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Biomedical subjects

Dean G Lorich

Publications and source records attributed to Dean G Lorich.

27 records · Page 2Linked to original sources
PubMed2004

Osteoporotic femoral neck fractures: management and current controversies.

Osteoporosis is a pervasive disease among the growing elderly population. Femoral neck fractures are often a direct result of osteoporosis and are challenging to treat. Surgical interventions seek to return the patient to preinjury function as quickly as possible, but many obstacles exist. Disruption of the blood supply occurs regardless of the fracture pattern, and in the active elderly population, reduction and fixation should be done as soon as possible to minimize healing problems. Closed reduction with percutaneous cannulated screw instrumentation is currently the fixation method of choice, but even with meticulous technique, moderate complication rates persist. Newer devices and biologic bone augmentation cement show promise in decreasing postoperative fracture collapse. Patients in whom a stable reduction cannot be achieved or who have a limited life expectancy should undergo arthroplasty. Unipolar and bipolar arthroplasty have both been effective in restoring function and have been the standard of care in these patients. Recent evidence suggests that active elderly patients who have acetabular disease or severely displaced fractures may benefit most from primary total hip arthroplasty.

Aged↗
PubMed2004

Osteoporotic pertrochanteric hip fractures: management and current controversies.

The treatment of intertrochanteric hip fractures has evolved over the past 80 years because of a better understanding of fracture anatomy, application of biomechanical principles, and novel technologic advances. Surgical treatment of intertrochanteric hip fractures is the current standard of care, with short-term goals of fracture stabilization and early patient mobilization and the long-term objective of restoring patients to their previous level of independence and function. Treatment for stable intertrochanteric hip fractures includes use of percutaneous intramedullary devices and open reduction and internal fixation using a sliding hip screw. To date, none of these devices has shown any clear clinical advantage over the dynamic hip screw. Intramedullary fixation has multiple theoretical advantages for the treatment of unstable fracture patterns; however, it remains unclear if ultimate functional outcome warrants the added expense of such treatment. For patients with a reverse obliquity fracture pattern, the advantage of the intramedullary construct has been shown.

Aged↗
PubMed2004

Has locked plating completely replaced conventional plating?

The 2 main approaches to fracture plate fixation--compression plating and internal splinting--result in differing biomechanics and subsequent healing response patterns. A number of advantages to using the newer internal fixators have been described, but there are still several indications for traditional compression plating.

Biomechanical Phenomena↗
PubMed2004

A minimally invasive approach for plate fixation of the proximal humerus.

Plate fixation for unstable fractures of the proximal humerus has seen mixed results as evidenced by the trials of new methods of fixation. The deltopectoral surgical approach is most frequently used and requires significant muscle retraction and soft tissue stripping to expose the lateral humeral neck. This may contribute to avascular necrosis and fixation failure. Lateral approaches have been limited to 5 cm distal to the acromion because of the course of the anterior branch of the axillary nerve. A recent anatomic study has demonstrated the predictability of the position of the axillary nerve as it crosses the anterior deltoid raphe, which allows it to be isolated and protected, and dissection can be extended distally. In addition, no accessory motor branches to the anterior head of the deltoid cross the raphe, so extending an incision through the raphe after protecting the main motor branch of the axillary does not place the innervation to the anterior deltoid at risk. This surgical approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.

Bone Nails↗
PubMed2002

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures.

OBJECTIVE: To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). DESIGN: Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons. SETTING/PARTICIPANTS: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI. Three experienced attending orthopaedic trauma surgeons were randomly presented three sets of studies for each injury: radiographs alone, radiographs with CT, and radiographs with MRI (including soft tissue injuries documented by an experienced MRI radiologist). The surgeons were asked to render fracture classification and treatment plan based upon the blind reading of each individual radiographic set. MAIN OUTCOME MEASURES: Agreement among the three surgeons was measured using kappa coefficients. RESULTS: For fracture classification, radiographs alone yielded a mean kappa coefficient of 0.68, which increased to 0.73 for radiographs with CT scan and 0.85 for radiographs with MRI. Fracture classification (Schatzker) was changed an average of 6% with the addition of the CT scan and 21% based on radiographs with MRI. For the fracture management plan, the mean interobserver kappa coefficient for radiographs alone was 0.72, which increased to 0.77 for radiographs with CT scan and 0.86 for radiographs with MRI. MRI changed treatment plan in 23% of the cases. CONCLUSION: Magnetic resonance imaging increases the interobserver agreement on fracture classification and operative management of tibial plateau fractures.

Adult↗
PubMedDate not supplied

Use of physical forces in bone healing.

During the past two decades, a number of physical modalities have been approved for the management of nonunions and delayed unions. Implantable direct current stimulation is effective in managing established nonunions of the extremities and as an adjuvant in achieving spinal fusion. Pulsed electromagnetic fields and capacitive coupling induce fields through the soft tissue, resulting in low-magnitude voltage and currents at the fracture site. Pulsed electromagnetic fields may be as effective as surgery in managing extremity nonunions. Capacitive coupling appears to be effective both in extremity nonunions and lumbar fusions. Low-intensity ultrasound has been used to speed normal fracture healing and manage delayed unions. It has recently been approved for the management of nonunions. Despite the different mechanisms for stimulating bone healing, all signals result in increased intracellular calcium, thereby leading to bone formation.

Bone and Bones↗
PubMedDate not supplied

Surgical dislocation of the hip for fractures of the femoral head.

Traumatic dislocations of the hip are high-energy injuries that frequently occur with fractures of the femoral head. Controversy exists regarding many aspects of the treatment of these fractures, but following reduction, large displaced head fragments require open reduction and internal fixation. Traditionally, an anterior approach to the hip joint has been used for surgical access to the femoral head, but this incision often results in limited visualization and subsequent difficulty with anatomic reduction. Recently, a surgical hip dislocation technique has been described for acetabular fractures and deformities of the proximal femur. At our institution, this technique has been used for femoral head fractures resulting in superior visualization and fracture stabilization. This article details the technique and its application.

Adolescent↗