Rapid osteolysis of the femoral neck after fracture.
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Aged↗
Biomedical subjects
J A Froehlich
Publications and source records attributed to J A Froehlich.
The appropriate use of contrast venography and pulmonary angiography in the orthopedic population.
Lower-extremity venous thrombosis and its major complication, pulmonary embolism, occur with an increased prevalence in the orthopedic population, even in patients receiving prophylactic therapy. Compression ultrasound has become the diagnostic test of choice to screen high-risk patients and to evaluate symptomatic patients. Contrast venography should be reserved to evaluate the few patients in whom adequate quality ultrasound examinations are unobtainable. Pulmonary angiography remains the "gold standard" in the diagnosis of pulmonary embolism and should be obtained in all patients in whom ventilation-perfusion scan results are discordant with clinical suspicion, and whenever treatment risks are extraordinary.
Arthroplasty↗
Lower-extremity venous thrombosis in patients with acute hip fractures: determination of anatomic location and time of onset with compression sonography.
Patients with acute hip fractures are at increased risk for the development of lower-extremity deep venous thrombosis and its major complication, pulmonary embolism. It is furthermore recognized that the risk of clinically important pulmonary embolism depends to some degree on the anatomic location of the preexisting thrombosis. Because of the increased risk of thromboembolic disease, most patients with hip fracture are treated with one of several prophylactic regimens. The potential for effective prophylaxis may depend on the time of onset of the venous thrombosis. We used compression sonography to determine the anatomic location and time of onset of deep venous thrombosis in patients with hip fractures being treated with antithrombotic prophylaxis. Ninety-six patients had compression sonography of the injured extremity perioperatively and serially until discharge. Ninety-three also were examined with contrast venography when the sonogram suggested thrombus or at discharge if all sonograms were normal. Twenty areas of thrombus were identified in 18 patients, thereby yielding a prevalence of thrombosis of 19%. All patients were asymptomatic. Above-knee clot was diagnosed in 14 (78%) of these 18 patients. Nine (64%) of the 14 patients with significant clot had the abnormality on their first perioperative investigation (in eight of nine cases, the clot was adjacent to the fracture site), before any means of prophylaxis could have been initiated. Significant thrombosis developed in six patients later in their course (in only one case was the clot related to the fracture site), and the thrombus was an extension of below-knee clot in the minority of the patients. We conclude that although currently acceptable prophylaxis may decrease the frequency of thrombosis, it does little to prevent above-knee clot, which often antedates the initiation of therapy. Furthermore, as the clinical diagnosis of deep venous thrombosis is difficult in patients with acute hip fracture, serial compression sonograms are recommended so that patients with unsuspected clot may be treated with appropriate anticoagulation and/or caval interruption.
Acute Disease↗
Compression ultrasonography for the detection of deep venous thrombosis in patients who have a fracture of the hip. A prospective study.
The effectiveness of compression ultrasonography in the detection of femoral and popliteal venous thrombosis was determined in a prospective trial over a period of seven months. Forty-two patients who had an isolated intertrochanteric or femoral neck fracture participated, and forty of these patients completed the study. The average age of the patients was 81.6 years. Venography was the standard with which all ultrasonic studies were compared. A total of 112 ultrasonic studies were performed. The incidence of major venous thrombosis, as detected by venography, was 12.5 per cent. All patients were clinically asymptomatic. The compression ultrasonic technique had an accuracy of 97 per cent, a sensitivity of 100 per cent, and a specificity of 97 per cent. Compression ultrasonography appears to be a very effective technique for diagnosing venous thrombosis in patients who have a fracture of the hip. It is safe, well accepted by both patients and staff, and simply and quickly performed, and it carries no inherent risks. It also can be readily repeated, making it ideal for monitoring high-risk patients.
Adult↗
Extensor tendon injuries at the proximal interphalangeal joint.
From the prior discussion, it should be apparent that the multitude of operative procedures reflects the complexity inherent in the extensor mechanism and the often unpredictable outcome of operative intervention. Large studies with detailed analysis of data are few. Despite this, several themes are apparent and need to be respected. The chronic boutonniere deformity reflects long-term derangement with secondary compensation of the extensor mechanism. The surgeons rendering treatment must have a thorough appreciation of normal anatomy as well as an understanding of the evolving pathomechanics. Both physician and patient must be committed to the need for long-term treatment of this disability. The literature leaves no doubt that surgical intervention is best initiated after the attainment of full passive PIP extension. Finally, even in the chronic situation, long-term splinting and exercises may be successful and both obviate surgery and result in a superior outcome.
Acute Disease↗
Isolation and identification of alternative riboflavin-binding proteins from human plasma.
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Carrier Proteins↗
Purification of riboflavin-binding proteins from bovine plasma and discovery of a pregnancy-specific riboflavin-binding protein.
Riboflavin-binding proteins have been purified from bovine plasma using flavinyl agarose beads. At least three major protein bands, migrating in regions assigned to the beta- and gamma-globulins of plasma, are observed by cellulose acetate electrophoresis. These proteins coelute from a calibrated Sephadex G-100 column in the volume corresponding to a molecular weight of approximately 150,000; a small amount of another riboflavin-binding protein (molecular weight approximately 37,000) is also present. Polyacrylamide gel electrophoresis of the proteins, with detection by autoradiography of those having tightly bound [2-14C]riboflavin, reveals one protein band which is present only in preparations from pregnant cows. This protein has been purified to apparent homogeneity by storing the mixture of riboflavin-binding proteins at 8 degrees C for 3 weeks, which precipitates the other, less stable proteins. Hence, bovine plasma, like that of the laying hen, contains a number of riboflavin-binding proteins, one of which correlates with pregnancy.
Animals↗
Image-directed Doppler ultrasound: a screening technique for patients at high risk to develop deep vein thrombosis.
Hip fracture patients typify a population at high risk to develop deep vein thrombosis (DVT). Recently ultrasound has been used successfully to diagnose DVT when clinical suspicion exists. In this prospective study, 88 hip fracture patients asymptomatic for DVT were screened serially with compression ultrasound to assess the development of thrombus within the femoral or popliteal systems. Contrast venography was employed as a control. Twelve of the 76 patients (16%) completing the study were noted by ultrasound to have a clot. Venography confirmed a clot in each case and detected no additional femoral or popliteal clot. The possibility of utilizing ultrasound to screen additional high risk groups for DVT should be investigated based on the encouraging results of this series.
Aged↗