38-year follow up of femoral endoprosthesis.
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Ankylosis↗
Biomedical subjects
E J Zenni
Publications and source records attributed to E J Zenni.
Ogden plate and other fixations for fractures complicating femoral endoprostheses.
Treatment of femoral shaft fractures complicating endoprostheses remains controversial. Nineteen such fractures were treated with open reduction and internal fixation using the Ogden plate. This modified plate allows for proximal fixation with heavy-duty Parham bands and distal fixation with screws. Sixteen of 19 patients healed their fractures in an average of 3.5 months. Two fractures developed delayed unions, one resulted in non-union. At final follow-up examination, results were rated as excellent (12), satisfactory (5), and poor (2). The procedure is not technically difficult. It can be applied to fractures both above and below the prosthetic tip as well as those with and without cement. Use of the Ogden plate provides immediate rigid fixation allowing early mobilization, preventing the complications of traction and/or cast immobilization.
Adult↗
Traumatic dislocation of the knee: a report of 30 cases and literature review.
Traumatic dislocation of the knee, an uncommon injury, is sustained as the result of violent trauma. Thirty documented cases of complete traumatic dislocation of the tibia from the femur are identified and retrospectively reviewed. Twenty had adequate documentation with a minimum two-year follow-up to evaluate the results of operative versus nonoperative treatment of this ligamentous injury. Nonoperative treatment can result in a functional knee depending on the patient's demands. However, early operative repair, followed by early limited motion (cast bracing), and aggressive physical therapy to regain motion, are recommended in young active patients. Prolonged immobilization postoperatively should be avoided.
Adolescent↗
Pierre Robin anomaly with an accessory metacarpal of the index fingers. The Catel-Manzke syndrome.
A two-year-old female with the Pierre Robin anomaly and bilateral index finger malformations is described. Hypertelorism, full cheeks, posteriorly rotated ears with prominent antihelix, short neck, simian creases, bilateral fifth finger clinodactyly, and short toes with hypoplastic small nails were also present. Her mother had a subsequent pregnancy that resulted in the delivery at 26 weeks, of a stillborn female fetus with cleft palate, index finger anomalies and congenital heart disease. These two patients are the first females reported with this group of anomalies. The etiology of this combination of malformations, the Catel-Manzke syndrome, is unknown.
Abnormalities, Multiple↗
Intramedullary fixation of humeral shaft fractures.
In this paper we document seventy fractures of the humeral shaft that were treated by intramedullary fixation between 1970 and 1981. Complications developed in forty-seven (67 per cent) of the fractures, and forty-five (64 per cent) required at least one additional operative procedure. Of the sixty fractures that were internally fixed within six weeks after injury, nine (15 per cent) had a delayed union and five (8.3 per cent) had a non-union, two of which persisted despite subsequent surgery. Three of the ten fractures that were internally fixed more than six weeks after injury never united despite additional procedures that were done to secure union. Delayed union and non-union were more common in open fractures (33 per cent) than in closed fractures (21 per cent), and with open reduction (39 per cent) than with closed or so-called semi-open reduction (9 per cent). Deep infection occurred in three (5 per cent) of the fractures and was more common in open (17 per cent) than in closed fractures (2 per cent). One of the three open fractures that were treated by immediate fixation became infected, as compared with only one of the nine open fractures treated by delayed fixation. Painful adhesive capsulitis of the shoulder developed in thirty-four (56 per cent) of the patients who had fractures treated with distally directed pins, but motion of the elbow was not restricted in the nine patients with fractures treated with proximally directed pins.
Adolescent↗
Open reduction and internal fixation of clavicular fractures.
Extensive clinical studies reported in the literature have indicated that non-operative treatment is the treatment of choice for clavicular fractures. It has also been suggested by some that open reduction may contribute to the development of non-union. From 1970 to 1978, twenty-five of approximately 800 patients with a fracture of the clavicle were treated by open reduction and internal fixation with a threaded intramedullary wire or pin or with cerclage suture (one case). The patients' ages ranged from thirteen to fifty-nine years. All fractures healed without infection or migration of the pin. Based on this experience and a review of the English-language literature, we concluded that the indications for open reduction and internal fixation should be: (1) neurovascular compromise due to posterior displacement and impingement of the bone fragments on the brachial plexus, subclavian vessels, and even the common carotid artery; (2) fracture of the distal third of the clavicle with disruption of the coracoclavicular ligament; (3) severe angulation or comminution of a fracture in the middle third of the clavicle; (4) the patient's inability to tolerate prolonged immobilization (required by closed treatment) because of Parkinson's disease, a seizure disorder, or other neuromuscular disease; and (5) symptomatic non-union following treatment by closed methods.
Adolescent↗
An axillary approach for a Putti-Platt repair.
Eighty-seven Putti-Platt repairs for traumatic recurrent anterior dislocations of the shoulder have been performed, utilizing the anterior axillary approach. This approach facilitated the surgical repair so well that its use has been continued. The anterior axillary approach provides an excellent exposure of key anatomical structures. This is obtained by undermining the skin. The blood loss has been minimal. Infection is rare and wound healing is rapid. The surgical scar is minimal and inconspicuous. This exposure requires one assistant, which can significantly shorten the operative time.
Athletic Injuries↗
Lateral ligamentous instability of the ankle: a method of surgical reconstruction by a modified Watson-Jones technique.
Forty-nine cases of lateral ligamentous instability of the ankle have been reviewed. Forty-one have been personally examined. Eight have been evaluated by questionnaire follow-up. The end results have been universally good. The results have been based on a subjective evaluation by the patient, 92% regarding the end results of the procedure to be excellent. In regard to function, 92% of the patients have been able to resume their preinjury activity. The evidence of instability of the ankle joint can be determined by preoperative x-ray examination. However, careful history and physical examination obviate the need for x-ray studies in most cases. Operative findings have confirmed our preoperative evaluation in all cases. The modification of the Watson-Jones procedure, using the peroneus longus, enables the operating surgeon use of a much greater tendon in reconstruction of the lateral ligamentous structures. No change in the function of the foot has been noted in the reported cases.
Adolescent↗