Biomedical subjects

J D Krakauer

Publications and source records attributed to J D Krakauer.

4 recordsLinked to original sources

PubMed1996

Hinged device for fractures involving the proximal interphalangeal joint.

Well known complications of proximal interphalangeal joint fractures and fracture dislocations are stiffness, chronic instability, and degenerative arthritis. The Compass PIP Hinge is a dynamic external fixator that allows protected proximal interphalangeal mobilization after closed reduction, open reduction and internal fixation, volar plate arthroplasty, or other salvage procedures. To help avoid these problems, 20 patients, 12 treated within 2 weeks of injury (Group I) and 8 treated more than 4 weeks after injury (Group II), are reported. Articular surface involvement among Group I cases averaged 66% (range, 50%-90%), and postoperative proximal interphalangeal motion for this group averaged 9 degrees to 82 degrees. Mild pain with heavy use was present in 3 patients, and 9 patients were pain free. Postoperative proximal interphalangeal motion for Group II averaged 21 degrees to 77 degrees. Pain was moderate to severe in 2 patients, mild with heavy use in 1 patient, and none in 5 patients. One patient from Group II underwent surgery to convert to a silicone proximal interphalangeal arthroplasty because of painful degenerative arthritis. It is concluded that there is a role for hinged external fixation in treating unstable proximal interphalangeal fracture dislocations. Outcomes in acute injuries are superior to those in chronic or salvage cases.

Acute Disease↗

PubMed1994

Surgical treatment of scapholunate advanced collapse.

This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner arthrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Proximal row carpectomy was performed in 12 cases, radioscapholunate arthrodesis in 5 cases, radioscaphoid arthrodesis in 3 cases, and primary total wrist arthrodesis in 4 cases. Following surgical treatment the majority of patients in all groups had less wrist pain. The nonunion rate was four cases for the capitolunate arthrodesis group compared with two for the four-corner arthrodesis group. Six of 51 motion-sparing cases were converted to total arthrodeses. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with stage III SLAC wrist while maintaining a 54 degrees flexion-extension arc. Stage II SLAC wrist can be successfully treated with this procedure, radioscaphoid arthrodesis, or proximal row carpectomy. Of the three procedures, proximal row carpectomy best preserves wrist mobility, with a flexion-extension arc of 71 degrees.

Adult↗

PubMed1994

Intercostal nerve transfer for brachial plexopathy.

Thirteen patients with traumatic brachial plexopathy underwent intercostal nerve transfer to the biceps motor branch (9 patients) or combined gracilis muscle and intercostal nerve transfer (4 patients; 3 for elbow flexion and 1 for elbow extension). Follow-up time ranged from 12 to 48 months (mean, 25 months) on 12 patients. Useful elbow flexion or extension was obtained in a total of 9 patients. Comparison of pre- and postoperative spirometry in 4 patients demonstrated a mild decline in pulmonary function, although there was no subjective change in respiratory status. Intercostal nerve transfer and combined gracilis muscle and intercostal nerve transfer are viable, although technically demanding, alternatives for restoring active elbow motion in patients with irreparable brachial plexus lesions when conventional tendon transfers are not feasible. The morbidity of intercostal nerve harvest with respect to pulmonary function is minimal.

Adult↗

PubMed1994

Two- to five-year follow-up of 100 total hip arthroplasties using DF-80 implants.

In an uncontrolled prospective study, 100 primary total hip arthroplasties (THAs) using the DF-80 implant were followed up for a minimum of 2 years with rigorous clinical and radiographic examinations to define the natural history of this prosthetic system. Three groups were identified: (I) hips requiring revision because of failure (n = 3); (II) "impending" failures with radiographic indices of loosening (n = 8); and (III) clinically and radiographically benign, stable implants (n = 89). The preoperative Harris hip score was similar for all groups. Postoperatively, the failure group demonstrated early progressive clinical and radiographic deterioration with surgical revision at an average of 33 months. Male sex, increased weight, and greater intraoperative hemorrhage correlated positively with failure. The impending-failure group developed limited radiolucencies in the later postoperative period. Calcar resorption was noted in 26% of the total population and heterotopic ossification in 46%. We conclude that this series of THAs using DF-80 implants included a subset of patients demonstrating early clinical failure and widespread aggressive bone-cement radiolucencies that required early surgical revision.

Aged↗