Biomedical subjects

M F Swiontkowski

Publications and source records attributed to M F Swiontkowski.

95 records · Page 6Linked to original sources

PubMed1984

Ipsilateral fractures of the femoral neck and shaft. A treatment protocol.

Ipsilateral fractures of the femoral neck and shaft present diagnostic difficulties and complex choices as to treatment. A review of the eighty-three cases reported in the literature revealed that one-third of the fractures of the femoral neck were missed initially. No consistent method of treatment can be recommended on the basis of this review. Our present protocol for this double fracture is treatment with immediate internal fixation: the femoral neck fracture is given first priority and is reduced and immobilized with multiple cancellous screws, and the femoral shaft fracture is then treated with retrograde closed intramedullary Küntscher nailing. Appropriate exceptions to the protocol exist. We reviewed the cases of fifteen patients who were treated at Harborview Medical Center and University Hospital from 1971 through 1981. Our experience with the first two patients led to the development of our protocol, which was applied in the thirteen subsequent double fractures. Two of the fifteen femoral-neck fractures were missed initially. All of the fractures had united four months postoperatively. Of the nine patients who were followed for three years or more, two had aseptic necrosis of the femoral head. Compared with other reports, our protocol seems to have produced somewhat better functional results.

Adult↗

PubMed1983

Tarsal coalitions: long-term results of surgical treatment.

We reviewed 40 patients who had undergone 57 operations for tarsal coalition between 1965 and 1980. Ten patients were treated for talocalcaneal coalitions. Four had successful resections and the remainder had successful single or combination arthrodesis. Thirty patients had 39 calcaneonavicular resections and five primary triple arthrodeses. In the entire series only two patients had a poor end result due to either technically poor surgery or failed calcaneonavicular resection because of advanced degeneration. Polytomography, computed tomography, or both were valuable in determining if talocalcaneal coalition resection was feasible. Care must be taken in evaluating the talonavicular joint for degenerative changes. The talar "beak" is not necessarily a degenerative spur, but rather a traction process occurring secondary to increased motion.

Adolescent↗

PubMedDate not supplied

Characterization of patients with high-energy lower extremity trauma.

PURPOSE: (a) to report the demographic, socioeconomic, behavioral, social, and vocational characteristics of patients enrolled in a study to examine outcomes after high-energy lower extremity trauma (HELET) and to compare them with the general population; (b) to determine whether characteristics of patients undergoing limb salvage versus amputation after HELET are significantly different from each other. DESIGN AND STUDY POPULATION: A prospective study of 601 patients admitted with high-energy lower extremity trauma to eight Level I trauma centers. PROCEDURES: Patients were evaluated during the initial hospitalization. They are being followed up for 24 months postinjury. Study patients are compared with the general population by using census information, population survey data, and published norms. Characteristics of patients undergoing limb salvage versus amputation are also compared. RESULTS: Most patients were male (77 percent), white (72 percent), and between the ages of twenty and forty-five years (71 percent). Seventy percent graduated from high school (compared with 86 percent nationally) (p < 0.05). One fourth lived in households with incomes below the federal poverty line, compared with 16 percent nationally (p < 0.05). The percentage with no health insurance (38 percent) was also higher than in the general population (20 percent) (p < .05). The percentage of heavy drinkers was over two times higher than reported nationally (p < 0.01). Study patients were slightly more neurotic and extroverted and less open to new experiences. When patient characteristics were compared for those undergoing amputation versus limb salvage, no significant differences were found among any of the variables (p > 0.05). CONCLUSION: In conclusion, LEAP patients differ in important ways from the general population. However, the decision to amputate verus reconstruct does not appear to be significantly influenced by patient characteristics.

Adolescent↗

PubMedDate not supplied

Direct, real time measurement of meniscal blood flow. An experimental investigation in sheep.

The functional microcirculatory system of the meniscus was investigated in nine sheep using laser Doppler flowmetry (LDF). The highest blood flows recorded were found at the periphery and at the anterior and posterior horns, and this finding was confirmed by india ink injections in five sheep and by meniscal autoradiographs following intraatrial injection of 20 million Cs46 microspheres in four sheep. LDF provides accurate and reproducible assessment of meniscal blood flow. If adequate probes can be developed, this method offers great promise in the clinical assessment of blood flow within the substance of meniscal tears, thus offering the surgeon initial information in the decision to repair or resect a meniscal tear.

Animals↗

PubMedDate not supplied

Pathophysiology of infections after internal fixation of fractures.

Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

Animals↗