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Biomedical subjects

Edward J Harvey

Publications and source records attributed to Edward J Harvey.

16 recordsLinked to original sources
PubMed2006

Anterior reduction for cervical spine dislocation.

STUDY DESIGN: Retrospective analysis of a prospectively followed cohort. OBJECTIVE: Long-term evaluation of patients with anterior stabilization for dislocations of the cervical spine. SETTING: Level 1 trauma center. SUMMARY OF BACKGROUND DATA: Anterior stabilization of unstable cervical spine injuries is gaining popularity. However, the method of open reduction is controversial. METHODS: Forty-one consecutive patients with unstable dislocations/subluxations of the subaxial cervical spine were included. Closed reduction was attempted in all patients using Gardner-Wells traction. If this failed, an anterior open reduction was performed. Tricortical iliac crest autograft and anterior plating was used. Patients were assessed for: 1) rate of successful reduction and stabilization using only the anterior surgical approach; and 2) complications and long-term clinical and radiologic outcome. RESULTS: Two of eight (25%) anterior open reductions failed requiring posterior surgery. One of these patients had associated pedicle fractures with horizontal rotation of the lateral masses. All grafts had healed successfully at the most recent follow-up visit. Moderate neck discomfort was found in 5 of 41 patients. Significant neurologic improvement was observed. CONCLUSIONS: Most subluxations/dislocations of the subaxial cervical spine can be reduced using Gardner-Wells traction and successfully stabilized with anterior surgery alone. If closed reduction fails, anterior open reduction is successful in the majority of cases.

Adolescent↗
PubMed2006

A vascularized technique for bone-tissue-bone repair in scapholunate dissociation.

Several surgical options have been used for the repair of scapholunate instability over the last 50 years. The many options have included neglect, reduction with percutaneous pinning, primary repair, partial fusions, tendon weaves, and others. Recent advancements in scapholunate repair and anatomy have been aimed at a more physiological repair. Composite replacement of the entire scapholunate interval similar to other tendon repairs seen in orthopedic surgery has become popular. Currently, more common hand-based grafts are bone-retinaculum-bone, third or second metacarpal-carpal bone or hamate-capitate grafts. There still exist some failures in the outcome after any of these procedures. This technique demonstrates the use of a vascularized autograft replacement on a pedicled graft. This procedure is the natural extension of the third or second metacarpal-carpal bone autograft, previously reported in the literature. The use of this proven graft, with a pedicle based on the intermetacarpal artery, may avoid some of the late complications seen with other autografts.

Bone Transplantation↗
PubMed2006

A new intramedullary nail device for the treatment of intertrochanteric hip fractures: Perioperative experience.

BACKGROUND: Traditional short nail fixation devices used for intertrochanteric (IT) fractures of the femur have several surgeon and patient benefits. However, these devices have had a high incidence of complications. A new intramedullary device designed to overcome these shortcomings has become commercially available. The goal of this study was to compare this intramedullary nail device with the traditional dynamic hip screw. METHOD: A prospective cohort study with 60 IT hip fractures was performed. Thirty patients treated with the trochanteric fixation nail (TFN) were compared with 30 patients treated with the dynamic hip screw (DHS) during the same time period. Implant selection was dictated by surgeon randomization. Primary outcomes planned for this study were immediate measures of operative blood loss, surgical time, and incidence of operative complications. Secondary outcome of return to preoperative ambulatory status was also recorded. Follow-up for secondary outcomes was conducted at an average of 6 months after surgery. Perioperative, functional, and radiologic outcome measures were collected. RESULT: No intra- or perioperative complications occurred with the new nail device. Operative time was 10 minutes shorter with TFN (50.7 minutes) compared with DHS (60.4 minutes). No Trendelenburg gait was noted in either group. No femur fractures or distal locking difficulties occurred in the TFN group. Twelve of 17 (71%) TFN patients returned to prefracture ambulation 6 months after surgery compared with only 6 of 18 (33%) DHS patients (p = 0.09). CONCLUSION: The rate of femoral fractures for short femoral nails was decreased compared with historical controls. Improved early mobilization was noted in TFN group.

Aged↗
PubMed2005

Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions.

PURPOSE: Radial-sided avulsions of the triangular fibrocartilage complex (TFCC) (Palmer 1D) with distal radioulnar joint (DRUJ) instability remain a challenging pathology to treat. We tested an intra-articular reconstruction that addresses unstable radial-sided TFCC avulsions. METHODS: Ten preserved, dissected, cadaveric forearm specimens with intact TFCC and without ulnar-positive variance had biomechanical testing using a hydraulic testing device. The measurement of total displacement of the ulna relative to the radius was performed with an applied load ranging from 20 N in a volar direction to 20 N in a dorsal direction. Specimens were tested sequentially with intact TFCC, with surgically induced Palmer 1D lesions, and after reconstruction of the TFCC. All tests were performed at neutral, maximal pronation, and maximal supination. RESULTS: The mean total displacements of the DRUJ of the specimens at neutral rotation were as follows: 4.1 +/- 0.4 mm for the intact specimens compared with 11.8 +/- 0.8 mm after creation of the tear and 3.9 +/- 0.7 mm for the reconstructed specimens. In maximal pronation the mean total displacements were as follows: 2.4 +/- 0.3 mm intact versus 4.9 +/- 0.7 mm for torn and 2.1 +/- 0.3 mm after reconstruction. In maximal supination the mean total displacements were as follows: 1.4 +/- 0.2 mm intact versus 5.7 +/- 1.3 mm for torn and 1.0 +/- 0.1 mm after reconstruction. All specimens obtained the preoperative pronation and supination motion after the reconstruction. CONCLUSIONS: Current procedures are unable to restore DRUJ stability without a significant limitation of pronation and supination. This intra-articular reconstruction of radial-sided TFCC avulsions succeeded in restoring baseline stability to the DRUJ without interfering with pronation/supination.

Biomechanical Phenomena↗
PubMed2005

Anatomical risks of using supra-acetabular screws in percutaneous internal fixation of the acetabulum and pelvis.

We conducted a study to determine whether a lag screw placed percutaneously at the level of the pelvic brim for treatment of iliac fracture risks injury to the lateral femoral cutaneous nerve (LFCN). A 4-mm Kirschner wire (K-wire) was placed percutaneously into each of 8 human cadaveric hemipelvises (4 pelvises) at the level of the pelvic brim to represent the path of screw placement. Under fluoroscopic guidance, each K-wire was advanced from the anteroinferior iliac spine toward the posterior iliac crest. Cadavers were dissected at study end. Proximity of the LFCN to the percutaneously inserted K-wire was the main outcome measured. In 4 of the 8 hemipelvises, the LFCN was disrupted; in 3 hemipelvises, it was within 4 mm of the K-wire; in the last hemipelvis, it was 23 mm away. LFCNs varied anatomically from 1 to 5 branches; disruptions occurred more in LFCNs with multiple branches than in those with 1 branch. The results suggest considerable risk for injury to the LFCN during percutaneous fixation of iliac and acetabular fractures using a percutaneous screw at the level of the pelvic brim.

Acetabulum↗
PubMed2004

All superior pubic ramus fractures are not created equal.

OBJECTIVE: To assess whether patients with a fracture of the high superior pubic ramus have functional outcomes worse than those of the lower or more central superior pubic ramus. METHOD: We carried out a retrospective cohort study of all patients with pubic ramus fractures seen in either the emergency department or outpatient clinic of a level-1 trauma centre in Montreal. Patients were grouped according to their fracture location, determined from radiographs of the anteroposterior pelvis. Harris Hip Score and Musculoskeletal Functional Assessment questionnaire (short form) data were determined by an independent observer. RESULTS: Both the hip score (p = 0.0024) and functional assessment (p = 0.0304) indicated that patients in the group with high superior fractures had significantly poorer functional status. CONCLUSION: High superior pubic ramus fractures have a poorer prognosis with respect to functional outcome.

Adult↗
PubMedDate not supplied

Avascular necrosis of the femoral head: vascular hypotheses.

Vascular hypotheses provide compelling pathogenic mechanisms for the etiology of avascular necrosis of the femoral head (ANFH). A decrease in local blood flow of the femoral head has been postulated to be the cause of the disease. Several studies in human and animal models of ANFH have shown microvascular thrombosis. Endothelial cell damage could be followed by abnormal blood coagulation and thrombus formation with any resulting degeneration distal to the site of vascular occlusion. Other studies suggest that thrombophilia, particularly impaired fibrinolysis, plays a potential role in thrombus formation in ANFH. Reduction in shear stress due to decreased blood flow could lead to apoptosis of endothelial cells, which can ultimately contribute to plaque erosion and thrombus formation. Dysregulation of endothelial cell activating factors and stimulators of angiogenesis or repair processes could also affect the progression and outcome of ANFH. Likewise, regional endothelium dysfunction (RED), referred to as a potential defect in endothelial cells located in the feeding vessels of the femoral head itself, may also have a crucial role in the pathogenesis of ANFH. Molecular gene analysis of regional endothelial cells could also help to determine potential pathways important in the pathogenesis of ANFH.

Endothelium, Vascular↗
PubMedDate not supplied

Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation.

The results of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation in skeletally immature children at one institution were reviewed. Six children with seven displaced intra-articular calcaneal fractures treated with open reduction and internal fixation were reviewed at an average of 30 months after surgery (range 18-48 months). All children were treated by one of two surgeons and followed by the same surgeon. The preoperative workup included computed tomography scans, which showed that all had displaced intra-articular fractures and five had comminuted fractures. At follow-up all children were pain-free with normal activities. All were able to return to full activities at an average of 10 months after surgery. All had normal ankle range of motion, but five had decreased subtalar range of motion. There were no postoperative complications, shoe wear problems, or peroneal tendinitis. This study demonstrates that open reduction and internal fixation for displaced intra-articular fractures in children yields encouraging results.

Adolescent↗
PubMedDate not supplied

Knee joint laxity in a native Canadian Indian population.

BACKGROUND: Clinical observation of increased laxity has been noted in native Canadians. Comparative studies support the possible relationship between joint hypermobility and the development of osteoarthritis or other joint ailments. If joint laxity predisposes to osteoarthritis, there may be far-reaching consequences to the general Native population. METHODS: A cohort of 52 Native Canadians (NC) and 52 non-Native Canadians (NNC) were evaluated for knee laxity. All patients had no prior history of knee injury or complaints of symptoms related to knee pathology at the time of the examination. Bilateral knee examination was performed. Objective laxity was measured using the KT-1000 tensiometer. Subjective findings were also recorded. RESULTS: Comparison for instability between the groups (NC and NNC) revealed that the NC group had significantly greater laxity on both right and left sides for all knee ligament grading (p < or = 0.0001). The values for displacement during KT-1000 measurements were significantly greater in the NC group for all forces (p < or = 0.0001). Presence of all the following were also significantly greater in the NC group: pivot shift (p < or = 0.001); medial and lateral collateral ligament opening (p < or = 0.001); posterior cruciate drawer test (p < or = 0.001). INTERPRETATION: This prospective matched cohort reveals that there is a significant joint hypermobility in this Native Canadian population.

Adult↗