Biomedical subjects
D A Bednar
Publications and source records attributed to D A Bednar.
Lumbosacral fusion in a patient with recurring Guillain-Barré syndrome and acute brachial neuritis.
A lumbar decompression and fusion with instrumentation was successfully completed on a patient with a history of acute brachial neuritis (ABN) and recurring Guillain Barré syndrome (GBS). Three weeks post-surgery there was a mild exacerbation of the GBS, which resolved with plasmapheresis. This case report shows that surgery may be conducted safely on a patient whose history includes GBS and ABN, without devastating neurological consequences.
Complications of forearm-plate removal.
Reconstruction of long-bone fractures with compression plates may give rise to stress shielding under the metal plate, which may be associated with late clinical problems due to insufficiency fractures around the implants. Therefore, it is common practice to remove forearm plates after fracture healing is completed. Increasing concern has been expressed recently about the complications and morbidity associated with forearm-implant removal. A retrospective review of the management of 111 forearm diaphyseal fractures at a major Canadian centre confirmed a substantial complication rate in elective forearm-plate removal. Because the true incidence of late insufficiency fracture is not well defined, elective forearm-plate removal may be contraindicated in the asymptomatic patient.
Experience with the "fixateur interne": initial clinical results.
Impressive clinical reports have come from several major spinal research centers regarding the results of using the AO spinal internal fixator, a recently released pedicle screw rod system. A retrospective review of the first 2 years of clinical results from a diverse group of orthopedic surgeons using this device at a Canadian University center may provide some insight into potential clinical outcomes in general use. These results contrast with the outcome data provided to date, which have been presented by expert academic spinal surgeons. The results suggest that there may be room for considering limited release of this device, perhaps with the requirement for special certification in its application.
Screw fixation of odontoid fractures and nonunions.
Surgical treatment of odontoid fractures has usually been carried out by C1-2 arthrodesis rather than by fracture fixation. An alternative treatment of compression screw fixation was used to treat selected acute odontoid fractures and nonunions. Ten patients were operated on. A variety of lag-screw types were used to compress and secure the fracture. Screw placement was considered excellent in five cases; in four, the screw tip protruded through the posterosuperior cortex of the dens by 1-3 mm. One patient died as a result of multiple injuries 2 days after surgery. In all other cases, including four cases of odontoid pseudarthroses, the fractures achieved solid union. It was concluded that screw fixation can be used for the successful treatment of selected odontoid fractures and nonunions.
Post-traumatic compartment syndrome of the foot.
Post-traumatic compartment syndrome in the foot is an unusual but well-recognized entity. If there is an awareness of the condition at the time of presentation it can be diagnosed and treated effectively. A case of compartment syndrome in the foot of a 17-year-old boy after massive lower-extremity trauma is described. The simple and readily available diagnostic techniques are emphasized and an alternative approach to plantar decompression, which avoids exposure of and potential damage to the posterior tibial neurovascular bundle, is presented.
Surgical palliation of spinal oncologic disease: a review and analysis of current approaches.
The clinical problem of primary and secondary vertebral tumours is encountered with increasing frequency throughout North America as oncologic management protocols evolve and the population continues to age. These lesions can present problems of pain, instability and paralysis. Optimal surgical palliation is often of benefit when more conservative methods have been unsuccessful. Vertebral tumours can be approached either anteriorly or posteriorly. These alternatives have led to the evolution in the clinical community of two "camps" championing their respective approaches. The authors have reviewed the accumulated literature up to December 1988 and have found that anterior approaches offer improved clinical outcome without substantially increased morbidity.
Symptomatic lumbar epidural lipomatosis in a normal male. A unique case report.
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Double hemangioma of the spine with paraparesis. A case report.
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Nonunion of cervical burst fracture: a unique observation.
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The spinal pedicle screw: techniques and systems.
New spine instrumentation systems are being developed that incorporate pedicle screws for purchase. This review article outlines techniques for the safe insertion of these devices. A description of the various screw-rod and screw-plate systems currently available is presented.