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Biomedical subjects

E D Sedlin

Publications and source records attributed to E D Sedlin.

13 recordsLinked to original sources

Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures.

This study reviews a group of 80 consecutive displaced ankle fractures treated operatively and followed for an average of 3.2 years. Fractures included bone or combined bone and ligamentous injuries in which the initial talar displacement was greater than or equal to 2 mm. The immediate postoperative roentgenograms were examined for several features, which included widening of the syndesmosis, fibular length, talo-crural angle, talar tilt, presence and size of a posterior malleolar fracture, and an abnormality of the medial clear space. Patients were examined at follow-up per Cedell, and their clinical evaluations were correlated with the analysis of radiographic features and demographic data. Good to excellent results were seen in 80% of the cases. The radiographic factors most predictive of a poor outcome were abnormal medial clear space and the presence of a large (greater than 20%) posterior malleolar fracture (p less than 0.05). Fibular shortening, talar tilt, and syndesmotic widening suggested a poor result, but these findings were not statistically significant. Multiple (two or more) radiographic abnormalities correlated with a poor prognosis. Conversely, a perfect radiographic result did not guarantee an excellent clinical outcome. Older patients and those with a delay between injury and surgery greater than 7 days tended to have a poorer result.

Adolescent↗

Postero-lateral rotatory instability in osteoarthritis of the knee.

Rotatory instability is well recognized following trauma to the knee, but it may also be seen in degenerative disease. The presence of chronic instability may affect the results of operative treatment of the osteoarthritic knee, as has been shown with postero-lateral rotatory instability in patients with varus deformity secondary to osteoarthritis. Recognition of these often subtle clinical entities is essential in order to improve patient selection when considering the various options for operation. An understanding of the pathomechanics of rotational instability in combination with abnormality of alignment in the joint will enable better classification of the changes which occur in osteoarthritis of the knee.

Female↗

Isolated dislocation of the radial head.

Isolated dislocation of the radial head without fracture of the ulna is an uncommon injury. Though rare in children, it has been reported. A review of the world literature revealed only two reported cases in adolescents. This paper presents three previously unreported cases and reviews the mechanism of injury and problems associated with delayed treatment.

Accidental Falls↗

Roller skating accidents and injuries.

A consecutive series of 65 fractures, dislocations, and ligament tears produced by roller skating accidents treated by the Orthopaedic Department of the Mt. Sinai Services at City Hospital Center of Elmhurst, New York, is reviewed. It was learned that the injuries resulting from collisions occurring in a skating rink were more serious than those resulting from street accidents. Data indicated that lack of expertise is a prominent factor in the production of serious injury. However, the sport has inherent risk which is not eliminated by expertise. It was concluded that roller skating can and does produce disabling injuries. In order to reduce the number of injuries it will be required to reduce crowding in rinks, designate separate beginners' areas, use training wheels or clampon-type of skates when learning, encourage lessons, and separate beginners in the rinks.

Accident Prevention↗

Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip.

Two hundred patients with a basicervical, intertrochanteric, or subtrochanteric fracture were treated by Ender-pin fixation during a three-year period. Their median age was 73.5 years and there was a 10 per cent mortality rate. Early partial weight-bearing with some external support was allowed for most patients. Minimum shortening and one non-union occurred. However, there was a substantial incidence of complications. The fixation failed in all basicervical fractures. Distal pin migration of more than two centimeters occurred in 50 per cent of the unstable intertrochanteric fractures. Seventy-six per cent of the forty-two patients who were personally examined at follow-up had pain in the knee and 36 per cent had external malrotation. The incidence of pin migration increased in the more unstable fractures.

Adult↗

Conservative treatment of low velocity gunshot wounds.

A retrospective study of gunshot wounds of the extremities present 148 patients who had sufficient clinical and radiological follow-up data to assess the results. The routine treatment for this injury consisted mainly of cleansing the wound, introduction of systemic antibiotics in the emergency room followed by hospitalization. More extensive treatment and surgical debridement were done only when intraarticular or vascular injury occurred. Two patients developed infected wounds. In 6 displaced humeral shaft fractures, there were 2 non-unions and one delayed union. In 11 comminuted, displaced fractures of the femoral shaft, one non-union occurred.

Aged↗

The Lottes nail in the closed treatment of tibia fractures.

The effectiveness of the Lottes nail was evaluated in 63 consecutive cases of tibia fractures treated by closed intramedullary fixation with image intensification. The procedure was offered to all adults except those with Gustillo and Anderson Type III open wounds and with fractures less than 10 cm from the knee or 5 cm from the ankle. The operations were generally performed within a few days in closed fractures and somewhat later in open fractures. Patellar-tendon-bearing casts were applied five to ten days after operation, and weight-bearing to tolerance was emphasized. All fractures united. Bridging callus was generally seen by seven or eight weeks. Complications not necessarily peculiar to the procedure included one each of delayed wound infection, peroneal neurapraxia, compartment syndrome, heel decubitus, and shortening of more than 2 cm. Technical failures included malunion of fracture, loss of fixation by the nail, backing out of the nail, and penetration into the ankle joint. Most of the complications and technical failures could be remedied and did not influence the ultimate result. The authors recommended the Lottes nail and closed intramedullary nail fixation as the preferred method of treatment of diaphyseal fractures of the tibia in adults.

Adolescent↗