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Biomedical subjects

S K Benirschke

Publications and source records attributed to S K Benirschke.

At least 19 recordsLinked to original sources
PubMed2003

The use of a locking custom contoured blade plate for peri-articular nonunions.

A retrospective chart and radiographic review was performed of 37 operative procedures over 7 years period for peri-articular nonunions. This was a consecutive cohort from a single orthopedic trauma service of a Level 1 center. Nonunions of the tibia and humerus were treated with blade plates fashioned from standard compression plates. Twenty-nine operative sites were treated successfully. The average age was 45.0 years; the average follow-up being 5.3 years. The average number of operations before blade plate was 4.0 (range 1-16). Sixteen blade plates were performed in patients with a diagnosis of clinical infection and all progressed to union and resolution of infection. Seven tissue transfers were used as adjunctive therapy. Five other patients with blade plate surgery had persistent nonunion, of which four united after a second custom contoured blade plate procedure. This study illustrates that surgeon contoured blade plates are an option for peri-articular nonunions even in the presence of infection. This technique resulted in a high union rate and a low complication rate compared to other options.

Accidental Falls↗
PubMed2001

Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach.

This is a review of 183 patients with 218 displaced intraarticular fractures of the calcaneus treated by open reduction and internal fixation. One hundred and ninety four (89%) wounds underwent primary uneventful healing. Twenty-four wounds (11%) required local wound care. One deep infection occurred in a neuropathic foot that required below-knee amputation. No free-tissue transfers, local tissue flaps or skin grafts were needed in patients who presented initially with a closed fracture. Ninety-five fractures (43.5%) required subsequent surgical procedures (hardware removal-88/95 [93% of secondary procedures]). Six patients (2.8%) had postoperative sural nerve findings. Seventeen procedures other than hardware removal were performed. There were five subtalar fusions including two subtalar distraction bone-block arthrodeses. There were seven claw toe correction procedures, four calcaneal valgus osteotomies for varus malunions and one subtalar arthrolysis at the time of hardware removal. These results suggest internal fixation of displaced intra-articular calcaneus fractures using a single lateral approach is a safe, reliable method of treatment.

Adolescent↗
PubMed2000

Comminuted fracture-dislocations of the elbow treated with an AO wrist fusion plate.

Comminuted fracture-dislocations of the elbow are complex injuries that can result in significant postoperative loss of motion. Rigid anatomic fixation with early range of motion is the required treatment. Because of the local anatomy of the proximal ulna, it often is difficult to achieve a rigid fixation construct. A fixation technique of a dorsally applied AO limited contact-dynamic compression wrist fusion plate contoured to fit the anatomy of the proximal ulna is presented. Advantages of the AO wrist fusion plate in comminuted olecranon fractures include the ease of contouring, a low profile, and the use of variable screw hole sizing to achieve stable fixation. The hybrid design allows for rigid 3.5-mm plate fixation distally while providing low profile 2.7-mm plate fixation over the subcutaneous olecranon. The technical and biomechanical features of this plate make it an ideal alternative for fixation of these complex injuries.

Adult↗
PubMed2000

The anterior T-frame external fixator for high-energy proximal tibial fractures.

The authors' experience using anterior T-frame external fixation combined with percutaneous internal fixation for treatment of high-energy proximal tibial fractures is reported. Thirty-six patients (38 fractures) were reviewed who were treated during a consecutive 42-month period. Three patients died and one patient had an amputation for a Type IIIC open injury, leaving 20 males and 12 females with 21 closed and 13 open fractures (two Type II, seven Type IIIA, three Type IIIB, and one Type IIIC). The average followup was 26 months. Fractures united at a mean of 20 weeks. Ten secondary surgical procedures were planned, including seven antibiotic bead removals with autogenous bone grafting and three soft tissue coverage procedures. Nine (26%) complications were found, including one deep infection (septic arthritis) and three pin tract infections, and one each malunion, nonunion, refracture, knee stiffness requiring manipulation under anesthesia, and deep venous thrombosis. The average Knee Society score was 85 for pain and 83 for function. All patients achieved full knee extension and mean flexion was 125 degrees. The anterior T-frame external fixator with percutaneous internal fixation is a reliable method to stabilize these injuries. It is simple, inexpensive, and effective.

Adolescent↗
PubMed2000

Outcome after open reduction and internal fixation of Lisfranc joint injuries.

BACKGROUND: Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management. METHODS: We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. Among ninety-two adults treated for that injury, forty-eight patients with forty-eight injuries were followed for an average of fifty-two months (range, thirteen to 114 months). Fifteen injuries were purely ligamentous, and thirty-three were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score. RESULTS: The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 points, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six of them required arthrodesis. The major determinant of a good result was anatomical reduction (p = 0.05). The subgroup of patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation. CONCLUSIONS: Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores.

Adult↗
PubMed1998

Angulated screw placement in the lateral condylar buttress plate for supracondylar femoral fractures.

Certain supracondylar femoral fractures are not amenable to internal fixation with fixed angle devices. In these instances, the condylar buttress plate is the recommended alternative; however, this is a less rigid device. Because of the decreased rigidity and strength of this device, there is a tendency toward varus angulation and malunion. In six fresh-frozen human knee specimens, segmental osteotomies were created to mimic supracondylar femoral fractures. The medial cortex was completely removed to make the fracture unstable to varus deformity. The fracture was fixed with a lateral condylar buttress plate using 4.5 mm screws. Each specimen was tested once with all the screws installed perpendicular to the plate, and again with the middle screw, just proximal to the fracture, angled 45 degrees diagonally across the fracture into the subchondral bone of the medial femoral condyle. For the construct with all screws placed perpendicular to the buttress plate, the initial stiffness was 410 N/mm, and after 1000 cycles it was 230 N/mm. With a screw placed diagonally across the fracture site, stiffness increased to 833 N/mm on the first cycle, and 796 N/mm after 1000 cycles. In all specimens with the screws placed perpendicular to the plate, the distal fragment had a permanent varus deformity after 1000 cycles, under no load, of 0.91 mm. For the diagonal screw condition, the average magnitude for all six specimens was 0.42 mm. This simple means of screw angulation in the plate strengthened the overall construct to resist the tendency toward varus deformity. The attractive features include the ease of application, and the use of an existing construct.

Aged↗
PubMed1998

Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation.

Displaced fractures of the glenoid fossa are an uncommon and anatomically diverse group of injuries. Failure to restore anatomy in these fractures results in poor outcome in most cases. The success of a treatment protocol that encompasses appropriate preoperative imaging, injury pattern assessment, prudent approach choice, and a comprehensive reduction and fixation tactic was evaluated. Twenty-seven patients were assessed clinically and radiographically at a mean followup interval of 43 months from surgery. Anatomic reconstruction was achieved in 24 (89%) patients. Three patients had residual joint incongruities measuring 2 mm or less. The only perioperative complication was a partial superficial wound dehiscence. Two additional patients had infraspinatus palsies of indeterminate origin. Functional rating revealed six (22%) excellent, 16 (60%) good, three (11%) fair, and two (7%) poor outcomes. The fair and poor outcomes largely were related to associated injuries. These findings show that anatomic surgical reconstruction with a low complication rate and good functional outcome can be obtained for most patients with glenoid fossa fractures.

Adolescent↗
PubMed1995

Retrograde nailing of femoral shaft fractures.

OBJECTIVE: The purpose of the study was to define the outcome following retrograde nailing of the femoral shaft. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: Seventeen retrograde intramedullary nailings of the femur were performed in 16 patients for management of complex orthopedic trauma. Thirteen patients were followed for an average of 22.8 months (range from 9 to 72 months). The indications for retrograde nailing were an ipsilateral femoral neck and shaft fracture in eight cases, knee disarticulation or long above knee amputation associated with a femoral shaft fracture in five cases, traumatic arthrotomy of the knee ipsilateral to a shaft fracture in two cases, one case of a shaft fracture ipsilateral to an acetabular fracture that required an extensile exposure, and one case of a femoral nonunion with a knee contracture. In fourteen of the seventeen cases the femur fracture was open including two grade III C injuries. MEASUREMENTS AND MAIN RESULTS: Two patients died in the early postoperative period due to the severity of the initial trauma and one patient was lost to follow-up. The results were generally poor and postoperative complications were common. There were five nonunions in the group, one which required revision to an above knee amputation for an infected nonunion following a grade III open femur fracture. The average range of motion of the knee was 3 degrees to 110 degrees, and two patients had an extensor lag of 5 degrees or more. Six patients underwent removal of hardware through a second arthrotomy with no significant loss of knee function related to the second procedure. CONCLUSIONS: The authors concluded that the high complication rate and poor results were related to the severity of the initial injury. An intercondylar starting can be used in properly selected cases with minimal effect on knee function.

Adult↗
PubMed1994

Iatrogenic fractures of the femoral neck during closed nailing of the femoral shaft.

We have reviewed our experience of four iatrogenic femoral neck fractures in 315 consecutive closed intramedullary nailings with the AO/ASIF universal femoral nail. The average neck-shaft angle in the bones that fractured was 139.3 degrees +/- 1.2 degrees SD (136 to 141); in the whole series the average neck-shaft angle was 125.3 degrees +/- 8.6 degrees and only 11 had angles of more than 135 degrees. The upper ends of the nails in the four which fractured were 17 mm, 5 mm, 3 mm, and 1 mm below the tip of the greater trochanter. In the seven patients with neck-shaft angles greater than 135 degrees but with no fracture, none of the nails had been inserted beyond the tip of the greater trochanter. We nailed six cadaver femora to simulate the forces produced by intramedullary nailing. Despite deep insertion, only one of the six sustained a neck fracture. This specimen had a radiographic neck-shaft angle of 140 degrees against an average of 127.3 degrees +/- 4.0 degrees for the other five. We believe that the medial prong of the AO insertion jig, with its medial overhang of 2 to 3 mm, may impinge on the superior aspect of a valgus femoral neck during final impaction, causing a neck fracture. This may be avoided by leaving the end of the nail above the tip of the trochanter in such cases.

Adolescent↗
PubMed1993

Ipsilateral fractures of the scaphoid and radius.

From 1985 to 1990, six patients were treated for ipsilateral fractures of the scaphoid and radius. All these injuries resulted from falls from a substantial height, with multiple injuries occurring in all patients. Two of the patients had minimally displaced fractures (1.0 mm), whereas the other four patients had moderately displaced scaphoid fractures (2.0 mm). The treatment for fracture of the distal radius was dependent on the fracture type, but all the scaphoid fractures were treated with internal fixation. All the fractures united, with the radial fractures healing in 6 weeks and the scaphoid fractures healing in an average of 13 weeks. The follow-up time averaged 2.9 years (range, 1.0 to 4.6 years). Internal fixation of the scaphoid in these combined injuries allowed for earlier and more aggressive therapy to maximize wrist and forearm motion.

Adolescent↗
PubMed1993

The use of resonant frequency measurements for the noninvasive assessment of mechanical stiffness of the healing tibia.

A study was performed to assess the usefulness of measuring the resonant frequency of vibration of the tibia as a determinant of its flexural rigidity in fracture healing. The measurement system consisted of an electronic tapper that struck the anteromedial distal surface of the tibia and an accelerometer, held against the proximal surface, that received the response. Custom software displayed the frequency spectrum from which the first mode bending frequency of the tibia could be pinpointed. We have found that resonant frequency was highly correlated to the log of tibial flexural rigidity, with an exponent of 0.582 (r2 = 0.815). In human volunteers, a series of four tests at monthly intervals showed a reproducibility of approximately 3% (95% confidence interval) with no significant variability between right and left legs. In 14 patients with healing tibial fractures, resonant frequency ratio (healing/injured leg) was correlated to time ratio (time of test/time healed) by a second-order polynomial fit (r2 = 0.58).

Adolescent↗
PubMed1993

Closed interlocking nailing of femoral shaft fractures: assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review.

Although closed interlocking femoral nailing is generally considered to be a difficult but effective procedure, the true incidence of technical complications has not been well documented. Similarly, long-term and functional patient-oriented data are limited. We reviewed our experience with an interlocking nail system that was introduced in our institution in October 1987. One hundred and twenty-three patients were retrospectively reviewed with particular attention to technical complications (Group I). A second group of 144 patients with femoral shaft fractures were reviewed prospectively as a part of our Orthopaedic Trauma Outcome Database (Group IIA). In the earlier retrospective group, the technical complications in 123 cases included one distal screw fracture, one broken drill bit left (in situ), one "missed" locking distal screw, and three cases where comminution at the fracture site was increased. In the prospective group of 144 fractures, the technical complications included two "missed" distal locking screws, two broken screws, and one bent nail due to additional secondary trauma. In a third group of 56 patients (Group IIB) selected from Group IIA, an abbreviated functional assessment was performed at a minimum of 12 months postinjury. Of this group, 37% of the patients had pain that was described as related to barometric changes and was either constant or activity related; 39% had some limitation in ability to ambulate or stand. Nine percent had to obtain new employment or seek job modifications. Based on our data we conclude that closed intramedullary nailing can be done at a Level I Trauma Center with relatively few technical complications, but the functional outcomes are not as good as had been previously believed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures.

Periodic cycles of enthusiasm for surgical management characterize the history of fractures of the calcaneus of the past century. After each period of advocacy for aggressive surgical therapy, there has been a trend toward nonoperative treatment. Morbidity and disappointing results were reported by those whose early attempts at open reduction were more difficult than expected. With the emergence of a subspecialty within orthopedic surgery devoted to fracture care, the pendulum has again swung toward operative treatment. A clearer understanding of fracture patterns from cross-sectional imaging, concentration of the injuries in the care of experienced fracture surgeons, perioperative antibiotics, rigid internal fixation, and early rehabilitation represent the latest attempts to improve the outcome from this vexing injury. Using an extensile lateral approach, rigid internal fixation, and early motion, more than 100 calcaneal fractures have been treated at the authors' institution between 1985 and 1989. Compared with published reports, the preliminary results demonstrate lower morbidity and improved outcome.

Calcaneus↗
PubMed1992

Misleading fractures after profundus tendon avulsions: a report of six cases.

From 1986 to 1990, twelve patients were treated for avulsions of the flexor digitorum profundus in either the ring or the long finger. Six patients had misleading x-ray films because the tendon had retracted farther than the fracture pattern had suggested. All of these patients had avulsion fractures from the palmar aspect of the distal phalanx. Although the classification of Leddy and Packer is very helpful in determining the prognosis for these injuries, the fracture patterns are not reliable in predicting the location of the retracted tendon end preoperatively. Therefore all flexor digitorum profundus tendon avulsions should be surgically repaired as soon as possible.

Adolescent↗
PubMed1992

Use of radial forearm flaps to treat complications of closed pilon fractures.

Between 1986 and 1990, five patients have been treated for full-thickness skin loss proximal to the level of the anterior joint line of the ankle following open reduction and internal fixation of closed C3 (ASIF) pilon fractures. The average delay from injury to the initial open reduction and internal fixation was 4.6 days. Anteromedial and posterolateral incisions were used to expose the fractures, resulting in a bipedicle flap over the anterior aspect of the ankle joint at the time of the initial surgery. The minimum distance between these two incisions for these five patients was 6.0 to 9.0 cm (average of 7.4 cm). Free tissue transfers using the radial forearm flap were effective in providing durable but thin coverage for this difficult problem of soft-tissue coverage in an area requiring a thin flap with a long vascular pedicle. The risk for skin necrosis at the time of surgery may be minimized by spacing the incisions up to 12.0 cm apart in addition to avoiding the period of maximal tissue ischemia occurring 3 to 6 days after the injury.

Adult↗
PubMed1992

Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol.

A retrospective review of 46 consecutive patients with complex (Schatzker V and VI) tibial plateau fractures treated at Harborview Medical Center between 1984 and 1989, disclosed a subset of 14 grade II or III (Gustilo) open injuries. We wished to determine the incidence of infection, union rate, and the number of operations required to achieve a satisfactory result, based on a treatment protocol: alignment and splinting of fracture at the scene of injury if possible, antibiotics administered in the emergency room (ER) and continued for 48 h, and admission of patient to the operating room as quickly as possible for irrigation and thorough debridement of the wound, immediate rigid internal fixation, and delayed primary closure at 5 days. No acute deep infection or radiographic evidence of implant loosening was noted. The final outcome was graded by Hospital for Special Surgery (HSS) Knee Rating Score at an average follow-up of 2 years 7 months. Radiographs were reviewed for reduction and evidence of postoperative change in reduction. The average HSS Functional Score was 81.5, and Knee Score was 84.6. Of 14 limbs, 10 had an excellent radiographic grade that did not change at follow-up, 2 had a satisfactory grade, and 2 had a poor grade.

Abbreviated Injury Scale↗