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Biomedical subjects

B R Moed

Publications and source records attributed to B R Moed.

At least 37 records · Page 2Linked to original sources
PubMed1996

Three-view radiographic assessment of heterotopic ossification after acetabular fracture surgery.

A random sample of 100 patients who had operative treatment for a fracture of the acetabulum, an otherwise normal appearing hip joint, and at least one year of follow-up were analyzed to assess heterotopic ossification (HO) and its relationship to hip motion. The extent of HO was graded in a blinded fashion according to the Brooker classification, which relies solely on the anteroposterior (AP) view, as well as a modified classification using three radiographic views (AP pelvis, internal, and external Judet oblique views). For each patient, range of motion of the affected hip was compared with that of the contralateral normal limb. There were 16 cases with disagreement between the two methods. As opposed to the Brooker method, the modified classification provided an accurate correlation with the actual hip range of motion.

Acetabulum↗
PubMed1996

Greenstick fractures of the radius in adults: a report of two cases.

To our knowledge, greenstick fractures, which are common in children, have not been found to occur in adults. We report on two cases of greenstick fracture of the radial shaft in an adult. Treatment principles, which differ from those for children's fractures, are discussed.

Adult↗
PubMed1996

Orthopedic trauma surgeons' attitudes and practices towards bloodborne pathogens.

A survey was conducted to determine orthopedic trauma surgeons' attitudes and practices towards occupational exposures to bloodborne pathogens. The survey was distributed to orthopedic trauma surgeons either by mail or through participation at the annual 1993 OTA meeting or the 1994 update meetings. Of the 1,058 surveys distributed, 504 were successfully completed (48%). The majority of respondents were attendings (72%) who performed at least 100 orthopedic procedures annually. Of the respondents, 74% reported they were moderately to very concerned about acquiring HIV at work. Despite their concern, 42% reported not routinely wearing gloves when changing would dressings. Of the 340 respondents who have access to maximum barrier protection, 83% reported not wearing it to nail a femur fracture and 33% reported not wearing it when operating on an HIV+ patient. At an institutional level, almost one-third of those surveyed did not believe their facility promoted safe work practices. Facilities judged by respondents to promote safe practices were significantly more likely to have resources available and infection control policies in place compared to facilities judged not to promote safe practices. Orthopedic trauma surgeons need to improve their compliance with infection control recommendations. Further efforts by individuals and their institutions are warranted.

Blood-Borne Pathogens↗
PubMed1995

Intramedullary nailing of aseptic tibial nonunions without the use of the fracture table.

Twenty-seven patients with 28 aseptic nonunions were treated with reamed intramedullary (IM) nailing of the tibia and were followed for at least 1 year postoperatively. The management protocol called for a radiolucent operating room table with the limb draped free and manual manipulation of the nonunion with a preference for closed nailing. Nail interlocking was used when residual axial or rotational instability was observed after nail insertion. Iliac crest bone grafting was performed on all patients requiring open nailing. Closed nailing, using the described technique, was accomplished in 20 cases; open nailing was necessary in eight. Although operative time and total blood loss were significantly increased with open nailing, time to union was similar in the two groups. Twenty-seven nonunions healed. The lone persistent nonunion responded to bone grafting, leaving the nail in situ. One infection occurred, which responded to debridement, drainage, and long-term antibiotic therapy without requiring nail removal. Acceptable bony alignment was attained in all patients. Functional results were excellent. This method is recommended for all tibial nonunions amenable to IM nail stabilization. A history of prior acute infection and/or excessive shortening due to bone loss constitute the relative contraindications.

Adolescent↗
PubMed1995

Early versus delayed treatment of severe ankle fractures: a comparison of results.

A retrospective review of 202 closed Weber B bimalleolar or bimalleolar equivalent ankle fractures treated using open reduction and internal fixation (ORIF) from January 1, 1991, through January 1, 1994 was completed at our institution. A total of 105 ankles (52%) were treated using ORIF within 5 days of injury (early group), with a mean 1.5 days from injury to surgery. A total of 97 ankles (48%) were treated after 5 days (delayed group), with a mean of 13.6 days from injury to surgery. Operative time, length of hospital stay, postoperative range of motion, adequacy of reduction, wound and other complications, and other sequelae were compared between the two groups. No significant difference in range of motion at latest follow-up or in operative time was evident between the groups. Minor wound complications were present in 4.8% of the early group compared with 6.2% in the delayed group. No deep infections or osteomyelitis were present in either group. Anatomic reductions were present in 89% and poor reductions (> 2 mm displacement) in 1% of those ankles treated within 5 days versus 83% anatomic reductions and 3% poor reductions in those treated after 5 days. The differences in wound complications and anatomic reductions between groups was not statistically significant. There was a significantly longer median hospital stay in the early (3 days) versus delayed groups (2 days). We conclude that the results and complications of early versus delayed treatment is not significantly different, except for a shorter median hospital stay in the delayed group. Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that offer an undesirable environment for surgical incisions. Using contemporary, a traumatic techniques, delayed surgery can provide anatomic reduction with minimal complications in severe ankle fractures.

Ankle Injuries↗
PubMed1995

Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients.

Twenty consecutive multiply injured patients who had a total of twenty-two fractures of the femoral shaft were managed with intramedullary nailing without reaming. A retrograde technique through the intercondylar notch of the knee was used. All patients were followed for at least one year or until union of the fracture. The operative time for the nailing averaged seventy-five minutes (range, thirty-five to 105 minutes). Union of the fracture occurred at an average of fifteen weeks. There were three non-unions and one rotational malunion. There were no infections, and no nail or screw failed. Normal motion of the knee was regained by all patients, except one who had had an ipsilateral dislocation of the knee. On the basis of these preliminary results, we concluded that retrograde nailing is a safe and effective technique for multiply injured patients. The apparently higher prevalence of non-union compared with that reported with antegrade nailing with reaming warrants additional study.

Adult↗
PubMed1995

Management strategies for bone loss in tibial shaft fractures.

Fifty open tibial fractures with circumferential cortical bone loss were reviewed. Prospective treatment protocols included fracture stabilization with repeated irrigation and debridement followed by wound coverage. Bony stabilization was accomplished using external fixators, small diameter unreamed interlocking nails, and, in rare instances, plate fixation. Bone graft procedures included posterolateral bone graft, elevation of the free flap or direct anterolateral grafting, bone transport techniques, and free vascularized fibula transfer. Average followup was 18 months (range, 9-40 months). The index graft procedure was used in 30 patients (60%) for fracture healing. The rate of union was 98%, with an average total treatment time of 42.4 weeks (range, 23-80 weeks). Malunion was more likely to develop in patients treated with external fixation and posterolateral bone graft (p = 0.007). Intramedullary nails with direct bone grafting had shorter times to union and shorter total treatment times. The use of free vascular fibular transfers in acute injuries was not successful. Good results were obtained with bone transport techniques. Developing a healthy soft tissue envelope before reconstruction of these injuries is important. Techniques of reconstruction had no correlation to the development of nonunion or infection. They were valuable in determining malunion and total treatment time. These data confirm that carefully staged reconstruction leads to successful outcomes.

Adolescent↗
PubMed1995

Ultrasound for the early diagnosis of fracture healing after interlocking nailing of the tibia without reaming.

Fourteen fractures (8 open, 6 closed) were treated with small-diameter interlocking tibial nails and observed for at least 1 year. Radiographs were obtained to monitor the maintenance of reduction and fracture healing. The treating orthopaedic surgeon was blinded to the results of ultrasound studies, which were obtained at 2-week intervals for 10 weeks postoperatively and read by a radiologist who was blinded to the clinical and radiographic progress. Ultrasound correctly predicted fracture healing in all 9 fractures that subsequently progressed to fracture union. Of the 5 fractures that did not heal and required secondary procedures, ultrasound predicted delayed healing in 4 fractures. Overall, ultrasound was able to predict fracture healing before it was radiographically evident. Ultrasound may provide important prognostic information concerning tibial fracture healing after treatment using interlocking nails without reaming. Additional study is warranted.

Adolescent↗
PubMed1994

Effect of two nonsteroidal antiinflammatory drugs on heterotopic bone formation in a rabbit model.

Using the model described by Michelsson, 24 mature New Zealand white rabbits underwent mechanical induction of heterotopic ossification in the quadriceps of the right hind limb. The rabbits were equally divided into four groups: indomethacin-treated, piroxicam-treated, and their respective controls. The effect of drug therapy on the production of heterotopic bone was assessed by analyzing plain radiographs of the femur using the grading system described by Scott. The results demonstrated that, while indomethacin is effective in decreasing the formation of heterotopic bone, piroxicam--when used in the dosage previously demonstrated to have no deleterious effect on healing bone--is not. The analysis of piroxicam blood levels demonstrated that the experimental piroxicam dose is inadequate to produce effective plasma blood levels in the rabbit. Therefore, any potential benefit from using piroxicam, as opposed to other nonsteroidal antiinflammatory drugs regarding fracture healing and bone remodeling, cannot be applied for the prophylactic treatment of heterotopic bone formation.

Animals↗
PubMed1994

Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients.

Thirty-seven male patients with acetabular fractures requiring an extensile surgical approach were treated using a uniform protocol that was begun in July 1984. In 1987, prophylactic indomethacin was added to the protocol to study its effects on the prevention of heterotopic ossification. Nineteen patients with at least 12 months' follow-up were operated on prior to, and 16 after the initiation of the indomethacin treatment program. Two patients were lost to follow-up. The severity of heterotopic ossification was evaluated for each of these two patient groups using the Brooker classification and was correlated with hip joint mobility. Statistical analysis revealed that indomethacin was effective in decreasing the overall incidence of heterotopic ossification (p < 0.01). The occurrence of severe heterotopic ossification (Brooker class III and class IV) was also significantly reduced (p < 0.01) and functional results thereby improved. The maximal extent of heterotopic ossification was evident by 6 weeks postoperatively in all patients. In the patients receiving indomethacin, heterotopic ossification did not progress after the drug was discontinued.

Acetabulum↗
PubMed1994

Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique.

A series of 44 fractures of the tibia requiring operative stabilization were treated using an intraoperative external transfixion pin frame to correct angular deformity and maintain length in preparation for intramedullary (IM) nailing, eliminating the need for a fracture table. The technique requires a radiolucent operating room table; the injured extremity is draped free. A transfixion pin is inserted in the os calcis. Rotational deformity is manually corrected. Using fluoroscopic control, a second transfixion pin is inserted at a location just distal and parallel to the proximal tibial articular surface, paralleling the horizontal plane of the first pin. The transfixion pins are connected with carbon fiber rods, creating a rectangular frame. Manual fracture reduction is followed by "fine tuning" with compressor/distractor clamps as needed. Alternatively, for added reduction force, the carbon fiber rod on the concave side of the angular deformity may be replaced with the AO/ASIF universal distractor. IM nailing is then performed in the usual fashion. In this series, an acceptable reduction was obtained in all cases. This technique shortens setup time, provides complete access to the distal part of the tibia, and allows free manipulation of the limb, thereby facilitating nail insertion and placement of distal locking screws. Use of medial and lateral bars prevents the angular deformity often created or exacerbated with the use of the universal distractor alone. This technique is recommended for IM nailing of all fractures of the tibia that would otherwise require use of the fracture table or universal distractor.

Adolescent↗
PubMed1994

Low-dose irradiation and indomethacin prevent heterotopic ossification after acetabular fracture surgery.

From 1987 to 1991, we treated 53 patients with 54 fractures of the acetabulum by reconstruction through a posterior or an extended iliofemoral surgical approach. For prophylaxis against heterotopic ossification we used perioperative irradiation and indomethacin. Indomethacin was given as daily doses of 25 mg started within 24 hours of operation and continued for four weeks. Irradiation was by either 1200 cGy in three daily doses or by a single 700 cGy dose on the first postoperative day. All patients were followed for at least one year postoperatively and the severity of heterotopic ossification was recorded using the Brooker classification and correlated with hip mobility. The combination therapy proved very effective; 44 fractures showed no heterotopic ossification and ten showed Brooker class I. The functional results were good and there were no complications of this therapy. Irradiation with 1200 cGy did not appear to offer any therapeutic advantage over the 700 cGy dose.

Acetabulum↗
PubMed1993

Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases.

Rupture of the extensor pollicis longus tendon at the tip of a prominent fixation screw occurred in two cases after fixation of fractures of the radial shaft and in one case after fixation of a fracture of the scaphoid. Patients were referred because of their inability to extend the thumb. Active thumb extension was restored in two patients by screw removal and tendon transfer. The third patient elected nonoperative care. Close scrutiny of good-quality intraoperative x-ray films after internal fixation about the wrist may detect screws that are too prominent and thereby prevent rupture of the extensor pollicis longus tendon.

Adult↗
PubMed1993

The effect of indomethacin on heterotopic ossification following acetabular fracture surgery.

Sixty-six patients with acetabular fractures requiring a posterior or extensile surgical approach were treated using a uniform protocol that was begun in July 1984. In 1987, prophylactic Indomethacin was added to the protocol to study its effects on the prevention of heterotopic ossification. Forty-six patients were operated on prior to and 20 after the initiation of the Indomethacin treatment program. Patients were observed for at least 6 months and the incidence in severity of heterotopic ossification between groups was compared using the Brooker classification. Patients' were also evaluated for associated risk factors. Statistical analysis revealed that the male sex and the extensile approach were the significant risk factors (p < 0.01). Evaluation of drug treatment revealed that while Indomethacin was not effective in completely eliminating heterotopic ossification, the occurrence of severe heterotopic ossification (Brooker Class III and Class IV) was significantly reduced (p < 0.05).

Acetabulum↗
PubMed1993

Evaluation of fractures of the femoral head using the CT-directed pelvic oblique radiograph.

Ten patients with femoral head fractures were evaluated with conventional hip radiographs, computed axial tomography (CT), and pelvic oblique radiographs. The CT scan was used to determine the plane of the fracture within the femoral head. The patient was then positioned with the fracture line parallel to the radiographic beam, resulting in a pelvic oblique radiograph. Intraoperative findings were correlated with the preoperative diagnostic studies. The CT-directed pelvic oblique radiograph was found to be the most accurate determinant of the extent of fracture displacement and joint congruency, thereby facilitating the choice of appropriate fracture treatment. Most importantly, similar radiographs, reproducible from one examination to the next, could readily be obtained after operation, providing excellent information concerning the adequacy and maintenance of fracture reduction and the progression of fracture healing.

Adult↗
PubMed1993

Clostridium perfringens infection of an anterior iliac crest bone graft donor site. A case report.

Postoperative infection of elective surgical wounds with Clostridium species has been linked to gastrointestinal tract lesions. A 55-year-old man with a history of peptic ulcer disease was treated by open reduction and internal fixation with autogeneic cancellous bone grafting from an anterior iliac crest donor site for nonunion of the clavicle. A mild serosanguinous drainage from the Penrose drain site at the iliac crest had ceased on postoperative Day 11; the patient complained of pain and a brownish drainage on postoperative Day 15. The infection was documented with cultures positive for Clostridium perfringens. Aggressive emergent surgical and antibiotic therapy resulted in complete clinical recovery. The wound infection did not advance to severe tissue damage and myonecrosis. This case represents the first reported infection of an iliac crest bone graft site with C. perfringens.

Bone Transplantation↗
PubMed1993

Clinically inapparent hypoxemia after skeletal injury. The use of the pulse oximeter as a screening method.

The efficacy of the pulse oximeter was evaluated in lieu of multiple arterial blood gas (ABG) determinations as a screening method for the early diagnosis of hypoxemia and clinical fat embolism syndrome. A prospective analysis was performed on 43 patients with long bone and pelvic fractures without any associated chest wall, head, or intraabdominal trauma. A standard pulse oximetry reading was obtained initially within 12 hours of injury and at 24-hour intervals thereafter until the patient had been observed for 72 hours. Fifteen patients were hypoxemic with an oxygen-hemoglobin (O2-Hb) saturation less than or equal to 94%. All hypoxemic patients were evaluated by ABG measurements that demonstrated the expected correlation with the pulse oximetry readings. These patients were subsequently managed with an intensive pulmonary care regimen. Hypoxemia resolved in all patients within 48 hours of the initiation of treatment. The pulse oximeter is an efficient and reliable screening device to identify patients with clinically unrecognized hypoxemia.

Adult↗