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Biomedical subjects

L A Crosby

Publications and source records attributed to L A Crosby.

At least 19 recordsLinked to original sources
PubMed1998

Fixation comparison for chevron osteotomies.

A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1 degrees with no fixation, 6.3 degrees with temporary K-wire fixation, and 9.5 degrees with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups (P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation (P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.

Adult↗
PubMed1998

Results of preprocedure and postprocedure toe cultures in orthopaedic surgery.

This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.

Adolescent↗
PubMed1997

Closed treatment of displaced middle-third fractures of the clavicle gives poor results.

We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We reviewed 52 of these patients at a mean of 38 months after injury. Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. No patient had significant impairment of range of movement or shoulder strength as a result of the injury. We found that initial shortening at the fracture of > or = 20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome. We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients.

Adolescent↗
PubMed1996

Open reduction and internal fixation of type II intra-articular calcaneus fractures.

Open reduction and internal fixation of 23 type II calcaneus fractures in 21 patients was performed using a standard extended lateral approach. Average follow-up was 26 months (range, 12-47 months). The Creighton-Nebraska Health Foundation Assessment Score for Fractures of the Calcaneus was used to evaluate fractures. The average score was 91.4 (range, 80-100), which represented an excellent result. A series of 10 type II fractures treated with closed methods was also evaluated using the same evaluation methods. The average score was 70 (range, 60-84), which represented a fair result. There was a clear statistically significant superiority with type II calcaneus fractures treated with open reduction and internal fixation (P < 0.0001). We recommend type I calcaneus fractures (nondisplaced) be treated with closed methods, and type II calcaneus fractures (displaced) be treated with open reduction and internal fixation.

Adolescent↗
PubMed1996

Complications following arthroscopic ankle arthrodesis.

Forty-two patients underwent an arthroscopic ankle arthrodesis utilizing a bi-framed distraction technique and demineralized bone matrix-bone marrow slurry as a graft substitute. The average follow-up was 27 months (range, 12-64 months). The overall complication rate was 55%, including three nonunions (7%), two fractures (4.8%), four pin site infections (9.5%), one deep infection, four hardware problems (9.5%), and four symptomatic painful subtalar joints (9.5%). Overall, 85% of patients were satisfied with their final result. The complication rate was high but most complications were minor and manageable. The demineralized bone matrix and bone marrow did not seem to increase the fusion rate over what has been documented previously for arthroscopic ankle fusions without the use of this graft substitute.

Adult↗
PubMed1996

Rotator cuff disorders.

The supraspinatus, infraspinatus, teres minor and subscapuĺaris muscles form a musculotendinous rotator cuff that provides dynamic stability to the shoulder joint. Symptoms of rotator cuff injury include limitation of motion, weakness and pain that often radiates down the upper arm and is present at night. Examination may reveal deltoid and rotator cuff atrophy, tenderness, limited passive range of motion and weakness on abduction and external rotation. Radiographs may show degenerative changes of the acromion or acromioclavicular joint, cysts, sclerosis and spurs of the greater tuberosity, and calcific deposits within the supraspinatus tendon. In most patients with subacromial impingement, conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs and subacromial injections, is successful. Failure of conservative therapy after six to 12 weeks merits further evaluation with magnetic resonance imaging or arthrography, and consideration of surgery.

Humans↗
PubMed1996

Knee Arthrodesis.

Explore the source record for details and available documents.

Arthrodesis↗
PubMed1995

Irreducible dorsal dislocation of the great toe interphalangeal joint: case report and literature review.

Irreducible dorsal dislocation of the interphalangeal joint of the great toe is rare. Few case reports can be found in the literature. Most cases have been treated with operative exploration of the joint and reduction through a dorsal midline incision. We present a case where a medial approach was used under local block anesthesia to treat an irreducible complex dislocation of the interphalangeal joint of the great toe.

Adolescent↗
PubMed1995

Intraarticular fracture of the calcaneus.

The treatment of displaced intraarticular fractures of the calcaneus continues to challenge the orthopaedic community. The recent development of prognostic classification systems based on computerized tomography has clarified the roles of non-operative and operative treatment. It has also opened the door for further prospective study of the appropriate treatment of this injury and comparison of operative methods. Based on current literature and our experience, we recommend CT evaluation of all intraarticular fractures of the os calcis in patients who are operative candidates with treatment guided by fracture classification.

Ankle Injuries↗
PubMed1995

Basic rescue and resuscitation. Trauma system concept in the United States.

Trauma has become the most expensive health care problem in the United States. It is the leading cause of death in persons younger than 44 years old. In 1990, there were approximately 92,000 deaths from trauma, 50% of which were caused by automobile accidents. Before 1976, there was no systemized approach for care of the traumatized patient. The American College of Surgeons Committee on Trauma has developed guidelines covering the spectrum of care of the trauma patient from access and prehospital care to hospital treatment and rehabilitation. The effectiveness of trauma systems has been proven in many studies that show a significant decrease in the preventable death rate in traumatized patients receiving care at a trauma center. The implementation of a national trauma system has proven difficult because of expense, commitment, and effective legislation. Small strides continue to be made, but many hurdles remain.

History, 20th Century↗
PubMed1995

Mycobacterium avium-intracellulare infection of the knee joint. Case report.

A 57-year-old white male with a history of scleroderma developed an osteoarticular infection of the right knee caused by Mycobacterium avium-intracellulare. The patient underwent arthroscopic synovectomy and was started on appropriate combination chemotherapy. The patient failed to improve clinically and developed osteomyelitis of the patella, distal femur, and proximal tibia. The patient refused further surgical intervention and subsequently developed a "Charcot-like" knee joint. This case report documents the failure of medical treatment alone for this infection, which must be combined with aggressive surgical intervention.

Antitubercular Agents↗