Biomedical subjects

David R Steinberg

Publications and source records attributed to David R Steinberg.

5 recordsLinked to original sources

PubMed2006

Determining lesion size in osteonecrosis of the femoral head.

BACKGROUND: Several studies have documented that the size of the osteonecrotic lesion in the femoral head is an essential parameter in determining prognosis and treatment. There are several methods currently available to measure lesion size, but no general agreement as to which is most useful. In the present study, three different radiographic methods for determining lesion size were evaluated and compared. METHODS: Anteroposterior and lateral radiographs of forty-two hips with osteonecrosis were examined. The extent of osteonecrotic involvement of the femoral head was determined through the use of three different methods: the volume of necrosis by quantitative digital image analysis, and the angular measurements described by Kerboul et al. and Koo and Kim. Graphs were constructed to demonstrate these relationships. RESULTS: Volumetric measurement appeared to be the most reliable. There was only a rough correlation with angular measurements. Several sources of error were noted when simple angular measurements of irregular, three-dimensional lesions were used. The Kerboul method routinely overestimated lesion size and designated 81% of the lesions as "large." The modified Koo and Kim method provided a more even distribution of lesion size and correlated with volumetric measurements in 74% of hips (thirty-one of forty-two hips). CONCLUSIONS: Quantitative volumetric measurements appear to be the most reliable method to measure the true size of a three-dimensional osteonecrotic lesion of the femoral head. Volumetric measurement is more accurate than angular measurement and can be performed easily with modern technology. Angular measurements, although somewhat simpler to use than volumetric measurements, may provide only a rough estimate of lesion size, partly due to the considerable differences in outline or location of the necrotic segments. Nevertheless, determination of lesion size must be part of a comprehensive system of staging of this disease, which includes the evaluation of other parameters, such as the extent and degree of articular surface involvement and the status of the hip joint and the acetabulum. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Body Weights and Measures↗

PubMed2004

Classification systems for osteonecrosis: an overview.

Currently a number of classification systems for osteonecrosis are in use. The use of different systems often leads to confusion and makes it difficult to compare the results of different methods of treatment. Because the management of osteonecrosis is determined in large part by the stage of the disease, it is important to use an effective and reliable method of staging and classification. This article provides an overview of the systems most commonly used so the reader can better understand and compare the outcome of studies that report their results using different methods of classification. The essential features of the ideal system are outlined to enable the reader to decide which of the available classification systems best meets these goals.

Diagnostic Imaging↗

PubMed2002

Surgical release of the carpal tunnel.

A thorough understanding of the normal anatomy and possible anomalies that may exist is important for the surgeon managing median nerve compression at the wrist. Given the high incidence of anatomic variability occurring in and around the carpal canal, open decompression of the median nerve is the preferred surgical technique for treating carpal tunnel syndrome. This approach provides complete visualization of the region, enabling the surgeon to decompress the nerve thoroughly, identify and treat anatomic abnormalities, and protect important neurovascular structures. Open carpal tunnel release is a safe and reliable operation with a high rate of functional improvement and patient satisfaction.

Carpal Tunnel Syndrome↗

PubMed2002

Open fractures of the distal radius.

A review of 18 patients treated at our institution for open distal radius fractures was performed. The patients were followed up for an average of 32 months (range, 12 months to 5.3 years). Wounds were classified according to Gustilo and Anderson with 9 type I (50%), 3 type II (17%), and 6 type III (34%) (3 IIIa, 2 IIIb, 1 IIIc) injuries. Seven patients underwent a total of 2 to 4 procedures to treat their injuries, and 3 patients required 5 or more procedures. Eleven (61%) patients had postoperative complications. Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand questionnaire and scored an average of 33. Wound severity was associated with an increased number of postoperative complications (p =.012), an increased number of complications per patient (p =.015), a higher number of surgical procedures (p =.003), a decreased average range of motion (p =.235), and fair or poor results at the latest follow-up (p =.03). Although type I injuries may be similar to their closed counterparts, patients with type III injuries experienced a much greater number of initial complications and had worse long-term clinical outcomes.

Adolescent↗

PubMed2002

Digital radiographs in the assessment of distal radius fracture parameters.

The purpose of the current study was to assess the reliability of measurement of distal radius fracture parameters using digital radiographs. Digital radiographs and corresponding plain radiographs of the wrists of 20 patients with intraarticular distal radius fractures were used to measure radial inclination, palmar tilt, radial height, and articular step-off. The plain radiographs and digital images were evaluated independently by three examiners in two sessions. The plain radiographs were assessed using a standard goniometer (manual measurements) whereas the digitized radiographs were evaluated using imaging software to do the computer-assisted measurements. The interobserver and intraobserver reliability were measured using repeated measures analysis of variance and weighted kappa statistics. Measurement of the digital images improved the interobserver reliability of measurement of palmar tilt from substantial to excellent, radial height from moderate to substantial, and articular step-off from fair to moderate. Similarly, intraobserver reliability increased from moderate to substantial when measuring radial height. In no instance (between or within observers) did the level of reliability decrease when using digital images for fracture evaluation. The current data suggest that the reliability of measurements of angular and linear fracture parameters of distal radius fractures is similar between plain and digital radiographs.

Humans↗