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Biomedical subjects

S L Henry

Publications and source records attributed to S L Henry.

46 records · Page 3Linked to original sources
PubMed1990

[Treatment of unstable thoracic and lumbar spinal fractures with Cotrel-Dubousset instruments].

The present study is a retrospective analysis of first experiences of fracture treatment with the Cotrel-Dubousset instrumentation technique. Thirty-five unstable spine fractures were treated with the CD implant at the University of Louisville--Level I Trauma Center--between June, 1985 and August, 1987. There were 17 burst fractures, 12 compression fractures and 2 fracture dislocations, 2 flexion distraction fractures and 2 flexion rotation injuries. Twenty patients underwent anterior cord decompression and strut grafting followed by posterior CD instrumentation and posterolateral fusion. Fifteen patients had posterior CD instrumentation and fusion alone. No neurological deterioration after the procedure was observed, 5 patients improved neurologically. In eleven cases bracing after the operation was unnecessary. Hospital stay varied between 6 and 35 days (mean 20 days). Follow-up ranged from 12 to 30 months, mean follow-up was 19 months. The loss of correction in the sagittal plane varied between 0 and 20 degrees (mean 5.6) at final follow-up. Complications due to the implant have not been observed except an avulsion of an upper thoracic hook, which did not effect the clinical or radiographic result. The high stability of the implant provides a decreased risk of neurological deterioration, posttraumatic kyphosis as well as early rehabilitation.

Adolescent↗
PubMed1990

The prophylactic use of antibiotic impregnated beads in open fractures.

Four hundred four compound fractures were reviewed in 339 patients treated between August 1983 and November 1987. The 252 males and 87 females had a mean age of 33 years (range, 14-86). One hundred twenty-seven (31.4%) fractures were classified as Grade I, 153 (38.9%) as Grade II, and 124 (30.7%) as Grade III by Gustilo's classification. The mean Injury Severity Score was 15 (range, 9-57). Three hundred thirty-four of the open fractures (82.7%) were managed with antibiotic-impregnated bead chains (tobramycin) and systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin). Seventy open fractures (17.3%) received systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin) without supplemental use of the antibiotic beads. All open fractures underwent acute irrigation and debridement. In the 404 fractures 46.5% of wounds were closed primarily, 12.9% underwent delayed primary closure, 7.9% were left open, and 32.7% were temporized by the antibiotic bead pouch technique until definitive flap coverage and skin grafting were performed. Of the 404 fractures evaluated, 17 (4.2%) developed an acute wound infection. Of these wound infections, eight (11.4%) were in the group managed with systemic antibiotics alone. By comparison, nine (2.7%) of open fractures treated with combined systemic antibiotics and antibiotic-impregnated beads developed an infection. Chronic osteomyelitis developed in 18 of 404 open fractures (4.5%). Ten (14.3%) open fractures which developed osteomyelitis were managed with systemic antibiotics whereas eight (2.4%) fractures managed with systemic antibiotics and antibiotic-impregnated beads developed a chronic infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1990

A preliminary experience: the Ilizarov external fixator.

The Ilizarov external fixator, though developed over 35 years ago in the Soviet Union, is only now gaining popularity in the United States. Its design and versatility allow the physician to treat a wider range of limb maladies than other external fixation systems (eg, the Hoffmann device). The Ilizarov method of fixation also permits treatment of some orthopedic conditions that were previously considered to be untreatable, such as dwarfism. The device can be used to correct limb length discrepancies, manage open and closed fractures, nonunions, and bony or soft tissue deformities. A review of the first 25 cases performed at the University of Louisville revealed 15 which have been successfully completed with significant, but manageable complications, and 10 cases which are still in progress.

Adult↗
PubMed1989

[Treatment of 2d and 3d degree complicated tibial shaft fractures with the PMMA bead pouch technic].

In a consecutive series of 222 compound fractures treated at the University of Louisville Level I Trauma Center from November 1984 to January 1987, 21 severe compound tibia shaft fractures in 20 patients were managed with the antibiotic bead pouch technique. There were 5 tibia shaft fractures and 16 tib-fib fractures. There were 9 type II and 12 type III (4 III A and 8 III B) open tibias. The patients' ages ranged from 16 to 50 years; the mean age was 29 years. There were 19 men and 1 woman. The Injury Severity Score (I.S.S.) ranged from 9 to 34; the mean I.S.S. was 14.4. Porous plastic film (Opsite) 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 external skeletal fixation, serial wound débridement, and parenteral systemic antibiotics (cefazolin, penicillin, tobramycin). An aggregate of 46 bead pouch changes were performed in the 21 tibia fractures. During these changes, 86 cultures were taken, 5 of which were positive. One patient developed a wound infection, which was caused by tobramycin-resistant Pseudomonas and Enterococcus. No cases of osteomyelitis were observed at the fracture site. Wound closure was obtained in 9 fractures with delayed primary closure, and in 12 fractures with flap coverage and/or split thickness skin grafting. All patients underwent autogenous cancellous bone grafting after wound closure was established. The mean follow-up was 26 months (range 13-43 months). At final follow-up, 4 results were rated excellent, 11 good, 3 fair and 3 poor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Wound and serum levels of tobramycin with the prophylactic use of tobramycin-impregnated polymethylmethacrylate beads in compound fractures.

Antibiotic-impregnated polymethylmethacrylate (PMMA) beads have been useful in treating orthopedic infections. Local delivery has been reported to establish wound antibiotic levels well above the therapeutic range while avoiding serum levels associated with increased incidence of side effects. After operative debridement, 70 patients with compound fractures were treated prophylactically with tobramycin-impregnated PMMA beads. Observations of antibiotic levels in 27 patients demonstrated antibiotic levels in the wound drainage and clot that were significantly in excess of the usual therapeutic range for tobramycin and simultaneous nontoxic serum levels. Significant levels of tobramycin can be achieved in the extracellular fluid at the fracture site when tobramycin-impregnated PMMA beads are placed in the wound after irrigation and debridement.

Debridement↗
PubMed1988

Intramedullary fixation of subtrochanteric fractures with the Williams Y-nail: report of three cases.

Küntscher Y-nailing is indicated for unstable proximal fractures of the femur in the elderly (5-7,10). The Williams modified Y-nail is an interlocking Y-nail that was designed to extend the indications beyond those of the Küntscher Y-nail. The Williams Y-nail was employed in three cases of subtrochanteric and subtrochanteric-intertrochanteric fractures, including one case in which there was an ipsilateral femoral shaft fracture. This procedure requires reaming and interlocking which are not performed in classic Küntscher Y-nailing. At follow-up (14-month minimum), each patient had a good clinical result and radiographic healing. Leg length shortening (maximum, 1.5 cm) occurred in two of three cases, primarily as a result of the failure to employ either a proximal or a distal interlocking screw. No other deformities have been observed. Williams Y-nailing can extend the indications of the Küntscher Y-nail to include rotationally unstable subtrochanteric fractures and associated ipsilateral femoral shaft fractures. The increased technical demands of the Williams modified Y-nail warrant cautious use depending upon the complexity of the fracture. Used properly, the Williams Y-nail may reduce the incidence of rotational and leg length deformities often experienced with other commonly used devices for unstable subtrochanteric and ipsilateral trochanteric-diaphyseal fractures of the femur.

Aged↗
PubMed1987

Heat of intramedullary reaming.

Cortical ischemia and necrosis after intramedullary reaming are well documented. Numerous authors have described ischemic changes attributed to mechanical disruption of the arterial system of the intramedullary canal. Few have investigated the potential thermal injury during extreme temperatures generated during intramedullary reaming. We reamed the medullary canal of cadaveric tibial and femoral diaphyses using a flexible shaft reaming device and stainless steel intramedullary reamer. The temperatures generated by reaming from 11 mm through 15 mm in 1 mm increments were measured after each pass. In the 17 specimens tested, we observed an incremental rise in temperature with reaming. The mean intramedullary temperature after reaming was 52 C ( +/- 8.3) with a range of 42 to 67 C. The mean extramedullary temperature was 46 C ( +/- 8.3) with a range of 36 to 59 C. There was a direct correlation between temperature increase and reamer size. Our results indicate that temperature elevations generated during intramedullary reaming are sufficient to cause thermal necrosis, and may cause delayed healing in vivo.

Aged↗
PubMed1983

Role of calcium and prostaglandins in the antidiuretic hormone response. Effect of ionophore A23187.

The calcium ionophore A23187 (IP) inhibited the antidiuretic hormone (ADH)-stimulated hydro-osmotic response in toad urinary bladder but had no effect on the osmotic transfer of water in the absence of hormone. Extracellular calcium was necessary for this effect at lower but not at higher IP concentrations. The hydro-osmotic response to exogenous cyclic AMP was unaltered by IP, but the same response produced by inhibition of phosphodiesterase was reduced significantly. Cyclic AMP concentrations in isolated toad bladder epithelial cells were reduced by 50% with IP or exogenous prostaglandin E2 (PGE2). Indomethacin, a prostaglandin synthesis inhibitor, prevented the inhibitory actions of the IP on the ADH-mediated response. Collectively, these observations suggest a key role for cellular calcium in modulating the actions of antidiuretic hormone and are consistent with the hypothesis that the ionophore, through increasing intracellular calcium, stimulates the synthesis of prostaglandins which have a negative feedback on adenylcyclase. This effect would terminate the action of the hormone.

Animals↗