Biomedical subjects
Publications and source records attributed to P Slabaugh.
An unusual case of dislocation of the midfoot through the calcaneocuboid and naviculocuneiform joints is presented. The prognosis is excellent for most midfoot dislocations, as long as they are recognized and treated early.
The treatment of isolated ulnar shaft fractures is controversial. Previous studies comparing treatment options have been largely retrospective and nonrandomized. In this study, consecutive patients were randomized into treatment groups of long arm plaster immobilization, short arm plaster immobilization, or Ace Wrap bandage, based on the order of hospital admission. Thirty-one patients were followed until radiographic or clinical union, with no significant difference in time to union between groups. Age, sex, fracture pattern, and displacement did not significantly influence time to union or final angulation. Two patients in both the long arm cast group and the short arm cast group lost significant motion at final follow up. Seventy percent of patients in the Ace Wrap group failed treatment secondary to pain and were converted to plaster immobilization. Furthermore, patients in this group demonstrated significantly greater angulation than those treated in a long arm cast. Our results demonstrate that above-elbow plaster immobilization offers no advantage over below-elbow immobilization. We recommend short arm casting for a period of 8 weeks.
The effect of early mobilization and unrestricted weight bearing on final ankle motion in 51 operatively stabilized ankle fractures was prospectively investigated. Patients were treated with an ankle-foot orthosis (AFO) or a cast. Full weight bearing was unrestricted in both groups. Thirty-two fractures received an AFO and 19 received a cast. The follow-up period ranged from 2.3 to 66 months, with a median of eight months. At the final follow-up examination, the motion in the AFO-treated group was not functionally different from that of the cast-treated group. However, 72% of the patients treated in an AFO compared with 37% of patients treated in a cast had ankle dorsiflexion greater than 15 degrees (p = 0.014). No complications were directly related to the AFO. No loss of reduction occurred in any patient. The results of this series indicate that early motion of a fractured ankle treated operatively does not affect ankle motion. Early motion was not associated with increased morbidity or loss of reduction.
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The literature concerning tibial plafond fractures is briefly reviewed, and a series of 11 tibial plafond fractures of the compressive variety is presented. These fractures fall both prognostically and therapeutically into different categories based upon whether the primary mechanism of injury is rotational or compressive. The severity of the fracture, the degree of contamination, and the severity of concomitant soft-tissue injury in large part appear to determine the morbidity of surgical therapy in these patients. If rigid internal fixation can be performed in those patients with closed injuries that are primarily of the rotational type and performed with a minimum of soft-tissue trauma, this appears to be a reliable alternative in the hands of surgeons experienced with A-O technique and with this type of fracture specifically. In the presence of severe comminution and open wounds, however, the efficacy of rigid internal fixation performed by surgeons without great experience with these types of fracture is dubious.
Selective tenotomy of one or two heads of the quadriceps based on electromyographic criteria improved knee flexion in hemiplegic patients who walked with a unilateral stiff-legged gait. The improvement was greatest in eight patients in whom the rectus femoris was released, either with or without release of the vastus intermedius, with activity in pre-swing stance and initial swing confined to those heads of the quadriceps; in these patients knee flexion improved an average of 20 degrees. Knee flexion improved an average of only 8 degrees in five patients in who activity was present in one head of the quadriceps that was not surgically released. No improvement in knee flexion occurred in seven of eight patients in whom activity was present in two or more of the quadriceps heads that were not surgically released.
A Salter-Harris Type II fracture of the distal radius in a skeletally immature adolescent was irreducible by closed means. At open reduction, an invaginated periosteal flap was found to be responsible for the incomplete reduction. Removal of the flap resulted in an anatomic reduction.