PubMed Health⌕ Search

Biomedical subjects

K M Niemann

Publications and source records attributed to K M Niemann.

At least 19 recordsLinked to original sources
PubMed1994

Bipolar shoulder arthroplasty.

Bipolar shoulder arthroplasty was designed as a salvage procedure for the arthritic shoulder with a massive rotator cuff tear. Between 1985 and 1989, 14 patients were treated with a bipolar shoulder arthroplasty and were followed for a mean of 3.3 years (range, 2-4.8 years). Two patient populations were studied, including: (1) rheumatoid patients undergoing a primary shoulder arthroplasty, and (2) reconstructive patients undergoing a secondary reconstructive procedure. The rheumatoid group had overall good pain relief. The average postoperative active forward flexion, abduction, and external rotation was 79 degrees, 66 degrees, and 20 degrees, respectively. The reconstructive group had fair pain relief, with an average postoperative active forward flexion, abduction, and external rotation of 39 degrees, 44 degrees, and 12 degrees, respectively. Six of seven complications were noted in the reconstructive group, including two bipolar cup dislocations, one bipolar cup subluxation, and one loosening of the prosthesis. The factors associated with complications included absence of an intact subacromial arch and deltoid abnormality. The bipolar shoulder arthroplasty appears to be an alternative to a primary arthroplasty for the arthritic rheumatoid shoulder with a massive rotator cuff tear.

Activities of Daily Living↗
PubMed1992

Musculoskeletal complications after renal transplantation: pathogenesis and treatment.

Renal transplantation is associated with several abnormalities of function and structure of the musculoskeletal system. Some of these skeletal problems result from incomplete resolution of abnormalities of bone and mineral metabolism present at the time of transplantation. In this regard, persistent hyperparathyroidism, diabetes mellitus type 1, and accumulation of beta 2-microglobulin may lead to residual skeletal effects despite excellent function of the allograft. Persistent hyperparathyroidism may accelerate bone loss and increase the risk for osteonecrosis, as well as cause hypercalcemia and hypophosphatemia; some patients with severe hyperparathyroidism require parathyroid surgery. Osteonecrosis is the most debilitating skeletal complication after transplantation and frequently requires surgical therapy. Although osteomalacia associated with aluminum overload generally resolves after transplantation, bone complications due to dialysis amyloidosis and diabetes mellitus type 1 often fail to improve. Alternatively, skeletal abnormalities can be acquired after transplantation. Most of the new derangements of bone and mineral metabolism are due to the immunosuppressive medications. Toxic effects of glucocorticoids on bone contribute to the pathogenesis of osteonecrosis, increase the risk for fractures by decreasing cancellous bone mass and synthesis of bone matrix, and dampen the linear growth response in pediatric recipients. Whether cyclosporine independently causes appreciable toxic effects on bone metabolism is not yet clear, but use of this drug increases the prevalence of gout and dental problems. Osteonecrosis, osteopenia, and short stature remain important skeletal complications in recipients of renal allografts. Therapeutic efforts should be directed toward alleviating pretransplant bone disease and attenuating bone loss after transplantation.

Bone Diseases, Metabolic↗
PubMed1991

Experience with surgical resection of heterotopic bone in spinal cord injury patients.

Extensive heterotopic ossification may occur after a spinal cord injury. Surgical removal of the heterotopic bone is considered only in patients who develop limitations of function or related skin pressure areas. In a prospective study of 21 patients, a total of 43 surgical procedures were performed to resect heterotopic bone. Long-term follow-up study was available for 18 patients who had 38 surgical procedures. This was a descriptive study since preoperative, surgical, and postoperative care varied slightly over time and were dependent on newer advances in surgical techniques and therapeutic agents. Primary complications included excessive bleeding, infection, fractures, and recurrence of the heterotopic ossification. Procedures are outlined that may reduce the incidence of postoperative infection. Fractures are related to the degree of regional osteoporosis. Recurrence is still a common problem, and any or all therapeutic agents that may reduce the extent of postoperative recurrence should be considered before surgical excision is planned.

Female↗
PubMed1987

Professional personnel in health care among secondary school athletics in Alabama.

To ascertain the use of professional personnel in health care among secondary school athletics in Alabama, a survey was sent to all high schools in the state. Smaller schools (classified 1A) are located an average of 10.8 miles from the nearest medical facility, while for larger schools (classified 4A) the average is 3.2 miles. Overall, 55% have a team physician; primary care physicians represent 65.8% and orthopedists 13%. Only 40% of the team physicians conduct preseason physical examinations for the boys and 25% for the girls. Also, 65% of all the schools reported that a physician was not readily available for practice and games for boys' or girls' teams. Almost 90% of the 4A schools reported that a physician lives in the community, compared to 30% for the 1A schools. On this survey, a physician or athletic trainer outranked a medical facility or training room as being most important to their athletic program, suggesting that the greatest need in health care among high schools in Alabama is the presence of personnel trained in athletic injuries.

Adolescent↗
PubMed1987

Improved treatment of femoral shaft fractures in children. The "pontoon" 90-90 spica cast.

In the past 15 to 20 years, little improvement has been made in the standard treatment of femur fractures in children. Children younger than two years of age or weighing less than 30 pounds are normally treated with skin traction or immobilized in a plaster cast or both. Older or heavier children are often treated with skeletal traction, followed by early or late application of spica cast in the neutral position. A method of spica cast treatment that immobilizes the limb in the 90-90 position using a reinforced cast incorporating a distal femoral traction pin--the pontoon spica--allows for early cast application and discharge from the hospital and encourages early motion of the knee joint. A series of 23 femur fractures in 21 patients were treated with this method. This series is compared with a series of 38 fractures treated with conventional methods. The follow-up period ranged from three to 24 months. The pontoon method provided better results in control of alignment than the conventional method, with no greater discrepancy in leg lengths than generally observed after skin traction and hip spica casts. The average hospital cost reduction was 73%, or approximately $13,334. There were no major complications with the pontoon method, which is now a standard treatment for femoral fractures in children.

Casts, Surgical↗
PubMed1985

Preoperative skeletal traction in Legg-Perthes disease.

In four of 11 patients with Legg-Perthes disease for which a varus femoral osteotomy was planned, routine split Russell traction failed to produce complete preoperative containment. Preoperative skeletal traction was used to distract the joint, displace the extruded lateral physis below the acetabular margin, and then reintroduce the femoral head into the acetabulum with progressive abduction. The femoral heads were rated postoperatively as good (two cases), fair (two cases), and poor (one case). Preoperative skeletal traction is an adjunctive treatment method for patients with "hinge abduction" in whom a varus femoral osteotomy is indicated.

Bone Plates↗
PubMed1983

High school football injuries in Birmingham, Alabama.

To investigate high school football injuries, we analyzed 1,877 injuries (661 game, 1,216 practice) treated from 1976 through 1979 at the Sports Medicine Clinic at the University of Alabama in Birmingham. The common injury types were sprain (32.2%), contusion (24.8%), strain (12.4%), fracture (11.0%), tear (3.8%), dislocation (2.1%), myositis ossificans (1.4%), tendinitis (1.3%), and concussion (1.0%). Position of the player injured was quarterback (8.7%), running back (19.6%), receiver (12.4%), offensive lineman (23.7%), defensive lineman (10.2%), defensive back (9.2%), and linebacker (9.0%). Body areas affected included head/neck (7.6%), shoulder (13.3%), upper arm (1.4%), elbow (3.4%), lower arm (2.0%), wrist (2.9%), hand/fingers (11.9%), chest/ribs (3.4%), back (4.9%), abdomen (0.7%), groin (0.7%), hip (2.4%), upper leg (4.6%), knee (22.2%), lower leg (4.0%), ankle (10.9%), and foot/toes (4.2%). These data are similar to those in previous reports, although subtle differences suggest variations in injury patterns due to rule changes and equipment modification.

Adolescent↗
PubMed1981

Surgical treatment of the tibia in osteogenesis imperfecta.

Segmentation and intramedullary rod fixation of the tibia have been found to be safe and effective procedures in osteogenesis imperfecta. An extensible rod is more difficult to insert than a solid rod due to the problem of obtaining an adequate fit distally, so the practical advantage of one type over the other is not as great as it is for the femur. When the procedure is used for the proper indications and with sufficient attention to detail, severe deformities can be corrected, thus allowing many children to become or remain ambulatory.

Braces↗
PubMed1978

Supracondylar fracture of the humerus in children.

Seventy-eight supracondylar fractures of the humerus in children were reviewed to compare four kinds of treatment: closed reduction and immobilization in a cast or splint, overhead skeletal traction, side-arm skeletal traction, and Dunlop's skin traction. The skeletal traction device usually used was a winged screw of our own design. The arms treated in overhead traction had significantly less change in carrying angle than those treated in side-arm traction. Significant changes in carrying angle were encountered in three instances of medially impacted so-called non-displaced fractures. There were two instances of significant carrying-angle change due to overgrowth of the lateral aspect of the distal part of the humerus. Overhead traction, utilizing a winged traction screw, was the most effective method of treatment that we found. There were no instances of Volkmann's ischemic contracture.

Casts, Surgical↗
PubMed1977

Condylar fractures of the distal humerus in adults.

Condylar fractures of the distal humerus are serious and in many instances pose a difficult treatment problem for the orthopedist. From 1969 to 1974, 24 condylar fractures of the distal humerus were treated at the University of Alabama Hospitals. Twenty of the fractures were closed and four were open. Eighteen fractures were treated open and fixed with a variety of K-wires and screws, and six fractures were treated closed. One postoperative wound infection occurred. Based on the 18 cases in which follow-up was sufficient to assess end result, we concluded that in comminuted fractures of the distal end of the humerus in adults, it may be technically very difficult to restore anatomic continuity. When secure fixation cannot be obtained or when the injury is of such a nature that internal fixation is contraindicated, such as a gunshot wound, traction may provide a functional range of motion. In fractures where good continuity and firm fixation can be obtained, open reduction and internal fixation give a superior functional range of motion.

Adolescent↗
PubMed1976

Biocompatibility studies on surgical-grade titanium-, cobalt-, and iron-base alloys.

An animal model system for the investigation of the influence of in vivo-produced metallic corrosion products upon tissues has been developed. Externally applied electrical stimulation produces the corrosion over a short period of time, and a poststimulation period is allowed for tissue stabilization. Tissue reaction adjacent to the metallic alloys shows fibrous tissue capsules and metallic corrosion product contamination. These preliminary studies show that this animal model and methodology may provide a technique for investigating long-term tissue biomaterial interactions and the influence of iron (316L), cobalt (Vitallium), and titanium (Tivanium) alloy corrosion products upon the susceptibility of tissues to various biocompatibility challenges.

Animals↗
PubMed1976

Disodium etidronate in the prevention of postoperative recurrence of heterotopic ossification in spinal-cord injury patients.

Disodium etidronate was used in a clinical trial with four patients to study its effectiveness in preventing the recurrence of mineralization after surgical removal of heterotopic ossification. These patients, who had sustained injuries to the spinal cord followed by anklysos of the hip, had seven surgical wedge resections as part of a controlled or double-blind study. Roentgenograms showed that in the resections done without the drug there was recurrence within three weeks, whereas with the drug there was no sign of recurrence as long as the drug was administered. After discontinuation of drug therapy, recurrence was variable but less than expected. Disodium etidronate is the first therapeutic agent which may delay and partially prevent postoperative recurrence of heterotopic ossification.

Adult↗
PubMed1975

Synovial chondrometaplasia. A case report.

Synovial chondrometaplasia is an uncommon benign lesion most commonly affecting males in the 20 to 60 age range. The youngest heretofore reported patient is 14 years of age. In a male patient of 7 years, 2 months, with a bone age of 5 years with left elbow involvement, there was no history of antecedent trauma. The presenting complaint was enlargement of the elbow with limitation of motion. At surgery 54 osteocartilaginous bodies were removed, some of which were still covered with synovium. Eighteen months following an anterior synovectomy, there was 5 degrees to 128 degrees of pain-free elbow flexion and full painless forearm pronation and supination with no recurrence of the disease.

Adolescent↗