Suture granuloma mimicking infection following total hip arthroplasty. A report of three cases.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
Richard Stern
Publications and source records attributed to Richard Stern.
Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome?
BACKGROUND AND AIMS: Many studies have identified specific demographic, social, health or life-style pre-operative indicators of long-term outcome among older hip fracture patients who underwent surgical treatment. The purpose of this study was to determine the predictive value of peri- and intra-operative factors, and more specifically of the pre-operative American Society of Anesthesiologists (ASA) score on functional outcome in these patients. METHODS: A questionnaire designed to assess pre-fracture functional and health status was administered to surgically treated hip fracture patients. Post-fracture functional and health status was further ascertained by in-home interview one year after the operation. Among 140 consecutive eligible patients older than 65 years, 10 either refused subsequent interviews or could not be contacted; an additional 16 patients died during the year of follow-up, leaving 114 patients available for this study. RESULTS: The average age of the patients was 82.4 years. Almost two-thirds of them suffered from severe systemic disease, whether or not incapacitating (ASA grades III-IV). Subjects classified in these categories presented more frequently with cardiovascular disorders, were more frequently disoriented, and already had some pre-fracture difficulty with ambulation. The mortality at one year was almost nine times higher in severely impaired patients (grades III-IV) than in healthy or mildly affected patients (grades I-II). Functional outcome and/or ambulatory ability assessed at one year did not reveal any statistically significant difference between the ASA I-II and III-IV groups. The most pronounced difference was noticed for the functional independence measured by the ADL score (p = 0.236). Better prognoses were consistently recorded for patients with an intracapsular fracture, for those who were operated within 24 hours, for those treated with a prosthesis as opposed to internal fixation, and for those whose operating time was less than 1 1/2 hours. CONCLUSIONS: Although the ASA classification is a good predictor of long-term mortality, the findings of the present investigation do not conclusively associate ASA score with post-operative restoration of mobility and functional independence.
Activities of Daily Living↗
Fracture of the ankle associated with rupture of the Achilles tendon: case report and review of the literature.
SUMMARY: A thirty-five-year-old man fell two meters from a ladder and sustained a closed fracture of the medial malleolus with an ipsilateral complete Achilles tendon rupture. The Achilles tendon rupture was diagnosed by means of the patient's complaints and physical findings. The ankle fracture was diagnosed incidentally on routine radiographs. Such a combination of injuries has been reported infrequently in the literature, and striking similarities have been described in the mechanism of injury and fracture pattern. Remarkably, in three of four reports the combined injury was initially misdiagnosed.
Accidental Falls↗
Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail.
OBJECTIVES: To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. DESIGN: Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n = 106) and those treated by intramedullary nailing (Group 2; n = 100). SETTING: University Level I trauma center. PATIENTS: All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA Type 31-A1 and A2. INTERVENTION: Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland). MAIN OUTCOME MEASUREMENTS: Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. RESULTS: The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients. CONCLUSIONS: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.
Aged↗
Complications of plate fixation in metacarpal fractures.
BACKGROUND: The objective of this study is to assess the complications after open reduction and plate fixation of extra-articular metacarpal fractures. METHODS: We retrospectively reviewed the clinical and radiologic records of 129 consecutive patients with 157 metacarpal fractures treated by open reduction and internal fixation with plates between 1993 and 1999. Intra-articular fractures and fractures of the thumb metacarpal were excluded. Eighty-one patients (64 men and 17 women) with 104 fractures were available for review, at an average follow-up of 13.6 months (range, 6-27 months). RESULTS: Twenty-eight patients (35%) and 33 fractures (32%) had one or more complications, including difficulty with fracture healing (12 patients [15%]), stiffness (eight patients [10%]), plate loosening or breakage (seven patients [8%]), complex regional pain syndrome (two patients), and one patient who developed a deep infection. CONCLUSION: Despite technical advances in implant material, design, and instrumentation, plate fixation of metacarpal fractures remains fraught with complications and unsatisfactory results.
Adolescent↗
Access to essential drugs.
Explore the source record for details and available documents.
Developing Countries↗
Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study.
BACKGROUND: Controversy persists regarding the ideal surgical technique for repair of a ruptured Achilles tendon. We propose a limited open procedure with use of an instrument that provides the advantage of an open repair but avoids the soft-tissue problems with which open repair has been associated. METHODS: We first performed a cadaver study in order to develop an instrument and a technique for a limited open repair and then, using this procedure in conjunction with an early functional rehabilitation protocol, we began a prospective multicenter study. We are reporting on the first eighty-seven patients consecutively treated with the new instrument and followed for an average of twenty-six months (range, eighteen to forty-two months). All patients were assessed clinically and with an enhanced American Orthopaedic Foot and Ankle Society (AOFAS) rating score. In addition, all fifty patients who had been followed for at least twenty-four months were further evaluated with isokinetic dynamometry. RESULTS: Four patients were lost to follow-up and one patient died, which left eighty-two patients for evaluation. There were no problems with wound-healing, and there were no infections. No patient noted a sensory disturbance in the sural nerve distribution. All patients returned to their previous professional or sporting activities. The mean AOFAS score was 96 points (range, 85 to 100 points). Isokinetic dynamometry showed no significant difference in strength between the injured and uninjured limbs of the fifty patients who were tested. Complications occurred in three patients. Two of them were noncompliant and removed the orthosis, so that the repair was disrupted by a new injury within the first three weeks postoperatively. One patient fell twelve weeks after the surgery and sustained a rerupture. All three new injuries were repaired with an open surgical procedure. CONCLUSIONS: This new procedure allows the surgeon to precisely visualize and control the tendon ends while avoiding excessive dissection and disturbance of local vascularity and minimizing nerve and wound-healing problems. Such a technique, along with an early functional rehabilitation program, allowed us to achieve a high rate of successful results with minimal morbidity.
Achilles Tendon↗
Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study.
BACKGROUND: Intertrochanteric fractures are composed of different anatomic patterns that vary in their degree of stability following open reduction and internal fixation. A particularly unstable group is classified as AO/OTA 31-A3, with the fracture pattern described as reverse oblique or transverse. The purpose of this study was to compare the results of intramedullary fixation with those of plate fixation for these intertrochanteric fractures in elderly patients. METHODS: Thirty-nine elderly patients with AO/OTA 31-A3 intertrochanteric fractures of the femur were randomized into two treatment groups and were followed for a minimum of one year. The nineteen patients in Group I were treated with a 95 fixed-angle screw-plate (Dynamic Condylar Screw), and the twenty patients in Group II were treated with an intramedullary nail (Proximal Femoral Nail). The treatment groups were comparable with regard to all demographic and injury variables. RESULTS: Patients treated with an intramedullary nail had shorter operative times, fewer blood transfusions, and shorter hospital stays compared with those treated with a 95 screw-plate. Implant failure and/or nonunion was noted in seven of the nineteen patients who had been treated with the 95 screw-plate. Only one of the twenty fractures that had been treated with an intramedullary nail did not heal. CONCLUSION: The results of our study support the use of an intramedullary nail rather than a 95 screw-plate for the fixation of reverse oblique and transverse intertrochanteric fractures in elderly patients.
Aged↗
Anterior shoulder instability: histomorphometric study of the subscapularis and deltoid muscles.
Recurrent traumatic anterior shoulder dislocation results in soft tissues lesions around the glenohumeral joint. The subscapularis muscle is a major active stabilizer of the shoulder and the hypothesis of the current study is that one would expect pathologic changes within its substance secondary to the trauma. A histomorphometric study of the subscapularis muscle was done of 52 patients operated on for recurrent traumatic anterior shoulder dislocation. At the time of surgery biopsy specimens were taken of the subscapularis muscle and the ipsilateral deltoid muscle as a comparison and to see if any changes were present. The results revealed interstitial fibrosis within the subscapularis muscle compatible with muscle scarring, and modifications in the ratio of fiber types as usually is seen with disuse atrophy. Both of these findings may alter strength and stability and therefore the function of the glenohumeral joint. The histologic findings were not compatible with a denervation pattern. After traumatic anterior shoulder dislocation rehabilitation of the subscapularis muscle is recommended.
Adolescent↗
Arterial supply of the glenoid: an anatomic study.
Surgery is performed on the glenoid for a variety of pathologic conditions, and an adequate blood supply is required to achieve good healing of soft tissue and bone. The objective of this investigation was to study the arterial supply of the glenoid in 24 fresh human cadaveric specimens. The vascular supply originates from branches of the anterior and posterior circumflex arteries and the suprascapular artery and branches directly from the infraspinatus and teres minor muscles. The antero-superior portion of the glenoid is poorly vascularized, with a specific area that is completely devoid of blood supply. In addition, circumferentially around the glenoid rim, there is an area of approximately 5 mm from the edge that is completely devoid of vascularity. Adequate bone and soft-tissue healing in the glenoid, particularly in its anterosuperior portion, after fracture repair, osteotomy, total shoulder arthroplasty, and capsular procedures may be compromised by the demonstrated hypovascularity.
Aged↗
Fixation of fractures of the proximal humerus with the PlantTan Humerus Fixator Plate: early experience with a new implant.
The majority of fractures of the proximal humerus can be managed nonoperatively. However, displaced fractures generally require operative repair, and in the young patient with good bone quality, the results are usually satisfactory. In contrast, the osteoporosis found in the elderly patient makes internal fixation problematic and frequently contributes to failure of fixation and poor results. We report our early experience with a new plate that locks two humeral head cancellous screws to the plate. In 3 of 7 patients, all under 65 years of age, the results were good. However, in the remaining 4 patients, all over the age of 75 years, there was a 100% failure rate, with screw penetration of the head in 3 patients and secondary displacement of the fracture at 7 days postoperatively in another. We conclude that this implant is unsatisfactory for patients with osteopenic bone in the humeral head.
Adult↗