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Biomedical subjects

B R Bach

Publications and source records attributed to B R Bach.

At least 55 records · Page 3Linked to original sources
PubMed1992

The surgical approach to lateral meniscal repair.

Peripheral lateral meniscal tears are amenable to meniscal repair. Rasp abrasion and fibrin clot deposition along with vascular access channels are advances that, one hopes will increase healing rates of meniscal repairs. A basic principle that is not emphasized in the literature is how to perform the surgical approach to the lateral meniscus for safe placement of a meniscal repair retractor. This article reviews the anatomical planes of which the surgeon must be cognizant to facilitate retractor placement.

Arthroscopy↗
PubMed1992

Meniscal tears: diagnosis, evaluation, and treatment.

Arthroscopic surgery for treatment of pathologic meniscal lesions has become the most commonly performed orthopaedic procedure in the United States. This article reviews the diagnosis, evaluation, and subsequent treatment of meniscal tears in the knee.

Anterior Cruciate Ligament Injuries↗
PubMed1990

Arthroscopic removal of painful Bristow hardware.

Complications of metallic hardware about the shoulder have been well documented in the literature. This case report presents a recreational athlete who presented to our office with a painful shoulder 4 years after a Bristow procedure. Radiographic imaging confirmed contact of the humeral head on the Bristow screw. In these unusual situations, arthroscopic evaluation, as this case suggests, should be considered. The patient's hardware was removed arthroscopically, obviating an open procedure and hospitalization.

Adult↗
PubMed1990

A suture "retractor": a technical aid for bucket-handle meniscal resections.

Meniscal repair, healing, and survival have been demonstrated in the literature. Meniscal preservation is, however, not always possible. We present a technique that may aid the surgeon in difficult bucket handle resections by stabilizing a portion of the meniscus with a "suture retractor" prior to resecting either a posterior or anterior meniscal horn. This technique may also be modified to prepare the inner rim when one is performing meniscal repair.

Humans↗
PubMed1990

Primary bone grafting following graft procurement for anterior cruciate ligament insufficiency.

A technical recommendation of primarily bone grafting the patellar tendon graft site created following harvesting the central third of the free bone-tendon-bone patellar tendon graft for anterior cruciate ligament (ACL) insufficiency is presented. Harvesting a patellar bone-tendon-bone graft produces a stress riser that increases the potential risk of a patellar fracture. Primary bone grafting of the patellar region is recommended as a simple and safe solution, especially if a graft wider than 10-12 mm or deeper than 6 mm is taken. We feel that this will reduce even further the small likelihood of late patellar fracture. Using these principles, we have not had any late patellar fractures in over 135 consecutive ACL reconstructions since July, 1986.

Anterior Cruciate Ligament↗
PubMed1990

Triceps brachii injuries.

Triceps brachii injuries are uncommon, resulting from indirect or direct trauma generally associated with an eccentric contraction. The tendo-osseous junction is the most common location. An extensor lag and palpable gap are diagnostic of complete rupture. Diminished extension strength against resistance implies a partial triceps rupture. A radiograph must be obtained as triceps ruptures are associated with olecranon or radial head fractures. A lateral radiograph may reveal an avulsion or 'flake' fracture. Early surgical repair of complete tendon ruptures is recommended. Surgical results are generally excellent.

Arm Injuries↗
PubMed1990

Massive heterotopic ossification after biceps tendon rupture and tenodesis.

Few complications from tenodesis of the long head of the biceps brachii have been described despite the wide variety of techniques. In a 53-year-old man, rupture of this tendon was treated by tenodesis and was complicated by heterotopic ossification that severely limited the function of the shoulder joints. Nonsurgical conservative treatment of biceps tendon ruptures may avoid the possibility of this complication.

Humans↗
PubMed1990

Arthrometric evaluation of knees that have a torn anterior cruciate ligament.

We used the KT-1000 arthrometer to test the knees of 107 patients who had an acute tear of the anterior cruciate ligament, 153 patients who had a chronic tear, and 141 control subjects, for a total of 401 individuals. The three testing parameters were the extent of anterior translation at eighty-nine newtons of force and at maximum manual force, and the compliance index. The differences between the involved and the uninvolved knees were calculated. At eighty-nine newtons, all but one of the control subjects had anterior translation of ten millimeters or less, compared with 58 per cent of the patients who had a chronic tear. At maximum manual force, all but two of the control subjects had translation of ten millimeters or less, compared with 20 per cent of the patients who had an acute or a chronic tear. Analysis of variance showed that the clinical diagnosis correlated well with the results for all tests (p less than 0.001). However, when the uninjured knees of patients who had an acute or a chronic tear were compared with the knees of the control subjects, significant differences were noted (p less than 0.001 to 0.006). In the patients who had a chronic tear, there was no relationship between the time from injury to operation and the extent of anterior translation. The arthrometric test at maximum manual force was the strongest discriminant; it differentiated normal from abnormal knees (p less than 0.001) with high sensitivity (92 per cent), high specificity (95 per cent), and high positive predictive accuracy; the cut-off point was eleven millimeters or less.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Gait adaptations by patients who have a deficient anterior cruciate ligament.

Sixteen patients who had unilateral deficiency of the anterior cruciate ligament and ten healthy control subjects were analyzed during level walking, jogging, and ascending and descending stairs. Kinematic and kinetic findings for the right and left hips, knees, and ankles of all of the patients and control subjects were recorded during each activity. Substantial differences from normal function were observed for both limbs of the patients during level walking and during jogging. The magnitude of the maximum moment that tended to flex the knee was reduced the most (140 per cent) during level walking. It was reduced less (30 per cent) during jogging, it was not changed while the patient descended stairs, and it was slightly increased while he or she ascended stairs. The reduction in the magnitude of the flexion moment about the knee was interpreted as the patient's effort to reduce or avoid contraction of the quadriceps. Reduction of the flexion moment reduces any contraction of the quadriceps because there must be a mechanical balance between the external moment (due to body weight and the weight and inertia of the segment of the limb) that tends to flex the knee and an internal moment (generated by contraction of the quadriceps) that tends to extend the knee. This so-called quadriceps-avoidance gait was related to the angle of flexion of the knee when the maximum flexion moment occurred during each activity. This angle of flexion was 20 degrees during walking, 40 degrees during jogging, and approximately 60 degrees during stair-climbing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

"Empty wall" and "vertical strut" signs of ACL insufficiency.

We report our observation on the "empty wall" and "vertical strut" signs of anterior cruciate ligament (ACL) insufficiency. ACL tears most commonly occur in the midsubstance; arthroscopic evaluation of patients with these tears often reveals minimal evidence of previous ACL tissue along the intercondylar wall, thus giving the appearance of an "empty wall." In proximal ACL tears, the long remnant of ACL tissue may adhere to adjacent PCL tissue. Arthroscopically, one may see this vertically oriented strut of tissue, which to the casual arthroscopist may mimic a normal-appearing ACL except for orientation and tension. In addition, the "empty wall" sign will be noted because the lateral intercondylar wall becomes easily visible following ACL injury. In two separate prospective studies of 84 such patients, the combined incidence of the empty wall sign was 82%, and the incidence of the vertical strut sign was 50%. These findings should be sought for meticulously at the time of arthroscopic evaluation. The vertical strut should not be misinterpreted as an aberrantly oriented ACL or partial ACL tear.

Adolescent↗
PubMed1988

Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation.

Experimental work has shown that dislocation of the shoulder may involve disruption of the capsule from its lateral humeral attachment. We report two patients with recurrent dislocation due to this injury. Lateral repair gave good results. It is suggested that this injury be considered and looked for when glenoid labral injury is minimal or absent.

Adult↗
PubMed1986

Financial charges of hospitalized motorcyclists at the Massachusetts General Hospital.

We studied 47 hospitalized motorcyclists admitted through the Massachusetts General Hospital emergency room during a 1-year period. Four factors were studied: 1) hospitalization charges, 2) hospitalization lengths, 3) medical insurance profiles, and 4) patterns of injuries. The mean hospitalization charges were +15,114. The total hospital charges for this group of patients were nearly +700,000. These figures excluded the costs of subsequent admissions, surgeons' fees, rehabilitation, vocational training, legal suits, and loss of wages. Sixteen per cent of the charges were uncollectable. Forty-six per cent of the patients were uninsured. The average hospitalization was 22 days. The mean age was 22 years and 90% of patients were less than 30 years old. Eighty-five per cent of the patients sustained at least one fracture. Lower extremity fractures occurred in 60%, open fractures in 55%, and tibia fractures occurred in 33% of the patients. Associated head, chest, or abdominal injuries occurred in 40% of the patients. Patients with multiple fractures, open fractures, and grade 3 open tibia fractures had substantially higher hospital bills.

Accidents, Traffic↗
PubMed1985

Air in painful total hip arthroplasty: diagnosis and treatment.

A 78-year-old woman presented with a painful total hip arthroplasty five years postoperation. Plain radiographs revealed air in the hip joint. Aspiration of the hip indicated hip sepsis, and arthrogram showed communication of the hip joint with the sigmoid colon. Cultures grew Bacteroides fragilis. Abdominal exploration showed a ruptured diverticulum that decompressed through the sciatic notch into the total hip arthroplasty. A colostomy was performed, and the hip joint was drained and debrided laterally at the same operation. The prosthesis was later removed with all cement, and the hip was converted to a Girdlestone resection. The authors conclude that air or gas shadows in a painful total hip arthroplasty are an ominous finding and mean either joint sepsis with a gas-forming bacteria or communication of the joint with a hollow viscus and sepsis.

Aged↗