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Biomedical subjects

C B Lavy

Publications and source records attributed to C B Lavy.

14 recordsLinked to original sources
PubMed1999

Percutaneous fixation of scaphoid fractures. An anatomical study.

Percutaneous scaphoid fracture fixation has many advantages over the open method of fixation. We describe the anatomical basis for a safe percutaneous approach. Cannulated screws were inserted into 32 cadaveric scaphoids through 1 cm palmar incisions under fluoroscopic control. We then measured the distance between the entry point in the scaphoid and important local neurovascular structures. We also measured the angle of entry of the guide wire in two planes. The mean distance of the entry point from the main radial artery was 14 mm (range, 7-24 mm); from the radial nerve 19 mm (range, 7-35 mm); from the recurrent branch of the median nerve 29 mm (range, 14-45 mm); and from the superficial branch of the radial artery 5 mm (range, 0-8 mm) The mean radial angle of insertion was 34 degrees and the mean palmar angle of insertion was 58 degrees. Percutaneous fixation of scaphoid fractures puts the superficial palmar branch of the radial artery at risk. We recommend a 1 cm incision centred over the scaphotrapezial joint and dissection under direct vision to the entry point in the scaphoid rather than a completely percutaneous approach.

Bone Screws↗
PubMed1998

Septic arthritis.

Explore the source record for details and available documents.

Africa South of the Sahara↗
PubMed1996

Comparative audit of blood transfusion during war and peace in Sarajevo.

A comparative study was made between 146 patients receiving blood transfusion at the State Hospital, Sarajevo, in a 3-month period of peace (group 1) and 250 patients receiving transfusions in a 3-month period of war (group 2). In group 1, trauma accounted for only 7% of transfusions while it accounted for 99% in group 2. The threshold for transfusion was increased in war and the mean pretransfusion haematocrit in group 2 was 21%, compared with 27% in group 1 (P < 0.001). Less blood was also transfused per patient in war with a mean transfusion volume of 1.1 units in group 2 compared with 2.6 units in group 1 (P < 0.001). The reasons and justification for such a conservative transfusion practice in a besieged city are discussed.

Blood Transfusion↗
PubMed1996

Salmonella septic arthritis of the shoulder in Zambian children.

Nineteen children under the age of two with salmonella septic arthritis (SSA) of the shoulder presented to Mukinge Hospital between 1st January 1992 and 31st March 1993. There were 13 boys and six girls. All patients were below the 50th centile for weight. The most common presentation was swelling, pyrexia and non-use of the arm. Pain was not always present. All patients were anaemic but in many cases had both WBC and ESR in the normal range. All patients were treated with drainage and antibiotics. All made a good recovery and were discharged pain free, apyrexial and using the affected arm. One patient was re-admitted because of recurrent infection. Nine patients reviewed after one month had continued good function with no clinical sign of infection. We conclude that where intestinal salmonella are endemic, low nutritional status is likely to be a factor in the development of a bacteraemia, and that the intra-articular extension of the proximal humeral metaphysis and repetitive minor trauma to the joint are predisposing factors to the development of shoulder infection.

Arthritis, Infectious↗
PubMed1995

Salmonella septic arthritis in Zambian children.

Thirty-four children under the age of 3 years with septic arthritis presented to Mukinge Hospital between 1 January 1992 and 31 March 1993. Twenty-six of these cultured Salmonella spp. The salmonella group comprised 17 males and 9 females with an average age of 10 months. Most patients were anaemic and all were under 50th centile for weight. The commonest presentation was swelling, pyrexia and non-use of the limb. The mean white cell count (WBC) was 14,000/mm3 and the mean erythrocyte sedimentation rate (ESR) was 15.8 mm/h, but in many cases both the WBC and ESR were normal. All patients were treated with drainage and antibiotics. All made a good recovery and were discharged pain free, apyrexial and using the affected joint. One patient was readmitted because of recurrent infection. Nine patients reviewed after 1 month had continued good function. We consider that malnutrition and local trauma are predisposing factors to the development of salmonella septic arthritis in a population where salmonella is endemic.

Arthritis, Infectious↗
PubMed1995

Cyclical micromovement and fracture healing.

We studied 56 patients with fractures of the tibial shaft in a multicentre prospective randomised trial of three methods of external fixation. Group I was treated with a fixator which was unlocked at 4 to 6 weeks to allow free axial compression (axial dynamisation) with weight-bearing. Group II was treated with a fixator that was similarly unlocked at 4 to 6 weeks but included a small silicone spring which on weight-bearing could be compressed by up to 2 mm. this spring returns to its original length on cessation of weight-bearing thus allowing cycles of motion of up to 2 mm. Group III had a spring fixator like group II, but it was unlocked from the start to allow cyclical micromovement as soon as weight-bearing began. Fracture healing was monitored by the measurement of fracture stiffness. We defined healing as achieving a stiffness of 15 Nm per degree. The mean time was 14.1 weeks in group I, 15.9 weeks in group II, and 19.3 weeks in group III. The difference between groups was statistically significant (p = 0.004). The 95% confidence intervals for the average delay in healing with early cyclical micromovement (group III) as compared with later axial dynamisation (group I) was 1.8 to 8.7 weeks. The healing time in patients whose cyclical micromovement was delayed for 4 to 6 weeks (group II) was between these two extremes, but the differences from either of the other groups could have been due to patient selection. In the patients who completed the full trial, there were pin-track infections in over 60% of those in the cyclical micromovement groups compared with 20% in the axial dynamisation group (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Pin placement in pelvic external fixation.

Early external fixation of major pelvic fractures reduces haemorrhage and mortality. The best site and method for pin placement remains unresolved. The superior iliac crest is biomechanically disadvantageous and hinders access to the abdomen. Low pin placement between the anterior iliac spines has been proposed as a better solution. A case-controlled study was performed on cadavers using a jig designed to place external fixator pins accurately in the pelvis; the study tested the safety of pin placement and the mechanical strength of the two placement sites. The results showed that pins could be placed safely using this method and that low placement in cadaveric bone is as strong as that of the conventional placement.

Biomechanical Phenomena↗
PubMed1993

Unrecognised joint penetration in treatment of femoral neck fractures.

Screw devices used to treat fractures of the femoral neck are usually positioned under image-intensifier control, using anteroposterior and lateral views. The volume projected by these views is over 27% larger than the femoral head; the tips of screws so placed may be outside the femoral head. This can be avoided by placement within the central two-thirds of the head: we have designed a template which can confirm safe placement.

Anthropometry↗
PubMed1992

Remanipulation or external fixation after slipped Colles' fractures? An anatomical study.

A series of 50 consecutive patients with Colles' fractures which redisplaced after reduction underwent either remanipulation and a plaster cast or remanipulation and external fixation. The external fixator group achieved a significantly better anatomical result than simple remanipulation and replastering. Where plaster immobilization has failed, external fixation gives a better anatomical result than remanipulation and replastering.

Adult↗
PubMed1992

Ionising radiation: are orthopaedic surgeons at risk?

Modern orthopaedic trauma practice involves increased exposure of the surgeon to ionising radiation. However, there have been no studies to investigate whether the doses received are within limits for non-classified workers. In this study, whole body, eye and extremity, namely hand, doses were measured in six orthopaedic surgeons during trauma cases requiring the use of X-rays in theatre. None of the subjects approached the recommended maximum dose levels for either the whole body, eyes or hands. This finding is reassuring. In orthopaedics, the limiting dose is that to the hands. This differs from previously studied groups, such as radiologists and cardiologists, in whom the limiting factor is the dose to the lens of the eye. Although current precautions appear to be adequate, safe practice in the future will depend on continuing vigilance and repetition of studies similar to this one as techniques and workloads change.

Fracture Fixation↗
PubMed1986

The fate of allogeneic and xenogeneic neuronal tissue transplanted into the third ventricle of rodents.

Neural grafts from day 17-19 fetal rats or mice survived well when transplanted into syngeneic, or immunodeficient hosts, thus demonstrating that there are no non-immunological barriers to cross-species transplantation of neuronal tissue in rats and mice. However, intraventricular grafts from rat to mouse, or vice versa, in immunocompetent animals were rejected in less than 30 days. By this time all graft tissue had been destroyed and scavenged, presumably by the macrophages seen infiltrating the grafts within 10 days of grafting. Rat allografts from major histocompatibility complex disparate donors disparate donors survived well as did grafts between rats differing only at minor histocompatibility loci. However, allografts from donors that differed from recipients at both major and minor histocompatibility complex loci had a variable survival time. When neural tissue was grafted into immunologically primed recipients, it was rejected as was similar tissue grafted beneath the kidney capsule of an allogeneic host. Concomitant grafting of allogeneic tissue under the kidney capsule and into the third ventricle was followed by rejection in both sites. A striking observation in these studies was the induction of Class I major histocompatibility complex antigens on grafted neuronal tissue. High levels of antigen expression were correlated with a vigorous host response and poor graft survival but lower levels were not indicative of impending graft destruction. Whilst the brain can be regarded as an immunologically privileged site, the privilege is not absolute and caution needs to be exercised in the interpretation of results from allogeneic or xenogeneic grafts.

Animals↗