Bone transport combined with free flap reconstruction and antibiotic bead spacers for a type IIIB open tibial fracture: case report.
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Adult↗
Biomedical subjects
M Itoman
Publications and source records attributed to M Itoman.
Problems of various fixation methods for open tibia fractures: experience in a Japanese level I trauma center.
Two hundred thirty-seven patients with open tibial fractures (245 fractures) were treated as follows: nonoperative stabilization alone (Nonop group, n = 54); immediate open reduction and internal fixation (ORIF group, n = 47); delayed ORIF (D-ORIF group, n = 109); or external fixation (EF group, n = 35). The D-ORIF group was further divided into ORIF after nonoperative treatment (Nonop/ORIF, n = 86), and ORIF after external fixation (EF/ORIF, n = 23). The open tibial fractures were classified as follows: 42 type I (no infections), 107 type II (4 infections), 43 type IIIA (3 infections), 42 type IIIB (12 infections), and 11 type IIIC (2 infections), with significant differences in infection rate between type IIIB and type I, type II, or type IIIA. The deep infection rates in Nonop, ORIF, Nonop/ORIF, EF/ORIF, and EF groups were 3.7%, 12.8%, 5.8%, 30.4%, and 2.9%, respectively. There were significant differences in deep infection rates between the EF/ORIF and Nonop/ORIF, and the EF group. The mean period of fracture healing for type IIIB fractures was delayed. The mean time to union of the EF/ORIF was significantly longer than that of the ORIF, Nonop/ORIF, and EF groups, respectively. Complete and consecutive debridement procedures and early soft-tissue coverage should be done to avoid wound infection, especially in type IIIB fractures. Delayed internal fixation after external fixation had the highest risk of infection, mandating meticulous wound management in such patients.
Adolescent↗
Attenuation of monosodium urate crystal-induced arthritis in rabbits by a neutralizing antibody against interleukin-8.
Accumulating evidence implicates interleukin-8 (IL-8) as an essential mediator in neutrophil-mediated acute inflammation. Neutrophils have also been shown to have a crucial role in the pathogenesis of acute gouty arthritis. Thus, we investigate the pathophysiological role of IL-8 in an experimental model of acute gout, monosodium urate (MSU) crystal-induced arthritis in rabbits. The injection of MSU crystals into knee joints caused a marked swelling of joints. Concomitantly, the infiltration ofleukocytes, mostly neutrophils, was observed in synovial membrane and synovial fluids. The injection of MSU crystals also induced an elevation in synovial fluid IL-8 levels preceding neutrophil infiltration into synovial fluids, without an accompanying increase in plasma IL-8 levels. Immunoreactive IL-8 protein was detected in synovial lining cells at 12-24 h after the injection. IL-8 protein was also observed in infiltrated leukocytes in synovium as early as 3-24 h after the injection. Finally, the intraarticular injection of a neutralizing anti-IL-8 antibody significantly attenuated the crystal-induced joint swelling that occurred at 12 h, and neutrophil infiltration into arthritic joints at 12 and 24 h after the induction. These results provide evidence on the pathogenic roles of locally produced IL-8 in MSU crystal-induced gouty arthritis.
Animals↗
Rat whole-limb viability after cold immersion using University of Wisconsin and Euro-Collins solutions.
The purpose of this study was to compare University of Wisconsin (UW) solution with Euro-Collins (EC) solution in their cold preservation effects on rat limbs. Thirty-six Lewis rat limbs were preserved in EC solution (n=18) or UW solution (n=18) at 4 degrees C for 72 hr, and grafted orthotopically to a syngeneic rat using microsurgical techniques. The surgeon was blinded to the solution used. We evaluated the vascular patency rate and death rate of both groups at day 7 after surgery and performed histological evaluations of bone, muscle, growth plate, and articular cartilage for each specimen of successful grafts in both groups. The vascular patency rates of the EC and UW groups were 27.7% (5/18) and 11% (2/18), respectively, and showed no significant difference. The death rates of the EC and UW groups were 50% (9/18) and 60% (10/18), which were not significantly different. There were no clear differences in histological viability between both groups, in all tissues exclusive of bone marrow and muscle tissue. Our results showed that in comparing EC and UW solutions, one was not significantly superior to the other as a cold immersion storage medium after a 72 hr ischemia-induced reperfusion injury.
Adenosine↗
Ultrasonography for diagnosis of rotator cuff tear.
In this study the clinical usefulness of ultrasonography in the diagnosis of rotator cuff tears was assessed. One hundred twenty-two patients undergoing preoperative ultrasonography were evaluated surgically. Three different ultrasonographic machines were applied with a 7.5-MHz linear-array transducer. Surgery confirmed a sensitivity of 79% for full-thickness tears and 50% for partial thickness tears. In 73 patients with negative ultrasonographic findings, the specificity was 100% for full-thickness tears and 90% for partial-thickness tears. The diagnostic sensitivity for full-thickness tears of the Hitachi EUB-340 system was significantly lower than those of Hitachi EUB-415 and EUB-515, and thus the former cannot be recommended for detection of rotator cuff tears. The sensitivity with regard to partial-thickness tears was also significantly lower with the Hitachi EUB-340 system as compared to the Hitachi EUB-515. There were no significant differences in false-positive rate among the three machines used. In conclusion, accurate ultrasonographic diagnosis of rotator cuff tear requires a high-resolution machine, as well as considerable experience in interpretation.
Adult↗
Closed intramedullary osteotomy for rotational deformity after long bone fractures.
Ten patients with rotational deformities after fractures of the femur or tibia were treated by closed intramedullary osteotomy. Eight had an external rotation deformity of the femur and 2 had deformities of the tibia. The rotational deformity varied from 30 degrees to 60 degrees and 6 patients had shortening of 15 mm to 30 mm. The osteotomies were carried out with an intramedullary saw and were fixed by an interlocking nailing. Shortening was corrected at the same time. At follow up the average rotational deformity was less than 5 degrees and shortening less than 15 mm. All the patients felt that they had a normal range of movement and equal length. There were no complications, except for one case of delayed union in which consolidation occurred at 24 months without any further procedures.
Adolescent↗
Open knee dislocation associated with vascular injury successfully salvaged by primary arthrodesis in an elderly patient: a case report.
Treatment by primary arthrodesis of the knee joint after temporary intraluminal shunt placement in a 70-year-old man with open knee dislocation involving the popliteal vessels is reported. After temporary shunting, the definitive vascular reconstruction of both the popliteal artery and vein was established by end-to-end anastomoses because of the shortening effect of the arthrodesis. Two skin coverage procedures were performed on day 0 and day 18. The patient recovered activity to a level near his pretrauma status. Primary arthrodesis for open knee dislocation associated with vascular injury in an elderly patient may be an efficacious procedure, depending on the patient's age, occupation, and level of activity.
Aged↗
Absence of immunity to type II collagen and proteoglycan in osteoarthritic C57BL mice.
We measured immunity to type II collagen and proteoglycans in osteoarthritic C57BL mice to determine whether it is related to osteoarthritis pathogenesis. Histological examination revealed articular cartilage lesions in all mice and synovitis in only a few mice. Immunological responses to type II collagen were found in collagen arthritic mice, but not in C57BL mice. Furthermore, immunological responses to proteoglycans were observed in proteoglycan-immunized mice, but not in C57BL mice. Therefore, articular cartilage degeneration may not result in autoimmunity to type II collagen and proteoglycans in osteoarthritis of C57BL mice, and immune responses to these components may not be a primary etiology of osteoarthritis in this model.
Animals↗
Effects of cyclosporin on serum hyaluronan levels in collagen arthritis.
Serum hyaluronan (HA) levels were measured in a rat model of collagen arthritis using a sandwich enzyme-linked immunosorbent assay. Values became elevated as the arthritis developed, correlating with its severity. Daily subcutaneous treatment with cyclosporin at the dose of 25 mg/kg per day for fourteen days completely prevented anti-type II collagen antibody production and the serum HA increase as well as development of collagen arthritis. HA in the blood may thus provide a good quantitative marker for joint disease in rat collagen arthritis with potential as a tool for evaluation of drug efficacy in this experimental model.
Animals↗
Do superoxide radicals in blood indicate anastomotic patency after microvascular tissue reperfusion?
Superoxide radicals were measured in the blood of six patients who underwent vascular reconstruction after ischemic injury in an attempt to predict prognosis following surgery. Three free-tissue transfers (two free latissimus dorsi flaps, one free vascularized fibular osteocutaneous graft) were performed on patients with skin or bone defects associated with open tibial fractures. Vascular reconstructions were performed on two patients with popliteal vascular injuries, in one case with an open femoral fracture and in another with an open knee dislocation. A third vascular reconstruction was performed on a patient with a subclavian artery injury associated with a clavicular fracture. Superoxide levels in the blood were quantified by a chemiluminescence method using a derivative of luciferin. Blood was obtained prior to reperfusion and periodically to 72 hr postoperatively. In patients who underwent successful reconstructions, superoxide levels increased after reperfusion. Vascular insufficiency was associated with acute drops in superoxide concentrations. Superoxide levels are a promising clinical marker which can predict insufficiency during reperfusion following tissue ischemia.
Adolescent↗
Contributing factors influencing type III open tibial fractures.
Ninety-five patients with severe open tibial fractures (96 fractures) were treated with nonoperative treatment alone (NO group, n = 16), immediate internal fixation (I group, n = 22), delayed internal fixation (D group, n = 34), or external fixation (EF group, n = 24). The D group was divided into a delayed internal fixation group following nonoperative treatment (D1 group, n = 14), and a delayed internal fixation group following external fixation (D2 group, n = 20). Using the classification system of Gustilo, there were 43 type IIIA, 42 type IIIB, and 11 type IIIC open tibial fractures. There were 17 deep infections (type IIIA, n = 3; IIIB, n = 12; IIIC, n = 2). The difference in the deep infection rate (DIR) between the type IIIA and type IIIB fractures was statistically significant (7.0% vs. 28.0%, p < 0.05). The DIRs in groups NO, I, D1, D2, and EF were 12.5, 27.3, 7.1, 35, and 4%, respectively. There was a significant difference in DIR between the D2 group and the EF group. The DIR in the D (D1 + D2) group and group I showed no significant difference. There was no relationship between the DIR and either Injury Severity Score or skin closure time. The authors of this study, therefore, do not feel there is an advantage to immediate internal fixation over delayed procedures for Gustilo type III open fractures of the tibia. However, careful attention must be given to the application of delayed internal fixation, especially intramedullary nailing, after external fixation.
Adolescent↗
Extensor carpi ulnaris syndrome. Findings in 43 patients.
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Adolescent↗
Immediate internal fixation for open fractures of the long bones of the upper and lower extremities.
Immediate open reduction with internal fixation was performed on 66 open fractures (54 patients) of the long bones in the upper or lower extremity, including one clavicle. Using the classification system of Gustilo, there were 13 (20%) type I, 30 (45%) type II, 11 (16%) type IIIA, six (9%) type IIIB, and six (9%) type IIIC soft tissue injuries. Thirty-two patients had associated major multiple trauma. Eighty-eight percent of the patients had good functional results using a modification of Katenjian's criteria. There were three late deep infections (4.5%), all at the sites of type III fractures. The nonunions occurred in four open fractures (6.1%). We conclude that, if a complete and timely debridement can be accomplished, immediate internal fixation of open fractures allows for improvement in ultimate function and a decrease in mortality in patients with multiple trauma. This procedure should be performed in selected patients who have type III open fractures, with careful attention to the general status of the patient and the severity of the soft tissue wound at the fracture site.
Adolescent↗
Isolated paralysis of the infraspinatus muscle.
We report six patients with isolated paralysis of the infraspinatus and discuss the diagnosis, pathology, treatment, and outcome over a mean follow-up period of 33 months. Four patients were shown to have space-occupying lesions at the spinoglenoid notch by MRI or ultrasonography or both, and ganglia were confirmed and removed surgically in three, with good results. Ganglia at this site are not uncommon and should be included in the differential diagnosis of patients presenting with shoulder pain and weakness.
Adolescent↗
The effect of superoxide production on the replantation of rat limbs after cold ischemia.
In order to clarify the effect of superoxide anion radicals on the "no-reflow phenomenon," the authors examined the utility of simple cold preservation of rat limbs in replantation. They quantified such radicals, derived from erythrocytes and plasma in the preserved limb, using a chemiluminescence method employing a derivative of luciferin (CLA). Eighty-four Lewis rat limbs were preserved at 4 degrees C in Euro-Collins solution for 10 to 120 hr, and grafted orthotopically to isogeneic rats by microsurgical technique. To determine the extent of oxidative stress, heparinized blood from the recipient animals was collected before, or at 5, 30, and 60 min after reperfusion, and chemiluminescence was measured in a total of 51 replantations. Cold ischemic groups at 0, 24, and 48 hr, with high rates of vascular patency, did not show a marked increase in superoxide anion concentration. However, there were significant differences in the production of superoxide between patent and non-patent cases in all groups, excluding a 120-hr ischemic group. This study showed that the increase in superoxide anion concentration after reperfusion following ischemia, correlates closely with the no-reflow phenomenon.
Animals↗
Histological examination of surface repair tissue after successful osteotomy for osteoarthritis of the hip joint.
In this study biopsy specimens of the surface repair tissue from the weightbearing area of the hip joint were collected from 15 patients who had undergone successful valgus osteotomy, and these were examined histologically. In 6 of the 15 patients the specimens stained strongly with safranin-O in all three layers of the matrix. However, the repair tissue from another 6 patients showed strong staining only in the intermediate and deep layers, while that from 2 patients stained only in the deep layer. Specimens from 5 patients were stained for S-100 protein and positive cells were detected in all cases, demonstrating that the cells in the repair tissue were chondrocytes. However, there was no tide mark in the repair tissue and the arrangement of the cells differed from that in normal cartilage. Discontinuity of the subchondral bone was also noted. These findings make it likely that the repair tissue was of bone marrow origin.
Adult↗
Protective effects of coenzyme Q10 on ischemia-induced reperfusion injury in ischemic limb models.
We examined simple cold preservation of rat limbs in Euro-Collins' solution to elucidate the protective effect of coenzyme Q10 (CoQ10) on the ischemia-induced reperfusion injury in an ischemic extremity replant model. A total of 126 Lewis rat limb replants were performed. Limbs were amputated from donor rats and preserved at 4 degrees C in Euro-Collins' solution and were orthotopically grafted to isogeneic rats by microsurgical technique. In the experimental groups (n = 42), coenzyme Q10 (10 mg/kg) was injected intraperitoneally into the recipients about 1 hour before reperfusion. In the control groups (n = 84), the same dose of solvent was given by the same route. We evaluated vascular patency of anastomoses by direct observation or microangiogram and performed histologic examinations 7 days after replantation. In the control groups, the ischemic limit was 96 hours. Ischemic limbs treated with coenzyme Q10 showed a statistically significant (p < 0.05) improvement in vascular patency after 72 and 96 hours of ischemia. Histologically, bone viability with osteoblastic activity was maintained in coenzyme Q10-treated animals of the 72-hour ischemic group. We conclude that the protective effect of coenzyme Q10 on reperfusion injury is suggested in this replant model.
Animals↗
Radiological evaluation on allograft reconstruction of the acetabulum combined with supporting device in revision total hip replacement.
We reviewed the radiographs of 25 hips of 20 patients who had received revisions of the acetabular components of total hip replacement supplemented by allograft for bone defects. Bone defects in 20 hips (80%) were classified into type D (cranio-central defect) according to Itoman's classification. In eight, sockets were installed directly on the allografts (group A). A metallic supporting device was used for reinforcing the grafts in 17 hips (group B). The position of the acetabular socket was measured on a radiograph, taken immediately after revision surgery and again at the latest follow-up. Using a MEM template, cranial and central migrations were determined. Mean cranial migration in hips of group A was 3.6 mm. Group B was 0.2 mm. Maintenance of thickness of the allografts was 60.6% in the cranial region and 75% in the central in group A. In the hips of group B, however, almost 100% of the initial thickness was maintained cranially and centrally. Allograft reconstruction of acetabular bone defect in revision total hip replacement is a beneficial procedure. The remaining pelvic bone is usually in poor condition, therefore, it is necessary to ensure primary fixation by the metallic supporting device.
Acetabulum↗