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Biomedical subjects

D Paley

Publications and source records attributed to D Paley.

At least 19 recordsLinked to original sources
PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur.

Angular deformities of the tibia or femur in the frontal plane lead to mechanical axis deviation of the lower limb and malorientation of the joints above and below the level of deformity. Accurate correction of the malalignment and of the joint orientation is important for function and to prevent joint degeneration. An accurate yet simple method to determine the apex of deformity and the type of correction required is based on the joint reference lines of the hip, knee, and ankle, and the individual mechanical axis lines of each bone segment. If the osteotomy is performed at the level of the apex of the deformity, then the only correction needed is angulation. If the osteotomy is performed at a level proximal or distal to the apex, then translation in addition to angulation is necessary to accurately correct the deformity.

Femur↗
PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia.

Multiapical deformities complicate the process of preoperative planning. It is necessary to determine the level of each apex of deformity to plan accurate correction. The basic principles of mechanical axis realignment and joint orientation need to be preserved. Using the joint reference lines and mechanical axis of each bone segment, one can accurately determine the apex of each deformity. Bowing deformities are multiapical angular deformities. There are two types of bowing deformities: compensated and noncompensated. Typical examples of compensated bowing are the anterolateral and posteromedial bows of the tibia. A noncompensated bow is typical of the deformity seen in rickets.

Femur↗
PubMed1992

Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique.

The principle of treatment of congenital pseudoarthrosis of the tibia (CPT) with the Ilizarov method corrects all angular deformity and maximizes the cross-sectional area of union of the pseudoarthrosis. Fifteen patients with a total of 16 CPT were treated using the Ilizarov apparatus. Various forces were used to treat the pseudoarthrosis site including compression, distraction, open reduction, resection and shortening, resection and bone transport, and invagination of one end in the other. Lengthening was performed in 12 of the 16. Deformity was corrected in all cases. The union rate was 94% with one treatment and 100% with two treatments. There were five refractures, three early and two late. Previous pin sites, residual angular deformity, and natural history were considered predisposing factors for refractures. One patient refractured twice but remained ununited. Fifteen remained united, with a mean follow-up period of four years (range, two to seven). There were two residual deformities, one in the regenerate and one at the level of the CPT.

Adolescent↗
PubMed1991

Ilizarov technique in treatment of congenital hand anomalies. Two case reports.

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities.

Child↗
PubMed1991

Percutaneous osteotomies. Osteotome and Gigli saw techniques.

Traditional methods of performing tibial and femoral corticotomies is discussed and then the modification using a percutaneous Gigli saw is explained. Advantages of the procedure are detailed, and numerous illustrations aid the reader.

Bone Lengthening↗
PubMed1991

Fractures of the spine in diffuse idiopathic skeletal hyperostosis.

Fractures of the spine in diffuse idiopathic skeletal hyperostosis (DISH) have rarely been reported. Only four cases could be found in the world literature. Eight new cases with nine fractures are reported in this study. The critical features are the frequent delays in diagnosis (three of eight patients) and the high rate of immediate and delayed neurologic deficit (seven of eight patients). Two fracture patterns occurred in this group. The first type occurred through the midportion of an ankylosed segment of the spine and involved the vertebral body (five fractures). The second type occurred at the top or bottom of a fused segment (four fractures). The latter were disk disruptions or odontoid fractures. This is a marked difference from spinal fractures in ankylosing spondylitis, in which the majority are transdiskal fractures. The difference can be explained on the basis of the different pathology of these two disease processes. Careful evaluation of patients with DISH who sustain trauma is critical. Treatment of this rare injury should be early stabilization of the spine to avoid complications of nonunion, deformity, neurologic injury, and death.

Aged↗
PubMed1990

A critical analysis of Swanson ulnar head replacement arthroplasty: rheumatoid versus nonrheumatoid.

Clinical and radiographic assessment of the results of 40 Swanson silicone ulnar head prosthesis implants in three different patient groups is presented. Twenty-eight were done for treatment of rheumatoid arthritis, eight for ulnoradial impingement after the Darrach procedure, and four for ulnocarpal impingement resulting from malunited Colles' fractures. Patients were reviewed 12 to 48 months after operation (mean, 29 months). Seventy-eight percent of patients reported relief of pain and improved function. Radiologic examination showed that all patients exhibited resorption of the distal ulna (mean 4.4 mm) and that resorption was worst in the group with rheumatoid arthritis. Bone resorption about the implant predisposed the cap to both side-to-side tilt and pistoning of the prosthesis on supination and pronation. There was a 10% revision rate because of silicone synovitis. Although clinical results remain satisfactory for patients with rheumatoid arthritis and ulnocarpal impingement, the radiologic results suggest that Swanson ulnar head replacement should be restricted to elderly patients with rheumatoid arthritis.

Age Factors↗
PubMed1990

Radiologic assessment of bones after Ilizarov procedures.

Ilizarov procedures, introduced recently in the United States, were performed in 163 patients aged 2-53 years who underwent pure limb lengthening for inherited conditions such as achondroplasia (37 procedures), correction of angular deformity secondary to nonunion or malunion of fractures (62 procedures), or correction of congenital/developmental angular deformities of the limbs (64 procedures). Before surgery, every patient was evaluated with plain radiography; after surgery, every patient was evaluated at weekly or biweekly intervals with standard plain anteroposterior and lateral radiography, with acquisition of additional radiographs centered over the distraction site. Every patient had complete bone healing, which took 3-14 months. In all patients, new bone formation was evident within 15 weeks after surgery. Complications associated with the Ilizarov technique were minimal (delayed formation in two cases and cyst formation within the distraction site in two cases), but success relies heavily on radiographic evaluation. Radiographs of the whole bone or joint must be obtained for overall assessment of bone alignment; specific views of the distraction site, with the x-ray beam centered over this site, may be required.

Adolescent↗
PubMed1990

Sonographic evaluation of bone production at the distraction site in Ilizarov limb-lengthening procedures.

The success of the Ilizarov distraction technique has resulted in a marked increase in the number of limb-lengthening and limb-straightening procedures performed for the correction of short and deformed limbs. This technique involves fracture of the bone and application of an external ring and bar support frame with circumferential screw threads and nuts, which allows systematic distraction of bone segments at a rate of 0.25 mm four times a day. During the procedure, the patient is encouraged to be ambulatory, as the strength of the frame allows weight bearing. Because of the limitations of plain radiographs in detecting the small amounts of new bone formation that occur at the distraction site in the early stages of healing, the success of the procedure cannot be determined for many weeks. The rate of distraction depends on the successful production of new bone in the distraction site. Early evaluation of new bone production is therefore important, because slow bone formation requires a decrease in distraction rate and vice versa. We examined 12 patients who had limb-lengthening procedures via the Ilizarov technique to determine if sonography could be used to detect early new bone formation at the distraction site. Our results show that new bone formation could be detected with sonography many weeks before its appearance on the radiograph. The sonographic appearance of new bone consists of echogenic foci within the distraction site, which become aligned in the longitudinal plane and which increase in number and size until they coalesce as echodense bone, which does not allow through-transmission of the ultrasound beam. In addition, sonograms showed 1.5-cm and 2-cm cysts within the distraction site in two patients in whom they were not visible on the radiographs. Timely percutaneous aspiration allowed continued normal bone generation. We conclude that sonography is useful for the detection of new bone formation at the distraction site in patients undergoing the Ilizarov procedure.

Amputation, Surgical↗
PubMed1990

Treatment of malunions and mal-nonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques.

Internal fixation has been the mainstay of treatment for post-traumatic deformities. External fixation has been used for correction of deformity in malunions and mal-nonunions. Treatment goals of achieving complete deformity correction with restoration or improvement of function were successful in this very complex group of malunions despite the numerous problems, obstacles, and complications of treatment.

Adult↗
PubMed1990

Lengthening of the forearm by the Ilizarov technique.

The Ilizarov technique was used for lengthening 13 forearms in 12 patients. The different types of treatment were: lengthening of the radius alone, lengthening of the ulna alone with or without radial head relocation, lengthening of one-bone forearms, lengthening of the radius and ulna to the same extent, and differential lengthening of the radius and ulna. The lengthenings ranged from 2 cm to 13 cm (10%-143%). Bone consolidation was achieved in three to 19 months without the need for bone grafting. Eleven of 12 patients were functionally and cosmetically improved. In nine patients, the cosmetic improvement made a significant psychologic difference to the patient. There were 11 complications, including three temporary deep radial nerve palsies, one sympathetic dystrophy, one malunion, one delayed malunion, two refractures, and three mild loss of motion. All of these dysfunctions were temporary, but mild stiffness persisted in three patients. The goals of treatment were achieved in all patients.

Activities of Daily Living↗
PubMed1990

Mechanical evaluation of external fixators used in limb lengthening.

Four external fixator systems (five configurations) used for limb lengthening were tested to determine the fixator stiffness and the fracture gap rigidity. There was a statistical difference between fixators in all modes of loading with respect to stiffness, shear, and axial motion. The fixators were graded to determine their relative stiffness, shear rigidity, and axial rigidity. The EBI Orthofix proved to be the most rigid fixator relative to the configurations tested with minimal shear or axial motion at the fracture site. The Ilizarov tibial configuration was the least rigid, demonstrating more shear and axial motion at the fracture gap. The Ilizarov femoral system combined excellent stability and shear resistance with preservation of axial dynamization. Fixators with a high stiffness provide less motion at the fracture site, which may cause stress shielding of the osteotomy. Fixators that provide more motion at the fracture gap are less stable. These data may be useful in determining which fixator may be ideal for a particular clinical situation.

Biomechanical Phenomena↗
PubMed1990

Problems, obstacles, and complications of limb lengthening by the Ilizarov technique.

Difficulties that occur during limb lengthening were subclassified into problems, obstacles, and complications. Problems represented difficulties that required no operative intervention to resolve, while obstacles represented difficulties that required an operative intervention. All intraoperative injuries were considered true complications, and all problems during limb lengthening that were not resolved before the end of treatment were considered true complications. The difficulties that occurred during limb lengthening include muscle contractures, joint luxation, axial deviation, neurologic injury, vascular injury, premature consolidation, delayed consolidation, nonunion, pin site problems, and hardware failure. Late complications are those of loss of length, late bowing, and refracture. Joint stiffness may also be a permanent residual complication. Pain and difficulty sleeping are other problems that arise during limb lengthening, especially in the more extensive cases. Forty-six patients had 60 limb segments lengthened between 1.0 and 16.0 cm, with a mean of 5.6 cm. The average treatment time was approximately one month per centimeter for single-level lengthenings with no deformity and 1.2 months per centimeter with deformity correction. The lengthening index for double-level lengthening was 0.57 month per centimeter with no deformity and 0.90 month per centimeter with correction of deformity. In adults, the lengthening index was 1.7 months per centimeter for single-level and 1.1 months per centimeter for double-level lengthening. There were 35 problems that had to be resolved in the outpatient clinic. There were 11 obstacles that required additional operative intervention to resolve. There were 27 true complications, of which 17 were considered minor and ten were considered major complications. Of the major complications, three interfered with achieving the original goals of treatment. All three required further operative intervention to achieve the original goal. These were nonunion in one and late bowing in two. Despite these problems, obstacles, and complications, the original goals of surgery were achieved in 57 of the 60 limb segments treated. Patient satisfaction was achieved in 94% of 46 cases.

Adult↗
PubMed1989

Radiographic definition of the dorsal and palmar edges of the distal radius.

The dorsal and palmar edges of the distal radius, as well as the concavity of the articular surface were labeled with wire and radiographs taken from neutral to 30 degrees of added dorsal tilt. The dorsal edge was identified as the structure that protrudes distally in neutral. The palmar edge was found to overlap with the sclerotic subchondral bone of the radius in neutral. With increasing dorsal tilt the profile of the palmar edge appeared as it protruded distal to the sclerotic subchondral line of the radius. The profile of the palmar edge could be distinguished from that of the dorsal edge on the anteroposterior view. The wire, which was placed midway between the dorsal and palmar edges and the concavity of the articular surface corresponded to the prominent sclerotic subchondral bone line of the distal radius. This did not change in position with increasing dorsal tilt. This clarification of the radiologic anatomy is helpful in extending the use of the anteroposterior radiograph for the interpretation of fractures and malunions of the distal radius.

Humans↗
PubMed1989

Distal radial osteotomy.

Malunions of distal radius fractures are commonplace. Patients are decreasingly willing to accept the disability that may be associated with them. While the first line of treatment is initial good fracture care, corrective osteotomies offer later opportunity for pain relief and improved function.

Adult↗
PubMed1989

Calcaneal fracture controversies Can we put Humpty Dumpty together again?

Intra-articular calcaneal fractures continue to pose a therapeutic challenge greatly out of proportion to their low incidence. The controversies of the use of operative versus nonoperative treatment, prognostic factors, the surgical approach, and the method of fixation are presented. Classification is also discussed.

Calcaneus↗