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Biomedical subjects

J W Pritchett

Publications and source records attributed to J W Pritchett.

At least 37 records · Page 2Linked to original sources
PubMed1995

External fixation or closed medullary pinning for unstable Colles fractures?

Fifty patients with complex distal radial fractures treated by primary external fixation were compared with 50 with similar fractures treated by closed medullary pinning. All the patients had Frykman type-VIII injuries. The two groups were similar in regard to demographic characteristics and the method of treatment was randomly chosen. All the fractures healed within three months. In the external fixation group 92% of fractures healed in excellent alignment as did 88% of the medullary pinning group. Both groups had similar results with respect to eventual function, range of motion, and grip strength. Complications and complaints were fewer and the estimated costs of treatment were significantly less in the medullary pinning group. More patients were satisfied with closed medullary fixation than with external fixation.

Colles' Fracture↗
PubMed1994

Lumbar decompression to treat foot drop after hip arthroplasty.

Twenty-one patients with spinal stenosis who developed foot drop after total hip arthroplasty were reviewed. Patients with other risk factors for nerve injury, such as dislocation, hematoma, intraoperative limb lengthening, revision surgery, and direct operative trauma, were excluded. Also excluded were patients without symptoms of spinal stenosis. Patients in this series had back and leg pain without weakness before their hip arthroplasty. When foot drop developed and persisted four months after hip arthroplasty, patients were examined with magnetic resonance imaging or myelography and computed tomography. High-grade spinal stenosis was found in each patient. Sixteen patients were treated by lumbar decompression. Twelve patients improved; six had complete recovery of foot drop. None of the five patients who did not have surgery significantly recovered. One patient developed a foot drop in the other leg after undergoing lumbar decompression. Coexisting spinal stenosis may be a risk factor for symptomatic nerve injury during hip arthroplasty. Selected patients may benefit from lumbar decompression surgery.

Aged↗
PubMed1993

Degenerative symptomatic lumbar scoliosis.

Scoliosis with progressive deformity can develop late in life. The authors studied 200 patients older than age 50 years with back pain and recent onset of scoliosis. Seventy-one percent of patients were women, and no patient had undergone spinal surgery. The curves involved the area from T12 to L5 with the apex at L2 or L3 and did not exceed 60 degrees. Degenerative facet joint and disc disease always were present, and the curves were associated with a loss of lumbar lordosis. Forty-five patients with severe pain and neurologic deficits were studied using myelography. Indention of the column of contrast medium was seen at several levels but was most severe at the apex of the curve. It was least severe at the lumbosacral joint. The curves progressed an average of 3 degrees per year over a 5-year period in 73% of patients. Grade 3 apical rotation, a Cobb angle of 30 or more, lateral vertebral translation of 6 mm or more, and the prominence of L5 in relation to the intercrest line were important factors in predicting curve progression.

Aged↗
PubMed1993

Straight-line graphs for the prediction of growth of the upper extremities.

A simple graphic method was used for the prediction of growth and the determination of when a corrective procedure should be performed to equalize the lengths of the upper extremities. Straight-line graphs, similar to those described by Moseley for the lower extremities, were constructed for the radius, ulna, and humerus. The data for the current study were derived from a multidisciplinary, longitudinal study of growth in 244 healthy children (123 boys and 121 girls)--from infancy to skeletal maturity--and from previously constructed graphs depicting remaining growth. The use of this method can simplify the planning of an equalization procedure for an upper extremity.

Adolescent↗
PubMed1993

Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly.

Fifty patients with unstable fibular fracture were randomized into two groups. Twenty-five were treated with Rush rods and 25 with AO plates. Eighty-eight percent of patients treated with intramedullary rods had good or fair functional results, compared with 76% of patients undergoing plate and screw fixation. Full weight bearing was possible 6 weeks earlier with Rush rods than with AO plates, and there was less morbidity in the intramedullary group than in the AO group. This study indicates that Rush rods are a useful tool in elderly patients with soft bone, who are at risk for complications with plate and screw fixation.

Aged↗
PubMed1992

Human growth hormone in polymethyl methacrylate. A controlled study of 15 hip arthroplasties.

Growth hormone-loaded polymethyl methacrylate (PMMA) was used in 15 hip replacements. The levels of growth hormone and insulin growth factor-I from the hip and the blood were measured before, and after, implanting PMMA containing 20 mg of growth hormone. Low levels of growth hormone and insulin growth factor-I were found in the femur initially, but very high local levels were found after implanting the growth hormone-loaded PMMA. These results were compared with the low levels found in 15 patients in a control group undergoing cemented or cementless hip replacement without added growth hormone. The local levels of growth hormone and insulin growth factor-I declined rapidly during the first 72 hours and were near normal at the end of this time. Systemic levels of growth hormone and insulin growth factor-I were not affected by the implantation of growth hormone-loaded PMMA. No complications or adverse reactions were noted. However, randomized studies with long-term follow-up are mandatory before the use of growth hormone-loaded PMMA is justified.

Aged↗
PubMed1992

Tobramycin-impregnated cement in total hip replacements.

The clinical effect of adding 1.2 g of tobramycin powder to each 40-g pack of powdered polymethylmethacrylate used in hip replacement surgery was investigated. Fifteen patients underwent total hip replacement in which a cemented femoral prosthesis and a cementless acetabular prosthesis were used. Postoperatively, the tobramycin levels in the blood and in the wound drainage fluid were measured. The serum tobramycin concentrations were low, whereas the wound drainage fluid contained highly effective antibacterial concentrations. There was no evidence of reaction or toxicity to the antibiotic-impregnated bone cement.

Aged↗
PubMed1992

Longitudinal growth and growth-plate activity in the lower extremity.

Teleroentgenograms of the lower extremity in 244 children (123 boys and 121 girls) were made at six-month intervals from age seven until skeletal maturity. Lengths were measured to determine the growth remaining in the femur and tibia. The subjects were healthy, well-nourished, middle class Americans, mostly of Northwest European descent. The percentage of growth occurring at each lower extremity growth plate was determined by roentgenstereophotogrametric analysis. The growth occurring at the distal femoral and proximal tibial growth plates was determined by multiplying the proportion of growth occurring at each age by the longitudinal growth remaining. The proportion of growth occurring at each growth plate is not equal. Also, growth-plate activity is not constant or average throughout growth. Overall, approximately 70% of growth in the femur occurs at the distal growth plate. The proportion of growth occurring in the distal femoral growth plate in girls varies from 60% at seven years of age to 90% at age 14. Similarly, the contribution of the distal femoral growth plate in boys varies from 55% at seven years of age to 90% at age 16. Overall, the contribution of the proximal tibial growth plate is approximately 57%. In girls, this varies from 50% at seven years of age to 80% at age 14. In boys it varies from 50% at seven years of age to 80% at age 16. From the age of seven to skeletal maturity, the distal femur contributes approximately 1.3 cm per year to femoral growth, except in the last two years, when it contributes half that amount.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Knee replacement in morbidly obese women.

Sixty-six total knee replacements in 50 morbidly obese women with osteoarthritis were performed. The results in these patients were compared with 64 knee replacements in 50 nonobese women and with 50 obese women who did not have knee replacement operations. All obese patients were advised by a physician to lose weight and were counseled by a dietician. Five obese patients with six replaced knees and four nonobese patients were lost prior to follow-up study. Follow-up examinations were performed after 24 to 60 months, with mean of 33 months, in the remaining patients. No significant sustained weight loss occurred in the obese patients who had knee replacement operations or in obese patients who did not have surgical treatment. Eighty-six per cent of nonobese patients had excellent or good results from knee replacement surgical treatment. Fifty-seven per cent of morbidity obese patients had excellent or good results. There were two infections and two revision operations in morbidly obese patients and no infections and one revision in nonobese patients. Total knee replacement is safe and reasonably effective in the morbidly obese. However, the results are not comparable with those achieved in nonobese patients, and knee replacement should not be expected to facilitate weight loss.

Aged↗
PubMed1991

Total hip replacement after central fracture dislocation of the acetabulum.

We performed total hip replacement (THR) for traumatic arthritis following central fracture dislocation of the acetabulum in 19 patients (15 men and four women). This situation is significantly challenging, as most patients have scarring, contractures, and unequal leg length. The average age was 49 years, and all patients were followed for a minimum of 2 years. A two-piece cementless acetabular component and a cemented or cementless femoral component were utilized. In each patient, prophylactic low-dose irradiation was administered to discourage heterotopic ossification, and gentamicin with either cefazolin or vancomycin were given as prophylaxis for infection. Overall, the results were excellent. The mean Harris hip score after surgery was 84. No infections, dislocations, or significant heterotopic ossification occurred. Limb length was within 1 cm in each patient. No revision surgeries were performed, and no components were roentgenographically loose. There was one case of transient nerve palsy. We conclude that THR after central fracture dislocation of the acetabulum is a safe and effective procedure.

Acetabulum↗
PubMed1991

Growth plate activity in the upper extremity.

Roentgenograms of 200 males and females were examined to determine the contribution of each growth center to the total length of the humerus, radius, and ulna. Subjects were healthy, middle-class Americans, mostly of northwest European descent. The nutrient foramen in the cortex provides the site of entry for the nutrient vessel and is a fixed point in the long bone. Growth occurring at each growth plate was measured in relation to the nutrient foramen. The proportion of growth from each upper extremity growth plate is not equal. Also, growth plate activity is not constant or average throughout the growth period. Growth occurs one or two years earlier in females than in males. Overall, approximately 80% of growth in the humerus occurs at the proximal growth plate. Before the age of two years, less than 75% of growth occurs at the proximal growth plate, increasing to 85% at the age of eight and remaining constant at 90% after the age of 11. For the ulna, approximately 85% of overall growth occurs at the distal growth plate, but by the age of five years, 90% of growth occurs distally. After the age of eight years, 95% of growth occurs at the distal growth plate. For the radius, approximately 80% of overall growth occurs distally. At the age of five years, the distal growth plate contributes 85% of total growth, increasing to 90% by the age of eight.

Adolescent↗
PubMed1990

Treated and untreated unstable hips in severe cerebral palsy.

One hundred patients with severe cerebral palsy (total body involvement) and dislocated hips were examined to determine their level of pain, sitting ability, pelvic obliquity, scoliosis, nursing care difficulties and complications of decubitus ulcers and fractures. 50 of the patients had undergone surgical procedures to treat the hip; 50 had received no treatment. No significant differences were found in the frequency of pain or other complications between the two groups. Nursing care difficulties and the ability to sit did not depend on the status of the hip. Pelvic obliquity and scoliosis were related to the severity of neurological damage rather than to hip stability. These findings suggest that surgical treatment of already dislocated hips of patients with severe cerebral palsy is not helpful.

Adult↗
PubMed1990

L-dopa in the treatment of nonunited fractures.

Twenty-five patients with delayed or nonunion of fractures of a long bone had adjunctive treatment with levodopa (L-dopa). Presumably, L-dopa stimulates growth hormone, which has been suggested as helpful in bone growth and repair. All patients had previously been immobilized, and 22 had one or more surgical procedures. L-dopa was administered 500 mg initially and over three weeks was gradually increased to 500 mg orally three times a day. Treatment was continued for six months or until the fracture healed. After six months, 21 patients (84%) had no pain with full activity and solid bony union by roentgenograms and were considered healed. This study suggests that L-dopa improves the capacity of nonunited fractures to heal. Proof would require a randomized, double-blind series of patients. L-dopa could prove to be a useful adjunct in the management of delayed or nonunion of long-bone fractures.

Adult↗
PubMed1989

Preexisting musculoskeletal conditions presenting as school sports injuries.

One hundred thousand insurance claims for secondary school injuries sustained between 1974 and 1986 were analyzed to determine the incidence of diagnosis and misdiagnosis of preexisting musculoskeletal conditions. Seventy-five percent of accident reports described acute injury to normal bones, joints, and soft tissues. Twenty percent were reinjuries or other sequelae of past trauma. Infection, congenital or developmental anomalies, or other nontraumatic conditions were found in 5% of the injuries reported. Patients with preexisting diseases had a higher morbidity than those with an acute primary injury. The majority of preexisting conditions were correctly described and documented by the attending physician. However, for 268 patients with a previous accident residual and 465 patients suffering from infection, pathologic fracture, congenital/developmental disorder, neoplasia, or other diseases, the potential role of the underlying condition was not correctly stated. Correct preexisting diagnoses need to be recognized if treatment is to be optimal.

Adolescent↗
PubMed1989

The neck shaft-plate shaft angle in slipped capital femoral epiphysis.

We looked for structural differences between normal patients and those with slipped capital femoral epiphysis to explain shear failure of the growth plate in terms of mechanics. Hip radiographs of 50 normal adolescents were examined, and it was found that lines drawn along the axis of the femoral neck and perpendicular to the growth plate intersected at an average angle of 23 degrees (neck shaft-plate shaft angle). Radiographs of 50 patients with slipped capital femoral epiphysis were examined, and the femoral neck shaft-plate shaft angle was found to be between 10 degrees and 20 degrees in patients with unilateral slips and less than 10 degrees in patients with bilateral slips. These abnormalities in the femoral neck shaft-plate shaft angle suggest there are mechanical differences between normal hips and those that develop a slip of the capital femoral epiphysis that may predispose to shear failure of the growth plate.

Adolescent↗