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Biomedical subjects

A M Pankovich

Publications and source records attributed to A M Pankovich.

At least 37 records · Page 2Linked to original sources
PubMed1980

Management of complex vascular injuries to the extremities.

Complex vascular injuries to the extremities are challenging and, to this day, continue to cause significant morbidity and tax the ingenuity of the vascular surgeon. we have presented complicating factors and conditions that may jeopardize a successful outcome. Distal ischemia and limb loss may be caused by conditions other than arterial injury. Venous repair for major venous injury, decompression fasciotomy in compartmental hypertension, early recognition and management of associated vascular injuries in fractures and dislocations, sensible use of arteriography and venography, and prevention of postoperative wound infection by radical debridement and adequate wound coverage for close-range shotgun wounds and replanted limbs are some of the important features that will aid in successful efforts to preserve the anatomy and function of the traumatized limb.

Adolescent↗
PubMed1979

Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies.

An anatomical study of the medial malleolus and the deltoid ligament of the ankle on fresh and formalin preserved legs of cadavera and amputation specimens has been carried out. The anterior and posterior colliculi, and the intercollicular groove of the medial malleolus were described. The deltoid ligament was found to have two layers: the superficial, attached primarily to the anterior colliculus, consisted of the naviculotibial, calcaneotibial, and superficial talotibial ligaments; the deep layer consisted of the deep anterior and posterior talotibial ligaments and was attached primarily to the posterior colliculus and the intercollicular groove. These findings are at variance with previous descriptions of the deltoid ligament.

Ankle↗
PubMed1979

Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. II. Clinical studies.

The anatomical concept of the deltoid ligament as being attached to the anterior colliculus of the medial malleolus by its superficial portion, and to the posterior colliculus by its deep portion has been applied to a clinical material. A number of singular and concurrent lesions of the medial malleolus and the deltoid ligament were recognized: fracture of the anterior colliculus, concurrent fracture of the anterior colliculus and rupture of the deep posterior talotibial ligament, fracture of the posterior colliculus, supracollicular fracture, rupture of the deltoid ligament, and chip fracture of the anterior colliculus. The clinical implications of these lesions are discussed.

Ankle↗
PubMed1979

Fractures of the fibula at the distal tibiofibular syndesmosis.

Two basic fracture types are found at the level of the syndesmosis, supination-external rotation (SE) and pronation-abduction (PA), reflecting the mechanism of injury. The SE-type fracture of the fibula extends from the anterior edge in a posterosuperior direction, and the PA-type fracture extends from the medial surface either transversely or obliquely in a laterosuperior direction, and are often comminuted. The SE-types exist in 2 locations above and below the anterior fibular tubercle. All 3 types exist also in atypical forms. Treatment of the initial stages is by cast immobilization, and advanced lesions are treated by open reduction and internal fixation of the medial and lateral lesions of the ankle. The most common type of Wagstaffe fracture was type 2 which represents fractured anterior spike of the proximal fragment of the fibula.

Adolescent↗
PubMed1979

Closed Ender nailing of femoral-shaft fractures.

Closed Ender nailing was used in sixty fractures of the femoral shaft. Follow-up examination in fifty-two cases is reported. There were only two failures of the method, both in fractures with supracondylar extension. Simple transverse and short oblique fractures and those with unicortical comminution were shown to be stable after nailing, while long oblique fractures and lesions with bicortical comminution had a tendency to shorten and often required cerclage wiring, cast-bracing, or traction. The average hospital stay was 23.7 days. The operations were simple and quick. There was one case of osteomyelitis, one of clinically apparent thrombophlebitis, and one of fat-embolism syndrome in a patient with multiple fractures and multisystem injuries. There were no cases of breakage of the nail, delayed union, or non-union. In most cases knee motion returned to the preinjury level, although in five knees removal of the nails was necessary. The two failures of nailing which required plate fixation occurred in fractures extending into the supracondylar region. Therefore, these fractures are not suitable for Ender nailing.

Adolescent↗
PubMed1978

Extra-articular low-velocity gunshot fractures of the radius and ulna.

Low-velocity gunshot fractures of the forearm are complex injuries and previously published studies have not emphasized the problems particular to these forearm lesions. Of the twenty-nine patients in this series, thirteen had peripheral nerve injuries, three had impending Voklmann's ischemia, and ten had delayed union or malunion of fractures after treatment by closed methods. Only thirteen had none of these problems. Eight patients had long-term disability resulting either from permanent nerve damage with loss of sensation or weakness of grip, or from significant loss of motion following delayed union or malunion. Although external fixation was adequate for undisplaced fractures, delayed (seven to fourteen days) primary internal fixation after the initial phase of wound healing had proved benign gave superior results in displaced fractures.

Adolescent↗
PubMed1978

Fractures of the fibula proximal to the distal tibiofibular syndesmosis.

Study of thirty-six cases of fracture of the fibula at levels proximal to the distal tibiofibular syndesmosis established that there are three types, distinguished by the direction of the fracture line, which are produced by different mechanisms: supination-external rotation, pronation-abduction, and pronation-external rotation. Advanced lesions that were seen were severe injuries of the ankle which included rupture of the deltoid ligament or fracture of the medial malleolus and complete diastasis of the distal tibiofibular syndesmosis in addition to the fracture of the fibula. Surgical treatment is necessary in most advanced lesions.

Adolescent↗
PubMed1977

Fracture-dislocation of the radiocarpal joint.

In five patients with fracture-dislocation of a radiocarpal joint, the wrist injury was severe and associated with injuries to other systems. Typically there was neurovascular impairment and closed reduction was performed as soon as possible to relieve pressure to tension on vessels and nerves. Fracture of the radial and ulnar styloid processes, fracture of the dorsal rim of the radial articular surface, and a multitude of carpal and intercarpal injuries were present in all cases. Early open reduction, internal fixation of the fractures, and repair of all torn ligaments appeared to be the treatment of choice.

Adult↗
PubMed1976

The use of tomography in the assessment of fractures of the tibial plateau.

Tomography was useful in the preoperative assessment of twenty-one tibial-plateau fractures. It helped in classifying these fractures more precisely, information which is very important if the results of different methods of treatment are to be compared. It demonstrated clearly the extent of fracture depression or displacement, or both, as well as the site of the fracture and the extent of fracture comminution. The findings were confirmed at operation in the thirteen patients who had surgery.

Adult↗
PubMed1976

Maisonneuve fracture of the fibula.

Study of seventeen cases of Maisonneuve fracture established that there are five stages in the development of a complete lesion. A strong external-rotation force with the foot in slight supination is thought to be responsible for the initial stages; this may change to neutral or slight pronation in the later stages. This is a severe injury to the ankle, which includes complete diastasis of the distal tibiofibular syndesmosis and often rupture of the anteromedial joint capsule and deltoid ligament or fracture of the medial malleolus. Surgical treatment is necessary in later stages.

Adolescent↗
PubMed1975

Primary internal fixation of femoral neck fractures.

The principles in treatment of femoral neck fractures by primary internal fixation have been reviewed. In the rare, undisplaced stress or fatigue fracture, early internal fixation with threaded pins is recommended. Impacted fractures should be treated by primary internal fixation in patients who do not follow orders and patients whose general condition is poor and would require early weight bearing. Displaced fractures may be treated by primary internal fixation at any age and regardless of the patient's general condition. The following principles are emphasized: early operation, anatomical reduction and slight valgus in some cases, compression and impaction of fragments, and firm immobilization of fragments with a device that has a sliding mechanism and provides lateral cortical fixation.

Bone Nails↗
PubMed1975

Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap.

A method is described that achieves end-to-end anastomosis of ruptures of the Achilles tendon. A sliding tendinous flap is developed over the proximal portion of the tendon by making an inverted V incision which is then repaired in a Y fashion. The procedure is recommended for patients with neglected ruptures of the Achilles tendon in which end-to-end anastomosis is otherwise impossible.

Achilles Tendon↗