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Biomedical subjects

R B Gustilo

Publications and source records attributed to R B Gustilo.

At least 55 records · Page 3Linked to original sources
PubMed1988

Reduction in cement-bone interface shear strength between primary and revision arthroplasty.

This study quantified changes in the cement-bone interface shear strength between primary and first- and second-revision arthroplasties as a function of mechanical interlock between the cement and bone. There were 128 segments obtained from four pairs of fresh human femora that were prepared sequentially as for primary and first and second revisions, taking care to maintain original canal morphology. Cement was pressurized into the cavity of the anatomic specimens, and the maximum interface shear strength between the cement plug and the bone was experimentally determined for each revision. First-revision interface shear strength was reduced to 20.6% of primary strength, and second revision strength to 6.8% of primary strength.

Adult↗
PubMed1988

Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study.

Patellar prosthesis positioning in 40 primary total knee replacements was evaluated with regard to (1) patellar tilt, (2) angle between the patellar component and patellar bony remnant, (3) lateral versus medial placement, (4) patellar height, and (5) size of the patellar component versus patellar length. Two different designs were evaluated. Twenty knees that were resurfaced with a patellar button prosthesis and implanted with conventional surgical technique constituted Group A. Twenty knees that were resurfaced with a new biconvex prosthesis and implanted with specially designed instrumentation constituted Group B. For Group A, the patellar tilt averaged 4.25 degrees preoperative and 8.35 degrees postoperative. For Group B the patellar tilt averaged 4.60 degrees preoperative and 1.83 degrees postoperative. In Group B, there was significant improvement in patellar position, with only two patients showing values exceeding the neutral range (p = 0.0409). The angle between the patellar component and the bony remnant in Group A averaged 5.975 degrees, and in Group B, 1.447 degrees. Two patients in Group A and 18 patients in Group B had values in the normal range for patellar tilt and the angle between the prosthesis and the bone. The prosthesis was inserted medial to the patellar center in six patients in Group A and one patient in Group B. A significant decrease in patellar height was noted for both groups, but values were still within the normal range. Both groups showed significant increase in the postoperative articular length, indicating that oversized prostheses were inserted and excess bone removed.

Follow-Up Studies↗
PubMed1988

Comparative analysis of ankle arthroplasty versus ankle arthrodesis.

In a retrospective study of 41 patients with total ankle arthroplasty (25 patients) and ankle arthrodesis (18 patients), the mean follow-up period was 3.8 years for total ankle arthroplasties and 3.3 for ankle arthrodeses. Sixteen of the 23 ankle arthroplasty patients, and 17 of the 18 arthrodesis patients had good or excellent results. Total ankle arthroplasty was successful in patients with rheumatoid arthritis, but not posttraumatic arthrosis. Total ankle arthroplasty is indicated in rheumatoid patients with severe ankle involvement who have not responded to medical management. It also may be used in the elderly or debilitated patients who will place minimal stress on the ankle. The elderly may not tolerate the prolonged immobilization or repeated operations that fusion may require. Total ankle arthroplasty should not be used in young patients with posttraumatic arthrosis.

Adult↗
PubMed1988

Radiographic changes in bone dimensions in asymptomatic cemented total hip arthroplasties. Results of nine to thirteen-year follow-up.

On twenty-six cemented total hip replacements that had been followed for an average of 10.4 years (range, nine to thirteen years), a retrospective radiographic study was done to assess dimensional changes in the cross section of the bone in a group of asymptomatic patients. Cortical dimensions were measured on radiographs and were normalized using a radiographic distortion factor that was derived from the width and length of the prosthesis. The data were then analyzed using a least-squares method. Analyses were performed for the men, for the women, and for the combined group. The results for all three groups showed a significant decrease in cortical thickness as well as widening of the medullary canal, but no periosteal expansion.

Adult↗
PubMed1988

Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening.

Fifty-seven hips (55 patients) had revision for failed cemented femoral component loosening using titanium ingrowth femoral components and cancellous bone grafting. The patients' average age was 59 years (range, 25-86 years), and the average follow-up period was 2.8 years (range, two to six years). The preoperative hip score averaged 45.5 (range, 10.0-80.7) and the postoperative hip score averaged 82.5 (range, 43.0-100.0). Complications included dislocation (4.0%), infection (4.0%, one recurrence from a previously infected hip and one acute hematogenous infection), and a 4.0% revision rate for loose femoral component. Another patient had a revision for a loose acetabular component. All parameters of hip function (i.e., pain, limp, activities of daily living, use of support, and distance walked) improved with time. Femoral component loosening is classified into four types based on the severity of loosening and instability. In Type I there is minimal endosteal or inner cortical bone loss, i.e., loosening from the cement-metal-bone interface or a broken stem (seven hips). In Type II there is proximal canal enlargement with cortical thinning of 50% or more and sometimes a lateral wall defect with an intact circumferential wall (23 hips). In Type III there is a posteromedial wall defect involving the lesser trochanter (23 hips). In Type IV there is total proximal circumferential bone loss in varying distances below the lesser trochanter (three hips). The Harris hip scores for the four groups were 93.0, 83.0, 80.0, and 78.0, respectively.

Adult↗
PubMed1987

Classification of type III (severe) open fractures relative to treatment and results.

Severe type III open fractures were subtyped according to the differences in prognosis for sepsis, amputation, and treatment: IIIA (adequate soft-tissue coverage of bone with extensive soft-tissue laceration or flaps), IIIB (extensive soft-tissue loss with periosteal stripping and bone exposure), and IIIC (arterial injury requiring repair). Analysis of 303 open fractures revealed a sepsis rate of 0% in type I, 2.5% in type II, and 13.7% in type III. The rate of amputation was 18.7%, and the rate of nonunion was 18.5% in type III open fractures. Type IIIA, IIIB, and IIIC open fractures had sepsis rates of 5%, 28%, and 8%, and amputation rates of 2.5%, 5.6%, and 25%, respectively. The overall wound sepsis rate in the 303 open fractures was 4.4%, and the nonunion rate was 8.6%.

Amputation, Surgical↗
PubMed1986

Revision of femoral component loosening with titanium ingrowth prosthesis and bone grafting.

Preliminary results of 24 cementless revision hips are very encouraging and show no evidence of loosening at 12 to 45 months follow-up. With the problem inherent in femoral component loosening and the high incidence of failure from cemented revision total hip arthroplasty, the use of a porous ingrowth long stem prosthesis fitted to the canal with bone grafting proximally offers a logical solution to a very difficult problem.

Adult↗
PubMed1986

Critical analysis of results of treatment of 201 tibial shaft fractures.

Two hundred one tibial shaft fractures, 160 closed and 41 open (Grades I and II), were treated between January 1978 and June 1982. Sixty patients underwent closed intramedullary Arbeitsgemeinschart Osteosynthesisfragen/Association for the Study of Problems of Internal Fixation (AO/ASIF) nailing with reaming and 141 patients were treated with closed reduction and cast immobilization. Intramedullary nailing resulted in one (1.7%) nonunion, two (3.3%) infections, and no malunions. In the cast treatment group there were 14 (9.9%) delayed or nonunions, two (1.4%) infections, and six (4.3%) malunions. Within this group there were 19 early failures from either inadequate reduction or loss of reduction, which led to a change from nonoperative to operative methods of management. The interval between injury and return to work was 22 weeks in the nailed group, compared with 25.8 weeks in the cast immobilization group.

Adolescent↗
PubMed1985

Epidemiology, mortality and morbidity in multiple trauma patients.

Three hundred, twenty-nine multiple trauma patients with skeletal injuries admitted to Hennepin County Medical Center, Minneapolis were analyzed for mortality and morbidity based on injury severity score (ISS) and timing of fracture stabilization. Fifty-three deaths (16%) occurred with 38% dying during the first six hours. Survival prospects with injury severity score over 40 were bleak. Age, sex, mechanism of injury, and time of occurrence of injury was also tabulated. Two hundred, twenty-nine patients with 474 long bone fractures were analyzed based on timing of fracture stabilization: immediate stabilization within 24 hours; delayed primary stabilization over 24 hours to one week; secondary osteosynthesis more than one week; non-operative treatment. Respiratory distress syndromes occurred in 6%, 2.4%, 9%, and 12%; mortality rate of 3%, 0%, 6.4%, and 26% for treatment groups A, B, C, and D respectively. However, it must be noted that treatment group B with lower ARDS and mortality rate had no type III open fractures and lower injury severity score.

Adolescent↗
PubMed1985

Results of operative treatment of displaced external rotation-abduction fractures of the ankle.

One hundred and fifty patients with a displaced fracture of the ankle caused by external rotation-abduction forces were treated by open reduction and rigid internal fixation. After an average follow-up of three and one-half years, the results were satisfactory in 90 per cent. Less satisfactory results were noted in the more severely injured ankles. We found that the ruptured deltoid ligament did not need to be repaired if the lateral side was anatomically and rigidly fixed; in the Maisonneuve fracture, restoration of the fibular length was as important as stabilization of the fracture; with the use of the suprasyndesmotic screw, walking was permissible with the screw in situ; conforming the plate to the bend of the lateral malleolus was essential; and as much as two millimeters of lateral residual displacement of the lateral and medial malleoli was compatible with a satisfactory result, as was a similar displacement of the talus provided there was anatomical restoration of the lateral side.

Adult↗
PubMed1984

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures.

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976-1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

Adolescent↗
PubMed1984

The use of preventive antibiotics in orthopaedic surgery.

The use of preventive antibiotic therapy in patients with femoral neck fractures and those treated by prosthetic joint arthroplasty is an accepted practice, yet it remains controversial in other clean orthopedic surgical procedures. The devastating consequences of prosthetic joint infection are the major rationale for antibiotic prophylaxis. Recent data indicate that some of the unfavorable effects of antibiotic prophylaxis, such as the expense and drug-related side effects, can be limited by restricting the duration of antibiotic use. The critical importance of instituting antibiotic therapy immediately prior to surgery is emphasized. The authors currently favor, for most clean, elective orthopedic surgeries, two grams of cefazolin administered intravenously immediately prior to surgery and one gram every eight hours for 24 hours after surgery. This view is reinforced by comparing the incidence of infection in 1341 total joint arthroplasties (0.6% infection rate) receiving three days of antibiotic prophylaxis and 450 cases (0.6% infection rate) receiving one day of antibiotic prophylaxis. Patients with prosthetic joints should be instructed regarding the possibility of late infections and encouraged to take antibiotic prophylaxis for various surgical procedures. Patients are further urged to notify their orthopedist in the event that any significant infectious process is present.

Anti-Bacterial Agents↗
PubMed1984

Refracture of bones of the forearm after plate removal.

Thirty-two plates originally used for fracture fixation in the ulna and radius in twenty-three patients were removed at Hennepin County Medical Center in Minneapolis between 1977 and 1982. The plate was on the ulna in eighteen arms and on the radius in fourteen. Removal of twenty-one plates was elective, and eleven were removed because of slight pain or discomfort. The interval between plate application and plate removal ranged from eight to sixty-two months. The average duration of cast immobilization used for protection after removal of the plate was six weeks. There were seven refractures, which occurred between two and forty weeks after plate removal. Three refractures occurred at the former fracture site; three, through the fracture site, extending into an adjacent screw-hole; and one, at one screw-hole. No refracture occurred more than forty weeks after removal of the plate.

Adolescent↗
PubMed1983

Critical analysis of results of 53 Malgaigne fractures of the pelvis.

Critical analysis of 53 cases of Malgaigne fracture of the pelvis was undertaken at Hennepin County Medical Center, Minneapolis, over a 10-year period (1968-1978) with particular emphasis to immediate and late complications. Thirty patients were followed from 2 to 12 years after injury. Eleven patients were asymptomatic. Eleven had paresthesias of the lower extremity on the same side as the fracture. Nine had gait disturbance, eight had severe low back pain, four had groin pain, and two had fecal incontinence. Low back pain as a late sequela was related to sacral or sacroiliac injury. There appeared to be a correlation between the amount of displacement of the detached hemipelvis and the frequency of subsequent low back pain. Reduction of the upward displacement of the hemipelvis, by whatever means, to anatomic configuration can be of help in reducing late sequelae. In the later years of this study external fixation was successful.

Adolescent↗