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Biomedical subjects

H S Tullos

Publications and source records attributed to H S Tullos.

At least 73 records · Page 4Linked to original sources
PubMed1984

Total hip arthroplasty with a low-modulus porous-coated femoral component.

Fifty-seven patients had sixty-three total hip replacements, performed using a femoral stem with a soft, low-modulus porous coating of Proplast and a conventional acrylic-cemented acetabular component. Forty-seven of the hips were followed for an average of thirty-seven months. Seventeen (36 per cent) of the forty-seven hips were judged to be clinical failures, and five of the failures were revised by inserting a new femoral component and fixing it with acrylic cement. The prostheses were thought to have failed because they had inadequate support, due to deficiencies in the design of the stem and in the fit of the implant in the femur. The five retrieved prostheses were found to have fibrous-tissue ingrowth into the coating, which had failed by shear within its substance. Therefore, we concluded that the coating had insufficient strength to withstand normal weight-bearing loads. To improve performance, a more stable prosthesis with a stronger porous coating is needed. In addition, a posterior surgical approach through a transtrochanteric osteotomy may give better exposure of the femoral canal and facilitate the use of longer-stem (140 to 153-millimeter) designs, which are less likely to be inserted in a varus position.

Biocompatible Materials↗
PubMed1984

Acute shoulder dislocations: factors influencing diagnosis and treatment.

The Bankart lesion is the most important single causative factor in traumatic anterior shoulder dislocations (85%). Capsular rupture occurs in approximately 15% of traumatic anterior shoulder dislocations and may or may not heal with redundancy. If so, recurrent dislocation in possible. Surgical repair of traumatic anterior dislocations requires that the capsule be opened for correct identification of the lesion and correct repair. Limitation of external rotation is not necessary for repair of anterior shoulder dislocations and should be considered as an untoward complication. While multiple procedures are available, all of which may be satisfactory at one time or another, no one procedure repairs all traumatic anterior shoulder dislocations.

Arthrography↗
PubMed1984

Management of concomitant ipsilateral fractures of the humerus and forearm.

We treated nineteen patients with concomitant ipsilateral fractures of the humerus and forearm resulting in a so-called floating elbow. The injuries that were treated without open reduction and internal fixation had a high incidence of non-union of the humerus. This has led us to prefer open reduction and internal fixation of both the humerus and the forearm fracture.

Adolescent↗
PubMed1982

Complications of distal radial fractures: pins and plaster treatment.

Recent advances in the treatment of comminuted distal radial fractures has led to the use of pins and plaster, a concept described by many authors. This paper examines whether the use of pins and plaster maintains reduction of distal comminuted radial fractures, and, if so, if it is accomplished with a minimum of complications. With follow-up ranging from 1 month to 1 year following pin removal, 80 consecutive comminuted distal radial fractures treated with pins and plaster were analyzed for change in fracture reduction, associated injuries, and complications incurred during and as a result of the treatment mode. Thirty-three percent of our patients had some complications due to their pins and 16% required reoperation for carpal tunnel syndrome or replacement of loose pins, sequestrectomy, or extended treatment in long arm casts.

Adolescent↗
PubMed1982

Pathologic morphology of the acetabulum in paralytic and congenital hip instability.

The nature of acetabular deficiency in both congenital and paralytic hip instability was investigated by computed tomography (CT). Sixty-six hips in 35 children with paralytic or congenital hip instability underwent transpelvic CT. Two angles were defined: angle 1 is a function of anterior and angle 2 a function of posterior coverage. The sum of the two angles represented acetabular depth. Results showed anterior deficiency in cerebral palsy and congenital hip instability. An absolute acetabular deficiency as opposed to a torsional disorder was present.

Acetabulum↗
PubMed1982

External fixation use in the management of massive upper extremity trauma.

Immobilization of fractures associated with instability and comminution by an external skeletal device facilitates wound care, skin coverage, and ultimate reconstructive surgery. External skeletal fixation was applied in 20 patients who sustained complex open injuries of the upper extremity. All injuries were associated with extensive soft tissue and skin defects. Associated neurovascular injuries included 14 nerve injuries and five major vascular injuries. The Hoffman fixation device was used in the majority of cases. Skin coverage was obtained in all patients by an appropriate method of skin grafts, pedicle flaps, and a free myocutaneous flap. Primary bone union was achieved in five of 16 patients. Ten of 16 patients required secondary procedure to obtain union in cases of delayed union or nonunion, and one case remained with a nonunion. Pin tract infection in three patients and osteomyelitis in two patients were effectively treated with antibiotics and appropriate surgery. The initial treatment goals of limb salvage, skin coverage, and bone stabilization without drainage or persistent osteomyelitis can be accomplished by the use of external skeletal fixation devices.

Adolescent↗
PubMed1982

Unstable fractures of the pelvis treated by external fixation.

Forty-five patients with an unstable fracture of the pelvic ring, for whom the conventional treatment would have been bed rest with skeletal traction or with a pelvic sling, were treated with the Hoffmann external-fixation apparatus. In eighteen fractures of the lateral compression type and fourteen fractures of the anteroposterior compression type, the treatment was successful. Proximal migration of the hemipelvis occurred in four of the eleven patients with a fracture of the unilateral shear type. There were two deaths from associated injuries.

Adolescent↗
PubMed1981

Hip endoprosthesis stabilization with a porous low modulus stem coating: factors influencing stabilization.

A polytetrafluoroethylene/vitreous carbon porous material has been investigated as an alternative to acrylic for hip endoprosthesis fixation. This material, which is mechanically fused to the endoprosthesis stem, has been shown to promote soft-tissue ingrowth. In 29 patients receiving a porous-coated Thompson endoprosthesis, stabilization of the porous-coated stem as observed by acceptable clinical results occurred in only about 50%. Stabilization of porous-coated endoprostheses is unsatisfactory for the following reasons: lack of press-fit, inadequate prosthetic design, infection, and technical difficulties. The major cause of 40% failure in this series was an initially inadequate press-fit.

Adult↗
PubMed1981

Factors influencing elbow instability.

Stability or instability of the elbow is contingent upon three distinct but interrelated conditions: radiocapitellar articular continuity, coronoid process integrity and medial collateral ligament competency through an intact anterior oblique ligament. The latter, the anterior oblique ligament of the medial collateral ligament both in anatomic experimentation and clinical cases appears to be the most critical factor in elbow stability. The reconstruction of the unstable elbow must focus on this medial supporting ligament for a predictable result.

Athletic Injuries↗
PubMed1980

Blair tibiotalar arthrodesis for injuries to the talus.

A retrospective clinical and roentgenographic study was done of seven patients who underwent Blair tibiotalar arthrodesis. The average age of the patients was twenty-six years and the average follow-up was 3.9 years. Results were good in five patients, fair in one, and poor in one. Results were more closely correlated to tibiopedal motion than to anatomical restoration. In two patients pseudarthrosis developed: painful in one and asymptomatic in one. A good result has 16 to 20 degrees of tibiopedal motion; a fair result, 11 to 15 degrees; and a poor result, 10 degrees or less.

Adolescent↗
PubMed1979

Pediatric pelvic fractures: review of 52 patients.

Fifty-two patients (ages 1 to 16 years) with pelvic fractures were hospitalized at an urban medical center during a 5-year period. All patients with acetabular fractures had adjacent hemipelvis fractures. None were seen to develop symptomatic acetabular dysplasia. Stable breaks in the ring (anterior ring fracture) were encountered most frequently. While many patients were discharged ambulating within a short time, over 50% had prolonged hospitalizations due to associated truma. Only one child had serious urologic trauma, demonstrating that isolated anterior ring fractures in children are not as treacherous in terms of pelvic content injury as those one might encounter in adults. Unstable breaks (anterior and posterior ring fractures) pose acute and chronic management problems and associated injuries are often fatal. Life-threatening complications may overshadow proper fracture management. It is critical to maintain a symmetrical pelvis in order to prevent either cephalad translation or anterior-posterior hemipelvis rotation. A child with the latter problem is presented in detail.

Adolescent↗
PubMed1979

Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.

Acute Disease↗
PubMed1978

Arthrodesis in failed total knee replacement.

Compression arthrodesis can be used as a salvage procedure in failed total knee replacement. In fourteen patients so treated, the fusion failed in five. As regards the cause of failure, the most important factor was technical inadequacy of the arthrodesis procedure; that is, the required stable fixation and solid bone-to-bone contact. In procedures that we considered technically adequate, there was fusion in seven of the nine knees. The fusion seemed to be delayed in these patients, averaging 5.3 months (range, two to twelve months). Fixation with a double clamp seemed to be more effective than with a single clamp.

Adult↗
PubMed1978

Slipped capital femoral epiphysis. A study of 50 cases in black children.

In 50 black children with 70 slipped capital femoral epiphyses, a satisfactory result was obtained in 87% of the hips. Chondrolysis developed in 6% of the hips, occurring only when there was persistent intraarticular protrusion of the transepiphyseal fixation device. The chondrolytic process resulted in a relatively painless fibrous ankylosis of each hip. Avascular necrosis developed in 7% of the hips, and occurred only in the presence of a valgus reduction of an acute slipped epiphysis. Each case of avascular necrosis was of the whole-head type and was severely progressive. Biplane subtrochanteric femoral osteotomy was employed as a reconstructive procedure in the severely-displaced slipped epiphysis; it was delayed until after epiphyseal plate closure, and restored satisfactory hip function in all cases. Black children are not predisposed to poor results after slipped capital femoral epiphysis contrary to a commonly held impression.

Adolescent↗