Biomedical subjects
Publications and source records attributed to R B Tross.
An improved technique for the dissection of the scapular free flap is presented. It includes identification of the triangular space by palpation and delivery and deep dissection of the proximal flap pedicle by means of a counterincision in the axilla. This technique allows for a rapid, safe, and easy dissection of the transverse scapular flap.
UNLABELLED: Wistar-Lewis rats received therapeutic doses of doxorubicin or methotrexate daily for five days, were pulse-labeled with a fluorescent compound (calcein) on the seventh and thirteenth days, and were killed fourteen days after initiation of the protocol. Proximal tail vertebrae were then evaluated histomorphometrically, and the effects of the chemotherapeutic agents on trabecular bone were quantitated with respect to changes in total bone mass, new-bone formation, and resorption. Short-term administration of methotrexate caused a 26.9 per cent reduction in net trabecular bone volume and doxorubicin, an 11.5 per cent decrease. Both drugs significantly and profoundly diminished bone-formation rates by nearly 60 per cent. The toxic effect on osteoblasts was also reflected in reduced volume and thickness of osteoid, but the total numbers of osteoblasts and the per cent of trabecular surface covered by bone-forming cells were not affected. The numbers of osteoclasts and the extent of their activity were not clearly different from those in untreated rats, but rates of resorption were not determined. The effects of chronic treatment with these chemotherapeutic agents on intact, fractured, and transplanted bone and the biomechanical significance of these changes has not yet been evaluated. CLINICAL RELEVANCE: Chemotherapeutic agents have an adverse effect on normal physiological bone turnover, especially osteoblastic activity, and would also be expected to alter fracture-healing and bone-allograft incorporation by these same mechanisms. Knowledge of these changes and efforts to favorably affect the remodeling cycle must address these specific defects before bone allografts can be reliably used and fracture-healing can be improved concomitant with chemotherapy.
The cases of fourteen adolescents with fifteen physeal fractures of the tibial tuberosity were reviewed to more accurately define specific fracture patterns, to establish treatment for the different types, and to determine the incidence of complications. A modified classification scheme with a greater emphasis on intra-articular extension of the fracture and communution of the tuberosity was devised. Closed or open reduction, as necessary, gave satisfactory results. The primary indications for surgery were: (1) displacement of one or more fragments of the tuberosity anterosuperiorly, and (2) extension of the fracture through the proximal tibial ossification center into the knee joint, with disruption of the joint surface. There appears to be an increased incidence of pre-existing Osgood-Schlatter disease (ipsilateral and contralateral) in patients who have an acute tuberosity injury. Complications are rare. The theoretical possibility of the subsequent development of genu recurvatum appears unlikely, since most of these injuries occur when the physis of the tuberosity is undergoing normal closure.