Biomedical subjects

Konrad I Gruson

Publications and source records attributed to Konrad I Gruson.

6 recordsLinked to original sources

PubMed2007

Glove tears during arthroscopic shoulder surgery using solid-core suture.

PURPOSE: Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. METHODS: We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. RESULTS: The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). CONCLUSIONS: Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. CLINICAL RELEVANCE: This study addresses surgeon and patient safety during arthroscopic shoulder surgery.

Arthroscopy↗

PubMed2003

Injury of the femoral nerve associated with acetabular fracture.

BACKGROUND: The purpose of the present study was to document the prevalence of, and recovery from, injuries of the femoral nerve associated with displaced acetabular fractures. METHODS: From 1986 to 2001, 726 acetabular fractures were treated with open reduction and internal fixation. Four patients who had an injury of the femoral nerve associated with a displaced acetabular fracture were identified and were followed for a mean of 3.4 years. The nerve injury was iatrogenic in two patients and traumatic in two patients. RESULTS: Clinically detectable quadriceps femoris motor function returned at an average of eighteen weeks (range, four to fifty-two weeks). All patients had satisfactory recovery of nerve function with a return of grade-4 or 5 motor power (the level of motor power needed to allow a normal gait) by an average of ten months (range, three to twenty-four months). Sensory recovery was incomplete but not debilitating. CONCLUSIONS: Preoperative examination of a patient who has an acetabular fracture should include an assessment of femoral nerve function. Regardless of whether the injury is traumatic or iatrogenic in origin, recovery of motor and sensory function without surgical exploration can be expected. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Acetabulum↗

PubMed2003

Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment.

BACKGROUND: The purpose of this study was to evaluate the results after operative treatment of fractures of the posterior wall of the acetabulum in relationship to the quality of the fracture reduction as assessed by postoperative two-dimensional computed tomography. METHODS: The functional results for sixty-seven patients who had open reduction and internal fixation of an unstable fracture of the posterior wall of the acetabulum and the findings of two-dimensional computed tomography performed postoperatively were analyzed. Sixty-one patients were followed for a mean of four years after the injury, and the remaining six patients who had poor early results necessitating reconstructive surgery were followed for less than two years. All patients were evaluated preoperatively and postoperatively with use of three standard plain radiographs (one anteroposterior and two Judet 45 degrees oblique pelvic radiographs) and a two-dimensional computed tomography scan. The functional outcome for the patients was evaluated with use of a modification of the clinical grading system described by Letournel and Judet. The radiographs were graded according to the criteria described by Matta. The two-dimensional computed tomography scans were used to determine fracture gap and offset measurements. RESULTS: The clinical outcome was graded as excellent in thirty-one patients (46%), very good in twenty (30%), good in eight (12%), and poor in eight (12%). The final radiographic results were graded as excellent in fifty-three hips (79%), good in four (6%), fair in three (5%), and poor in seven (10%). There was a strong association between clinical outcome and final radiographic grade. Fracture reductions were graded as anatomic in sixty-five and imperfect in two, as determined with use of plain radiography. However, postoperative computed tomography revealed an incongruency (offset) of >2 mm in eleven hips and fracture gaps of > or = 2 mm in fifty-two. Fracture gaps of > or = 10 mm in any dimension or a total gap area of > or = 35 mm(2) were associated with a poor result. The main risk factors for a poor result were a residual fracture gap width of > or = 10 mm and osteonecrosis of the femoral head. CONCLUSIONS: The degree of residual fracture displacement is detected more accurately on postoperative computed tomography scans than on plain radiographs. The accuracy of surgical reduction as assessed on postoperative computed tomography is highly predictive of the clinical outcome. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Acetabulum↗

PubMed2003

Functional outcomes of acetabular fractures.

BACKGROUND: The Musculoskeletal Function Assessment is a validated, well-designed, self-administered questionnaire that is useful for determining health status. The modified Merle d'Aubigné clinical hip score is the most generally accepted clinical grading system for evaluating the results of acetabular fracture treatment. The purpose of the present study was to evaluate the relationship between the Musculoskeletal Function Assessment and modified Merle d'Aubigné scores in evaluating the results of acetabular fracture treatment. METHODS: One hundred and fifty patients with an acetabular fracture met the criteria for inclusion in the present study, which included a minimum of two years of postoperative follow-up, a complete physical examination with use of the Merle d'Aubigné score, and successful completion of the Musculoskeletal Function Assessment questionnaire. Patients were stratified according to a number of factors, including the type of fracture and whether the fracture was an isolated injury or was part of a multiple-injury complex. The mean duration of follow-up was five years (range, two to seventeen years). RESULTS: The mean modified Merle d'Aubigné score was 16.8 (range, 9 to 18), and the mean Musculoskeletal Function Assessment score was 24.9 (range, 0 to 79). The Spearman correlation coefficient between the Merle d'Aubigné score and the Musculoskeletal Function Assessment score was -0.61 (p < 0.0001). Stratification of the patients did not alter these overall results. However, the presence or absence of associated injuries was a significant factor for the Merle d'Aubigné score (p = 0.03). In addition, the Merle d'Aubigné score data were asymmetric, demonstrating a ceiling effect. CONCLUSIONS: The Musculoskeletal Function Assessment scores for these patients were relatively high compared with those for the normal population, indicating that complete return to a preinjury functional level is uncommon despite a good-to-excellent Merle d'Aubigné clinical score. Furthermore, the ceiling effect demonstrated by the Merle d'Aubigné score (despite its high correlation with the Musculoskeletal Function Assessment score) limits its usefulness as a method for evaluating the outcome of treatment of acetabular fractures. There have been few published clinical studies in which the Musculoskeletal Function Assessment score has been used as an outcome measure, and reference values are lacking. The present study provides initial guideline reference values for use in the evaluation of patients following an acetabular fracture.

Acetabulum↗

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↗

PubMedDate not supplied

Laminoplasty: a review of its role in compressive cervical myelopathy.

BACKGROUND CONTEXT: The currently accepted surgical treatments for compressive cervical myelopathy include both anterior and posterior decompression. Anterior approaches including multilevel discectomy with fusion or vertebral corpectomy with strut grafting, both with and without instrumentation, have enjoyed successful outcomes, but have been associated with select postoperative complications. Laminoplasty has been developed to decompress the spine posteriorly while avoiding the spinal destabilization seen after laminectomy. PURPOSE: The purpose of this article is to provide a review of the various techniques, biomechanical basis, predictive value of imaging modalities, clinical outcomes, and postoperative complications associated with cervical laminoplasty. STUDY DESIGN: A review of the literature. METHODS: A comprehensive literature review using Medline was performed identifying relevant articles that addressed the techniques, clinical outcomes, and complications after cervical laminoplasty, as well as preoperative radiographic predictors of outcome. RESULTS: The various modifications of cervical laminoplasty have generally been associated with excellent clinical outcomes when used for myelopathy secondary to cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Recent long-term studies have identified issues with this technique including axial neck pain, canal restenosis, nerve root palsy, diminished cervical motion, and loss of cervical lordotic alignment. CONCLUSIONS: Cervical laminoplasty remains a reliable procedure for posterior decompression of the spine, but the optimal approach to cervical myelopathy must take into account both patient and disease characteristics, as well as the capabilities and experience of the surgeon.

Biomechanical Phenomena↗