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Biomedical subjects

Kenneth J Koval

Publications and source records attributed to Kenneth J Koval.

At least 91 records · Page 5Linked to original sources
PubMed2003

Tape blisters following hip surgery. A prospective, randomized study of two types of tape.

BACKGROUND: Tape blisters after hip surgery can be a source of postoperative morbidity and can increase patient discomfort. The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation. METHODS: Ninety-nine patients (100 hips) were enrolled in the study. Patients were randomized into one of two treatment groups: one treated with a nonstretchable silk tape and one treated with a perforated, stretchable cloth tape. After surgery, the assigned tape was applied over the postoperative dressing with care not to produce skin tension. At the first dressing change, the presence or absence of blisters was recorded as were the number, size, location, and type of any blisters. The presence or absence of tape blisters was recorded at the time of each subsequent dressing change. RESULTS: A tape blister developed on twenty-five hips in twenty-five patients. The risk of a blister developing was 41% (twenty of forty-nine patients) when the nonstretchable silk tape was used and 10% (five of fifty patients) when the perforated cloth tape was used (relative risk = 4.08, 95% confidence interval = 1.53 to 10.87, p = 0.005). We found no association between formation of tape blisters and the age or gender of the patient, number of medical comorbidities, smoking history, results of nutritional assessment, or type of surgery. CONCLUSIONS: The prevalence of tape blisters was significantly lower when perforated cloth tape was used than it was when nonstretchable silk tape was used.

Adolescent↗
PubMed2003

Comparison of two headless screw designs for fixation of capitellum fractures.

In order to determine the effects of two different headless screw designs on fixation of simulated capitellum fractures six matched pairs of embalmed humeri had simulated capitellum fractures created. Fixation with Acutrac compression screws was compared to Herbert screws in a matched pair experimental design. All specimens were cyclically tested with simulated physiologic loading. Both displacement of the capitellum as a function of the number of cycles and failure loads were determined. Fixation by the Acutrac screws was significantly more stable than Herbert screws at 2000 cycles, 0.17 mm wersus 1.57 mm (p < 0.02) The Acutrac fixation also had a higher failure load, 154 N versus 118 N (p < 0.05). The Acutrac screws tested in this biomechanical study provided more stable fixation of simulated capitellum fractures than Herbert screws. This appears to be related to the design of these screws.

Biomechanical Phenomena↗
PubMed2003

Prevention of heterotopic ossification at the elbow following trauma using radiation therapy.

The objective of this study was to determine the efficacy of postoperative single dose radiation therapy of 700 centigray on fracture/dislocations of the elbow in the prevention of heterotopic ossification. Eleven patients were reviewed for this study. Each patient sustained high-energy trauma to the extremity causing a fracture/dislocation of the elbow. After open reduction and internal fixation, a postoperative single dose of 700-centigray radiation therapy was administered to the patients within 72 hours of surgery. Primary outcome measurements were clinical physical examination of range of motion and radiographic analysis of heterotopic bone formation at 12 months follow-up. Three of eleven patients (27%) had radiographic evidence of heterotopic ossification formation. Ten of eleven patients (91%) however, were without functional limitations. All fractures healed without complications. There were no complications from the radiation therapy. A single dose of 700-centigray radiation therapy postoperatively within 72 hours may lessen the functional loss from heterotopic ossification formation without effecting healing at the fracture site.

Adult↗
PubMed2002

Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty.

Simulated supracondylar fractures were created proximal to posterior cruciate ligament-retaining total knee arthroplasty components in paired human cadaver femora and stabilized with either a retrograde-inserted locked supracondylar nail or the Less Invasive Stabilization System (LISS; Synthes USA, Paoli, PA). Loads were applied to create bending and torsional moments on the simulated fracture stabilized with either no gap or a 10-mm gap. The LISS exhibited less torsional stability with anterior (P<.001) and posterior loads (P<.01). When varus loads were applied to 10-mm-gap specimens, the specimens stabilized with a retrograde nail had an 83% reduction in fracture displacement (P<.001) and 80% less medial translation of the distal fragment (P<.001). The samples stabilized with the LISS had a 93% reduction in fracture gap displacement when a valgus load was applied with a 10-mm gap (P<.001). Overall, these results suggest that the retrograde-inserted nail may provide greater stability for the management of periprosthetic supracondylar femur fractures in patients with a posterior cruciate ligament-retaining femoral total knee arthroplasty component.

Arthroplasty, Replacement, Knee↗
PubMed2002

The relationship between admission hemoglobin level and outcome after hip fracture.

OBJECTIVE: To determine the effect of admission hemoglobin level on patient outcome after hip fracture. STUDY DESIGN: Prospective, consecutive. PATIENTS: From July 1991 to June 1997, 395 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: Postoperative complications, in-hospital mortality rate, hospital length of stay, hospital discharge status, place of residence at one year, and mortality and recovery of ambulatory ability and activities of daily living status at three, six, and twelve months. RESULTS: Women with admission hemoglobin levels below 12.0 grams per deciliter and men with admission hemoglobin levels below 13.0 grams per deciliter were classified as anemic. One hundred eighty patients (45.6 percent) were considered anemic on admission. Patients who were anemic were more likely to have an American Society of Anesthesiologists rating of III or IV and have sustained an intertrochanteric fracture. Hospital length of stay and mortality rate at six and twelve months were significantly higher for patients who were anemic on admission. There were no differences in the incidence of postoperative complications, hospital discharge status, place of residence at one year, in-hospital mortality rate, and three-month mortality rate between patients who were and were not anemic on admission. In addition, there were no differences in the recovery of ambulatory ability and of basic and instrumental activities of daily living status at three, six, and twelve months between the two patient groups. CONCLUSIONS: Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission.

Aged↗
PubMed2002

Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up.

OBJECTIVES: This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis. DESIGN: A retrospective review of prospectively collected data. SETTING: Hospital-based tertiary care orthopaedic trauma practice. PATIENTS AND PARTICIPANTS: Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement. INTERVENTION: One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis. MAIN OUTCOME MEASUREMENTS: The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up. RESULTS: The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups. CONCLUSION: Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.

Aged↗
PubMed2002

Capitellum fractures: a biomechanical evaluation of three fixation methods.

OBJECTIVE: To determine the relative stability of three fixation methods for displaced capitellum fractures. DESIGN: Twelve matched pairs of embalmed humeri were divided into two equal groups and simulated capitellum fractures created. The first group compared cancellous lag screws placed in an anteroposterior direction to screws placed in the posteroanterior direction. The second group compared the Acutrac compression screw, inserted anteroposteriorly, to the more stable construct from the first test group. METHODS: All specimens were cyclically tested with simulated physiologic loading. Both displacement of the capitellum over a range of cycles and the number of cycles to failure were recorded. RESULTS: Fixation with posteroanteriorly directed cancellous lag screws was significantly more stable than anteroposteriorly directed screws at 2000 cycles (p = 0.007); loads to failure were not statistically different. Fixation by the Acutrac screws was significantly more stable than posteroanterior cancellous screws at 2000 cycles (p = 0.03). The Acutrac fixation had a higher failure load; however, this was not statistically significant. CONCLUSION: The headless screws tested in this biomechanical study provided more stable fixation of capitellum fractures in the cadaveric specimens than four-millimeter partially threaded cancellous lag screws and may do so in the clinical setting. When the cancellous lag screws were tested, insertion in the posteroanterior direction provided more stable fixation than the anteroposterior direction and has clinical benefit of not violating the articular surface. Ultimately, the decision of which method to use lies with the attending surgeon and the technique with which he or she feels most comfortable.

Biomechanical Phenomena↗
PubMed2002

The effect of posterior sag on the fixation stability of intertrochanteric hip fractures.

BACKGROUND: This study evaluates the effects of posterior sag on the fixation stability of intertrochanteric hip fractures. METHODS: A simulated, two-part intertrochanteric fracture was created in human cadaveric femurs. One of each pair was stabilized using a sliding hip screw in anatomic reduction and the other in 30 degrees of posterior sag. Measurements for load versus inferior head displacement, gapping, and shearing were made in axial and torsional loading. RESULTS: Initial axial and torsional loading showed no significant differences between the two groups. During cyclic loading, the osteotomy gap in the posteriorly angulated specimens decreased by 0.11 cm at 10 cycles (p = 0.006) and by 0.22 cm at 10,000 cycles (p = 0.33), corresponding to a 2-degree and 6-degree reduction in sag angle. Axial stiffness differed between the two groups: 10.3 N/mm for anatomic versus 6.7 N/mm (p = 0.002) for posteriorly angulated specimens. Loading to failure demonstrated no significant differences between the two groups. CONCLUSION: This study demonstrated that 30 degrees of posterior sag does not result in a significant difference in construct strength or stability.

Biomechanical Phenomena↗
PubMed2002

Fixation stability of comminuted humeral shaft fractures: locked intramedullary nailing versus plate fixation.

BACKGROUND: This study compared the fixation stability of two treatments for humeral shaft fractures with segmental bone loss during cyclic, physiologic loading. METHODS: Six matched pairs of human humeri received either a 10-hole broad dynamic compression plate or a locked antegrade inserted humeral nail applied to a humeral diaphyseal osteotomy with a 1.5-cm gap defect. The bone-implant humeral constructs were axially loaded for 10,000 cycles at 250 N and 500 N, with measurements of gap displacement and calculation of construct stiffness. The specimens were then loaded to failure. RESULTS: Cyclic loading showed no difference between the two groups for average gap displacement or construct stiffness. The intramedullary nail constructs failed by humeral shaft splitting (n = 4) or head cut-out (n = 2) at an average of 958.3 N, whereas the plate constructs failed by humeral shaft splitting and screw pull-out (n = 3) or plate bending (n = 3) at an average of 641.7 N (p < 0.001). CONCLUSION: Although both methods offer similar fixation stability under physiologic loads, the higher load to failure demonstrated by intramedullary nail fixation may have implications for the patient with multiple injuries for whom partial weightbearing on the injured upper extremity may be necessary.

Adult↗
PubMed2002

Thromboembolic prophylaxis for patients with a fracture of the proximal femur.

Patients with a fracture of the proximal femur are at high risk for thromboembolic complications necessitating some form of preoperative and postoperative thromboembolic prophylaxis. Despite the knowledge that patients with a proximal femur fracture are at particularly high risk for both deep venous thrombosis and pulmonary embolism, there is no consensus on which strategy is most effective at preventing thromboembolic events in this patient population. The pathophysiology and associated risk factors for thromboembolic complications in this patient population are discussed. We present a review of studies that address the efficacy and safety of both mechanical and pharmacological methods of thromboembolic prophylaxis to assist the orthopedic surgeon in selecting among the different modalities available for thromboembolic prophylaxis.

Anticoagulants↗
PubMed2002

Gunshot wounds to the lower extremities.

In this article, we briefly mention the personal, social, and economic costs of gunshot injuries; describe the science of ballistics and how differences in ballistics affect gunshot wounds and their treatment; and review the general principles involved in managing gunshot injuries. We will summarize the strategies for treating adults with gunshot injuries to specific regions of the lower extremities--the hip, the femur, the knee, the tibia, and the foot.

Debridement↗
PubMed2002

Orthopedic issues after cerebrovascular accident.

Patients who have had a cerebrovascular accident with resultant hemiplegia often present to the orthopedic surgeon with characteristic complaints and deformities. The most common of these include muscle spasticity and contracture, shoulder pain, hip fracture, and heterotopic ossification. Although some of these disorders are clinically evident, others may be easily overlooked. The purpose of this article is to summarize the most common orthopedic aspects of hemiplegic patients who have had a cerebrovascular accident.

Activities of Daily Living↗
PubMedDate not supplied

A comparison of immediate postreduction splinting constructs for controlling initial displacement of fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting.

PURPOSE: To compare, in a prospective, randomized manner, the sugar tong splint with a short-arm radial gutter splint in terms of patient satisfaction and the ability to maintain reduction of distal radius fractures. METHODS: A total of 118 patients with displaced distal radius fractures were enrolled; 85 patients (85 fractures) were available for follow-up evaluation and were included in the study population. There were 26 men and 59 women with a mean age of 64 years. Thirty-eight fractures were immobilized in a short-arm radial gutter splint and 47 in a sugar tong splint. Forty fractures had a stable pattern and 45 had an unstable fracture pattern. The initial patient follow-up examination occurred a mean of 8 days after splint application. RESULTS: A total of 33 fractures showed loss of fracture reduction at the initial follow-up evaluation. Sixteen of 38 fractures immobilized with the radial gutter splint displaced, whereas displacement was seen in 17 of 47 fractures immobilized with a sugar tong splint; this difference was not significant. When the splint constructs were evaluated based on fracture stability no differences were found between the splints' ability to maintain fracture reduction in both stable and unstable displaced fractures. Patients in the short-arm radial gutter splint group had significantly better Disabilities of the Arm, Shoulder, and Hand scores than those patients whose fractures were immobilized with a sugar tong splint. CONCLUSIONS: Both the sugar tong splint and the short-arm radial gutter splint had comparable performance in maintaining the initial reduction of distal radius fractures, with the short-arm splint tolerated better by patients. Based on our study we recommend the use of a short-arm radial gutter splint for initial immobilization of displaced distal radius fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, level II.

Adult↗
PubMedDate not supplied

Clinical pathway after hip fracture.

PURPOSE: Hip fracture occurs frequently, resulting in considerable morbidity, mortality and utilization of healthcare resources. Technical advances in fracture fixation and surgical treatment have improved outcomes following hip fracture in the elderly. However, further improvement in outcomes of hip fracture patients may be possible with utilization of a clinical pathway designed to enhance outcomes in a standardized, cost-effective manner. This paper presents a clinical pathway for the treatment of hip fractures in the elderly with the above aims. METHOD: The clinical pathway presented is based on personal experience and literature pertaining to the treatment of the elderly hip fracture patient. It outlines a suggested algorithmic approach to the patient that begins with the initial evaluation, progresses on through pre-operative and operative management, and ends with post-operative rehabilitation and treatment. RESULTS: The clinical pathway for the hip fracture patient in this paper is a working treatment algorithm that has been successful in personal experience. CONCLUSION: This treatment algorithm has been utilized successfully in personal experience. Further input from healthcare professionals may prove to enhance outcomes in a cost-effective, standardized manner.

Aged↗
PubMedDate not supplied

Predictors of discharge to a skilled nursing facility following hip fracture surgery in New York State.

BACKGROUND: Hip fracture is always a very traumatic event, especially for an older person. Often, it is followed by a marked decrease in the level of functioning a patient is able to achieve after recovery. It is even more debilitating when a previously independent person must be discharged to an institution. OBJECTIVE: This study examined factors and trends associated with discharge to a skilled nursing facility following hip fracture surgery. METHODS: Data were analyzed for 89,723 hip fracture patients admitted in New York State from 1986 to 1996. Factors examined included age, gender, race, type of fracture, surgical technique, comorbidities, length of hospitalization and year of admission. RESULTS: Thirty-five percent (32,130) of the patients were discharged to skilled nursing facilities. They tended to be 85+ years old, female, white, have 3+ comorbidities, a history of dementia, have sustained an intertrochanteric fracture, and have been admitted after 1990. In addition, there was a gradual increase in institutionalizations after 1990. CONCLUSION: In this study, factors were found that predicted discharge to skilled nursing facilities following hip fracture.

Age Factors↗
PubMedDate not supplied

Elder abuse: the role of the orthopaedic surgeon in diagnosis and management.

Increased awareness of elder abuse has led to the recognition that mistreatment of individuals over the age of 65 years is a widespread public health problem. It is estimated that the prevalence of elder abuse is 32 cases per 1,000 persons and is increasing with the growing elderly population. Elder abuse is suspected to be a major source of morbidity and mortality, representing a high economic burden to society. The diagnosis of elder abuse is seldom straightforward due to social issues, cognitive impairment, and comorbid conditions, and requires careful correlation of historical and clinical findings. Comprehensive evaluation, including a detailed history, systematic physical examination, and appropriate laboratory and radiographic assessment, is essential. The orthopaedic surgeon consulted to evaluate an elderly individual with musculoskeletal injuries must be cognizant of the potential for elder abuse, especially when circumstances are suspect. The role of the orthopaedic surgeon is often fundamental to establishing whether musculoskeletal injuries are consistent with the stated mechanism of injury. Due to the variety of presentations, there are no fracture patterns considered pathognomonic of elder abuse. Rather, the nature and pattern of injury must be viewed in the context of the general health and psychosocial environment of the patient to determine whether abuse has occurred. Once the diagnosis of elder abuse has been made, a comprehensive, multidisciplinary long-term care plan must be formulated to ensure patient safety while respecting the autonomy of a competent individual. Physicians have an ethical and legal responsibility to protect patients from suspected abuse, and most states mandate reporting by health-care personnel.

Aged↗
PubMedDate not supplied

Correction of tibia vara with six-axis deformity analysis and the Taylor Spatial Frame.

Operative correction for infantile and adolescent tibia vara has been described using both external and internal fixation. Gradual correction using a circular fixator offers the advantage of accurate coronal, sagittal, and axial plane correction without significant soft tissue dissection. This study evaluated the use of six-axis deformity analysis and the Taylor Spatial Frame (TSF) for the correction of tibia vara. Nineteen patients (22 tibias), 6 with infantile and 13 with adolescent tibia vara, underwent correction with TSF. On the basis of mechanical axis correction, 21 of 22 tibias were corrected within 3 degrees of normal. Using Schoenecker's criteria, all patients achieved good results (no pain, <5 degrees difference in tibial-femoral angle from the normal side). Complications included one intractable pin-site infection, two superficial pin-site infections, and one delayed union. Six-axis deformity analysis and TSF provide accurate and safe correction of infantile and adolescent tibia vara.

Adolescent↗