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Biomedical subjects

M Tile

Publications and source records attributed to M Tile.

At least 37 records · Page 2Linked to original sources
PubMed1987

Anterior approach and stabilization of the disrupted sacroiliac joint.

Pelvic fractures with disruption of the important weight-bearing sacroiliac area can lead to impaired gait due to malunion or pelvic obliquity, back or buttock pain arising from the sacroiliac joint, and permanent neurologic damage. In eight patients with sacroiliac joint dislocation, an anterior retrofascial approach and stapling of the sacroiliac joint was performed. Six of these patients maintained an anatomic reduction of the sacroiliac joint and their results were rated as excellent. Two of the eight patients had a slight loss of reduction and because of intermittent mild pain were rated as having fair results. In another eight patients, plate fixation of the anterior sacroiliac joint was done. New stabilization methods utilizing dynamic compression plates, reconstruction plates, and a new four-hole plate have been developed to provide more secure fixation of these unstable injuries.

Adult↗
PubMed1987

The unstable pelvic fracture. Operative treatment.

While the pendulum has swung to the operative side, open reduction and internal fixation will surely not prove to be the panacea for all unstable pelvic fractures. The lasting effects, however, of attempts at aggressive fixation of the pelvic fracture will be the principles of management that are being established. This begins with the recognition of pelvic instability. It is in these unstable injuries that obtaining and maintaining an anatomic reduction is the best way to alter the natural history of the untreated pelvic fracture and to maximize the probability of obtaining a good long-term result. While the actual methods of internal and external fixation will continue to change, this principle is unlikely to alter. Therefore, if effective treatment can be achieved by closed means alone, that is an acceptable method. Similarly, external, internal, and combined operative and traction treatment methods that achieve this goal would also be acceptable. The question remains: Which method achieves the goal of obtaining and maintaining an anatomic reduction yet minimizes the early and late morbidity? This question is best answered by appropriate preoperative evaluation, subsequent planning, and precise, technically skillful surgery done by an experienced surgeon.

Bone Plates↗
PubMed1986

Centrode characteristics of the lumbar spine as a function of segmental instability.

A cadaveric study provides a quantitative measurement of early degenerative disc disease before significant radiographic changes are present. Accurate assessment of spinal motion is hampered by the inaccessibility of the lumbar joints and because of the small range of motion at each motion segment. Using Moiré fringes and, more recently, computerized digitization of spinal motion, the authors have developed a technique of measuring centers of rotation for small ranges of motion. The centers of rotation when joined form a locus that has characteristics that allow one to identify spines with degenerative disc disease. These loci, or centrodes, are longest in the earliest stages of degeneration, but maintain their length through moderate degenerative disc disease. Furthermore, radiographic changes consistent with moderate disc disease are associated with inferior migration of the centrode.

Biomechanical Phenomena↗
PubMed1986

Immediate internal fixation of open fractures of the diaphysis of the forearm.

Between 1975 and 1983, fifty-seven patients were treated at Sunnybrook and Harborview Medical Centers with immediate internal plate fixation of an open diaphyseal fracture of the forearm. Fifty patients were available for follow-up, which ranged from one to nine years and averaged three years. The injuries were classified on the basis of the extent of soft-tissue injury as defined by Gustilo and Anderson, and consisted of twenty Type-I injuries, nineteen Type-II injuries, and eleven Type-III injuries. The complications included deep infection in two patients and non-union in six. The functional results were excellent or good in 85 per cent of the series. This study demonstrates that immediate stable plate fixation is a beneficial method of treatment of open fractures of the forearm. The results are related to the severity of the initial soft-tissue injury and the surgical technique. Autogenous cancellous bone-grafting at the time of closure of the wound in comminuted fractures in which interfragmental compression cannot be obtained is recommended.

Adolescent↗
PubMed1985

Moiré patterns: an accurate technique for determination of the locus of the centres of rotation.

This study describes an accurate technique for the determination of the centre of rotation of small angles. The moiré fringe method localizes the centre of rotation by defining two primary fringes, each of which is found by the intersection of three lines. The primary fringes intersect at the centre of rotation at 90 degrees to each other, the angle least likely to produce an error in measurement. By utilizing joints with known centres of rotation, we have found that the method is extremely accurate and reproducible to within 2 mm of the real centre for angular changes as small as 3 degrees. This technique is useful in evaluating whether a joint is a simple hinge, i.e. rotating about a single axis of rotation or whether the joint moves about a changing axis of rotation referred to as a locus or centrode.

Arthrography↗
PubMed1985

Centrode patterns and segmental instability in degenerative disc disease.

Moiré fringes were used to determine centrode patterns in cadaveric spines with degenerative disc disease. The normal centrodes were compared with those with minor, mild, moderate, and severe degenerative disc disease. The most complex loci noted were those discs that showed minimal radiographic evidence of degeneration, that is, the minor and mild groups. The loci lengthened significantly (P less than 0.001) when compared with normal controls. The position of the centrode shifted downward into the body of L5 in the moderate group.

Adult↗
PubMed1984

Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study.

Since 1970, when the concept of continuous passive motion (CPM) was originated by one of the authors (R.B.S.), he and a succession of his research fellows have investigated its biological effects on the healing and regeneration of articular tissues in a wide variety of experimental models in rabbits. From this basic research he concluded that CPM is well tolerated, seems to be painless, stimulates the healing and regeneration of articular tissues, prevents joint stiffness, and permits the normal healing of arthrotomy incisions. Beginning in 1975, one of the authors (H.W.H.), and in 1978, the remaining authors, (from two additional Canadian cities) applied the knowledge from the basic research on CPM to the orthopaedic care of human patients. The CPM devices for humans (CPM Mobilimbs), which have been designed in collaboration with University of Toronto engineers, include, to date, devices for the ankle-knee-hip, the elbow, and the finger. Indications for CPM in patients have been the immediate postoperative management following such operative procedures as open reduction and internal fixation of fractures, arthrotomy and arthrolysis for post-traumatic arthritis, synovectomy, surgical drainage for septic arthritis, release of extraarticular contractures, metaphyseal osteotomies, total joint replacement, and ligamentous reconstruction. The case reports of nine selected patients are presented as examples of the clinical application of CPM. These patients have been relatively free of pain, have maintained the increased motion gained at operation, and have accepted the application of CPM well. There have been no complications of CPM; the operative wounds have healed well and the period of hospitalization has not been prolonged. The authors believe that the clinical application of CPM is feasible and that the clinical and radiographic results of CPM in these patients are encouraging. Long-term, prospective clinical investigations (including control patients in whom CPM is not used) will be required to assess the efficacy of CPM in relation to the various stated indications.

Adolescent↗
PubMed1984

Computer analysis of spinal segment motion in degenerative disc disease with and without axial loading.

The center of rotation of the spinal motion segment is an indicator of spinal instability. However, the motion segment does not move about a single fixed axis of rotation, but rather a locus of instantaneous axes of rotation, the centrode. This paper studies centrodes in various stages of degenerative disc disease comparing them with normal spines. Computer analysis is undertaken in 47 cadaveric spines, 22 of which also were evaluated with axial loading. The normal centrode fell within the posterior half of the disc space and averaged 21 mm in ten specimens. In the earliest stages of degenerative disc disease, the centrode lengths increased significantly (average 116 mm). Specimens with moderate disc degeneration also migrated inferiorly into the L5 vertebra. Axial loading did not appear to influence the centrode lengths or position. This technique is highly sensitive, detecting 94% of the abnormal spines as compared with only 25% detected by means of measuring an excessive range of motion on flexion and extension radiographs. This method provides a highly reliable and quantifiable method of detecting early changes in spinal motion in degenerative disc disease prior to the well recognized radiographic abnormalities.

Biomechanical Phenomena↗
PubMed1982

Harrington instrumentation as a method of fixation in fractures of the spine.

The results of the use of Harrington rods in the treatment of spinal fractures were reviewed. It was found that with burst fractures where the anterior pillar was deficient there was a significant incidence of loss of reduction. Anterior bone supplementation is recommended in these fractures when major loss of height or angulation occurs. Several technical faults were detected which, in most cases, also led to a loss of reduction. Almost all patients with an anatomical reduction were free of pain. There was no correlation between the loss of reduction and the lapse of time before operation, the levels of instrumentation, the length of the fusion, the severity of the initial deformity, the degree of initial correction or the presence or absence of a neurological deficit.

Fractures, Bone↗
PubMed1982

A radiographic analysis of 166 Charnley-Müller total hip arthroplasties.

A review of 166 total hip arthroplasties, with follow-up from six months to 11 years, showed a 73% incidence of femoral "looseness," 22% incidence of progressive femoral "loosening" and 95% incidence of acetabular "looseness" for all radiolucent line sizes. Part of the reason for the high incidence of femoral "looseness" may be explained by the rigorous criteria in the authors' definition of "looseness." However, femoral "looseness" remains high at 47% and 36% incidences at the cement-bone and cement-stem interfaces, respectively, for radiolucent lines greater than 1 mm. Only one trochanteric osteotomy was performed and it is suggested that omission of trochanteric osteotomy results in inadequate cement filling of the femoral stem, as well as a lack of proper placement of the stem, contributing to the high incidence of femoral "looseness." Larger and more tapered stems, with routine trochanteric osteotomy, together with the use of low viscosity cement under pressure, should be investigated to reduce the incidence of femoral "loosening" and necessity for revision. The Harris Hip rating was found to have good correlation with the radiologic findings of loose and nonloose femoral stems.

Bone Cements↗
PubMed1980

Pelvic fractures: operative versus nonoperative treatment.

These most difficult patients require an expert early general assessment and rapid resuscitation. We have suggested a treatment algorithm that has helped us in managing these patients. The degree of posterior instability in the initial radiographs of the pelvis is of considerable prognostic value. The patient's bone injury should be rapidly assessed by history, physical examination, and radiological examination, and treatment should progress in a logical fashion on the basis of that assessment. We have found the use of the external skeletal fixator to be helpful in some types of pelvic injury. One must remember, however, that the present external fixators that fix the anterior hemipelvis only may produce increased deformity across the posterior structures in cases of posterior instability of the ring. Refinements in technique may eventually solve that problem. Further research into pelvic biomechanics is required to improve our methods of management of these difficult patients.

Adult↗
PubMed1980

Fractures of the acetabulum.

A rational approach to acetabular fractures based on a precise diagnosis of the fracture pattern is suggested. The surgeon must adopt an individual approach to these difficult problems and precisely define the type of patient, the type of health care team, and the type of fracture he is dealing with. If the principles of treatment of lower extremity joint fractures are followed, logical management will ensue. If an operative approach is indicated, careful planning is needed to choose the proper approach so that the surgeon can achieve anatomic reduction and rigid fixation. Failure to do so will add needless trauma to an already traumatized patient and compromise the end result as much as will failure to achieve congruity by closed means.

Acetabulum↗
PubMed1980

Pelvic disruption: assessment and classification.

A precise radiologic technique for assessing the forces producing pelvic disruption has been helpful in arriving at a logical classification of pelvic injury. The radiologic examination should include anteroposterior, inlet and outlet views, as well as tomograms and occasionally computed-assisted tomographic evaluation (CT scanning). On the basis of this radiologic assessment with some biomechanical studies, a classification of three major forces producing injury is suggested. The anteroposterior and lateral compression types, while vastly different, may both have stable and unstable subtypes associated with them. The vertical shear fracture is always unstable. An accurate history and physical examination in conjunction with the above radiologic principles will lead the surgeon to a precise determination of the fracture pattern. A knowledge of the forces necessary to produce this pattern is helpful in the management of the patient with this particular traumatic lesion.

Adult↗
PubMed1980

Pelvic disruption in the polytraumatized patient: a management protocol.

This article reviews the experience with the management of 79 polytraumatized patients with pelvic fractures. The incidence of involvement of other systems was measured by the injury severity score. The average severity score was 33.5, and the mortality was 19%. Patients with a posterior disruption of the pelvis had a higher mortality, a higher "injury severity score," and required greater resuscitation efforts. Resuscitation of these patients requires efficient effective action. Adherence to our management algorithm, based on assessment of the patient's response, should help achieve that end.

Adolescent↗
PubMed1980

Pelvic disruption: principles of management.

Using the previously outlined classification of pelvic disruption to assess the displacement and stability, a logical method of treatment for the individual case follows. Anteroposterior fractures of the open-book variety and with intact posterior sacroiliac ligaments require simply reduction of the fracture (closure of the book), and immobilization by a sling, plaster spica or external skeletal fixators. The lateral compression types all produce some degree of inward rotation of the hemipelvis. If the supine position does not reduce the hemipelvis spontaneously, a general anesthetic and the application of external rotation forces are often required. Immobilization can be maintained either by complete bed rest with traction through a supracondylar femoral pin or with external skeletal fixators. Pelvic slings or binders will increase the deformity and are contraindicated. The very unstable types of vertical shear fractures can be reduced easily with traction, but maintenance of reduction is difficult. Fracture healing may be delayed because of instability through the hemipelvis and some degree of compression through the posterior fracture is desirable, either by various forms of external skeletal fixation, or occasionally by open reduction. Pelvic fractures associated with acetabular disruption and requiring open reduction of the acetabular fracture also require anatomic repositioning of the pelvic fragments simultaneously, in order to anatomically restore the integrity of the acetabulum. Finally, the pelvic fracture should not be neglected during the early phase of general resuscitation of the patient, but management should proceed concomitantly with the management of the associated injuries. Delay in treatment of the pelvic injury makes management much more difficult and even hazardous at a later phase.

Acetabulum↗
PubMedDate not supplied

Analysis of the analgesic efficacy of acetaminophen 1000 mg, codeine phosphate 60 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg in the relief of postoperative pain.

Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. They also rated pain relief, pain half gone, and any adverse effects. Sum of pain intensity difference and total pain relief scores were analyzed using Dunnett's procedure. The drug combination was statistically superior to codeine as measured by SPID, TOTPAR, pain half gone, and time to remedication. The combination achieved better mean scores than acetaminophen on all efficacy measures, but was (marginally) statistically superior only in pain half gone. No appreciable differences in adverse effects were noted among the treatments. The difficulty of showing the analgesic efficacy of codeine in a single dose trial is discussed.

Acetaminophen↗
PubMedDate not supplied

The role of surgery in nerve root compression.

If nonoperative treatment fails to relieve the symptoms of nerve compression in a 6-8 week period, surgical decompression may be indicated. Prior to embarking on such a course the surgeon must have a precise neurologic diagnosis. This diagnosis must be clinical, with corroborating radiographic, electrodiagnostic and nerve block evidence. The important concept is: think nerve root. Surgical management must be tailored to the individual, depending on that individual's local anatomy and local pathology, be it disc or lateral bony entrapment. The surgeon should not have preconceived ideas about the cause of nerve compression and should be guided by the findings at operation. To prevent intractable back pain following nerve decompression, those patients with spondylolisthesis or segmental instability should be considered candidates for a spinal fusion.

Humans↗