Blood transfusion in orthopaedic operations.
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Adolescent↗
Biomedical subjects
M J Lemos
Publications and source records attributed to M J Lemos.
Assessment of initial fixation of endoscopic interference femoral screws with divergent and parallel placement.
Divergence of the interference screw placement used for femoral fixation during endoscopically assisted reconstruction of the anterior cruciate ligament has been described. This study is a biomechanical evaluation in 12 pairs of fresh intact bovine knees of femoral interference screws placed divergently and parallel relative to the bone block and its tunnel. One knee of each pair had the interference screw placed in a parallel fashion and the other knee had a 15 degrees divergence from the bone plug. Paired specimens were used to provide an optimal comparison of biomechanical data of the two different screw placements. No statistically significant differences were seen between the two groups when looking at ultimate load, deformation, and stiffness. Mode of failure was of more concern: in 4 of 12 divergent constructs, bone plug pullout occurred compared with only 1 of 12 in the parallel construct. The pullout strength remains high even with divergence of up to 15 degrees between the bone plug and femoral interference screws placed endoscopically.
Animals↗
Radiographic analysis of femoral interference screw placement during ACL reconstruction: endoscopic versus open technique.
Fifty patients with anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft performed by two techniques were evaluated roentgenographically to compare the position of the femoral interference screws. Group I consisted of 25 patients in whom the screw was placed using a distal lateral femoral incision (the two-incision technique). Group II patients underwent arthroscopically assisted intraarticular placement of the screw. These patients were then evaluated with anterior-posterior (AP) and lateral roentgenograms. We observed that the AP and lateral screw angles were significantly different with the two techniques. In addition, the endoscopic placement of the femoral screw had an associated divergence of the screw relative to the bone plug in nine of 25 patients compared with zero of 25 in the open group. In conclusion, radiographic differences do exist between femoral interference screws placed for fixation of an ACL graft using the open approach and those placed endoscopically. Although the clinical significance of these differences is not known, we raise the question of greater divergence in femoral interference screw placement with the newer intraarticular femoral interference screw placement techniques.
Anterior Cruciate Ligament↗
Pulmonary embolism in total hip and knee arthroplasty. Risk factors in patients on warfarin prophylaxis and analysis of the prothrombin time as an indicator of warfarin's prophylactic effect.
This study was designed to identify those total arthroplasty patients at high risk for embolism even while on a proven warfarin prophylactic regimen and to identify the measure of anticoagulation that would be most efficacious in the prevention of pulmonary embolism (PE). A series of 2348 total arthroplasty patients had a preoperative perfusion scan and a postoperative ventilation/perfusion scan. All patients were placed on a low-dose warfarin protocol. Eighty-one patients were identified as having a PE by pulmonary arteriography (incidence of 3.4%). Of these, 89% were asymptomatic and no case was fatal. A control group of 159 patients without PE was used for comparison. Patients older than 65 years of age with a history of genitourinary infection were identified as being at higher risk of PE while on a proven warfarin prophylactic program. These patients may need additional prophylactic measures to reduce the risk of PE. In contrast, patients with a history of phlebitis, PE, obesity, or varicosities were not at excess risk for PE while on warfarin prophylaxis; therefore, no additional prophylactic measures are required. All prothrombin time profiles were within the prophylactic range. Therefore, the actual prothrombin time may not be the critical determinant of the level of anticoagulation or prophylaxis achieved.
Analysis of Variance↗
Scalp lacerations resulting in hemorrhagic shock: case reports and recommended management.
Scalp lacerations may bleed profusely when not adequately controlled. Three cases of isolated scalp lacerations that resulted in hemorrhagic shock are reported. A technique for achieving hemostasis using scalp clips is presented. Rapid assessment and early hemostasis of scalp lacerations are advocated, especially in the patient with multiple injuries.
Accidents, Traffic↗
Posterior spinal arthrodesis for atlantoaxial instability in Down syndrome.
Nine children with Down syndrome who had atlantoaxial instability underwent posterior spinal fusion. At follow-up, all patients had stabilization or improvement of their neurologic symptoms. Evaluation of the spine using flexion and lateral radiographs, as well as selective cineradiography, showed no instability over the fused area or adjacent motion segments. Stable fibrous union with no clinical significance was noted in three of the nine patients. We recommend posterior spinal fusion in situ with external immobilization as the safest and most effective means of surgical stabilization in the patient with Down syndrome who has symptomatic atlantoaxial instability.
Adolescent↗
Acromioclavicular separation. Reconstruction using synthetic loop augmentation.
A total of 110 patients with a diagnosis of acromioclavicular joint separation were seen at our clinic between 1986 and 1991. Of these, 14 patients (12.7%) with grade III, IV, or V injuries required surgical reconstruction and were examined 2 years after surgery. All 14 patients underwent acromioclavicular reconstruction using a synthetic loop passed through drill holes in the base of the coracoid and the anterior third of the clavicle. When the loop is tightened, the clavicle is reduced anatomically without the anterior subluxation caused by simple clavicular cerclage. At an average followup of 44.2 months, patients were evaluated using the University of California, Los Angeles, rating scale. Twelve of the 14 had good or excellent results and returned to normal sport and work activities at 6 months. Of the two initial poor results, one required revision 1 month post-operatively because the patient was noncompliant, and the other required manipulation under anesthesia 3 months after surgery. The results in these two patients at 2 years were good and excellent, respectively. We concluded that, when medically indicated, fixation of the clavicle to the coracoid using this technique yields satisfactory results in an athletic population.
Acromioclavicular Joint↗
The evaluation and treatment of the injured acromioclavicular joint in athletes.
Injuries to the acromioclavicular joint are among the most commonly occurring problems in the athletic patient population. However, these injuries are often confused with other problems associated with the shoulder complex. This confusion was noted by Hippocrates (460-377 BC), who realized that acromioclavicular dislocation often was misdiagnosed as a glenohumeral injury. Galen (129-199 AD) experienced an acromioclavicular dislocation and could not tolerate the tight bandaging recommended at the time and thus became one of the earliest noncompliant patients. The understanding of acromioclavicular injuries and their management has evolved rapidly during the last 2 decades. This review will clarify the current concepts in the management and treatment of acromioclavicular injuries in the athlete.
Acromioclavicular Joint↗