Biomedical subjects

Michael J DeFranco

Publications and source records attributed to Michael J DeFranco.

5 recordsLinked to original sources

PubMed2006

Stress fractures of the femur in athletes.

Femoral stress fractures represent an uncommon but important lower-extremity injury in athletes and soldiers. Careful assessment of the involved and contralateral lower extremity and the spine is required to make the diagnosis. Based on a review of the literature, specific treatment is based on individual patient assessment. In most cases, nonoperative management results in an excellent outcome. Certain fractures will require operative intervention to prevent displacement or to reduce a displaced fracture and return stability to the lower extremity. Complications in athletes with femoral stress fractures are rare. Most athletes can expect to return to their preinjury level of competition, if they are compliant with the treatment plan.

Adult↗

PubMed2006

Radial nerve injuries associated with humeral fractures.

A radial nerve injury associated with a humeral shaft fracture is an important injury pattern among trauma patients. It is the most common peripheral nerve injury associated with this fracture. Although treatment for this injury pattern is a controversial subject among upper-extremity surgeons, certain principles of management need to be applied in all cases. As our understanding of the pathoanatomy of the humerus and surrounding neurovascular structures has evolved, surgeons have adapted their strategies to improve outcome and avoid long-term morbidity. The principles of management and the clinical outcomes of various treatment strategies, defined in the literature, are reviewed in this article.

Braces↗

PubMed2006

Evaluation and management of valgus impacted four-part proximal humerus fractures.

UNLABELLED: A valgus impacted, four-part humerus fracture is an uncommon but important injury to recognize in patients with orthopaedic trauma. Recognizing this fracture pattern and understanding the pathoanatomy of it are essential to providing appropriate care. The treatment options for valgus impacted, four-part humerus fractures range from nonoperative care to hemiarthroplasty. The peer-reviewed literature provides insight into the important factors to consider in deciding how to treat patients with valgus impacted, four-part humerus fractures. Recently, less invasive surgical techniques have been reported as a way to preserve the blood supply to the articular fracture fragment, which decreases the risk of developing avascular necrosis. Even though these techniques are becoming more popular, they are not indicated for all patients. Surgeons must use an individualized approach for each patient with this fracture. Satisfactory results have been reported for the nonoperative and operative techniques used to treat valgus impacted, four-part humerus fractures. However, less invasive procedures may help to achieve a more favorable clinical outcome. Limiting the surgical approach and achieving stabilization with minimal fixation helps to preserve the viability of the humeral head and to prevent postoperative morbidity related to osseous and soft tissue healing. Hemiarthroplasty becomes a reasonable treatment option in older patients with substantial displacement of the fracture fragments and poor bone quality that would not support internal fixation. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty↗

PubMed2006

The floating shoulder.

The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, recent studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Determining the specific injury patterns indicates the potential for significant instability, and correlating these patterns with clinical outcome is a challenge. Because the degree of ligament disruption is difficult to assess on radiographs, indications for nonsurgical and surgical management are not well defined. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain, and the indications for surgery can be controversial. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, and often indirectly reduces the scapular neck fracture. Fixation of both fractures is recommended in certain fracture patterns. Because these controversies cannot be resolved by current evidence, surgeons must choose an individualized approach based on an understanding of the pathoanatomy and personal experience.

Clavicle↗

PubMedDate not supplied

New therapies in tendon reconstruction.

Despite the use of various types of grafts, no surgical treatment currently exists to restore a tendon to its normal condition. Tissue engineering techniques are being used to develop therapies for tendon reconstruction. Biologic and synthetic scaffolds can both repair tendon defects and improve healing by allowing for the regeneration of the tendon's natural biologic composition to restore its mechanical capacity. This process can be further enhanced through augmentation methods such as cell seeding, growth factor implantation, and gene therapy.

Genetic Therapy↗