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Biomedical subjects

L X Webb

Publications and source records attributed to L X Webb.

At least 19 recordsLinked to original sources
PubMed1992

Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture.

Pulmonary embolism is a potentially lethal complication among patients with acetabular fractures requiring surgery. The reliability, safety, and extent of efficacy of pharmacologic as well as existing nonpharmacologic anticoagulation prophylaxis in this patient group has not been determined. A careful analysis of the myriad factors acting on these patients who have had major trauma and have undergone a major surgical procedure about the hip prompted a change in our approach to prophylaxis in this patient group. In the period from March 1984 through October 1987, 51 patients having 52 acetabular fractures underwent osteosynthesis at the Wake Forest University Medical Center. Twenty-four patients had two or more identifiable risk factors and underwent insertion of a Greenfield filter for prevention of pulmonary emboli. Filters were inserted at the time of acetabular surgery with C-arm guidance via the internal jugular vein approach. The average time for insertion was 57 min. Placements were verified by plain roentgenograms. There were no complications during filter insertion. Four patients with filters (17%) developed leg edema; in three the edema was minor, and in one the filter trapped what could have been a fatal embolus but caused lower extremity venous stasis severe enough to result in peripheral lower extremity tissue loss. There were no pulmonary emboli (by clinical criteria). The remaining 27 patients had routine medical prophylaxis and no filters. In this group, two patients had a clinically evident pulmonary embolus (7%), and one of these patients died. Two other patients (7%) had minor chronic leg edema. In one of them, a proximal deep venous thrombosis in the lower extremity was documented with venography, requiring rehospitalization and anticoagulant therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1992

Exertional compartment syndrome in a Marine grunt.

Exercise-induced exertional compartment syndrome was first described by Vogt in 1945 as "march gangrene." The authors report a case of a 20-year-old United States Marine presenting with the florid findings of acute crural compartment syndrome. The patient's history of prior episodes of crural pain following long hikes led the authors to conclude that this patient had a chronic exertional compartment syndrome.

Adult↗
PubMed1990

Results in patients with craniocerebral trauma and an operatively managed acetabular fracture.

Results in 23 patients with significant craniocerebral trauma (Glasgow Coma Scale less than or equal to 10) and displaced acetabular fracture requiring surgery were reviewed after a minimum follow-up of 1 year. Despite a postoperative anatomic reduction in all but one case, clinical outcome for these hips was poor, with an average Harris hip rating of 59. Patients older than 40 years had a significantly poorer outcome than did younger patients (p = 0.004). Postoperative problems occurred in 70% of patients (n = 16); the largest portion of these represented symptomatic heterotopic bone, which occurred in 61%. None of the four patients who had an anterior ilioinguinal surgical approach had symptomatic heterotopic ossification. The average Glasgow outcome score was 3.9 out of 5, and 20 of the 23 patients, despite a prolonged convalescence, were able to return to independence and self-care. The authors conclude that patients with combined significant craniocerebral trauma and an operatively managed displaced acetabular fracture are likely to have compromised hip function despite a well-executed osteosynthesis. This was especially true for those patients over age 40 in this series. The authors suggest that if the fracture pattern permits it, the operative management of the acetabular fracture in these patients be by an anterior ilioinguinal approach, so as to minimize the formation of heterotopic bone.

Acetabulum↗
PubMed1989

Comparative in vitro antibiotic resistance of surface-colonizing coagulase-negative staphylococci.

The MBCs of nafcillin, vancomycin, gentamicin and daptomycin (LY146032) were determined for three clinical isolates of coagulase-negative staphylococci grown in suspension and adherent to biomaterials. Strains studied were the slime-producing strain Staphylococcus epidermidis RP-12 (ATCC 35983), S. hyicus SE-360, and the non-slime-producing strain S. hominis SP-2 (ATCC 35982). All three strains were allowed to colonize surgical-grade disks of stainless steel, polymethylmethacrylate, and ultrahigh-molecular-weight polyethylene for 24 h, and the disks were then exposed to various concentrations of antibiotics for 24 h. Surviving adherent bacteria were mechanically dislodged from the disks and quantitated by standard broth dilution plating techniques. Biomaterial-adherent RP-12 and SE-360 yielded approximately 10 times more CFU per disk than non-slime-producing SP-2 did. For all organisms, 10 times more bacteria bound to polymethylmethacrylate disks than to the other biomaterials. In general, bacteria adherent to biomaterials exhibited greater resistance to antibiotics than the same strains in suspension did. Resistance was independent of bacterial slime-producing characteristics and was related to the biomaterial colonized.

Anti-Bacterial Agents↗
PubMed1989

Treatment of infected nonunion and delayed union of tibia fractures with locking intramedullary nails.

Treatment of infected nonunion of tibial fractures has focused on irradicating infection before attempting to secure union. To secure union in the presence of infection in cases not amenable to conventional treatment, intramedullary nailing combined with open wound management was the treatment in 19 fractures of infected tibial nonunions in 18 patients. Eighteen fractures united. Drainage lessened or ceased after union of fractures and/or removal of nails. Only three cases had bone grafts. All were initially Type III open fractures. The majority occurred in motorcycle accidents. Time to union averaged 6.6 months (range, three to 14 months). Fourteen cases (15 tibias) healed without further drainage; four had minimal but persistent drainage. In properly selected cases, the treatment was safe and effective.

Adolescent↗
PubMed1988

Bioimplant surfaces: binding of fibronectin and fibroblast adhesion.

The adhesion of baby hamster kidney 21C/13 fibroblasts to surfaces of passivated titanium, carbon fibers, bioactive glasses B5 and B6, fibronectin-precoated passivated titanium, and fibronectin-precoated B6 was quantified. The order of adhesive cell avidity for the uncoated surfaces was passivated titanium (greatest), B6 and carbon fibers (intermediate), and B5 (least). Precoating with fibronectin enhanced the adhesive characteristics of fibroblasts on passivated titanium and B6 by 74% and 118%, respectively.

Animals↗
PubMed1988

Inability to deploy the distal fixator fin of a Brooker-Wills nail.

While a Brooker-Wills nail was being placed in an osteotomized femur during the course of a closed femoral shortening procedure, the slot holding the distal fixator fin was deformed as it was driven across the fracture/osteotomy site (approximately 50% apposition), and the fin could not have been deployed had it been needed for stabilization of the fracture. This case illustrates the importance of maintaining a meticulous closed reduction and of obtaining oblique image intensifier views of the distal portion of this nail while it is being inserted.

Adolescent↗
PubMed1988

Two-hole plate fixation for traumatic symphysis pubis diastasis.

Techniques for managing traumatic diastasis of the pubic symphysis include bed rest, hip spica casting, pelvic slings, external fixation, and internal fixation. We report herein our experience with 14 consecutively managed patients in whom we successfully stabilized traumatic pubic diastasis with a single two-hole plate fixation. The average age of the 13 men and one woman was 30 years; followup averaged 17 months. Most of the patients had associated injuries (Injury Severity Score average, 19). Nine patients had concomitant disruption of the sacroiliac joint requiring either delayed open reduction and internal fixation or prolonged skeletal traction; among the five remaining patients, time to mobilization (bed to chair) averaged 1 day. There were no complications attributable to the procedure; i.e., no infections, and no failures of fixation. In this small series of patients early two-hole plate fixation of the traumatic diastasis of the pubis satisfactorily restored the disrupted anterior pelvic ring, contributed to early mobilization of the patients, and made reduction of a concomitantly disrupted sacroiliac joint easier, whether accomplished by skeletal traction or open reduction and internal fixation during a second procedure.

Adolescent↗
PubMed1988

Disruption of the posterior pelvic ring caused by vertical shear.

Disruption of the posterior pelvic ring caused by vertical shearing forces is associated with significant morbidity and mortality. We reviewed the intermediate results in 18 patients who had 20 disruptions of the posterior pelvic ring. Depending on the location of the injury, patients were treated by either skeletal traction or open reduction and internal fixation. Patients who had open reduction and internal fixation had a significantly shorter hospitalization, a shorter confinement to bed, a shorter time to full weight-bearing, and fewer early complications. In addition, on intermediate follow-up, these patients had less back and leg pain and fewer gait disturbances, and were more likely to be able to do heavy work. Further study is needed to determine whether these results will be preserved on long-term follow-up.

Accidents, Traffic↗
PubMed1988

Unstable femoral shaft fractures: a comparison of interlocking nailing versus traction and casting methods.

Among 60 femur fractures not amenable to fixation by simple intramedullary nailing, 30 were treated with balanced skeletal traction followed by cast bracing or spica casting, and 30 were treated with closed interlocking nailing. The criteria for using an interlocking nail were fractures with less than 50% cortical contact or fractures with rotationally insecure purchase of the nail in either the proximal or distal fragment. In terms of fracture severity, patient age, injury severity, and clinical follow-up, the patient groups were similar. There were three open fractures in each group. The average hospital stay was 61 days for the traction group, and 19 days for the interlocking nail group (p less than 0.001). Time to clinical and radiographic union averaged 34 weeks with traction and casting and 18 weeks with interlocking nail fixation (p less than 0.001). Failure by the criteria of Johnson et al (2) occurred in 67% of the traction group and in 3% of the interlocking nail group (p less than 0.001). Minor complications were more common in the traction group. On the basis of this study and the experience of others, interlocking nail fixation appears to be the method of choice for managing unstable femoral shaft fractures.

Adolescent↗
PubMed1987

Adhesive colonization of biomaterials and antibiotic resistance.

This study addresses the problem of antibiotic resistance in adhesive, biomaterial-centred infections. It is suggested that this anionic, extracapsular, polysaccharide slime produced by bacteria protects them from antibiotics and sequesters critical ions from the surface of biomaterials. Biofilm-enclosed bacteria on the surface of stainless steel substrata in a test chamber were challenged with incremental levels of tobramycin. In this setting, the minimum inhibitory concentration and minimum bactericidal level of tobramycin for Staphylococcus epidermis were well above normal.

Acrylic Resins↗
PubMed1987

The crowded carpal sign in volar perilunar dislocation.

Three cases of volar perilunar dislocation were seen at North Carolina Baptist Hospital over a 6-year period. An important finding on anteroposterior radiographs was the overriding of proximal and distal carpal rows giving rise to the "crowded carpal" appearance. Review of the literature demonstrates this configuration in all illustrations of volar perilunar dislocation. Although some authors have noted its presence, the diagnostic significance of this finding has not, to our knowledge, been emphasized.

Adult↗
PubMed1987

Total shoulder replacement.

In total shoulder replacement the result is highly dependent upon the integrity or reconstructability of the muscles, tendons, and capsule, as well as the experience of the surgeon. Stability and function of an unconstrained implant are a result of the interrelationship of critical factors such as humeral length, humeral and glenoid version, appropriate abductor tension, rotator cuff integrity, and capsular reconstruction. If these factors are not present and preserved, they must be reconstructed. The results obtained in this study are comparable to those previously published using similar shoulder arthroplasty systems. Total shoulder replacement must be considered a relatively new procedure, but results justify some optimism for the durability of this procedure.

Adult↗
PubMed1987

Adhesive bacterial colonization of exposed traumatized tendon.

Recent studies of compromised or damaged tissues, as well as biomaterials, have shown that they provide a particularly fertile substratum for bacterial colonization. Colonization in these environments is mediated by a process of microbial adhesion to surfaces of the substrata. In this report, we present electron microscopic studies of a portion of damaged and infected tendon. These studies demonstrate colonies of bacteria surrounded by a ruthenium red-staining exopolysaccharide biofilm and adhesion to the surface of the tendon by means of an exopolysaccharide polymer. We suggest that this adhesive form of bacterial colonization may partially explain the resistance of exposed tendon to effective debridement by simple mechanical measures and to coverage with granulation tissue, partial-thickness skin grafts, and vascularized tissue grafts.

Adult↗
PubMed1986

Bilateral rupture of the patella tendon in an otherwise healthy male patient following minor trauma.

A case of bilateral patella tendon rupture in an otherwise healthy 38-year-old man who sustained relatively minor trauma is presented. A flexion moment against a contracted or contracting quadriceps muscle is thought to have been the mechanism of injury. A survey of the literature yielded reports of three other cases of otherwise healthy patients who had had bilateral simultaneous disruption of the patella tendons.

Adult↗
PubMed1986

Inhibition of bacterial adhesion by antibacterial surface pretreatment of vascular prostheses.

Polytetrafluoroethylene grafts were pretreated with oxacillin, with the cationic detergent benzalkonium, or with both substances, either at room temperature or at 90 degrees C. Inhibition zones ranging from 6.4 to 15.2 mm formed around all grafts incubated on Staphylococcus aureus-streaked agar plates except control disks and those treated with oxacillin. Treated grafts were exposed in vitro to S. aureus in high concentration, followed by distilled water lavage. The graft surface was then stained with ruthenium red to stain polysaccharides and studied by scanning and transmission electron microscopy. Colonization of the graft surface by adhesive bacteria was demonstrated in all cases, although it was less prevalent on grafts pretreated with benzalkonium bound at 90 degrees C.

Adhesiveness↗