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Biomedical subjects

J F Kellam

Publications and source records attributed to J F Kellam.

18 recordsLinked to original sources
PubMed1991

Open reduction and internal fixation of radial head fractures.

Open reduction and internal fixation of displaced fractures of the radial head were reviewed in 14 elbows. Follow-up averaged 32 months. The average elbow score for Mason type II fractures was 96.8 points, corresponding to 100% good or excellent results. Average flexion was 142.5 degrees, and the mean fixed flexion deformity was 3.9 degrees. There was no loss in grip strength. An almost normal elbow was the expected result. Good or excellent results were achieved in only 33% of Mason type III fractures treated with open reduction and internal fixation. The average elbow score was 72.9 points, and this was statistically significantly different than the Mason type II fractures (p less than 0.05). An associated elbow dislocation did not affect the results significantly, but was associated with a slightly increased fixed flexion deformity. Fractures may be more comminuted than suggested by plain radiographs, and intraoperative decision making is required in deciding between reconstruction or excision of the radial head. Excellent results were obtained provided an anatomical reduction with stable fixation and early range of motion were achieved. If a stable anatomic reduction cannot be obtained, then alternative treatment methods should be considered.

Adult↗
PubMed1989

The role of external fixation in pelvic disruptions.

External fixation has a definite role in the management of pelvic fractures. Biomechanically, it is not useful for maintaining reduction of the unstable, vertically migrating pelvis and must be used with some other form of treatment, such as traction, spica cast, or internal fixation. In vertically stable fractures, that is, rotationally unstable fractures, the anteroposterior and lateral compression injuries, the external fixator should probably be the first course of treatment.

Adult↗
PubMed1988

Heterotopic ossification around the hip with intramedullary nailing of the femur.

Heterotopic ossification (HO) at the proximal end of a reamed intramedullary femoral nail is a complication of the procedure. Kuntscher stated that these "callus caps" were due to the prominence of the nail above the greater trochanter. A study of patients undergoing locked intramedullary nailing of the femur to assess subsequent development of heterotopic ossification at the proximal end of the implant was done. The purpose was to study the clinical significance of the ectopic bone and identify etiologic factors of bone formation. This group consisted of 59 patients with 60 locked intramedullary nails who were reviewed after prospective clinical and radiologic followup. Ectopic bone around the proximal end of the nail was classified with respect to quantity and clinical importance. A number of parameters were evaluated and a multifactorial analysis was performed. There were 52 males and seven females. Heterotopic bone was graded as: none--32%; minimal--20%, mild--28%; moderate--15%; and severe--5%. There was a positive correlation between bone formation and head injury, Injury Severity Score, and ventilator and ICU days. Prominence of the nail was not significant.

Adolescent↗
PubMed1988

Plate fixation of open fractures of the tibia.

The results of immediate plate fixation of 97 open fractures of the tibial shaft in 95 patients are reported. Significant joint stiffness occurred in 11.4% and angular malunion of greater than 5 degrees in any plane was seen in 3.1%. The infection rate was 10.3%. However, even in those cases which develop delayed union or other complications, plate fixation of open fractures can produce excellent recovery of limb function.

Adolescent↗
PubMed1987

Anterior approach and stabilization of the disrupted sacroiliac joint.

Pelvic fractures with disruption of the important weight-bearing sacroiliac area can lead to impaired gait due to malunion or pelvic obliquity, back or buttock pain arising from the sacroiliac joint, and permanent neurologic damage. In eight patients with sacroiliac joint dislocation, an anterior retrofascial approach and stapling of the sacroiliac joint was performed. Six of these patients maintained an anatomic reduction of the sacroiliac joint and their results were rated as excellent. Two of the eight patients had a slight loss of reduction and because of intermittent mild pain were rated as having fair results. In another eight patients, plate fixation of the anterior sacroiliac joint was done. New stabilization methods utilizing dynamic compression plates, reconstruction plates, and a new four-hole plate have been developed to provide more secure fixation of these unstable injuries.

Adult↗
PubMed1987

The unstable pelvic fracture. Operative treatment.

While the pendulum has swung to the operative side, open reduction and internal fixation will surely not prove to be the panacea for all unstable pelvic fractures. The lasting effects, however, of attempts at aggressive fixation of the pelvic fracture will be the principles of management that are being established. This begins with the recognition of pelvic instability. It is in these unstable injuries that obtaining and maintaining an anatomic reduction is the best way to alter the natural history of the untreated pelvic fracture and to maximize the probability of obtaining a good long-term result. While the actual methods of internal and external fixation will continue to change, this principle is unlikely to alter. Therefore, if effective treatment can be achieved by closed means alone, that is an acceptable method. Similarly, external, internal, and combined operative and traction treatment methods that achieve this goal would also be acceptable. The question remains: Which method achieves the goal of obtaining and maintaining an anatomic reduction yet minimizes the early and late morbidity? This question is best answered by appropriate preoperative evaluation, subsequent planning, and precise, technically skillful surgery done by an experienced surgeon.

Bone Plates↗
PubMed1987

Bilateral lower extremity amputations after prolonged application of the pneumatic antishock garment: case report.

The authors describe the case of a 29-year-old man with multiple trauma who suffered compartment syndromes necessitating bilateral lower limb amputations as a result of the prolonged (9.5 hours) application of a pneumatic antishock garment (PASG). There was no evidence of lower limb trauma before the garment was put on. Despite the apparent benefits of the PASG in traumatized hypovolemic patients, the lowest possible inflation pressures should be used and removal attempted as soon as hemodynamic stability can be assured.

Adult↗
PubMed1986

Open versus closed intramedullary nailing of femoral shaft fractures.

A retrospective study was performed including only fractures involving the middle three fifths of the femoral shaft with a minimum of 2 years followup. There were 65 fractures in Group I treated with the closed technique utilizing the image intensifier. These were compared with 65 fractures treated with open reduction and nailing. Followup averaged 4 years (Group II). Group 1 had 92% satisfactory results; Group II achieved 97% satisfactory, not statistically significantly different. Our recommendations are delaying the procedure did not appear to be advantageous; excluding the fractures with segmental bicortical loss, there are limited indications for locked nails in these fractures; the decision to use a specific type of internal fixation should be based on the fracture pattern, the surgeon's experience, and the equipment available; if a closed technique is chosen, be prepared to open the fracture if a satisfactory closed reduction cannot be attained. This, in our study, did not increase the risk of reducing the functional result.

Adult↗
PubMed1986

Immediate internal fixation of open fractures of the diaphysis of the forearm.

Between 1975 and 1983, fifty-seven patients were treated at Sunnybrook and Harborview Medical Centers with immediate internal plate fixation of an open diaphyseal fracture of the forearm. Fifty patients were available for follow-up, which ranged from one to nine years and averaged three years. The injuries were classified on the basis of the extent of soft-tissue injury as defined by Gustilo and Anderson, and consisted of twenty Type-I injuries, nineteen Type-II injuries, and eleven Type-III injuries. The complications included deep infection in two patients and non-union in six. The functional results were excellent or good in 85 per cent of the series. This study demonstrates that immediate stable plate fixation is a beneficial method of treatment of open fractures of the forearm. The results are related to the severity of the initial soft-tissue injury and the surgical technique. Autogenous cancellous bone-grafting at the time of closure of the wound in comminuted fractures in which interfragmental compression cannot be obtained is recommended.

Adolescent↗
PubMed1986

Fracture dislocation of the calcaneus. A report of two cases.

In two typical cases of calcaneal fracture dislocation, the primary fracture, which runs forward and medially from a point behind the sustentaculum tali, is associated with inversion of the hindfoot. The calcaneus splits into a small anteromedial and a larger posterolateral fragment. Rupture of the lateral collateral ligament allows the posterolateral calcaneal fragment to move laterally to lie immediately subjacent to the distal fibula. Closed reduction is impossible. Open reduction of this rare fracture dislocation is essential. A lateral approach to the calcaneus is generally sufficient, but a second medial incision may be required.

Aged↗
PubMed1985

Traumatic scapulothoracic dissociation.

Scapulothoracic dissociation represents a closed traumatic forequarter amputation associated with major neurovascular injury. Radiographic findings consist of lateral displacement of the scapula on a well-centered plain film of the chest. Associated abnormalities include disruption of the acromioclavicular joint or, as in our two cases, distracted fractures of the clavicle. Persons in whom scalpulothoracic dissociation is diagnosed should undergo emergency angiography and surgery.

Adult↗
PubMed1985

Early results of the Sunnybrook experience with locked intramedullary nailing.

In the past two years the closed locked intramedullary nailing system has been used at the Sunnybrook Trauma Unit. This system has equalled the results reported by Hansen in the use of closed intramedullary nailing with conventional indications, and has provided an excellent means of handling complex and difficult shaft fractures of both the tibia and the femur. It appears to provide excellent rates of union with very rapid and early rehabilitation of the patient. It is particularly useful in the multiply injured patient with very difficult high energy femoral and tibial shaft fractures. It has a minimal blood loss and can be done with practice in a reasonable period of time. This technique will add greatly to the armamentarium of the trauma surgeon.

Adult↗
PubMed1985

Review of the operative treatment of Achilles tendon rupture.

Sixty-eight patients' charts were reviewed for ascertainment of the complication rate following operative repair of ruptured Achilles tendons. Ninety-two percent of 48 patients whose cases underwent clinical evaluation returned to their preinjury activity status: 13% had incisional complications, most of which resolved. The rerupture rate was 3% (2/68). The results of this series and a literature review show that operative treatment can be regarded as an acceptable method. Nonoperative treatment should be considered in a nonathletic patient over the age of 50 years because of potentially serious problems with wound healing.

Achilles Tendon↗
PubMed1979

Fractures of the distal tibial metaphysis with intra-articular extension--the distal tibial explosion fracture.

In a study of 26 distal tibial explosion fractures in 24 patients two fracture patterns were identified: Type A, a rotational pattern; and Type B, a compressive fracture pattern. The rotational pattern was found to be less common than the compressive fracture and to have a substantially better prognosis. Operative treatment of the Type A pattern led to an overall acceptable result of 84%, while the Type B patients had 53% acceptable results. The results of operative treatment were however, superior to the results of nonoperative treatment in both fracture groups. Adequate treatment consists of anatomic reconstruction of the distal tibia, rigid internal fixation, early active motion, and nonweight bearing in 3 to 5 months.

Ankle↗
PubMed1978

Abdominal aortic aneurysms: recent experience with 210 patients.

In the 6 1/2 years ending June 1977, 210 patients with abdominal aortic aneurysms underwent operation at Toronto Western Hospital; 160 aneurysms (76%) were unruptured and 50 (24%) were ruptured. In the patients with unruptured aneurysms the mean age was 68 years; the oldest was 91, and 12 were more than 80 years of age. The overall hospital mortality was 5.6%. Death in hospital occurred in 1 (1.2%) of the 83 asymptomatic patients, 4 (7.4%) of the 54 symptomatic patients and 4 (17.0%) of the 23 patients for whom operation was considered urgent. In the patients with ruptured aneurysms the mean age was 71 years; the oldest was 90, and five were more than 80 years of age. The overall hospital mortality was 54%. The morbidity and mortality were analysed; in particular the reasons for the markedly variable hazard of operations for the three categories of unruptured aneurysm were sought. The surgical literature is confusing because of the interchanging use of the words unruptured, elective and symptomless. The current philosophy management and technique of operation in a large cardiovascular surgery service with many trainees are presented and a plea is made for a standardized and simplified operation, always performed with three assistants helping the operating surgeon.

Aged↗
PubMedDate not supplied

Analysis of the analgesic efficacy of acetaminophen 1000 mg, codeine phosphate 60 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg in the relief of postoperative pain.

Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. They also rated pain relief, pain half gone, and any adverse effects. Sum of pain intensity difference and total pain relief scores were analyzed using Dunnett's procedure. The drug combination was statistically superior to codeine as measured by SPID, TOTPAR, pain half gone, and time to remedication. The combination achieved better mean scores than acetaminophen on all efficacy measures, but was (marginally) statistically superior only in pain half gone. No appreciable differences in adverse effects were noted among the treatments. The difficulty of showing the analgesic efficacy of codeine in a single dose trial is discussed.

Acetaminophen↗