PubMed Health⌕ Search

Biomedical subjects

D Paley

Publications and source records attributed to D Paley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Ilizarov treatment of tibial nonunions with bone loss.

Twenty-five patients aged 19-62 years were treated for tibial nonunions (22 atrophic, three hypertrophic) with bone loss (1-23 cm, mean 6.2 cm) by the Ilizarov technique and fixator. Thirteen had chronic osteomyelitis, 19 had a limb-length discrepancy (2-11 cm), 12 had a bony defect (1-16 cm), and 13 had a deformity. Six had a bone defect with no shortening, 13 had shortening with no defect, and six had both a bone defect and shortening. Nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. Bone defects were closed from within without bone grafts by the Ilizarov bone transport technique of sliding a bone fragment internally, producing distraction osteogenesis behind it until the defect is bridged (internal lengthening). Length was reestablished by distraction of a percutaneous corticotomy or through compression and subsequent distraction of the pseudarthrosis site (external lengthening). Distraction osteogenesis resulting from both processes obviated the need for a bone graft in every case. Deformity was corrected by means of hinges on the apparatus. Infection was treated by radical resection of the necrotic bone and internal lengthening to regenerate the excised bone. Union was achieved in all cases. The mean time to union was 13.6 months, but it was only 10.6 months if the time taken for unsuccessful compression-distraction of the nonunion is eliminated from the calculation. The bone results were excellent in 18 cases, good in five, and fair in two based on union in all cases, persistent infection in three, deformity in four, and limb shortening in one. The functional results were excellent in 16 cases, good in seven, fair in one, and poor in one based on return to work and daily activities in all cases, limp in four cases, equinus deformity in five cases, dystrophy in four cases, pain in four cases, and voluntary amputation for neurogenic pain in one case.

Adult↗
PubMed1989

A biomechanical analysis of the Ilizarov external fixator.

Five configurations of the Ilizarov fixator were analyzed in vitro. The overall stiffness, shear stiffness, and axial motion of the fracture site were determined. The data were compared with the results of eight conventional one-half frame fixators previously tested in the same manner. The Ilizarov fixator allowed significantly more axial motion at the fracture site during axial compression than the other fixators tested. The overall stiffness and shear rigidity of the Ilizarov external fixator were similar to those of the one-half pin fixators in bending and torsion. The stability of the Ilizarov fixator was a function of bone position within the fixator rings and fixation wire tension. The use of olive stop wires increased the shear resistance of the Ilizarov system.

Biomechanical Phenomena↗
PubMed1988

Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius.

Intra-articular incongruity of the distal radius at the radiocarpal joint is a bad prognostic feature; reduction by closed or open operative techniques is important. However, both techniques have limitations. We describe a new technique of reduction of the lunate facet under radiographic control, with very limited operative exposure and tissue trauma. In two cases anatomic restoration of the radiocarpal joint was obtained by this technique and maintained with external and limited internal fixation. Follow-up results are very encouraging. Currently we suggest use of this simple technique when faced with an incongruous radiocarpal joint after unsatisfactory attempts at closed reduction.

Adult↗
PubMed1988

Heterotopic ossification around the hip with intramedullary nailing of the femur.

Heterotopic ossification (HO) at the proximal end of a reamed intramedullary femoral nail is a complication of the procedure. Kuntscher stated that these "callus caps" were due to the prominence of the nail above the greater trochanter. A study of patients undergoing locked intramedullary nailing of the femur to assess subsequent development of heterotopic ossification at the proximal end of the implant was done. The purpose was to study the clinical significance of the ectopic bone and identify etiologic factors of bone formation. This group consisted of 59 patients with 60 locked intramedullary nails who were reviewed after prospective clinical and radiologic followup. Ectopic bone around the proximal end of the nail was classified with respect to quantity and clinical importance. A number of parameters were evaluated and a multifactorial analysis was performed. There were 52 males and seven females. Heterotopic bone was graded as: none--32%; minimal--20%, mild--28%; moderate--15%; and severe--5%. There was a positive correlation between bone formation and head injury, Injury Severity Score, and ventilator and ICU days. Prominence of the nail was not significant.

Adolescent↗
PubMed1987

Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: the empty sulcus sign.

Two cases of distal radioulnar joint (DRUJ) disruption and diastasis secondary to distal radial fractures were associated with displacement of the ulnar styloid and extensor carpi ulnaris (ECU) into the DRUJ. Both cases had a palpable empty ECU tendon sulcus. In one case surgical exploration revealed that the ulnar styloid, triangular fibrocartilage, and extensor carpi ulnaris tendon had dislocated into the DRUJ as a unit. The end result was good. In the second case lack of recognition and reduction of the ECU tendon and ulnar styloid led to persistent subluxation and diastasis. The end result was poor. Early recognition of the dislocation of the ulnar and ECU into the DRUJ and their significance may avoid poor results.

Aged↗
PubMed1987

Pathologic conditions of the pisiform and pisotriquetral joint.

In eight of sixteen patients with symptomatic pisotriquetral joints the pisiform was excised. A detailed study allowed correlation of the etiologic factors with the pathologic diagnosis. In a similar fashion pathologic-etiologic data were retrieved from 216 cases identified from the world literature and organized into the following four pathologic groups: primary OA (2.3%), secondary OA (48.4%), other arthritides (4.7%), and flexor carpi ulnaris enthesopathy (44.6%). The most common causes were acute and chronic trauma and instability. On the basis of these data, we hypothesized that loss of integrity to the surrounding retinacular structures of the pisiform may lead to instability and thus dysfunction of the joint.

Adult↗
PubMed1987

The unstable pelvic fracture. Operative treatment.

While the pendulum has swung to the operative side, open reduction and internal fixation will surely not prove to be the panacea for all unstable pelvic fractures. The lasting effects, however, of attempts at aggressive fixation of the pelvic fracture will be the principles of management that are being established. This begins with the recognition of pelvic instability. It is in these unstable injuries that obtaining and maintaining an anatomic reduction is the best way to alter the natural history of the untreated pelvic fracture and to maximize the probability of obtaining a good long-term result. While the actual methods of internal and external fixation will continue to change, this principle is unlikely to alter. Therefore, if effective treatment can be achieved by closed means alone, that is an acceptable method. Similarly, external, internal, and combined operative and traction treatment methods that achieve this goal would also be acceptable. The question remains: Which method achieves the goal of obtaining and maintaining an anatomic reduction yet minimizes the early and late morbidity? This question is best answered by appropriate preoperative evaluation, subsequent planning, and precise, technically skillful surgery done by an experienced surgeon.

Bone Plates↗
PubMed1987

Median nerve compression by volarly displaced fragments of the distal radius.

Median nerve compression may occur acutely, subacutely, or late following fractures of the distal radius. Hematoma and swelling at the mouth of the carpal tunnel are the likely cause in acute cases. A contributing factor generally not recognized initially is a volarly displaced fragment of distal radius compressing the median nerve against the proximal edge of the flexor retinaculum. In nine such fractures, median nerve compression occurred in eight. Lack of recognition led to the delay in diagnosis and treatment of two patients. The volar fragment could always be seen on the first postreduction roentgenogram. Carpal tunnel release and removal or reduction of the displaced volar fragment should be carried out as early as possible to avoid the complications of reflex sympathetic dystrophy. Removal of the bony fragment alone, without carpal tunnel decompression, may be insufficient.

Carpal Tunnel Syndrome↗
PubMed1986

Synovial haemangioma of the knee joint: diagnosis by arthroscopy.

Synovial haemangiomas are a rare cause of recurrent knee effusions. The problem usually presents in childhood, but the diagnosis is often not made for many years. Clinical, laboratory, and radiographic diagnosis is often non-specific, leading to prolonged diagnostic uncertainty. Arteriography, venography, thermography, and computer tomography may be useful once the diagnosis is made. Arthroscopy should be considered early on to make the diagnosis and biopsy the tumor so that further surgery, studies, and treatment can be carried out.

Adult↗
PubMed1986

Irreducible dislocation of distal radial ulnar joint.

Volar dislocations of the distal radioulnar joint are often missed initially. Late closed reduction of this joint is generally unsuccessful. Even acute reductions of the distal radioulnar joint is often incomplete or unsuccessful. This is not the case for dorsal dislocations. Obstruction to reduction may be due to the contracted volar soft tissues in late cases or to the dynamic pull of the pronator quadratus acutely. A previously unrecognized cause for difficulty in reduction is the torn triangular fibrocartilaginous complex (TFCC). When the tear occurs at its dorsal insertion on the radius, leaving the TFCC attached to the volar radius and to the ulna, it may block the reduction of the ulnar head into the sigmoid notch. Open reduction is required in such cases with repair of the TFCC.

Cartilage, Articular↗
PubMed1986

Percutaneous bone marrow grafting of fractures and bony defects. An experimental study in rabbits.

Since bone marrow has been shown to contain osteoprogenitor cells, an experiment was devised to test its effects when injected percutaneously into osteotomies and 2-cm bony defects produced in rabbit radii. The parameters tested included callus volume, breaking load, tensile strength, and cross-sectional area of callus at the fracture or bony defect site. At two weeks postgrafting callus volume was significantly higher (p less than 0.01) in the grafted radii than in the contralateral saline controls. By four weeks all four parameters were significantly greater in the bone marrow grafted radii than in the contralateral saline controls. Serial radiographs and histology confirm this advanced fracture healing in the grafted bones. The earlier and more abundant callus, at the bone marrow grafted sites, was felt to provide earlier and greater stability, resulting in decreased early healing time when contrasted with the saline controls. Similarly, the bony defects that were grafted with bone marrow united by a bony bridge, whereas the saline controls did not. Percutaneous bone marrow grafting is a simple semi-invasive technique that may have potential clinical applications.

Animals↗
PubMed1986

Angiomatous involvement of an extremity. A spectrum of syndromes.

Congenital diffuse hemangiomatous involvement of the entire left thigh and knee joint in a 12-year-old girl was complicated by a Kasabach-Merrit type of consumptive coagulopathy. Repeated pathologic fractures of the left femur resulted in a nonunion. She also had a progressively increasing leg-length discrepancy, a stiff contracted knee, and leg atrophy distal to the knee. She was misdiagnosed originally as a Klippel-Trenauney syndrome, the progress of which is usually self-limited progression and involution. Despite steroid treatment, femoral artery banding, and intramedullary fixation of her femur, the hemangioma caused progressive debilitation of her left lower limb. At age nine, nonunion progressed to marked osteolysis and was treated by a through-knee amputation. A review of the literature revealed much confusion about multiple syndromes associated with angiomatous involvement of the lower limb. Prognostically, the depth and extent of the lesion were the most significant characteristics. This is well illustrated in this long-term follow-up study showing diffuse deep involvement that led to eventual amputation. Furthermore, this patient presents a multitude of complications developing from large angiomas.

Amputation, Surgical↗
PubMed1985

What determines the symptoms associated with subclavian artery occlusive disease?

Symptoms associated with subclavian artery stenosis are related to reduced cerebral or arm blood flow. A large difference in blood pressure between the two arms is associated with symptoms of arm ischemia alone and is usually caused by an anatomic variant. The presence or absence of a radiologic steal alone did not seem to determine the type or presence of symptoms. The type of cerebral symptoms seems to be determined by the location of other extracranial vascular stenosis. In patients with hemispheric symptoms there was a higher incidence of anterior circulation insufficiency and a greater reduction in the overall cerebral blood flow. In patients with nonhemispheric symptoms a higher incidence of posterior circulation insufficiency occurred. There may be a small group with nonhemispheric symptoms and a subclavian artery stenosis in whom reversed vertebral artery blood flow is the sole determinant. Perhaps more accurate delineation of other extracranial vascular stenosis would help determine what stenosis in addition to the subclavian artery occlusive disease determines the presenting symptoms. Surgical repair of these lesions may lead to an improved cure rate in this group of patients.

Arm↗
PubMed1985

[Analysis of different factors affecting results of the surgical treatment of gastroesophageal reflux].

Gastric emptying, gastric secretion and esophageal pH were studied prospectively in 32 patients who had either a Lortat-Jacob type operation (n = 7) or a fundoplication with a 360 degrees (n = 4), 270 degrees (n = 5) or 180 degrees (n = 16) gastric fundic wrap. The goal was to determine the effects of various antireflux mechanisms on these functions as well as to try to explain abnormal postoperative esophageal pH scoring indexes. Esophageal pH was recorded during the 3 h period following a standard meal. Acid reflux was expressed using a scoring index taking into account the duration and magnitude of pH fall. Preoperatively, all patients had an abnormal pH scoring index. Postoperatively, the pH scoring index remained increased in 7 patients (group A) and returned to normal values in 25 (group B). Clinical data, esophageal pH parameters and gastric acid secretion measured preoperatively were not significantly different in the two groups of patients. Preoperative gastric emptying for liquids was shorter in group A than in group B patients (p less than 0.05). Postoperative gastric emptying of radiopaque markers was not different in the two groups of patients. Postoperative resting pressure of the lower esophageal sphincter was always less than 10 cm H2O in group A and more than 10 cm H2O in group B patients. Changes in lower esophageal pressure after surgery were higher in group B than in group A patients (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗