them today. We searched PubMed, the archives of longstanding medical journals, Google, the Internet Archive, and the HathiTrust Digital Library for information regarding the inventors and the developments of 7 instruments: the Steinmann pin, Bovie electrocautery, Metzenbaum scissors, Freer elevator, Cobb periosteal elevator, Kocher clamp, and Verbrugge bone holding forceps. A combination of ingenuity, necessity, circumstance and collaboration produced the inventions of the surgical tools numbered in our review. In some cases, surgical instruments were improvements of already existing technologies. The indications and applications of the orthopaedic devices have changed little. Meanwhile, instruments originally developed for other spe...

Journal of Pediatric Orthopaedics, 1989