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Biomedical subjects

Thomas J Ellis

Publications and source records attributed to Thomas J Ellis.

9 recordsLinked to original sources
PubMed2005

Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw.

OBJECTIVE: The purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw. DESIGN: Retrospective review. SETTING: Level I county trauma center. PATIENTS: Twenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment. INTERVENTION: All fractures were treated with a sliding hip screw. MAIN OUTCOME MEASUREMENTS: Radiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined. RESULTS: Treatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction. CONCLUSION: We conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.

Adult↗
PubMed2005

Interobserver reliability of a CT-based fracture classification system.

OBJECTIVES: This study was designed to determine whether the interobserver reliability of a fracture classification scheme applied based on a single, carefully defined, computed tomography (CT) cut is greater than those previously reported for systems designed for use with plain radiographs. DESIGN: Observer review of selected cases. SETTING: Four, level one, trauma centers. PATIENTS: Pretreatment CT scans of patients with calcaneus fractures were screened by the authors. Thirty cases were selected that had an appropriate semicoronal CT image. Ten orthopaedic traumatologists who were members of the Orthopaedic Trauma Association and had a minimum of 5 years postresidency experience were selected as reviewers. INTERVENTION: The reviewers were provided with a digital CT image for each case as well as written and diagrammatic representations of the Sanders classification system. The observers then classified each fracture according to the Sanders classification. RESULTS: : The mean kappa value for interobserver reliability for fracture types I-IV was 0.41 +/- 0.02 (mean +/- standard error of the mean; range, 0.07-0.64). Observers disagreed by more than 1 fracture type (ie, I vs. III or II vs. IV) in 10% of the cases. Observers agreed on the location of the fracture lines (A, B, C) in 90% of type II fractures and 52% of type III fractures. CONCLUSIONS: The results indicate that in a carefully controlled paradigm, the interobserver reliability with a classification system based on interpretation of a single, carefully defined CT image was no better than the results reported for the same classification system used with full CT data or for other classification systems used for various fractures in the skeleton. Agreement in identifying the location of the fracture lines was very good for simple fractures but much worse for complex injuries. Additional study may determine whether the use of a full complement of CT images can improve reliability in classification of complex injuries.

Ankle Injuries↗
PubMed2005

Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial.

BACKGROUND: Pelvic ring injuries are associated with a high incidence of mortality mainly due to retroperitoneal hemorrhage. Early stabilization is an integral part of hemorrhage control. Temporary stabilization can be provided by a pelvic sheet, sling, or an inflatable garment. However, these devices lack control of the applied circumferential compression. We evaluated a pelvic circumferential compression device (PCCD), which allows for force-controlled circumferential compression. In a prospective clinical trial, we documented how this device can provide effective reduction of open-book type pelvic injuries without causing overcompression of lateral compression type injuries. METHODS: Sixteen patients with pelvic ring injuries were enrolled. Pelvic fractures were temporarily stabilized with a PCCD until definitive stabilization was provided. Anteroposterior pelvic radiographs were obtained before and after PCCD application, and after definitive stabilization. These radiographs were analyzed to quantify pelvic reduction due to the PCCD in comparison to the quality of reduction after definitive stabilization. Results were stratified into external rotation and internal rotation fracture patterns. RESULTS: In the external rotation group, the PCCD significantly reduced the pelvic width by 9.9 +/- 6.0%. This reduction closely approximated the 10.0 +/- 4.1% reduction in pelvic width achieved by definitive stabilization. In the internal rotation group, the PCCD did not cause significant overcompression. No complications were observed. CONCLUSIONS: A PCCD can effectively reduce pelvic ring injuries. It poses a minimal risk for overcompression and complications as compared with reduction alternatives that do not provide a feedback on the applied reduction force.

Adolescent↗
PubMed2004

A prospective, modernized treatment protocol for periprosthetic femur fractures.

This article reports a prospective series of periprosthetic femur fractures in 33 patients treated with a modernized fracture treatment protocol. Some form of operative treatment was selected prospectively based on the categorization of the fracture by the Duncan-Vancouver and Beals-Tower Oregon classification systems. Fractures in which the prosthesis-bone interface was stable were treated with open reduction and internal fixation of the fracture around the stable implant. Unstable prosthesis-bone interfaces required removal of the primary prosthesis and revision to an uncemented long-stem prosthesis after stabilization of the femoral fracture with plates or allograft struts. Complications were minimal over an average follow-up period of 28.3 months; restoration of function was predictable.

Arthroplasty, Replacement, Hip↗
PubMed2004

Trochanteric osteotomy for acetabular fractures and proximal femur fractures.

Anatomic reconstruction of the articular surface is a primary goal of internal fixation of fractures of the hip joint. The quality of the reduction correlates with long-term outcomes. The traditional Kocher-Langenbeck and the ilioinguinal approaches, however, rely on extra-articular assessment of the quality of the reduction. Ganz et al described a technique of trochanteric osteotomy combined with a Kocher-Langenbeck approach that allows direct visualization of the joint without the risk for avascular necrosis of the femoral head. This article reviews the indications of this approach in the treatment of fractures around the hip joint.

Acetabulum↗
PubMed2003

Absorbable plates for rib fracture repair: preliminary experience.

BACKGROUND: Absorbable prostheses are currently used in a variety of bone reconstructions and fixations. METHODS: This is a case series of rib fracture fixation using absorbable plates and screws consisting of 70:30 poly(L-lactide-co-D,L-lactide) from April 2001 through November 2002. RESULTS: Ten patients underwent rib fracture fixation with absorbable plates and screws. Indications included flail chest with failure to wean (five patients), acute pain with instability (four patients), and chest wall defect (one patient). All patients with flail chest weaned from mechanical ventilation successfully. All patients with pain and instability reported rapid subjective improvement or resolution. The patient with a chest wall defect repair returned to full athletic activity without limitations at 6 months. Thoracoscopic assistance was used in three cases and muscle-sparing incisions were used in eight cases. Two patients with screw fixation only developed loss of rib fracture reduction. One patient developed a wound infection requiring drainage. The period of follow-up ranged from 3 to 18 months. CONCLUSION: Absorbable plates produce good clinical results and are an option for rib fracture repair. Two-point fixation (screw fixation plus suture cerclage) is required. Further refinements in technique should focus on minimally invasive methods.

Adolescent↗
PubMed2003

Hip fractures in the elderly.

The incidence of hip fractures in the elderly is increasing worldwide, with 650,000 fractures expected in the United States by the year 2050. The mechanism of injury is typically a ground-level fall. Efforts at prevention focus on reducing risk factors by aggressive medical management of comorbidities, use of protective garments, and modification of the individual's environment to lessen the chance of falling. Treatment is associated with an elevated mortality rate and compromised functional outcome.

Aged↗
PubMed2002

Extensively porous-coated femoral revision for severe femoral bone loss: minimum 10-year follow-up.

Of 275 femoral revisions done at our institution from 1982 to 1986, we identified 34 patients (35 hips) who represented the senior author's (C.A.E., Sr.) most difficult revision cases as a result of extensive femoral bone loss at least 10 cm below the lesser trochanter. The patients were revised with fully porous-coated femoral components >or=190 mm. We evaluated 25 of the patients (26 hips) who had a minimum 10-year follow-up (mean, 13.3 years). Survivorship was 89% at 10 years with femoral revision as the endpoint (Kaplan-Meier). The femoral aseptic loosening rate was 15% (4 of 26). Three stems were loose but did not warrant reoperation. One stem was revised for aseptic loosening, 1 was revised for septic loosening, and 1 was revised for a fractured femoral component. Bypassing weak or absent femoral bone with an extensively porous-coated stem is an effective reconstructive technique for patients with extensive femoral bone loss.

Adult↗