Biomedical subjects

S L Henry

Publications and source records attributed to S L Henry.

At least 37 records · Page 2Linked to original sources

PubMed1993

Antibiotic-leaching from polymethylmethacrylate beads.

Aminoglycoside-impregnated polymethylmethacrylate beads, which are used to deliver antibiotic directly to infected sites in the musculoskeletal system, are available as a manufactured product or they can be mold-made by a pharmacy or hand-rolled by the orthopaedist in the operating suite. We investigated the leaching of antibiotic from each of these types of beads. Our hypothesis was that the elutions of antibiotic from the three types of beads are similar. Three study groups (hand-made, mold-made, and manufactured beads), each composed of four five-bead subsets, were formed so that twenty beads of each type were tested. Each bead was leached daily in a two-milliliter aliquot of normal saline solution throughout a sixty-day period, and the aminoglycoside concentration in twenty of these aliquots was determined. Analysis of variance showed no statistically significant differences when the antibiotic elutions within each subset, between the different subsets, and between the three groups were compared. The clinically important finding of this investigation is that the leaching characteristics of the three types of aminoglycoside-impregnated beads are equivalent when the beads have been fabricated out of comparable materials.

Diffusion↗

PubMed1993

Intramedullary supracondylar nailing of femoral fractures. A preliminary report of the GSH supracondylar nail.

From 1987 through 1990, 34 acute supracondylar femoral fractures in 33 patients were treated with an interlocking closed-section intramedullary nail inserted retrograde into the femur through the intercondylar notch. Follow-up data of at least five months were available for 25 of these fractures. The patients suffered injuries more extensive than comparable patients reported in the literature. All fractures healed clinically and radiographically. The average arc motion at the most recent evaluation was 100 degrees. The average operative time was 156 minutes and the average estimated blood loss was 224 ml. Complications related to this treatment were successfully resolved. The genucephalic nail is a good treatment for supracondylar femoral fractures.

Adolescent↗

PubMed1993

[Stabilization of 150 unstable spinal injuries with the Cotrel-Dubousset instrument--analysis of results].

The present study is a retrospective analysis of spinal fracture treatment with the Cotrel-Dubousset instrumentation technique. 150 unstable injuries of the spine were treated with the CD implant at the University of Louisville--Level I Trauma Center--between February 1985 and March 1989. There were 67 burst fractures, 48 compression fractures and 21 fracture dislocations, 8 flexion distraction fractures and 6 flexion rotation injuries. Ninety-three patients underwent anterior cord decompression and strut grafting followed by posterior CD instrumentation and posterolateral fusion. Fifty-seven patients had posterior CD instrumentation and fusion alone. No neurological deterioration after the procedure was observed, 33 patients improved neurologically. Hospital stay ranged between 7 and 60 days (mean 20 days). 114 patients had a minimum follow up of 6 months (range 6-52 months). The mean follow up was 17.7 months. At final follow up 77.8% of the patients had returned to work and 84.2% of the patients were almost painfree. The mean loss of correction in the sagittal plane was 6.2 degrees (range: 0 and 42 degrees) at final follow up. As technical complications there were four hook cut outs (2.6%) of which two underwent reosteosynthesis and two did not effect the clinical or radiographic result. The high stability of the device provides a decreased risk of neurological deterioration, a decreased risk of posttraumatic kyphosis and early rehabilitation.

Adolescent↗

PubMed1993

The role of local antibiotic therapy in the management of compound fractures.

Seven hundred four compound fractures (198 [28%] Grade I, 259 [37%] Grade II, and 247 [35%] Grade III) were treated during a seven-year period at the author's institution. One hundred fifty-seven open fractures (22%) (Group A) received systemic antibiotic prophylaxis only, whereas 547 compound fractures (78%) (Group B) were treated with local application of antibiotic beads (tobramycin) in addition to prophylaxis. Fracture grades, age, gender, fracture location, and length of follow-up period were not significantly different between the two groups. All fractures underwent timely irrigation, debridement, and skeletal stabilization. Forty-nine of 704 compound fractures (7%) developed an infection (acute wound infection or chronic osteomyelitis or both). Group A showed an infection rate of 17% (26/157); treatment in Group B resulted in 23 compound fracture infections (4.2%). The difference in the incidence of infection was statistically significant. Comparison of the infection rates in either wound infection or chronic osteomyelitis showed a trend toward decreased rates in Group B versus Group A throughout all fracture grades. However, by subdivision into the fracture grades, only the IIIB types had a statistically significant decrease of infection in Group B versus Group A; the wound infection rate was 39% (9/23) in Group A and 7.3% (7/96) in Group B. The rate of chronic osteomyelitis was 26% (6/23) in Group A and 6.3% (6/96) in Group B. Prophylactic use of antibiotic-laden PMMA beads in addition to systemic antibiotics was of benefit in preventing infectious complications in compound fractures, in particular in Type IIIB open fractures.

Acute Disease↗

PubMed1993

The treatment of infected nonunions with gentamicin-polymethylmethacrylate antibiotic beads.

Fifty-two patients enrolled in the Septopal study of infected nonunions were prospectively examined in a randomized, controlled, closed study. Patients were divided into two groups. Group 1 consisted of 24 patients treated with debridement and intravenous antibiotics for four weeks. Group 2 consisted of 28 patients treated with debridement, gentamicin-polymethylmethacrylate (Septopal) beads, and perioperative broad-spectrum parenteral antibiotics. Both groups were treated with similar methods for reconstruction of the nonunions. The demographics of the two groups were similar. The average patient age in Group 1 was 38.4 years, and in Group 2, 37.1 years. Group 1 included 21 men and three women and Group 2, 23 men and five women. The nonunions in both groups ranged from simple hypertrophic nonunions to atrophic unions to segmental defects. The end results were good in both groups. Twenty patients in Group 1 and 25 patients in Group 2 had their infections successfully arrested (83.3% and 89.3%, respectively). Nonunions were successfully healed in the two groups, with similar results (Group 1, 83.3%; Group 2, 85.7%). Infected nonunions responded equally well to either systemic treatment with long-term intravenous antibiotics or local treatment with gentamicin-polymethylmethacrylate beads.

Adult↗

PubMed1993

Long-term implantation of gentamicin-polymethylmethacrylate antibiotic beads.

Fifty-two chronic osteomyelitis patients treated with gentamicin-polymethylmethacrylate (Septopal) antibiotic bead chains were observed retrospectively to explore the relationship between the duration of bead implantation and clinical results. Group A contained 35 asymptomatic patients who had elective bead removal based on protocol, surgeon's preference, and patient variables. Group B consisted of 17 patients who retained the antibiotic beads. The presence or absence of redness, abscess, drainage, pain, or swelling at the wound site was documented for clinical evaluation. Findings indicate that Septopal bead chain implants exhibit higher success (remission) rates with increasing length of duration without increasing the risk of complications.

Adult↗

PubMed1993

The antibiotic bead pouch technique. The management of severe compound fractures.

In a consecutive series of 704 compound fractures, 227 open fractures in 204 patients were managed with the antibiotic bead pouch technique. There were 16 Grade I compound fractures, 83 Grade II fractures, and 128 Grade III open fractures. The mean patient age was 35.25 years (range, 14-87). The Injury Severity Score (ISS) ranged from 9 to 57, with a mean of 15. Porous plastic film is placed over the soft-tissue defect to establish a "closed" bead-hematoma-fracture environment containing high local levels of antibiotic at the fracture site. All patients had serial wound debridements and parenteral systemic antibiotics (cefazolin, tobramycin, penicillin). Bead pouch changes ranged from one to seven per patient (mean, two). During these changes, 1248 cultures were taken, 78 (6.25%) of which were positive in 34 patients. Seventeen patients developed clinical signs consistent with an infection. The wound infection rate was 0% in Grade I open fractures, 1.2% in Grade II compound fractures, and 8.6% in Grade III open fractures. The osteomyelitis rate was 0% in Grade I compound fractures, 2.4% in Grade II open fractures, and 5.5% in Grade III compound fractures. Wound closure was obtained in 134 fractures with delayed primary closure of the skin, in 53 fractures with flap coverage, and in 23 fractures with split-thickness skin graft. Coverage was not completed in 17 wounds, at which time an amputation was performed or death occurred. Time of closure ranged from one to 32 days (mean, 7.1 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis.

These data do not prove a statistical superiority of conventional antibiotics or Septopal in the treatment of chronic osteomyelitis. This result, however, is complicated by the biased data set represented by the combined treatment. The data do suggest that cost of treatment is considerably less in patients who are treated with local antibiotics (i.e., Septopal) alone. The rate of adverse experiences was directly related to the use of parenteral antibiotics, with higher rates of adverse experiences in the conventional and combined treatment groups. Furthermore, the Cierny-Mader Physiologic Class had the best correlation with outcome, suggesting that host factors are probably of critical importance in inducing remission of chronic osteomyelitis. This protocol was not designed to test the role of debridement in the treatment of osteomyelitis: it was assumed that debridement would be the same in both groups. It is the investigators' strong opinion, however, that adequacy of debridement was an important determinant in quiescence or recurrence in the study patients. Similarly, there was no strict control for adequacy of soft-tissue coverage provided by local or distant tissue transfer. Again, the investigators believe that adequacy, including viability and durability, of soft-tissue covering was an important determinant for the end result in these patients. Other covariants such as smoking, history, nutritional status, and other measures of general health will be added to this model when data are available. This analysis will allow definition of the appropriate clinical situations in which use of Septopal alone or combined with parenteral antibiotic is indicated.

Anti-Bacterial Agents↗

PubMed1993

A comparison of gentamicin-impregnated polymethylmethacrylate bead implantation to conventional parenteral antibiotic therapy in infected total hip and knee arthroplasty.

A multicenter study of infected total knee and total hip arthroplasties was conducted from 1985 until 1990. Twenty-eight patients (22 total hip arthroplasties and six total knee arthroplasties) who had periprosthetic infections were treated according to a prospective, randomized protocol. After initial debridement for their infections, patients were randomized into one of the two following groups: Group I, debridement and the implantation of gentamicin-polymethylmethacrylate (PMMA) beads; and Group 2, debridement and conventional parenteral systemic antibiotic therapy. After initial treatment, the patients were then scheduled for a delayed reconstruction total joint arthroplasty. Of the 28 patients, 25 subsequently had delayed total arthroplasty, and if acrylic bone cement was used for fixation at the time of reimplantation, antibiotics were not added to the cement. The average follow-up period was three years (range, six months to 5.6 years). Infection recurred in two patients treated by debridement and the implantation of gentamicin-PMMA beads (15%) and in four patients treated with debridement and conventional systemic antibiotic therapy (30%). All recurrences occurred in patients who had infected total hip arthroplasties; none occurred in patients with total knee arthroplasties. The conditions that were common in patients with recurrent infection were (1) multiple previous surgeries, (2) host compromise and malnutrition, (3) extensive infection, and (4) inadequate debridement. The recurrence of infection was not statistically significantly more common in either treatment group. The outcome of treatment in patients with infected total joint arthroplasties using debridement, gentamicin-PMMA bead implantation,and a two-stage delayed reconstruction was similar to that of patients treated with debridement combined with conventional parenteral systemic arthroplasty and two-stage reconstruction.

Adult↗

PubMed1992

The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.

The effect of antibiotic bead chains on the evolution of infection cannot be studied entirely in man due to the ethical problems of obtaining valid controls. Therefore, a model of musculoskeletal injury was devised in rabbits by making a paraspinal wound, fracturing a spinous process, and contaminating the wound with 1 x 10(4) colony-forming units/ml of Staphylococcus aureus. These contaminated wounds were treated with tobramycin-containing polymethylmethacrylate (PMMA) beads. Control rabbits were either treated with PMMA beads that did not contain antibiotic, treated with IM tobramycin, or left untreated. At 5 days, six of eight animals treated with antibiotic-impregnated beads had no recoverable organisms. Six of eight rabbits receiving IM tobramycin had wound infections, and five of five in whom non-antibiotic-containing beads had been implanted had significant wound infections, with one of the five dying of sepsis on the 3rd day of the experiment. The clinical course of infected controls was the same as the course of those animals receiving IM antibiotics and the same as those in whom beads without antibiotics were implanted. That is, the rabbits had grossly infected wounds and the organisms recovered were of the same type as those implanted. This research shows a highly statistically significant effect of tobramycin-containing antibiotic beads in retarding the evolution of an experimental Staphylococcus infection in rabbits.

Animals↗

PubMed1992

[Treatment of type II B open fracture--therapeutic regimen and results].

A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. There were 13.5% wound infections and 10.1% osteomyelitis observed. The additional local antibiotic therapy was of significant (p less than 0.001, p less than 0.025) benefit to lower both infectious complications. The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.

Adolescent↗

PubMed1992

Bacterial adherence to plain and tobramycin-laden polymethylmethacrylate beads.

Antibiotic-impregnated polymethylmethacrylate (PMMA) bead chains are in current clinical use for prophylaxis and management of osteomyelitis. The in vivo interaction between PMMA beads and an experimentally infected wound is examined. Two modes of bacterial adherence to plain PMMA beads are demonstrated. In this report, tobramycin-sensitive bacteria did not attach to tobramycin-laden beads. Therefore, implanted PMMA beads should contain an antibiotic to which the infecting bacteria is sensitive.

Animals↗

PubMed1992

Domestic violence--the medical community's legal duty.

During the last decade, domestic violence has been identified as one of the major causes of emergency room visits by women. As many as 30% of the women who are seen by emergency room physicians exhibit at least one or more symptoms of physical abuse. Unfortunately, the vast majority of these cases go unreported due to a lack of awareness on the part of physicians and other health care providers regarding the law, actual reporting procedures, and potential liability. This article addresses both the medical community's legal liability and the results of a January 1992 survey conducted by the Jefferson County Medical Society and University of Louisville. This survey evaluated local physicians' awareness of the statutory requirements imposed on the medical community when treating suspected victims of domestic violence. According to this survey of 215 physicians, only 29% were aware that Kentucky law requires physicians and other health care practitioners to report to the Cabinet for Human Resources any suspected abuse, neglect, or exploitation of an adult. Furthermore, the Jefferson County Medical Society survey reported that only 24% of the physicians polled had ever filed a domestic violence report on behalf of a patient. In an effort to compare the physicians' knowledge of other domestic violence issues, the physicians were also questioned regarding the issue of child abuse. Over 80% of physicians surveyed were aware of the Kentucky statute which requires a physician to report child abuse, and greater than 60% of those physicians surveyed had filed a complaint with a local or state agency. Domestic violence is now being publicly recognized as a social problem with far-reaching consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1991

Treatment of compound fractures.

Management of compound fractures remains a challenge to the surgeon. Methods to decrease patient morbidity include early fracture stabilization and sequential débridement. External fixation remains the standard; however, early internal fixation in low-grade injuries may be an acceptable option. Early soft tissue coverage is critical. The use of prophylactic parenteral antibiotics has decreased the incidence of acute infection and chronic osteomyelitis. Supplemental use of local antibiotic polymethyl methacrylate (PMMA) beads appears to further diminish the morbidity in high-grade open fractures.

Administration, Topical↗

PubMed1991

Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report.

The GSH supracondylar nail is a closed section rigid intramedullary device that combines the biomechanical advantages of intramedullary fixation with the stability of rigid internal fixation for the management of supracondylar fractures of the femur. The use of this implant is indicated in the management of distal comminuted nonarticular fractures and fractures with intraarticular extension. Intramedullary fixation provides improved fracture stabilization in both elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. The experience with the GSH supracondylar nail has shown that it provides better results than supracondylar plating for the stabilization of acute fractures or revision of failed internal fixation.

Adult↗

PubMed1991

Factors in pin tract infections.

To determine the factors pertinent to the etiology of pin tract infections, 214 pins in 42 patients were examined prospectively at the time of pin removal. Eighty-nine (41.6%) pin tracts were inflamed, 49 (22.9%) pins had loose anchorages, and 160 (74.8%) pin tips cultured positive for bacteria. The predominant organism cultured was Staphylococcus epidermidis (90.6%), considered nonvirulent, followed by virulent Staphylococcus aureus (37.5%), and Escherichia coli (9.4%). There were 32 loose, inflamed pin tracts. This correlation was statistically significant (P less than .005). There were 40 loose pins whose pin tips had positive cultures. Loose pins correlated for infection with virulent species of bacteria at a highly significant level (P less than .005). Results demonstrate that most pins possess bacterial colonization. Clinically, this means that either inflamed pin tracts or pins with cultures positive for invasive organisms are probably loose and should be removed. Also, mechanical factors are the critical variable in determining the flora of external fixation pins.

Adolescent↗

PubMed1991

Antibiotic-impregnated beads. Part I: Bead implantation versus systemic therapy.

Parenteral antibiotic therapy for acute bone infections, soft-tissue infections, and osteomyelitis may result in high serum concentrations associated with nephrotoxic, ototoxic, and allergic complications. Conversely, the local release of antibiotics into the wound with the use of antibiotic-impregnated cement or antibiotic-impregnated polymethylmethacrylate beads has been found effective and does not induce negative effects or result in systemic concentrations of clinical significance. The antibiotic-impregnated cement beads are fabricated on a surgical steel wire, and they have bimodal elution properties. They provide local antibiotic concentrations that surpass the minimum inhibitory concentrations for pathogens commonly isolated in orthopaedic infections. Their use effectively controls chronic osteomyelitis and acute musculoskeletal infections. Compared with systemic antibiotic therapy, the incidence of nephrotoxic, ototoxic, and hypersensitivity reactions is significantly diminished. The beads release 5% of the antibiotic within the first 24 hours. The sustained elution then progressively diminishes to undetectable levels within a few weeks or months.

Anti-Bacterial Agents↗

PubMed1991

Antibiotic-impregnated beads. Part II: Factors in antibiotic selection.

Part I of this series discussed the advantages of implanted antibiotic-impregnated polymethylmethacrylate beads over systemic therapy for managing chronic osteomyelitis and acute musculoskeletal infections. Numerous antibiotics are available for use in polymethylmethacrylate. However, specific characteristics should be considered prior to therapeutic selection: the antibiotic should be water-soluble, bactericidal, nontoxic to tissues, and readily available in powder form. In this concluding segment, the organisms most commonly cultured from orthopaedic infections and appropriate combinations of antibiotics and bone cements are outlined.

Aminoglycosides↗