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Biomedical subjects

D A Wiss

Publications and source records attributed to D A Wiss.

At least 37 records · Page 2Linked to original sources
PubMed1991

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.

Adult↗
PubMed1991

Interlocking nailing for the treatment of femoral fractures due to gunshot wounds.

Fifty-six patients who had a fracture of the femur due to a low-velocity gunshot injury were treated with interlocking nailing with the Grosse-Kempf nail. Patients who had an isolated fracture were treated by intravenous administration of antibiotics followed by delayed interlocking nailing. Ninety-three per cent of the fractures had Grade-III or IV comminution. At an average duration of follow-up of sixteen months (range, twelve to twenty-nine months), the results of closed interlocking nailing were excellent. All of the fractures united an average of twenty-three weeks (range, fourteen to forty weeks) after the nailing. There were no apparent infections in the entire series. There were two delayed unions and seven malunions. Five patients had a serious associated vascular injury; four of these five had interlocking nailing immediately after vascular repair. The fractures united without any residual vascular insufficiency.

Adult↗
PubMed1990

Interlocked nailing for treatment of segmental fractures of the femur.

Thirty-three segmental fractures of the shaft of the femur were treated with the Grosse-Kempf interlocking nail. Twenty-eight of the fractures had been caused by high-energy trauma. There were twenty-six closed and seven open fractures. Thirty-two of the thirty-three fractures united, at an average of thirty-two weeks, without additional intervention other than dynamization of the nail. There were one non-union, one delayed union, and two malunions. Virtually all fractures located between the lesser trochanter and the femoral condyles can be nailed, regardless of the pattern of the fracture or the degree of comminution. Closed interlocked nailing is the treatment of choice for most segmental fractures of the shaft of the femur.

Adolescent↗
PubMed1990

Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus.

Twenty-one adults who had a fracture of the middle of the humeral shaft and an injury of the ipsilateral brachial plexus were followed for an average of twenty-eight months. Only two of these patients showed evidence of neurological improvement. Of the eleven patients who had an associated traumatic injury to the brain, eight were treated non-operatively and three, operatively. The presence of a fracture of the humerus in a flail extremity has been found to delay rehabilitation markedly and to result in prolonged hospitalization. Eleven fractures were treated non-operatively with a brace or cast, and there were five non-unions, two delayed unions, and two malunions. Of the ten fractures that were treated operatively, three that were treated by compression-plating all united. Two fractures were treated by external fixation; one had a delayed union and one, a malunion. In the remaining five patients, who were treated with an intramedullary rod, there were two non-unions, one delayed union, and one malunion.

Adolescent↗
PubMed1988

Immediate internal fixation of open ankle fractures.

Seventy-six consecutive displaced open ankle fractures were treated by immediate internal fixation between 1983 and 1986 at Los Angeles County University of Southern California Medical Center. Sixty-two patients were available for clinical and radiological examination at an average of 16.4 months post-fixation. Seventy-two percent of the patients had a satisfactory result. Poor results (20%) were most commonly due to non-anatomic reductions, articular surface damage, or deep infection. Deep infection occurred in 5% of the patients while 8% required late ankle arthrodesis. We believe immediate internal fixation is the treatment of choice for displaced open ankle fractures, but this form of treatment does have a significant rate of complications.

Adolescent↗
PubMed1988

Supracondylar fractures of the humerus: prediction of the cubitus varus deformity with CT.

Rotation of the distal fracture fragment in the supracondylar fracture is a contributing factor in the development of the cubitus varus deformity. Computed tomography (CT) is superior to conventional radiography in the assessment of the position of fracture fragments and was used to study 20 patients with supracondylar fractures after reduction. These fractures were followed up with radiography until healed. As determined from CT scans, rotation of the distal fracture fragment of greater than 10 degrees resulted in an abnormal Baumann angle and a cubitus varus deformity in all patients. Use of CT should facilitate the identification of this complication and thus treatment of these fractures and prevention of subsequent deformity.

Child↗
PubMed1987

Compartment syndrome: a complication of use of the MAST suit.

A case of compartment syndrome following the use of a MAST suit is reported. The most significant factor in its development is prolonged application combined with severe hemodynamic compromise. Amputation was performed or death occurred in 50% of reported cases. Compartment pressure monitoring should be done in patients who require a MAST suit for more than 4 h.

Adolescent↗
PubMed1987

Lisfranc fracture-dislocations of the foot: a clinical-kinesiological study.

Twenty-three patients with Lisfranc fracture dislocation of the foot were reviewed at an average of 19.4 months following injury. Results were assessed by a subjective questionnaire, physical examination, and radiographic analysis. There were 10 good (43.5%), 10 fair (43.5%), and 3 poor (13.0%) results. A subgroup of 11 patients underwent gait analysis in the pathokinesiology laboratory. No patient had a normal gait following a displaced Lisfrance fracture. Limp was thought to be due to a prolonged hindfoot period, and a delayed and shortened period of weight transfer through the midfoot to the forefoot as a result of pain inhibition. The best results both clinically and by gait analysis were achieved in those patients who had anatomic reductions.

Adult↗
PubMed1986

Flexible medullary nailing of tibial shaft fractures.

Fifty-two tibial shaft fractures in 50 patients were treated with flexible medullary nails (Ender type). In 32 cases the fracture was closed and in the remaining 28 cases the fracture was open. Forty-eight of the 52 fractures united in an average time of 16.8 weeks and there were no cases of deep infection or osteomyelitis. Nonunion in four patients required a secondary procedure to obtain union. Flexible medullary nailing is an excellent method for fixation of tibial shaft fractures because it combines the benefits of closed nailing and functional bracing while minimizing the disadvantages of each. Three-point fixation within the medullary canal maintains length alignment and avoids rotational problems. Nailing is done by closed methods without reaming. The technique allows early weight-bearing in a patellar tendon bearing cast or functional brace. Dynamic controlled motion at the fracture site leads to early callus formation which is biomechanically and biologically favorable. The procedure is relatively easy to perform, short in duration, and requires little specialized equipment. Flexible medullary nailing is an alternative treatment modality for selected open and closed displaced tibial shaft fractures.

Adolescent↗
PubMed1986

The mechanics and biology of intramedullary fracture fixation.

Intramedullary (IM) fracture fixation serves to stabilize fracture fragments and maintains alignment, while permitting motion at the fracture site during functional activities. Acting as an internal splint, the implant serves as a load-sharing device and fracture healing progresses with the formation of peripheral callus. By allowing motion of adjacent joints, rehabilitation is concurrent with treatment, and stress-shielding is thought to be minimal using these techniques. Recently, IM nails have been introduced to widen indications for their use based on variations in the cross-sectional geometry, length and shape of nails, interlocking designs, and surgical techniques. Although the most important mechanical factors in the design of IM nails are strength, stiffness, and rigidity, anatomic constraints and surgical technique limit nail variations. Closed nailing is preferred to open procedures to preserve periosteal blood supply and minimize surgical trauma adjacent to the fracture. Blood flow to the fractured bone is elevated in nailing experiments, although callus maturation is somewhat delayed. However, the end result in terms of healing was similar to that of plate fixation.

Animals↗
PubMed1986

Flexible medullary nailing of acute tibial shaft fractures.

In a nonrandomized prospective study, 111 tibial shaft fractures (55 closed, 56 open) were treated with flexible intramedullary nails. Open injuries were nailed immediately following irrigation and debridement in the vast majority of cases. Ninety-four percent of the fractures united in an average time of 18.8 weeks. There were seven nonunions (6.3%), all of which healed following a secondary procedure. Six patients demonstrated delay in union but healed their fractures within 26 weeks (5.4%). Five patients developed angulatory malunions between 6 degrees and 10 degrees after nailing (4.5%). Three patients had rotational malalignment requiring treatment (2.7%). There were four deep wound infections, which required irrigation and debridement (3.6%). In two cases the nails were retained and in two they were replaced with an external fixator. In one patient, chronic osteomyelitis developed. Flexible medullary nailing extends the indications for intramedullary fixation of tibial shaft fractures because maintenance of length, alignment, and rotation are usually possible.

Adolescent↗
PubMed1986

Infection following intramedullary nailing of long bones. Diagnosis and management.

In 30 patients (23 femurs and 7 tibias) with infection of long bone fractures following intramedullary (IM) nailing, the follow-up study ranged from eight to 84 months (mean, 20 months). Six patients retained active infection at the time of follow-up examination. Ununited fractures were present in four and sequestra in two patients. Stabilization for fracture healing after irrigation and debridement with appropriate systemic antibiotic therapy was the critical factor in the orthopedic management of this series of patients.

Adult↗
PubMed1986

Comminuted and rotationally unstable fractures of the femur treated with an interlocking nail.

One hundred twelve comminuted or rotationally unstable fractures of the femur were treated with the Grosse-Kempf interlocking nail. Two-thirds of the fractures had comminution involving more than 50% of the cortex. Of the 112 nailings, 82 were static and 30 dynamic. Clinical and radiographic fracture union occurred in 98% of cases; there were two nonunions. There were no instances of deep wound infection or osteomyelitis. Only two patients had a change of limb length greater than 1 cm. Angulation in any plane greater than 10 degrees was noted in three patients (2.5%). External rotation deformities occurred in eight patients (7.0%). The interlocking nail has expanded the indications for the use of closed intramedullary nailing in the treatment of complex fractures of the femur. The incidence of infection and nonunion is remarkably low. Immediate stability of the fracture allows for immediate mobilization of the patient, early rehabilitation of the limb, and a shorter hospital stay.

Adult↗
PubMed1985

Functional bracing and rehabilitation of ankle fractures.

For normal daily activities, 10 degrees of ankle dorsiflexion is essential. Plantiflexion follows dorsiflexion and exceeds it by an average of 5 degrees. Normal ankle motion takes place with the talus rotating on an obliquely oriented axis distal to the tips of the medial and lateral malleolus. Mortise widening of less than 1 mm accommodates the talus with the fibula apparently rotating along its vertical axis. Ankle fractures treated nonsurgically will regain functional range of motion if immobilization in equinus is avoided and early weight-bearing with early functional bracing is applied. With the aid of a functional brace, fractures treated surgically may start weight-bearing and exercise within five to seven days, provided all fracture components have been stabilized. The functional brace allows dorsiflexion and plantiflexion via a rigid hinge and reduces rotational stresses acting on the fractured ankle.

Adult↗
PubMed1985

Posterior fracture dislocation of the hip with fractures of the femoral head.

In general, all traumatic dislocations of the hip must be treated as surgical emergencies. Multiple attempts at closed reduction are contraindicated, particularly in Type V dislocations. Every effort must be made to recognize the dislocation, particularly in patients with other severe lower extremity trauma. Reduction within 24 hours gives better results than late reductions. Roentgenograms of the pelvis must include both hips after closed or open procedures as a check for a concentric reduction of the hip. Any abnormality, or failure to reduce the avulsed head fragment, demands an immediate hip arthrotomy. The good results, after primary open reduction, although under 50%, were better than closed or closed followed by open reduction. Our approach is to discard the avulsed head fragment. No conclusions can be made regarding screw fixation of the avulsed fragment because there was an insufficient follow-up period in this procedure. Long-term follow-up examination is necessary in Type V fracture dislocations because one can anticipate that arthritic changes will develop in more than 50% of patients. Anterior approaches to excise head fragments in Type V dislocations are contraindicated. Early intervention is indicated in all dislocations with sciatic or peroneal nerve paralysis. Because most dislocations in this series were due to automobile accidents, the routine use of seat belts could have prevented many of these injuries.

Acetabulum↗