Biomedical subjects

D Herscovici

Publications and source records attributed to D Herscovici.

24 records · Page 2Linked to original sources

PubMed1992

The use of Ender nails in femoral shaft fractures: what are the remaining indications?

The use of Ender nails for the treatment of femoral shaft fractures has been described as technically easier and less time consuming than current intramedullary nailing techniques. We reviewed our results with unlocked Ender nails in 26 stable and 17 unstable fracture patterns an average of 3-4 years after injury. Because of continued instability, 42% of the stable and 76% of the unstable groups required adjunctive stabilization in the form of skeletal traction, a cast, or an external fixator. Additionally, nail migration and shortening and loss of motion at the knee were seen in 14 fractures in each group. Although two thirds of the patients with stable fracture patterns obtained good or excellent results, no outcome in the unstable group was rated excellent and only 19% were considered good. We therefore recommend that rigid locked intramedullary nails be used in femoral diaphyseal injuries. The use of Ender nails should be limited to stable fracture patterns and locked with screws or wires. They may be particularly useful for fractures in femora with small medullary canals (less than or equal to 8 mm), fractures below noncemented femoral prostheses, and fractures in young children requiring intramedullary stabilization without injuring the physeal plates.

Adolescent↗

PubMed1992

The floating shoulder: ipsilateral clavicle and scapular neck fractures.

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle by a plate and screws. We treated seven patients with this unusual injury; all achieved an excellent functional result without deformity.

Adolescent↗

PubMed1992

Understanding the os odontoideum.

Five cases of os odontoideum and associated instability of C1-2 involving patients who underwent a posterior spinal fusion are reviewed, along with the literature. Four of the patients had Down's syndrome, and two of them were symptomatic at the time of presentation. In the two asymptomatic patients, the os odontoideum was an incidental finding on routine roentgenographic survey. The fifth patient presented with trauma and neck pain. The operation was successful in all of the patients with Down's syndrome but one, who had preoperative signs of myelopathy. Patients known to have an os odontoideum must be followed closely; if there is instability, posterior spinal fusion is recommended to avoid the risk of neurologic compromise. An understanding of the pathoanatomy of this condition is essential to recognize and properly treat these patients.

Adolescent↗

PubMed1992

Superior dislocation of the fibular head associated with a tibial shaft fracture.

Superior dislocation of the proximal tibiofibular joint occurred in a 34-year-old woman who sustained a Grade 3B open left tibial fracture. An external fixator was applied to the tibia, and the tibiofibular joint was treated by closed reduction. Two bone graftings were performed, and the patient ultimately required a fibular osteotomy to allow tibial impaction. At 10 months posttrauma, the patient is fully weight-bearing and has no pain either at the tibia or the tibiofibular joint.

Adult↗

PubMed1990

Cervical instability as an unusual manifestation of Hajdu-Cheney syndrome of acroosteolysis.

Acroosteolysis is a disease that primarily affects distal areas of extremities, with osteolysis involving the phalanges of the hand most commonly reported. Some authors have noted acroosteolysis to be acquired secondarily to the initiation of an immune complex disease that results in the vascular occlusion of the small arteries of the hand. Although the pathoetiology is unknown, the Hajdu-Cheney syndrome of idiopathic acroosteolysis is distinct from the other forms because a generalized skeletal dysplasia is the most distinct feature, and it is usually not present in early childhood. The purpose of this study is to present an unusual case of cervical instability in a girl with Hajdu-Cheney syndrome. This case not only demonstrates that cervical osteolysis and acroosteolysis can coexist and require primary surgical intervention but also that patients with these concurrent problems need to be monitored closely to identify any subsequent changes that may require secondary surgical stabilization.

Cervical Vertebrae↗

PubMedDate not supplied

Retrograde versus antegrade nailing of femoral shaft fractures.

OBJECTIVES: To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS: Two hundred eighty-three consecutive adult patients with 293 fractures of the femoral shaft who underwent stabilization with antegrade or retrograde inserted femoral nails were studied. There were 140 retrograde nails and 153 antegrade nails. Twelve fractures in twelve patients were excluded (three in patients who died early in the postoperative period, three in patients because of early amputation, four in patients who were paraplegic, and two in patients who fractured through abnormal bone owing to metastatic carcinoma), leaving 134 fractures treated with retrograde nails and 147 treated with antegrade nails. One hundred four femurs treated with retrograde nails (Group R) and ninety-four femurs treated with antegrade nails (Group A) had sufficient follow-up and served as the two study groups. The average clinical follow-up was twenty-three months (range 6 to 66 months) for Group R and twenty-three months (range 5 to 64 months) for Group A. Both groups were comparable with regard to age, gender, number of open fractures, degree of comminution, mode of interlocking (i.e., static or dynamic), and nail diameter (p > 0.05). INTERVENTION: Retrograde intramedullary nails were inserted through the intercondylar notch of the knee, and antegrade nails were inserted through the pirformis fossa using standard techniques. MAIN OUTCOME MEASURES: Union, delayed union, nonunion, malunion, and complication rates. RESULTS: After the index procedure there were no significant differences in healing or incidence of malunion between Group R and Group A (p > 0.05). Healing after the index procedure occurred in ninety-one (88 percent) of the femurs in Group R and in eighty-four (89 percent) of the femurs in Group A. In Group R, there were seven delayed unions (7 percent) and six nonunions (6 percent). In Group A, there were four delayed unions (4 percent) and six nonunions (6 percent). Healing ultimately occurred in 100 (96 percent) femurs from Group R and in ninety-three (99 percent) femurs from Group A. In Group R, there were eleven malunions (11 percent), and in Group A, there were twelve malunions (13 percent). When patients with ipsilateral knee injuries were excluded, the incidence of knee pain was significantly greater for Group R patients (36 percent) than for Group A patients (9 percent) (p < 0.001). When patients with ipsilateral hip injuries were excluded, the incidence of hip pain was significantly greater for Group A patients (10 percent) than for Group R patients (4 percent) (p < 0.05). CONCLUSIONS: Retrograde and antegrade nailing techniques provided similar results in union and malunion rates. There were more complications related to the knee after retrograde nailing and more complications related to the hip after antegrade nailing.

Adolescent↗