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Biomedical subjects

J A Nunley

Publications and source records attributed to J A Nunley.

At least 19 recordsLinked to original sources
PubMed1995

Fracture of a supracondylar humeral myositis ossificans.

Although myositis ossificans is a well-known sequela of elbow trauma, reinjury to the affected region can also occur, resulting in acute symptoms from a fracture of the myositis ossificans. An 18-year-old man presented with localized pain, soft-tissue swelling, and a bony mass along the anterolateral distal humerus with restricted elbow range of motion after injury to his elbow during football. One year earlier he had sustained a similar crush injury to his elbow that resulted in a limited, although painless, arc of motion. Radiographs and tomograms established the diagnosis of a fractured supracondylar humeral myositis ossificans. Surgical excision of the large mature ossified fragment confirmed the diagnosis and restored a full range of motion of the elbow.

Adolescent↗
PubMed1995

Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

The results for 103 consecutive hips (eighty-nine patients) that had been treated with free vascularized fibular grafting because of symptomatic osteonecrosis of the femoral head were reviewed in a prospective study. The disease was associated with consumption of alcohol in 30 percent of the hips, use of steroids in 17 percent, trauma in 13 percent, and Perthes disease in 3 percent; in the remaining 38 percent, the condition was idiopathic. All patients, except for one who died of unrelated causes 4.5 years after the operation, were followed for at least five years. By the time of the most recent follow-up evaluation, a total arthroplasty had been performed in thirty-one hips: two of the nineteen that were in stage II, according to the criteria of Marcus et al., at the time of the operation; five (23 percent) of the twenty-two that were in stage III; seventeen (43 percent) of the forty that were in stage IV; and seven (32 percent) of the twenty-two that were in stage V. Kaplan-Meier survivorship analyses demonstrated that the probability of conversion to a total hip arthroplasty within five years after free vascularized fibular grafting was 11 percent for the stage-II hips, 23 percent for the stage-III hips, 29 percent for the stage-IV hips, and 27 percent for the stage-V hips. There was a trend toward a lower rate of conversion to a total hip arthroplasty in patients who were less than thirty years old, but this difference did not reach significance (p = 0.06). No association was found between a causative factor and the probability of conversion to a total hip arthroplasty. The average Harris hip scores had improved at the latest follow-up evaluation, compared with the preoperative values (p < 0.001). For the stage-II hips, the average score improved from 56 to 80 points; for the stage-III hips, from 52 to 85 points; for the stage-IV hips, from 41 to 76 points; and for the stage-V hips, from 36 to 75 points. An outcome questionnaire, completed for 73 percent of the hips, revealed that 59 per cent of the hips that had not been subsequently treated with an arthroplasty did not limit or only slightly limited the patient's ability to carry out daily activities, and 62 percent did not limit or only slightly limited the patient's ability to work.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

The restoration of elbow flexion with intercostal nerve transfers.

Seventeen patients with absent elbow flexion secondary to brachial plexus avulsion injury underwent intercostal neurotization of the biceps muscle. Followup was performed at an average of 5 years. The average age in this series was 21.8 years; the mean time interval from injury to the surgical procedure was 6 months. Eight of the 17 patients (47%) obtained good or excellent results as defined by Nagano et al. Five patients had muscle function ratings of M2 but were unable to power the elbow against gravity. The overall success rate theoretically may be increased by (1) decreasing the time interval from injury to neurotization to < 5 months; (2) selecting patients < 50 years of age; and (3) using adjuvant surgical procedures after neurotization, including tendon transfers and shoulder arthrodesis, which may improve results from good to excellent.

Adolescent↗
PubMed1995

A nursing career leadership program.

A three-level leadership track to parallel the clinical career ladder focuses on communication and interpersonal skills, professional, clinical and leadership experience, continuing education and leadership training. The program's success has led to career ladders in respiratory, physical and occupational therapy.

Career Mobility↗
PubMed1995

Interlocked supracondylar intramedullary nails for supracondylar fractures after total knee arthroplasty. A new treatment method.

Supracondylar fractures in patients with total knee prostheses are challenging surgical problems for which there has been no single satisfactory method of management. The authors present four cases to show that a fully cannulated, closed-section, stainless steel supracondylar intramedullary nail can be inserted in a closed fashion through a 3 cm longitudinal patellar splitting incision between the metal condyles of a nonconstrained femoral component of a total knee prosthesis. The nail can be interlocked with percutaneous screws and provides primary stability of a supracondylar femoral fracture, even in the presence of total knee and total hip prostheses.

Aged↗
PubMed1994

Fractures of the supracondylar process of the humerus.

The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.

Adolescent↗
PubMed1994

A biomechanical comparative analysis of two techniques for tibiotalar arthrodesis.

Two commonly used techniques for tibiotalar fusion were quantitatively compared using instrumented testing of the strength of the construct. The tibiae and tali from 10 pairs of fresh-frozen cadaveric limbs were used. One joint of each pair was fused using two 6.5-mm crossed cancellous screws from proximal to distal while the contralateral joint was fused using two 6.5-mm parallel cancellous screws from distal to proximal. Each specimen was subjected to cantilever bending and torsional testing by servohydraulic actuators. The bending tests included plantarflexion, dorsiflexion, inversion, and eversion, and measured the load during deflection applied 10 cm distal to the fusion site. The rigidity was expressed as newtons per millimeter of deflection. The torsional tests measured construct stiffness in external and internal rotation, and were expressed as newton-meters per degree of rotation. For the bending tests, the crossed screw construct was more rigid in eversion (23.1 N/mm, P = .0004) and dorsiflexion (16.9 N/mm, P = .02), while the parallel screw construct was more rigid in inversion (22.8 N/mm, P = .02) and plantarflexion (22.3 N/mm, P = .0007). In torsional testing, the crossed screw construct was at least 1.5 times stiffer than the parallel screw construct in resisting internal (1.7 N-m/deg versus 0.9 N-m/deg, P = .0001) and external (1.4 N-m/deg versus 0.9 N-m/deg, P = .02) rotation. In laboratory testing, the crossed screw technique is more rigid than the parallel screws, especially in resisting torsional stresses.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle Joint↗
PubMed1994

Results after replantation and revascularization in the upper extremity in children.

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that had been injured, the number of arteries that had been repaired, or the use of venous grafts. The rate of survival after replantation of completely amputated parts was 72 per cent (twenty-eight of thirty-nine parts) when the amputation had resulted from a laceration injury and 53 per cent (eighteen of thirty-four parts) when the amputation had resulted from a crush or an avulsion injury. The rate of survival after revascularization of incompletely amputated parts was 100 per cent (all forty-five parts) when the injury had been the result of a laceration and 75 per cent (thirty-three of forty-four parts) when it had been the result of a crush or an avulsion. We did not find any relationship between the age of the patient and the rate of survival of the amputated part after revascularization; however, there was a significantly higher rate of survival (p , 0.02) after replantation in children who were less than nine years old (77 per cent [twenty-four of thirty-one parts]) compared with the rate in those who were nine to sixteen years old (52 per cent [twenty-two of forty-two parts]). The viability of the digit was in jeopardy after twenty-nine (40 per cent) of the seventy-three replantations and nineteen (21 per cent) of the eighty-nine revascularizations. Immediate reoperation resulted in the salvage of only two of the twenty-one replanted parts and six of the twelve revascularized parts that had a reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1992

Direct end-to-end repair of flexor pollicis longus tendon lacerations.

Between 1976 and 1986, 38 consecutive acute isolated flexor pollicis longus lacerations were repaired. This study excluded all replanted or mutilated digits and all lacerations with associated fracture. Average follow-up was 26 months. Tendon rehabilitation was standardized. Range of motion and pinch strength were measured postoperatively. Seventy-four percent (28/38) of the flexor pollicis longus injuries occurred in zone II. Neurovascular injury occurred in 82% of the lacerations, and this correlated with the zone of tendon injury. In 21% of the patients (8/38) both digital nerves and arteries were transected. Postoperative thumb interphalangeal motion averaged 35 degrees and key pinch strength was 81% that of the uninjured thumb. One rupture occurred in a child. Laceration of the flexor pollicis longus is likely to involve damage to neurovascular structures, and repair may be necessary. Direct end-to-end repairs within the pulley system do at least as well as delayed tendon reconstruction and do not require additional procedures.

Adolescent↗
PubMed1992

Replantation proximal to the wrist.

Technical aspects of importance in replantation proximal to the wrist are somewhat different from those involved with digital replantation. Re-establishing blood flow rapidly by insertion of an arterial shunt, meticulous debridement, stable internal fixation of fractures, fasciotomy, and re-examination of the tissue 48 to 72 hours after replantation are discussed. Indications and contraindications for replantation in addition to maximizing use of "spare parts" are illustrated.

Amputation, Traumatic↗
PubMed1991

Replantation in children.

The authors have replanted 162 parts in 120 children over the past 15 years. The youngest patient, undergoing successful replantation, was aged 7 months, 3 weeks. Unlike an adult, any child suffering a traumatic amputation should be considered for a possible replantation. Replantation should consist of minimal bone shortening to preserve epiphyseal plates, with repair of all severed structures. Longitudinal K-wires usually provide adequate fixation. Our survival rate for complete replantation in children under the age of 16 years is 77%. Long-term study showed that continued skeletal growth occurred and the digit attained 81% of normal longitudinal length at maturity. Recovery of sensibility in the replanted digit is nearly as good as for isolated digital nerve repair. Patient and parent satisfaction is high when replantation is successful, with uniform approval of the extensive effort required.

Bone Wires↗
PubMed1991

Biomechanical and functional testing of plate fixation devices for proximal phalangeal fractures.

Functional testing in fresh cadaver digits of a dorsally applied mini-H plate, a mini-straight plate, and a laterally applied mini-condylar plate demonstrated that all three significantly reduce (p less than 0.2) simulated active PIP joint flexion. The mini-condylar plate, however, provided the least reduction of any of the three plates. Biomechanical testing of the same three plates on proximal phalanx after osteotomy in apex palmar and apex dorsal direction bending showed all three plates to provide rigidity less than the intact bone.

Biomechanical Phenomena↗
PubMed1991

Digital ranges of motion: normal values in young adults.

Analysis of the range of motion of fingers was done in young (eighteen to thirty-five year old) adult volunteers with no history of previous injury to their hands. The data show that there are slight differences between the individual digits. Notably, metacarpophalangeal flexion and total active motion increase linearly in proceeding from the index to the small finger. There were also minor differences in comparing sexes. Women have greater extension at the metacarpophalangeal joint in both active and passive motion and have a greater total active motion at all digits as a result. A significant tenodesis effect was found at the distal interphalangeal joint in normal subjects. No differences were found that could be attributable to handedness.

Adult↗
PubMed1991

Occult orthopaedic trauma in the multiply injured patient.

A retrospective review of 111 multitrauma patients revealed that of 401 orthopaedic injuries, 24 injuries (6%) were not initially diagnosed in 20 patients. Patients with occult injuries tended to have greater overall trauma, as reflected by lower trauma and lower Glasgow coma scores and longer hospital and intensive-care unit stays. Twenty prospectively identified cases were added to the series to further define risk factors. Seventy percent of occult bony injuries were ultimately diagnosed by physical examination and plain radiographs alone. Only 27% of cases required sophisticated imaging techniques for diagnosis. Based on these 44 cases of occult injuries in multitrauma victims, the following risk factors were identified: (1) significant multisystem trauma with another more apparent orthopaedic injury within the same extremity, (2) trauma victim too unstable for full initial orthopaedic evaluation, (3) altered sensorium, (4) hastily applied emergency splint obscuring a less apparent injury, (5) poor quality or inadequate initial radiographs, and (6) inadequate significance assigned to minor signs/symptoms in a major trauma victim. Due to the nature and extent of the overall trauma, all injuries cannot be diagnosed on initial patient evaluation.

Adult↗
PubMed1991

Rupture of the posterior tibial tendon associated with closed ankle fracture.

Rupture of the posterior tibial tendon has rarely been associated with closed ankle fractures. All previous cases have been in association with pronation-external rotation type fractures in which the medial malleolus has been fractured. This case represents the first such report of a severed posterior tibial tendon in the absence of a medial malleolar fracture and reemphasizes the importance of critically evaluating intraoperative radiographs following the open reduction and internal fixation of closed ankle fractures to assess the possibility of soft tissue interposition. In the event of an acute rupture of the posterior tibial tendon, the authors recommend primary tendon repair.

Adult↗
PubMed1991

Influences of the protected passive mobilization interval on flexor tendon healing. A prospective randomized clinical study.

A prospective multicenter clinical study was carried out to determine whether improved tendon gliding could be achieved with greater durations of daily passive-motion rehabilitation after flexor tendon repair. Fifty-one patients were placed randomly into two controlled passive-motion protocols. Group 1 patients received greater intervals of passive-motion rehabilitation using a continuous passive-motion device. Group 2 patients were treated with a traditional early passive-motion protocol for tendon rehabilitation. For Group 1 patients, the mean interval of controlled motion rehabilitation was 75 hours a week, and the mean number of cycles was 12,000. For Group 2 patients the mean interval of controlled passive motion was four hours a week, and the mean number of cycles was 1000. The minimum follow-up time was six months (mean, 10.8 months). Using Strickland and Glogovac's formula, the mean active motion for digits in Group 1 was 138 degrees +/- 6 degrees. Mean motion for tendons in Group 2 was 119 degrees +/- 8 degrees. The difference between Groups 1 and 2 was statistically significant. The effect of the number of tendons injured per digit within each group was not significant. The data from this experiment indicate that the duration of the daily controlled motion interval is a significant variable insofar as postrepair flexor tendon function is concerned.

Adult↗
PubMed1991

Tetracycline labeling of the femoral head following acute intracapsular fracture of the femoral neck.

The purpose of this study was to assess the utility of tetracycline hydrochloride (HCl) labeling of the femoral head following acute intracapsular fracture of the femoral neck to indirectly assess femoral head viability and vascularity. A standard labeling (1.5-3.0 g) and fixative protocol (70% ethanol) was used. The initial tetracycline dose was given in the emergency room. The time from last dose to bone sampling in the operating room ranged from six to 36 hours (average, 21.2 hours). There was no evidence of tetracycline deposition at the bone-osteoid interface in any of the femoral head specimens or the ipsilateral extracapsular greater trochanter control specimens. Sources of labeling failure are multifactorial: problems with label delivery to the patient, in vivo deposition of the label, and the fixation protocol.

Aged↗