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Biomedical subjects

Wesley P Phipatanakul

Publications and source records attributed to Wesley P Phipatanakul.

5 recordsLinked to original sources

Indications for prosthetic replacement in proximal humeral fractures.

Prosthetic replacement is a good treatment option in osteoporotic patients with four-part fractures, fracture-dislocations, head-split fractures with more than 40% articular surface involvement, anatomic neck fractures, dislocations present for longer than 6 months, and selected three-part fractures. Early prosthetic replacement of proximal humeral fractures has a better outcome than late reconstructive prosthetic management. Prosthetic design features specific forfracture care have led to a reduction in complications. Techniques will continue to improve as prosthetic design features specific for fractures evolve.

Adult↗

Immune response in patients receiving fresh osteochondral allografts.

Immunologic response to cartilage-specific protein (CSP) antigens was tested in patients treated with fresh osteochondral allografts. Eight of 14 allograft recipients showed immune reactivity against CSP, whereas only 2 of 14 controls were reactive (P<.05). The molecular weights of the most common immunoreactive proteins were 220 kd and 95 kd. The precise identity of these proteins could not be determined using standard anticollagen antibodies. These data indicate the presence of antibodies to CSP--which supports the concept of immunologic response to the cartilage component of osteochondral allografts.

Adult↗

Dynamic hip screw removal using a blade plate extraction device.

Dynamic hip screw implants are extracted by removing the side plate and compression screws. Occasionally, ingrown bone will prevent easy plate removal. A common solution is to use an osteotome as a levering device; however, the stress riser on the proximal femur caused by this maneuver could result in a catastrophic fracture. A blade plate extraction device fits into the dynamic hip screw side plate and allows relatively atraumatic removal of the implant, preventing the use of excessive force and decreasing the risk of an intraoperative fracture.

Bone Plates↗

Treatment of glenoid loosening and bone loss due to osteolysis with glenoid bone grafting.

Twenty-four patients underwent conversion of a total shoulder replacement to a humeral head replacement with glenoid bone grafting for glenoid loosening due to osteolysis. Of the 24 patients, 18 (75%) had satisfactory pain relief at a mean follow-up of 33.4 months (range, 24-63 months). Four had good pain relief with conversion back to total shoulder replacement at a mean of 11 months (range, 9-15 months) after the index procedure, thus bringing the rate of overall satisfactory pain relief to 92%. Two patients continued to report significant pain and were not satisfied with the procedure. Significant functional motion improvements were not seen (P > .05). Graft subsidence was seen in 10 of 20 cases (50%). Bone grafting of glenoid defects in revision arthroplasty provides satisfactory improvement in terms of pain relief and, by improving bone stock, allows for placement of a glenoid component at a later date if there is persistent pain. However, high rates of graft subsidence are concerning.

Aged↗