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Biomedical subjects

R R Karpman

Publications and source records attributed to R R Karpman.

At least 19 recordsLinked to original sources
PubMed1997

Analgesia for emergency centers' orthopaedic patients: does an ethnic bias exist?

Several prior studies have demonstrated that Hispanics treated in some emergency centers were prescribed less analgesia than white patients with similar extremity trauma. The purpose of this study was to determine if other institutions had a similar experience with regard to undermedication of certain ethnic groups. Two cohorts were studied, 1 adult and 1 pediatric group. The adult group consisted of 84 patients seen at Maricopa Medical Center, Phoenix, Arizona, between January 1, 1992, and December 31, 1992, who were treated for isolated long bone fractures requiring a closed reduction. The pediatric group consisted of 63 children younger than 16 years, seen between January 1, 1992, and April 30, 1993, with isolated distal radius or ulna fractures requiring a closed reduction. Results indicated that Hispanics were not likely to be undermedicated for fracture reduction in this level I trauma emergency center compared with whites. It is thought that a hospital with a larger populations of underrepresented minorities may be more sensitive than other private institutions.

Adult↗
PubMed1995

Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment.

The investigators of this study reviewed 112 consecutive frail elderly patients with supracondylar femoral fractures to evaluate primarily functional outcomes to optimize initial treatment of these challenging patients. A high 1-year mortality rate (22%) and significant decrease in function and quality of life occurred in frail elderly patients who sustained supracondylar femoral fractures. No statistical relationship could be found among preinjury function, age, cognitive function, type of fracture, treatment, and overall results. Nine percent of patients required late above-knee amputation in the involved extremity because of displacement of the fracture or infection or both. Optimal treatment for this type of patient remains elusive. Primary above-knee amputation may be the preferred treatment in patients who are this severely affected.

Aged↗
PubMed1995

Foot problems in the geriatric patient.

Foot disorders are 1 of the most common problems of the elderly population. Most of these disorders are acquired and can be managed easily with shoe modifications and pads. Surgery should be reserved for those with severe fixed deformities. Determination of adequate arterial supply is mandatory before beginning any surgical correction. In most cases, the simplest procedure leads to the best result to avoid prolonged immobilization and wound problems.

Aged↗
PubMed1992

Early failure of noncemented porous coated anatomic total hip arthroplasty.

From July 1984 through October 1987, 63 consecutive primary Porous Coated Anatomic total hip arthroplasties were performed. Follow-up observation ranged from one to four years, with a mean of 2.4 years. The mean postoperative Harris hip score in 81 cases was 38% excellent results, 23% good results, 6% fair results, and 23% poor results. Eight percent of hips required revision of the femoral component related to subsidence. Persistent thigh pain was found in 33% and persistent limp in 58%. Poor clinical outcome was correlated with persistent thigh pain and 3 mm or more subsidence of the femoral component. Subsidence occurred despite adequate canal fill. This high percentage of early failure is unacceptable when compared with standard techniques of total hip replacements with cement fixation.

Adult↗
PubMed1992

The effects of fibular and talar displacement on joint contact areas about the ankle.

The purpose of this study was to advance prior techniques and studies regarding the effects of fibular and talar displacement of contact areas of the tibio-talar joint. Type IV supination external rotation injuries were experimentally created on five fresh cadaveric specimens. Tibio-talar contact and peak pressures were measured using Fuji pressure-sensitive film with the talus in a neutral position and then displaced 1, 3, 4, 5, and 8 mm laterally as well as a repeat measurement following reduction and plate fixation. Results demonstrated a 50% reduction in contact area with only 1 mm of talar displacement along with a linear increase in average peak pressures. Reapproximation of the fibular osteotomy with a plate and rereduction of the talus allowed for return to normal pretesting contact areas. This study confirms prior studies demonstrating the significance of 1 mm of talar displacement in regards to marked reduction in contact area of the tibio-talar joints. In addition, restoration of the normal anatomy and fixation of the osteotomy allows for return of normal contact areas.

Ankle Injuries↗
PubMed1990

Comparison of ultrasonically applied vs. intra-articular injected hydrocortisone levels in canine knees.

Phonophoresis of hydrocortisone is a commonly performed treatment for a wide variety of soft-tissue as well as intra-articular musculoskeletal disorders. There have been no previously reported studies indicating the degree of hydrocortisone penetration into joints achieved by means of phonophoresis. Twenty-four purebred greyhounds were used to compare intra-articular levels of hydrocortisone resulting from intra-articular injection, phonophoresis, and external application of hydrocortisone. A total of 40 samples from canine knees were analyzed by means of fluorescence polarization. Intra-articular hydrocortisone levels obtained with phonophoresis were extremely low in comparison with those obtained with intra-articular injection. There were no statistically significant differences in intra-articular hydrocortisone levels between the phonophoresis and external application treatments, or between either of these and placebo control measurements taken from knees of untreated dogs and from shoulders of treated dogs. It appears that phonophoresis is an ineffective method of obtaining hydrocortisone penetration into a joint in the canine model.

Animals↗
PubMed1990

Iatrogenic tibial pseudoaneurysm following below-knee amputation.

Tibial vessel injury during lower extremity amputation has not been reported, despite the obvious proximity of these vessels to the fibula and tibia. We present a case of acute pseudoaneurysm with arteriovenous fistula of the posterior tibial vessels following amputation, due to (unrecognized) arterial and venous injury due to fibular periosteal elevation.

Adult↗
PubMed1989

Split posterior tibial tendon transfer for spastic equinovarus foot deformity.

This paper describes a simplified technique for split posterior tibial tendon transfer in the treatment of spastic equinovarus deformity of the foot. Thirteen children with spastic equinovarus foot deformities were treated at Children's Rehabilitative Services in Phoenix, Arizona, from 1983 to 1986. The technique was modified in 10 of the 13 patients by attaching the split posterior tibial tendon more proximally to the peroneus brevis, compared to a more distal attachment as described by other authors. The mean length of followup was 21 months. Eleven patients obtained a good or excellent result. Two patients were considered to have a fair result. No poor results or complications were noted in any of the patients. It was felt that the split posterior tibial tendon transfer was an effective procedure for correction of spastic equinovarus as reported by other authors. Modification of the technique significantly simplifies the operation by requiring less dissection while still producing favorable results.

Adolescent↗
PubMed1989

Complications of the PCA anatomic patella.

A retrospective review of the total knee arthroplasties performed using the PCA anatomic patella (Howmedica, Rutherford, NJ) was undertaken after a high rate of complications was noted. Eighty-seven knees in 75 patients were evaluated with an average follow up of 16 months. Eighteen complications of the patella in 14 knees were found (16%); these included lateral subluxation (10 knees), fracture of the patella (5 knees), patellar tendon rupture (2 knees) and prosthetic loosening (1 knee). Seven patients required secondary procedures with the ultimate result greatly compromised in four patients. It is proposed that if the component is not precisely aligned, the eccentric shape and central ridge increases the forces acting at the patella and leads to an increased risk for complications, making the component less forgiving than the more standard dome-shaped patellar component.

Aged↗
PubMed1989

Approaches to senior care #8. Hip fractures in nonagenarians.

A retrospective review of 56 hip fractures in 52 patients aged 90 years and older was performed, looking specifically at perioperative morbidity and mortality, one-year mortality, and postoperative functional outcome. The one-year mortality rate was 46% as compared to 22% in younger individuals. The presence of cerebral dysfunction preoperatively proved to be the major risk factor for increased mortality. The highest one-year mortality rate was seen in those patients with cerebral dysfunction who were ambulators preoperatively, and the lowest mortality rate was in nonambulators. Only 25% of functional ambulators preoperatively gained a similar level of function postoperatively. Despite these findings, the low perioperative mortality and morbidity indicate that operative treatment is still the treatment of choice in all nonagenarians with hip fractures, as it provides for easier nursing care and maximized functional outcome, with an expected 54% one-year survival rate.

Aged↗
PubMed1989

Necrosis of the skin over the metacarpal as a result of functional fracture-bracing. A report of three cases.

Use of a functional brace for the treatment of a fracture of a metacarpal caused necrosis of the skin under the dorsal pad in three patients. In order to evaluate the mechanism of the necrosis, we made in vivo and in vitro measurements of pressures that are typically found under the pad. We found that the pressures easily exceeded 260 millimeters of mercury. Pressures of this magnitude have been shown to cause necrosis of the skin. Orthopaedic surgeons should be aware of this problem when using the brace, and perhaps a wider pad should be used to distribute the force.

Adult↗
PubMed1988

Arthrography of the metatarsophalangeal joint.

Arthrography has been an extremely useful tool in the diagnosis of various intra-articular disorders of multiple joints. To date, little has been written regarding the technique and value of arthrography of the metatarsophalangeal (MTP) joints of the foot. The purpose of this paper is to briefly describe the technique, demonstrate a normal arthrogram of the MTP joint, and provide case descriptions in which arthrography has been useful in diagnosis of intra-articular problems related to the MTP joint.

Arthrography↗
PubMed1987

Work-in-progress #1. The lithotriptor and its potential use in the revision of total hip arthroplasty.

Revision total hip arthroplasty, particularly femoral component replacement, has proved extremely difficult and has met with frequent complications. Despite a variety of devices and techniques that have been developed to facilitate removal of the femoral stem, the procedure remains difficult. Extracorporeal shock wave lithotripsy (ESWL) is a new technique initially created to pulverize renal stones by means of repetitive shock waves delivered to a discrete area. It was felt that perhaps this technique might also be utilized to facilitate the removal of the femoral component and cement from the femoral canal in revision total hip arthroplasty. Using bone cement, cadaveric canine femora were implanted with stainless steel rods placed within the medullary canal. The implanted femora were treated with ESWL, sectioned, and examined, using scanning electron microscopy. Microfracturing of the cement and a disruption of the cement/bone interface were seen in the treated specimens. ESWL has the potential to be used prior to revision total hip arthroplasty to facilitate cement and component removal, although there are several questions that need to be answered prior to considering its clinical use.

Animals↗
PubMed1982

Spinal cord injury, spinal fracture, and spinal stenosis in ankylosing spondylitis.

The authors report a retrospective review of 105 patients with ankylosing spondylitis (AS) diagnosed over a 6-year period in Tucson, Arizona. In the series, there were 13 patients with spinal fractures and eight with severe spinal cord injury. Two patients with central cord contusion had no demonstrable cervical spine fracture. Injury was often trivial and dislocation at fractures sites was minimal, demonstrating the extreme fragility of these patients. Spinal stenosis, which has not previously been associated with AS, was documented in three cases. Pseudarthrosis, a destructive vertebral lesion that does not require surgical decompression or fusion, was found in four patients; this entity is believed to originate as a pathological or traumatic fracture. Atlanto-axial subluxation and basilar invagination associated with spinal ankylosis occurred in one patient. The study emphasizes the value of computerized tomography scanning of the spine for diagnosis, and halo-vest application as a nonoperative treatment for cervical immobilization. Early diagnosis and appropriate therapy to decompress, reduce, and immobilize unstable spinal lesions may result in reduction of the 29% mortality rate and 45% permanent neurological morbidity rate observed after spinal fracture in this series of AS patients. Because of the high operative complication rate observed, nonsurgical immobilization is the recommended treatment unless spinal dislocation or bone fragment displacement has occurred at the fracture site.

Adult↗