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K D Merrill

Publications and source records attributed to K D Merrill.

6 recordsLinked to original sources
PubMed1997

Is duplex venous surveillance worthwhile after arthroplasty?

Deep venous thrombosis (DVT) complicates 60% of knee and 80% of hip arthroplasties performed without prophylactic therapy. Routine postoperative duplex ultrasound surveillance has been proposed for the detection of venous thrombosis following arthroplasty. In order to determine whether surveillance represents an effective strategy to detect postoperative DVT when prophylaxis is used, surveillance duplex exams obtained after primary or revision hip or knee arthroplasty were analyzed using decision analysis techniques. DVT was suspected clinically after 95 of 738 (13%) arthroplasties, with no symptoms suggestive of DVT after the remaining 643 procedures. Surveillance duplex scans were performed within 2 weeks of 371 procedures, while no surveillance studies were performed after the remaining 272 procedures. In these asymptomatic patients only 2 (0.5%) surveillance duplex studies were positive for DVT. In contrast, 4 of 37 (11%) duplex exams and 5 of 62 (8%) contrast phlebograms performed among symptomatic patients were positive for DVT. The overall incidence of DVT after arthroplasty in the entire population was 1.4% (10/738) with no pulmonary emboli. Patient follow-up averaged 162 +/- 285 days. Using the 1995 Medicare reimbursement of $163 for venous duplex, the incremental cost was $35,000 to detect 1 additional unsuspected DVT and $110,000 per additional quality-adjusted life-year gained. The low incidence of clinically significant DVT and pulmonary emboli with current prophylaxis does not justify an aggressive screening program. Decision analysis suggests that a greater incidence of DVT is required for screening to be worthwhile.

Adolescent↗
PubMed1994

Knee dislocations with vascular injuries.

Any knee that is dislocated or that has both anterior and posterior cruciates and one collateral ligament torn should be carefully evaluated for neurologic and vascular injury. Reduction and immobilization should be performed. If the pulses are anything but normal, arrangements should be made to proceed to the operating room immediately. A one-shot arteriogram can be obtained in the operating room, but proceeding directly with popliteal artery exploration is reasonable if the pulses have not returned to normal. If the pulses have returned to normal, an arteriogram should be obtained. After the vascular repair has been done, a fasciotomy of the lower leg should be performed. In the young healthy active patient who does not have significant necrotic muscle or severe nerve injury, delayed reconstruction and early, very aggressive rehabilitation is recommended. Whether this treatment improves the results of this injury remains to be seen. Discussion with the vascular surgeon concerning the use of a tourniquet is recommended. If not functioning, the peroneal nerve is often severely stretched, and no treatment to date has been very encouraging. An ankle foot orthosis or tendon transfers to achieve dorsiflexion may be needed.

Anterior Cruciate Ligament↗
PubMed1993

The Maisonneuve fracture of the fibula.

Nine patients sustained a Maisonneuve fracture of the fibula (MFF), which is a proximal fibula fracture associated with an ankle fracture or deltoid ligament tear. Eight were treated with closed reduction and plaster casts. One was treated by open reduction and internal fixation. Reexamination was performed at an average of 25.7 months. This included subjective, objective, and functional evaluations, along with stress roentgenograms. Six patients had an excellent result, two a good result, and one a fair result. The MFF is often more stable than generally assumed. For injuries with only a partial syndesmotic disruption, nonoperative treatment is recommended.

Ankle Injuries↗
PubMed1990

Perioperative teaching of parents. A unit-based study.

The study findings supported our hypothesis that parents would achieve a greater than 80% score on posttest following perioperative teaching intervention by the nurses in our ambulatory surgery unit. Feedback from parents indicated their perceived need for both written and verbal instructions. Limitations of this study included too few patients in the control sample and the uncontrolled presence or absence of the teaching sheet at the time of posttest. Recommendations for future studies. Unit-based research requires commitment, flexibility, administrative support, resource availability, documentation, time, and patience. Postoperative care instructions for most surgeries include some basic key points for home care (eg, fever, return to normal activity and behavior, diet, incision care, when one needs to contact his or her physician). This study can be adapted to evaluate effectiveness of teaching efforts by nurses, reinforce current practices, and make effective changes in existing teaching protocols.

Adolescent↗
PubMedDate not supplied

Occipitoatlantal instability in a child with Kniest syndrome.

A case report of occipitoatlantal instability in a 3-year-5-month-old child with Kniest syndrome is presented. Upper cervical spine instability has not previously been reported in Kniest syndrome. Presenting symptoms are similar to those of atlantoaxial instability, which has been reported in patients with skeletal dysplasia. Our patient was effectively treated with occipito-C2 fusion and halo cast immobilization.

Atlanto-Occipital Joint↗