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Biomedical subjects

R Whitehill

Publications and source records attributed to R Whitehill.

At least 37 records · Page 2Linked to original sources
PubMed1986

Complications associated with the halo-vest. A review of 245 cases.

The cases of all patients treated with halo-vests for cervical trauma at the University of Virginia since 1977 were analyzed retrospectively. A standardized chart and radiographic review protocol were used to identify complications associated with the use of the orthosis. Two hundred and forty-five patients satisfied the criteria for inclusion in the study. No patient developed or suffered progression of a neurological deficit while immobilized. Complications included: pneumonia causing death (one patient); loss of reduction or progression of the spinal deformity (23 patients); spinal instability following orthotic immobilization for 3 months (24 patients); pin-track infection (13 patients); migration of anteriorly placed iliac-strut grafts (two patients); cerebrospinal fluid leakage from a halo pinhole (one patient); and miscellaneous (seven patients). The findings indicate several conclusions. The halo-vest protects patients with cervical instability from neurological injury. It does not absolutely immobilize the cervical spine nor does it prevent progressive deformity of malpositioned strut grafts. Even after a 3-month orthotic treatment period, surgery may be required on ligamentous and osseous injuries to provide spinal stability. Elderly kyphotic patients may require custom-made vests. A small subset of patients exists for whom the confining nature of the halo-vest is intolerable for 3 months.

Adolescent↗
PubMed1984

The nonsurgical management of odontoid fractures in adults.

Twenty-five odontoid fractures that were treated nonsurgically at the University of Virginia Hospital in the last 5 years were reviewed. Motor vehicle accidents were the major cause of this injury in our series. Early recognition and firm external stabilization of Type I and Type III fractures of the odontoid resulted in union in 100% of our patients. There were 12 Type II fractures with a nonunion rate of 42%. Thus, an overall rate of union of 80% was obtained. It is suggested in the literature and by this series that early recognition, reduction, and rigid external immobilization of Types I and III fractures of the odontoid should promote bony union. Type II fractures may also be managed successfully by closed methods, although the outcome is less certain.

Adolescent↗
PubMed1984

Reconstruction of the cervical spine following anterior vertebral body resection: a mechanical analysis of a canine experimental model.

In some quadriplegic patients whose acute spinal injury consists of a vertebral body fracture with bony retropulsion anteriorly and ligamentous damage posteriorly, it is appropriate to perform a decompression of the injured spinal cord by excision of the fractured body. Reconstruction of such a spine to achieve immediate and ultimate stability can be quite difficult. This is a report of mechanical testing using a canine in vitro experimental model to simulate different general types of reconstruction systems applicable to the spine destabilized as above. The results explain some of the previously noted failures of the traditional anterior strut grafting procedures. In addition, one of the reconstruction systems tested (anterior and posterior tension bands compressing an anterior strut graft into place) appeared to have sufficient immediate stability to eliminate the need for a halo-vest in the postoperative period. If such a reconstruction system were to prove clinically applicable, it would be quite beneficial to the quadriplegic patient in his rehabilitation.

Animals↗
PubMed1984

The use of methylmethacrylate cement as an instantaneous fusion mass in posterior cervical fusions: a canine in vivo experimental model.

The authors previously predicted the failure of posterior cervical fusions utilizing methylmethacrylate cement as an instantaneous "fusion" mass, based on research using an in vitro canine experimental model. This report describes the results of in vivo canine studies on the same subject. Three groups of dogs had application of a posterior C4-C5 20-gauge cerclage wire and autologous iliac crest bone graft; application of a posterior C4-C5 20-gauge cerclage wire and methylmethacrylate cement; or application of a C4-C5 20-gauge cerclage wire only. This group represented the control group. The dogs were allowed to live for 3 months postoperatively, at which time they were killed and their spine fusions studied radiologically, mechanically, and histologically. Five of the bone fusions united solidly radiologically. Their flexion stability was statistically superior to the others. Histologic studies confirmed solid union of the fusion mass to the underlying bone. Four of the six methylmethacrylate fusions demonstrated cerclage wire fracture and methacrylate-bone separation by the second postoperative month. At the time the dogs were killed, their flexion stability was statistically inferior to the bone fusions and tended to be inferior to the controls as well. Histologically, fibrous tissue was noted to have grown between the methacrylate "fusion" mass and the underlying bone. This work provides a mechanical explanation for the well-known success of the traditional bony fusion. It further supports our original prediction regarding the failure of methylmethacrylate "fusions."

Animals↗
PubMed1984

Carcinoma of the breast metastatic to the skeleton.

A review of 319 patients with breast carcinoma metastatic to the skeleton revealed a large variation in age at diagnosis, interval between diagnosis of primary disease and metastasis, and survival time with metastasis. The presence of bony metastasis only is a good prognostic sign, and the presence of neurologic defects without successful correction is a poor prognostic sign. Bone lesions are radiosensitive, and fractures usually heal with radiation. It is difficult to define impending fractures, but large lytic lesions, increased body weight, increased activity, and areas of high stress are factors that can be used to determine the risk of fracture. Femoral neck fractures should be treated by endoprostheses or total hip arthroplasty and femoral shaft fractures by appropriate internal fixation. In the present series humeral fractures were successfully managed conservatively, but it is possible that with a wider data base the advantages of immediate rigid fixation by internal fixation with methylmethacrylate cement would be more obvious. Use of methylmethacrylate should be restricted to patients with short-term survival expectancies and large defects. Most spinal metastases can be treated by radiation and orthoses, but an aggressive approach is indicated for patients with neurologic deficits. Laminectomy is indicated for lesions that produce posterior compression, anterior decompression for lesions producing anterior compression, and stabilization for alignment deformities or instability.

Adult↗
PubMed1983

The posterior interspinous fusion in the treatment of quadriplegia.

The purpose of this report is to describe our experience with the posterior interspinous fusion in the treatment of spinal injury with quadriplegia. The charts and roentgenograms of 22 patients treated with this operation by the senior author (RW) from July 1978 to June 1981 were reviewed retrospectively. Follow-up averaged 19.5 months. All injured spines had significant posterior ligamentous damage. There were 14 fracture-subluxations, two unilateral facet dislocations, and six bilateral facet dislocations. The specific operative indications included six unacceptable closed reductions, nine failures of three-month trials in a halo vest, and seven cases of predominantly ligamentous injury. All fusions were solid by the third postoperative month. There were no non-unions. There was horizontal translational deformity (2.0 and 3.0 mm, respectively) within the fusion in two cases. In one case, there was an 18 degrees kyphosis within the fusion. Flexible kyphosis adjacent to the fusion, which averaged 16 degrees, was seen in five cases. The overall rate of neurologic recovery for this group was 32%. No patient lost function. Eliminating those patients who were complete quadriplegics preoperatively, the neurologic recovery rate was 77%. In comparison with the other treatments for cervical instability, posterior interspinous fusion is seen to be safe and effective.

Adolescent↗
PubMed1983

Nonclostridial gas gangrene: late infection after hip pinning.

An 86-year-old diabetic man had a late, gas-forming infection about Knowles pins. Although blood cultures were negative, a urinary tract infection followed by infection with the same organism in bone, muscle, and lung strongly supports hematogenous spread of E coli from the genitourinary system in this patient. The genitourinary system is well recognized as a source of bacteremia, and the skeletal system is the most often affected distant tissue when this occurs. A hematogenous cause of nonclostridial gas gangrene about an implant has not previously been reported.

Aged↗
PubMed1982

Reconstruction after the Tikhoff-Linberg procedure.

The Tinhoff-Linberg operation is a limb salvage technique that permits intercapulothoracic resection of malignant neoplasms of the shoulder with preservation of neuromuscular function of the upper extremity. A metallic interpositional device can be used to fix the humerus to the second rib, thus increasing stability and function. This device was used in a patient with a proximal humeral osteosarcoma who was also treated with radiation and chemotherapy and who has reasonably good extremity functional and is free of tumor at one year postoperatively.

Adult↗
PubMed1978

Traumatic arteriovenous fistula of the popliteal artery associated with a closed subtrochanteric fracture: report of a case.

Major vascular injuries associated with closed fractures of the femur are rare. A 35-year-old man incurred a subtrochanteric fracture associated with an arterial injury distally. The femoral fracture type most likely to be associated with a major vascular injury is one near the junction of the middle and distal thirds of the bone. The mechanism involves tethering of the artery in the adductor hiatus. The location of the arterial injury is usually at the fracture site.

Adult↗