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Biomedical subjects

R B Gustilo

Publications and source records attributed to R B Gustilo.

At least 73 records · Page 4Linked to original sources
PubMed1983

Bone and serum concentrations of five cephalosporin drugs. Relevance to prophylaxis and treatment in orthopedic surgery.

Bone and serum concentrations of five cephalosporins were assayed in 92 patients undergoing elective hip or knee prosthetic joint arthroplasty. One hundred twenty-five bone samples were assayed. Although there was no direct relation between serum and bone antibiotic concentrations, a trend toward increased bone antibiotic concentration for drugs with higher serum levels and longer half-lifes (cefazolin and ceforanide) was noted. Bone antibiotic concentrations were maximal within 60 minutes of drug administration. Although bone antibiotic concentrations following 2-g doses were greater than those following 1-g doses, the differences were not statistically significant. A trend toward higher bone antibiotic concentrations at hip surgery was noted, and this difference achieved statistical significance (p less than 0.05) for cefazolin. As a result of analysis of bone antibiotic concentrations, antimicrobial sensitivities, and cost, administration of 2 g of cefazolin immediately prior to operation, followed by 1 g every eight hours for 24 hours, is recommended in elective prosthetic joint surgery.

Adolescent↗
PubMed1980

Prophylactic antibiotics in hip fractures. A double-blind, prospective study.

Three hundred and seven patients, each of whom had a fracture of the proximal part of the femur, were studied in a randomized, double-blind fashion to determine whether perioperative administration of cephalothin would prevent postoperative infection. Major postoperative wound infections were significantly reduced in the cephalothin-treated group (4.7 per cent versus 0.7 per cent; p less than 0.05). There also was a reduction in the incidence of postoperative urinary-tract infections and a reduction in mean peak body temperatures. The duration of hospitalization was not affected and no hospital stay was prolonged by complications of antibiotic administration. However, in the cephalothin-treated group, a strong trend toward colonization by cephalothin-resistant organisms was noted.

Adolescent↗
PubMed1980

Immediate internal fixation in open fractures.

Open fractures require emergency treatment. Adequate debridement and copious irrigation are essential in their management. The parenteral administration of antibiotics should be started immediately. If the wound is closed primarily, the antibiotics are discontinued after three days. If the wound is closed secondarily, the antibiotics are continued for another three days after this procedure. Most open fractures should be treated without the use of internal fixation techniques. However, we believe that there are reasons for employing immediate internal fixation, particularly in polytraumatized patients and others sustaining type III open fractures, to facilitate care of the soft tissue. When immediate internal fixation techniques are used in open fractures, the wound must not be closed primarily.

Adult↗
PubMed1979

Use of antimicrobials in the management of open fractures.

The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care. Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Intial wound cultures of 158 open fracture wounds revealed bacterial growth in 70.3%. Eighty-six were Gram-positive, 57 were Gram-negative, and 32 yielded mixed bacterial growth. Sensitivity studies of these organisms suggest that cephalothin sodium is the most effective antibiotic for prophylaxis. In a prospective study from 1969 to 1975, treatment of 520 patients was as follows: debridement, copious irrigation, and primary closure for types 1 and 2 fractures and secondary closure for type 3 fractures. No primary internal fixation was done except in vascular injuries. Cultures were taken of all wounds and antibiotics were given before surgery and for three days postoperatively. In type 3 open fractures, severe soft tissue injury, and segmental or traumatic amputation, the infection rate was 9%, compared to a 44% infection rate in the retrospective study from 1955 to 1968.

Anti-Bacterial Agents↗
PubMed1979

Analysis of six hundred and twenty-two intertrochanteric hip fractures.

Of 622 intertrochanteric fractures, 57% were stable (Types I and II). Twenty-eight per cent were Type III, and 15% were Type IV (the unstable types). The 150-degree telescoping Massie nail proved superior to the fixed 135-degree Jewett nail (particularly for unstable fractures) because it allowed a controlled impaction of the fracture fragments to a stable position. In about one-third of the fractures, some medial displacement occurred. With anatomical reduction and the use of the Massie or ASIF nails, we achieved a decrease in the morbidity and mortality and 96% satisfactory results. Our prospective study was compared with a retrospective study in which other devices were used. Early ambulation and weight-bearing also was a major contributing factor to the improved results in the prospective study. Intertrochanteric hip fractures that are unstable can be fixed with a collapsible nail, and that treatment appears to give as good or better results than the displacement method of Dimon and Hughston or Sarmiento.

Aged↗
PubMed1979

Joint replacement in non-ambulatory patients.

We treated eighteen non-ambulatory patients by multiple operations consisting of total replacement of the hip or the knee, or both. Thirteen patients had rheumatoid arthritis, four had degenerative arthritis, and one had had bilateral resection of the femoral head and neck. The patients were followed for an average of forty months. We devised a classification based on the number of joints involved and a rating scale for function. Good to excellent results were achieved in the patients who had two or three joints operated on (with one exception). Fifteen patients became ambulatory and seven could climb stairs. Seven patients were pain-free. The factors responsible for poor results were significant neural problems and loss of motivation. The presence of severe upper-extremity involvement was not an obstacle preventing walking.

Adolescent↗
PubMed1979

The use of methylprednisolone and hypertonic glucose in the prophylaxis of fat embolism syndrome.

In a prospective randomized trial of prophylactic therapy in fat embolism syndrome (FES) 64 patients with femoral and/or tibial shaft fractures uncomplicated by other significant injuries were treated with hypertonic glucose (A), methylprednisolone (B), and placebo (C). Clinical findings and several laboratory parameters were used to establish the diagnosis. Two of the 23 patients in the placebo group (C), 3 of the 21 patients in the hypertonic dextrose (A) group and none of the 20 patients in the methylprednisolone (B) group developed clinical fat embolism syndrome. All patients with fat embolism syndrome were hypoxemic (pO2 less than 65 mm Hg) and exhibited central nervous system symptoms. Four out of 5 were hypocalcemic and 3 patients had thrombocytopenia. There was a high incidence of subclinical hypoxemia or subclinical fat embolism syndrome (29% in A Group, 15% in B Group and 39% in C Group). A comparison between groups of the mean pO2 for each patient demonstrated a statistically significant difference between the methylprednisolone group and the control group (p less than 0.025) as was the comparison of proportions of pO2 less than 70 mm Hg (methylprednisolone versus control p less than 0.01, glucose versus control p less than 0.03). Methylprednisolone given prophylactically may reduce the incidence of fat embolism syndrome and can reduce the degree of hypoxemia associated with long bone fractures of the lower extremmity.

Adult↗
PubMed1976

Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.

In 673 open fractures of long bones (tibia and fibula, femur, radius and ulna, and humerus) treated from 1955 to 1968 at Hennepin County Medical Center, Minneapolis, Minnesota, and analyzed retrospectively, the infection rate was 12 per cent from 1955 to 1960 and 5 per cent from 1961 to 1968. In a prospective study from 1969 to 1973, 352 patients were managed as follows: débridement and copious irrigation, primary closure for Type I and II fractures and secondary closure for Type III fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type III open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study.

Arteries↗
PubMed1973

John H, Moe, M.D.

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History, 20th Century↗