Biomedical subjects

Michael J Patzakis

Publications and source records attributed to Michael J Patzakis.

6 recordsLinked to original sources

PubMed2003

Gunshot femoral shaft fractures: is the current classification system reliable?

The reliability of the AO/Orthopaedic Trauma Association classification system has not been evaluated for diaphyseal fractures or fractures attributable to gunshot injuries. Therefore, the current authors assessed its reliability for diaphyseal femur fractures and investigated the effect of a gunshot mechanism of injury. Forty-seven diaphyseal femur fractures, 23 caused by gunshots and 24 caused by blunt trauma, were classified by four observers on two occasions. The interobserver and intraobserver reliability of each level of the AO/Orthopaedic Trauma Association classification was assessed with kappa statistics. Determination of fracture type had substantial interobserver and intraobserver reliability for gunshot and blunt injuries. Reliability decreased at the subsequent levels of the classification. Fractures caused by gunshots compared with those caused by blunt trauma were characterized by significantly lower interobserver agreement on fracture group (k = 0.26 versus 0.45) and subgroup (k = 0.21 versus 0.38). The AO/Orthopaedic Trauma Association classification system has substantial interobserver and intraobserver reliability when evaluating the type of diaphyseal femur fractures. Determination of fracture group and subgroup, however, progressively reduces the reliability of the classification, especially for fractures caused by a gunshot. Diaphyseal femur fractures caused by gunshots, by means of their fracture patterns, cannot be classified reliably with the AO/Orthopaedic Trauma Association classification system.

Femoral Fractures↗

PubMed2003

Laboratory monitoring in pediatric acute osteomyelitis and septic arthritis.

The purpose of the current study was to determine the usefulness of erythrocyte sedimentation rate and C-reactive protein in pediatric bone and joint infections treated with and without surgery. The medical records of 50 patients admitted for acute osteomyelitis, septic arthritis, or both were reviewed retrospectively. There were 22 patients with septic arthritis, 20 with osteomyelitis, and eight with osteomyelitis with adjacent septic arthritis. There were 25 patients each in the surgical and nonsurgical groups. There was a statistically significant difference between the two groups regarding mean days to peak and normalization of erythrocyte sedimentation rate values and normalization of C-reactive protein values. Statistically significant differences were revealed for the mean days to normalization of erythrocyte sedimentation rate and C-reactive protein values among the patients with a diagnosis of osteomyelitis, septic arthritis, or both. The mean days to peak and normalization for erythrocyte sedimentation rate and C-reactive protein were twice as long in the surgical group as compared with the nonsurgical group. Complete recovery was achieved by all patients. This information should help the clinician in the diagnosis and treatment of children having surgery for acute osteomyelitis and septic arthritis.

Acute Disease↗

PubMed2003

Musculoskeletal sepsis: principles of treatment.

Musculoskeletal sepsis is infection of bone, joints, muscles, and skin and often occurs after open fractures. Thus, the main objective in the treatment of open fractures in restoration of function and prevention of infection. It is important to consider all open fracture wounds as contaminated. The principles of open fracture treatment include taking appropriate cultures, instituting immediate systemic antibiotic therapy, surgical débridement and wound management, stabilizing the fracture, and early bone grafting when indicated. The open tibial fracture, classified according to Gustilo and Anderson, serves as an exemplary model for musculoskeletal sepsis because this type of injury is described extensively in the literature. Early diagnosis and effective surgical and antibiotic management can control musculoskeletal sepsis, and the suppression of infection may last a lifetime.

Anti-Bacterial Agents↗

PubMed2003

Newer methods of antimicrobial delivery for bone and joint infections.

The advantages of systemic therapy include the ability to deliver antibiotics to areas that cannot be reached with topical therapy, the choice of a large selection of agents directed against the pathogens encountered in orthopaedic infections, and arrest or eradication of infection in most cases (in conjunction with adequate débridement). Disadvantages include the potential for toxicity from systemic agents, difficulty in achieving high concentrations of antimicrobial agents at the site of infection, and problems with compliance. To combat these disadvantages, newer methods for the delivery of antimicrobial agents have been investigated. Some of these newer methods include new formulations of antimicrobial agents to decrease systemic toxicity and improved methods for delivering local antimicrobial therapy.

Absorbable Implants↗

PubMed2002

Osteomyelitis attributable to vancomycin-resistant enterococci.

Vancomycin-resistant enterococcus first was described in 1988, and has become a major problem in nosocomial infections. This is a retrospective review of 10 patients, seen at the authors' hospital during a 2-year period, with confirmed vancomycin-resistant enterococcal osteomyelitis: four patients had total joint arthroplasty infections, one patient had an infected tibial nail, three patients had infections associated with external fixators, and two patients had osteomyelitis of the femur. Four of the 10 patients had underlying medical illnesses (diabetes mellitus, systemic lupus erythematosus, human immunodeficiency virus infection); four of the 10 patients were intravenous drug users. Two patients had vancomycin-resistant enterococci on admission, and the other eight patients were admitted to the hospital for a mean of 21.3 days (range, 3-73 days) before vancomycin-resistant enterococci were identified in the bone. Eight of the 10 patients had monomicrobial infections with vancomycin-resistant enterococci. Patients were treated by surgical debridement, removal of hardware, and antibiotics (chloramphenicol in eight patients, quinupristin and dalfopristin (Synercid) in two patients). All patients initially improved with therapy, but one patient had a recurrence of vancomycin-resistant enterococcal osteomyelitis and died of bacteremia. Bone infections with vancomycin-resistant enterococcus still may be uncommon, but with time and selective antibiotic pressures, vancomycin-resistant enterococci may become a more prominent entity in orthopaedic infections.

Adult↗

PubMedDate not supplied

Open fractures: evaluation and management.

Open fractures are complex injuries that involve both the bone and surrounding soft tissues. Management goals are prevention of infection, union of the fracture, and restoration of function. Achievement of these goals requires a careful approach based on detailed assessment of the patient and injury. The classification of open fractures is based on type of fracture, associated soft-tissue injury, and bacterial contamination present. Tetanus prophylaxis and intravenous antibiotics should be administered immediately. Local antibiotic administration is a useful adjunct. The open fracture wound should be thoroughly irrigated and debrided, although the optimal method of irrigation remains uncertain. Controversy also exists regarding the optimal timing and technique of wound closure. Extensive soft-tissue damage may necessitate the use of local or free muscle flaps. Techniques of fracture stabilization depend on the anatomic location of the fracture and characteristics of the injury.

Fractures, Open↗