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Biomedical subjects

K A Pettine

Publications and source records attributed to K A Pettine.

14 recordsLinked to original sources
PubMed1993

External electrical stimulation and bracing for treatment of spondylolysis. A case report.

Evidence indicates that osseous healing of acute spondylolysis can occur without surgery, although no existing data supports a particular regimen that optimizes healing. This article presents a case study of a 17-year-old athletic male student who presented with acute spondylolysis and who was treated with intermittent bracing and daily external electric stimulation. The patient was treated with a thoracic lumbar sacral orthosis to which an external bone growth stimulator was added. Computer tomography scans performed throughout the treatment process and described in this report illustrate the progressive healing of the right and left pars fractures.

Adolescent↗
PubMed1993

Modified repair of a defect in spondylolysis or minimal spondylolisthesis by pedicle screw, segmental wire fixation, and bone grafting.

A surgical technique for treatment of spondylolysis or minimal isthmic spondylolisthesis is described. The authors based their treatment on the Scott technique, which involves placing an 18-gauge stainless steel wire around the transverse process bilaterally and then tightening the wires to each other inferiorly to the posterior spinal process. The modified technique consists of a tension band wire around the posterior spinous process and a 4.5 mm AO cortical screw in the pedicle. A case study of a 20-year old female athletic student is presented to illustrate the effectiveness of the modified technique. The authors believe that this technique offers the advantages of maintaining all motion segments and avoiding the risks of damaging the exciting nerve root just beneath the transverse process.

Adult↗
PubMed1993

Analysis of the external fixator pin-bone interface.

External fixator pins were inserted into tibiae of dogs under four in vivo loading conditions to examine the mechanism of pin loosening. Pins were quantitatively measured for pin torque resistance, and the pin tracts were studied radiographically and histologically. The pins holding an unstable fracture had more gross pin loosening. Pins also may become loose under static loads. Radiographic lucency of 1 mm or more in the cortical bone around a pin was evidence of gross pin loosening. Histologic examination showed that tight pin tracts were characterized by a lack of bone remodeling. Loose pin tracts were characterized by extensive bone resorption and inflammatory infiltrates. Pin loosening can be detected radiographically. Pin insertion technique is important to improve the initial pin torque resistance to minimize pin loosening. Sixty-nine percent of pins with an initial torque resistance of less than 68 Ncm became grossly loose compared with only 9% of pins with an initial torque resistance greater than 68 Ncm, regardless of the experimental group. Unstable external fracture fixation is another important factor in producing pin loosening. Pins loaded under unstable fracture fixation had the highest incidence of gross loosening. When applying an external fixator, the fracture rigidity should be critically evaluated and, if necessary, protected weight bearing must be introduced initially to minimize pin loosening.

Animals↗
PubMed1992

Prophylactic cerclage: a method of preventing femur fracture in uncemented total hip arthroplasty.

The incidence of femur fracture in non-cemented hip arthroplasty has been reported to be between 4.1% and 27.8%. To quantitate the hoop stress generated during insertion of a femoral broach in total hip arthroplasty and determine the effect of cerclage with both braided cable and wire, we harvested 14 pairs of embalmed cadaver femurs. These were reamed and broached to duplicate the surgical technique of inserting a straight non-cemented femoral component. Group one consisted of eight matched cadaver femurs which were tested using a single 2.0 mm chrome-cobalt cable placed around the calcar of one femur, with the other serving as a control. Group two consisted of five matched cadaver femurs which were tested using a single 18 gauge cerclage wire in the same manner. In group one, the femurs serving as controls were found to have a mean microstrain of (1425.00 +/- 1180.19). The eight femurs tested with a 2 mm cable were determined to have a mean microstrain of (4179 +/- 2853.89). In group two, the femurs serving as controls were found to have a mean microstrain of (962.60 +/- 956.78). The five femurs in group two tested with a cerclage wire were determined to have a mean microstrain of (1112.00 +/- 975.66). Using a paired t-test, statistical significance was achieved with a confidence level of P less than or equal to .01 in group one. Prophylactic wiring of the proximal femur with 2 mm cable increases the hoop stress resistance and, therefore, should decrease the incidence of intraoperative femur fractures in uncemented total hip arthroplasty.

Bone Cements↗
PubMed1991

Spinal narcotics for postoperative analgesia in total joint arthroplasty. A prospective study.

Sixty patients who were scheduled to have an elective total hip or knee arthroplasty were randomly assigned to one of three groups of twenty patients each before operation with spinal anesthesia. A double-blind technique was used throughout the study. The patients in Group I (control group) received hyperbaric 1 per cent tetracaine with epinephrine as the subarachnoid spinal anesthetic; the patients in Group II (morphine group), hyperbaric 1 per cent tetracaine with epinephrine and a single subarachnoid dose of Duramorph (morphine sulphate), 0.5 milligram; and those in Group III (Dilaudid group), hyperbaric 1 per cent tetracaine with epinephrine and a single subarachnoid dose of Dilaudid (hydromorphone hydrochloride), 0.002 milligram per kilogram of body weight. During the first twenty-four hours after the operation, the patients in Group II and Group III had significantly less pain compared with those in Group I. This was shown by the use of a visual linear-analog pain scale (p less than 0.05), the patients' ratings of the quality of relief of pain (p less than 0.02), and comparative measurements of the pain-altering medications that were used (p less than 0.05). The patients in Group II and Group III did not have any more complications or side effects than those in Group I. There was no significant difference in the quality and duration of analgesia between Group II and Group III.

Aged↗
PubMed1991

Elective total hip arthroplasty in patients older than 80 years of age.

Elective total hip arthroplasties (THA) were performed in 91 patients (101 hips) older than 80 years of age at operation. A control group of 87 patients (102 hips) aged 64 to 67 years who had elective THA was chosen statistically to represent the average THA patient. There were 51 minor and eight major perioperative complications in the elderly group and 26 minor and two major complications in the control group. The only in-hospital death was in the control group. The mean hospital stay was two days longer in the elderly group. Five years postoperatively, 83% of the patients in both groups were ambulating without pain. The mean hip score improved from 49 to 84 points in the elderly group and from 52 to 88 points in the control group. These functional results justify elective THA in patients older than 80 years of age.

Aged↗
PubMed1990

Supracondylar fractures of the femur: long-term follow-up of closed versus nonrigid internal fixation.

Twenty-nine patients were evaluated a minimum of ten years (average: 16 years) after femoral supracondylar fracture. Fracture type, mechanism of injury, and age of 14 patients initially treated nonoperatively were similar to those of 15 patients treated with nonrigid internal fixation. Complications were more common and more severe in the surgically-treated group. Knee range of motion remained permanently decreased in both groups, averaging 3 degrees lack of extension to 63 degrees of flexion. In both groups, 60% had symptoms of knee pain, instability, and gait abnormalities. Long-term poor results were caused by degenerative arthritis or loss of knee motion (or both). Degenerative arthritis developed in patients whose fracture healed with articular incongruity, greater that 15 degrees of valgus, any amount of varus, or a loss of normal mechanical axis. Results were satisfactory in seven of 15 patients in the surgical group and eight of 14 in the nonoperative group.

Adult↗
PubMed1990

A comparative study of ultrasonography and arthrography in evaluation of the rotator cuff.

Fifty patients with signs and symptoms of chronic impingement syndrome and/or rotator cuff tear were evaluated with shoulder arthrograms and ultrasonography. Ninety asymptomatic shoulders of a comparable age had ultrasonography to serve as a control group. All controls had normal ultrasonograms with no hypoechoic or sonolucent areas. The 50 symptomatic shoulder patients had the following: 28 had a normal arthrogram with either normal ultrasonograms or buckling of the supraspinatus tendon; eight had normal arthrograms, but ultrasonography indicated a thin (less than 4 mm) irregular supraspinatus tendon; 11 had complete rotator cuff tears visualized on both arthrography and ultrasonography (nine of these 11 patients had surgery confirming complete tears in all); two had a false-positive sonogram, and one had a false-negative sonogram. Thus, the ultrasonography's overall positive predictive value to detect a full-thickness rotator cuff tear was 85%, its negative predictive value was 97%, its sensitivity was 92%, and its specificity was 95%. Real-time ultrasonography is a diagnostically sensitive and specific noninvasive method to evaluate patients with shoulder impingement syndrome, leading to the recommendation that it be used as a primary imaging technique to obviate or supplement arthrography in evaluating rotator cuff disease. However, static ultrasonographic pictures, without real-time ultrasonography as a supplement, were not helpful.

Adult↗
PubMed1989

The use of epidural bupivacaine following total knee arthroplasty.

Pain relief and maximization of knee joint range of motion (ROM) are the two major goals in the postoperative management of the total knee arthroplasty (TKA) patient. Epidural bupivacaine infusions have been reported to be safe and effective for pain control in obstetric anesthesia, chronic pain management, and postoperative pain relief. The purpose of this study was to evaluate the effect of continuous epidural bupivacaine on postoperative pain and progressive knee ROM as well as to record the incidence of urinary retention and other side effects or complications. Continuous epidural bupivacaine infusion was found to provide safe, effective analgesia for TKA patients in the immediate postoperative period. Excellent pain relief with reduced narcotic requirements was observed in the patients as compared to intramuscular narcotic analgesia. No complications occurred and serum bupivacaine levels remained well below toxic levels. Short term clinical orthopaedic outcome was improved, and patient, surgeon, and nurse acceptance of the technique was excellent.

Aged↗
PubMed1988

Ingrown toenail: results of surgical treatment.

When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment.

Follow-Up Studies↗
PubMed1987

Osteochondral fractures of the talus. A long-term follow-up.

Sixty-eight patients with 71 osteochondral fractures of the talus were evaluated an average of 7.5 years after the onset of symptoms to determine which factors influenced the final result. It was found that the type of fracture was the most important; delay in treatment also affected the result adversely. A scheme of treatment for each type of fracture is proposed.

Adolescent↗
PubMed1986

A previously unreported cause of pain after total knee arthroplasty.

Total knee arthroplasty achieves consistently excellent results in most patients. The most common causes of failure are loosening and infection. This article reviews the records of five patients in whom intraarticular fibrous tissue hypertrophy was the cause of pain after total knee arthroplasty. All of the patients had increasing pain and decreasing knee motion. Evaluation for loosening, malalignment, intraarticular debris, and infection gave negative results. Examination revealed a blocked range of motion and a palpable, tender, intraarticular mass. Injection of anesthetic relieved the symptoms. Surgical excision of the hypertrophic fibrous tissue relieved symptoms and increased knee range of motion. This cause of pain in the total knee arthroplasty patient is rare.

Aged↗
PubMed1986

Osteoid-osteoma and osteoblastoma of the spine.

Thirty-one patients with osteoid-osteoma and eleven patients with osteoblastoma of the spine were evaluated after operative excision of the tumor. The average duration of symptoms in the seventeen patients whose tumor had been diagnosed by technetium bone-scanning was twelve months, as compared with thirty-five months in the twenty-five patients who had been diagnosed without the aid of bone-scanning. There were no false-negative bone scans. Scoliosis was present in fourteen of eighteen patients with a lumbar lesion, in ten patients with a thoracic lesion, and in two of the twelve patients with a cervical lesion. Twelve of the twenty-six patients with scoliosis had had symptoms for less than fifteen months before diagnosis (Group A), and eleven had had symptoms for more than fifteen months (Group B). The duration of symptoms was unknown in the other three patients. Eleven of the twelve patients in Group A had a decrease in or complete correction of scoliosis after excision of the tumor, whereas ten of the eleven patients in Group B had no decrease in the pre-operative scoliosis.

Adolescent↗