Biomedical subjects

John F Kragh

Publications and source records attributed to John F Kragh.

10 recordsLinked to original sources

PubMed2006

Radiographic indicators of ankle instability: changes with plantarflexion.

BACKGROUND: The effect of plantarflexion on radiographic indicators of instability was investigated in matched pairs of stable ankles and unstable ankle fractures with complete deltoid ligament tears to test the hypothesis that differences exist in indicators as a function of either stability or position. The purpose of this study was to determine whether plantarflexion increases radiographic indicators of ankle fracture instability. METHODS: Measurements from 34 patients scheduled for operative treatment of unstable ankle fractures were collected prospectively from normal, stable ankles and the injured, unstable ankles. Instability was defined as a positive fluoroscopic stress examination under anesthesia. Stability and instability and neutral position and plantarflexion were associated with eight radiographic indicators of which five were distances in millimeters and three were binomial (either stable or unstable). RESULTS: Measurements were larger in the unstable ankles than in the normal stable ankles. Plantarflexion was associated with increased distances in stable ankles, and a trend was seen in unstable ankles. Plantarflexion was associated with increased binomial indicators in unstable ankles but not in stable ankles. DISCUSSION: Joint positioning affected measurement of ankle stability: plantarflexion increased the sensitivity of radiographic indicators.

Ankle Injuries↗

PubMed2006

Waterproof versus cotton cast liners: a randomized, prospective comparison.

Casting injured extremities can cause complications (eg, itching, odor, rashes, skin maceration), many of which are associated with the inability to wash the extremity because of water retention and slow drying of conventional cast liners. A waterproof cast liner allows casts to become wet and perhaps improves hygiene and comfort. Fifty-nine patients (age, > or = 10 years) with upper or lower extremity injuries were randomized to a waterproof-liner group (n = 29) or a cotton-liner group (n = 30). Both groups had casts made of fiberglass tape. At each clinic visit, patients and physicians completed questionnaires evaluating comfort and skin condition, respectively. The waterproof-liner group had better scores for itch (P = .008), discomfort (P < .001), irritation (P = .002), overall patient score (P = .012), and overall physician score (P = .049).

Adolescent↗

PubMed2005

Suture holes in anterior cruciate ligament bone-patellar tendon-bone grafts.

Anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft is a common and technically demanding surgery. Traditional preparation of the femoral bone plug includes 2 transcortical holes with leading sutures to pull the graft into the knee. The pull of the sutures and patellar tendon are not colinear with the bone plug and femoral socket. The bone plug tilts, thus impairing passage into the femoral socket. A new preparation technique was devised that, by changing the location of the suture holes, decreases graft tilting and improves passage. In our study, traditional and new techniques of femoral bone plug preparation were investigated by force diagramming and then graft modeling. Bone plug tilting was caused by the trailing pull of the patellar tendon eccentric to the plug and socket. By preparing the femoral bone plug with a diametric, transverse trailing suture hole, the plug became colinear with the femoral socket for easier passage. The new technique was then surgically implemented with straighter and faster graft passage.

Femur↗

PubMed2005

The role of epimysium in suturing skeletal muscle lacerations.

BACKGROUND: Direct muscle trauma is a common and disabling clinical problem. Surgical muscle repair is difficult to evaluate because reliable repair techniques have not been established scientifically. The purpose of this study was to assess the biomechanical properties of epimysium, the collagenous tissue sheath that surrounds muscles in the body. STUDY DESIGN: We surgically repaired transected porcine muscle bellies with and without epimysium. For both groups, 25 figure-eight stitches in lacerated quadriceps bellies from a euthanatized pig were loaded under tension on a biomechanical machine (model 8521S, Instron Company). Maximum loads and strains were measured and mechanisms of failure recorded. RESULTS: The mean load for repairs with epimysium (25.1 N) was significantly higher (p = 0.034) than that for repairs without epimysium (21.2 N). The mean strain for repairs with epimysium (10.4%) was significantly higher (p < 0.001) than that for repairs without epimysium (7.3%). The mechanisms of failure were also different. Among epimysium repairs, 15 stitches avulsed muscle transversely, and 10 stitches tore out longitudinally from the muscle. In the nonepimysium group, 1 suture avulsed muscle and 24 sutures tore out. Muscle was the weakest element in each test. CONCLUSIONS: These data showed that epimysium incorporation into suturing improves the capacity of repairs to bear force. These findings fill a knowledge gap and may improve outcomes of muscle suturing. By focusing the experiment on biomechanical properties of muscle stitching, this study showed the key role epimysium plays in muscle suturing.

Animals↗

PubMed2005

Measuring medical education and curriculum during orthopedic surgical residency.

BACKGROUND: Evaluating residency programs requires objective assessment tools, but few are readily available. The purpose of this study was to measure education by correlating resident test scores with several measurements of educator performance. MATERIALS AND METHODS: The study group included residents and educators from a single residency program. We performed a retrospective analysis of scores from the Orthopaedic In-Training Examination collected during a 6-year period. Resident examination scores were indexed by dividing program averages by national averages to determine yearly score trends and then were correlated with educator attendance and teaching hours. Subspecialty scores were ranked to gauge residency strengths and weaknesses. Teaching hours devoted to subspecialties were compared with test scores to measure curricular emphases and to appraise teaching efficiency. RESULTS: Yearly average examination scores were proportional to national averages (P < 0.001). However, of 3436 possible educator-score associations, only 15 scores correlated highly (r > 0.9) with educators, and only 26 were significant (P < 0.05). Trend analysis put subspecialty scores in yearly perspective. Ranking was inaccurate until scores were indexed to the national average. In 2002, the distribution of 238 teaching hours ranged from 4 to 48 h for subspecialties, and 9 of 12 subspecialties were emphasized disproportionately to the examination. Teaching efficiency varied more than 10-fold by subspecialty. CONCLUSIONS: The creation of a score index helped to identify and address imbalances between teaching hours devoted to subspecialties and resident needs as evidenced by low In-Training examination scores. The present study improved educator accountability by correlating measurements of teaching and learning.

Curriculum↗

PubMed2005

Epimysium and perimysium in suturing in skeletal muscle lacerations.

BACKGROUND: Direct muscle belly trauma is common. Selecting optimal methods for surgical repair of muscle disruption is difficult because reliable methods have not been established. Suturing tendon offers strong repairs, but epimysium and perimysium, the connective tissues that coalesce to form tendons, offer unknown repair strength. The purpose of this study was to compare biomechanical properties of repaired muscle in transected muscle bellies with epimysium and perimysium. METHODS: The authors surgically repaired with figure-eight stitches in both epimysium and perimysium groups. Individual stitches were placed in lacerated quadriceps bellies from a euthanized pig and were tensioned on a biomechanical machine. Maximum loads and strains were measured, and failure mechanisms were recorded. RESULTS: Loads and strains for repairs with epimysium were higher than those for repairs with perimysium. Failure mechanisms were significantly different between groups. CONCLUSION: These data showed that epimysium incorporation into suturing improves capacity to bear forces compared with perimysium incorporation.

Animals↗

PubMed2005

Pullout forces of sutures in muscle lacerations.

The purpose of this study was to determine if complex suture techniques had higher pullout forces from muscle tissue than conventional stitching. Using transected cadaver muscle bellies, we performed repairs with various suture techniques and measured pullout forces. Epimyseal repair with conventional stitches (Kessler, figure eight, horizontal mattress) was inferior to complex stitches (modified Mason-Allen, perimeter). The combined complex stitches (perimeter and Mason-Allen) were strongest. Conventional stitches failed longitudinally through the muscle, whereas complex stitches failed transversely across the muscle. The complex combination of perimeter and Mason-Allen stitches had superior pullout resistance compared to conventional stitches.

Biomechanical Phenomena↗

PubMed2004

Primary coracoid impingement syndrome.

We measured treatment responses for patients with primary coracoid impingement syndrome to determine whether coracoplasty provided pain relief and improved function. Eleven patients (12 shoulders) were included in the primary group, and secondary cases were excluded. Symptoms included burning pain occurring at the site of the coracoid process aggravated by exercise (push-ups). Magnetic resonance imaging and computed tomography showed a narrow coracohumeral interval. Surgical findings confirmed the diagnosis. Follow-up averaged 2.7 years. After follow-up, coracoplasty responses showed significant relief of pain (P < 0.0001) and improved function (P = 0.006). Treatment responses were good in primary cases, as indicated by pain and function scores.

Adult↗

PubMed2002

Surgical repair of acute traumatic closed transection of the biceps brachii.

BACKGROUND: Effective techniques to repair transected muscles are not well described. We determined the outcome of surgically repaired closed transections of the biceps muscle with regard to strength, appearance, and patient satisfaction. METHODS: We conducted a study on surgical repair of acute traumatic closed transection of the muscle belly of the biceps brachii in paratroopers. Muscle fibers and epimysium were sutured with use of running interlocked stitches as well as modified Mason-Allen stitches. We gathered data on the supination torque, appearance of the arm, and patient satisfaction. Nine patients underwent surgical repair and were followed for a mean of 2.2 years. Three patients, who constituted a comparative group, had nonoperative treatment of complete transections of the biceps and were followed for a mean of eleven years. RESULTS: We found that the patients who had surgical repair had better results than did those who had nonoperative treatment, with respect to supination torque (a mean of 11.0 N-m compared with 5.8 N-m, p = 0.0005), appearance (a mean of 4.6 cm compared with 3.0 cm, according to the cosmetic visual analog scale; p = 0.000002), and satisfaction (excellent in all nine patients who had surgical repair and satisfactory in all three who had nonoperative treatment). CONCLUSIONS: The results after repair of acute traumatic closed transection of the biceps brachii with the new surgical technique described in the present study demonstrated a significant improvement in terms of function, appearance, and patient satisfaction compared with those after nonoperative treatment.

Acute Disease↗

PubMedDate not supplied

Passive biomechanical properties of sutured mammalian muscle lacerations.

Muscle trauma, such as laceration or transection, is a common occurrence, but repairing delicate tissue poses a clinical challenge. This is at least partially due to the lack of established muscle repair models. The purpose of this study was to compare the biomechanical properties of stitches in transected porcine and bovine muscle bellies. A biomechanical protocol was designed for measuring suture performance in muscle belly lacerations. Twenty simple stitches in porcine and 21 stitches in bovine specimens were tested. Individual stitches were placed in lacerated muscle bellies and tensioned on a biomechanical tester (model 8521S, Instron Corporation, Canton, MA). The mean maximum load for porcine (22.0 N) and bovine (23.9 N)stitches was not significantly different (p = .48). The difference in mean strains at maximum load between porcine (9.70/%) and bovine(8.0%0/) groups was statistically significant (p = .004). Failure mechanisms were similar. One porcine stitch avulsed the muscle transversely,while 19 stitches tore out longitudinally. All 20 stitches tore out in bovine specimens. Sutured muscle was the weakest element in each test. The present study demonstrated that sutured muscles performed similarly for the two mammals regarding the parameters of maximum load and mechanism of failure. Regarding suturing of skeletal muscle lacerations, both mammalian models had similar biomechanical performance for maximum loads and failure mechanisms, while strain data differed. The stitch load magnitudes in this study approximate those required to successfully repair transected muscle. Knowledge introduced by this study fills a gap concerning muscle stitching relevant to clinical care.

Abdominal Muscles↗