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Biomedical subjects

Charles N Cornell

Publications and source records attributed to Charles N Cornell.

6 recordsLinked to original sources
PubMed2007

Innovations in the management of displaced proximal humerus fractures.

The management of displaced proximal humerus fractures has evolved toward humeral head preservation, with treatment decisions based on careful assessment of vascular status, bone quality, fracture pattern, degree of displacement, and patient age and activity level. The AO/ASIF fracture classification is helpful in guiding treatment and in stratifying the risk for associated disruption of the humeral head blood supply. Nonsurgical treatment consists of sling immobilization. For patients requiring surgery, options include closed reduction and percutaneous fixation; transosseous suture fixation; open reduction and internal fixation, with either conventional or locking plate fixation; bone graft; and hemiarthroplasty. Proximal humerus fractures must be evaluated on an individual basis, with treatment tailored according to patient and fracture characteristics.

Algorithms↗
PubMed2004

Osteobiologics.

"Osteobiologics" is the term that has been introduced to refer to the class of engineered materials that have been created and which promote healing of fractures and bone defects. The list of osteobiologics is rapidly expanding as new products incorporating osteoconductive materials are mixed with a variety of osteoinductive proteins, demineralized bone, and preparations of osteogenic cells. The growth in osteobiologics has been stimulated by the early success of osteoconductive materials as graft substitutes in the repair of fractures and by the increasing demand for grafts in all areas of orthopaedics. Although allografts have historically been employed with success, the number of donors has grown much slower than demand leading to the development of artificial materials. Manufactured bone graft substitutes, or osteobiologics, attempt to mimic the components of an autogeneous bone graft by reproducing the bone matrix, which is osteoconductive and osteoinductive. Other products aim to introduce osteogenic cells by concentrating bone marrow while others introduce differing growth factors from platelets in peripheral blood. Very few of these products have been supported by appropriate clinical studies and as such their value is unknown. Orthopaedic surgeons employing these products must understand the basic science principles behind their development in order to understand the indications and limitations of their application. Properly designed clinical studies should be performed to determine the usefulness and cost-effectiveness of both current and future products.

Biocompatible Materials↗
PubMed2003

Orthopedic management of vertebral and long bone fractures in patients with osteoporosis.

Because of the evolving demographics of the world's population, fracture surgeons must become experts in the treatment of fractures in osteoporotic bone. Toward this end, fracture surgeons are learning to modify the classic techniques of internal fixation to adapt them to the elderly population. Screws should be placed into the best quality of bone available, which, in most cases, is an opposing cortex. Screw fixation can be augmented using acrylic cement. When using plate fixation, stable bone contact at the fracture site is the most important factor in reducing strain in the plate. Shortening of the affected bone is advisable to achieve this contact in comminuted fractures. Plates should not be used to bridge areas of comminution in osteoporotic bone. Plates should generally be as long as is compatible with the affected bone, with screws placed as close to and as far away from the fracture site as possible. When confronted with diaphyseal fractures or fractures with metaphyseal-diaphyseal comminution, locked intramedullary nails can be used. Angled blade plates are applicable to osteoporotic metaphyseal fractures but should be used as tension band plates, which require stable load-sharing contact opposite the plate. Antiglide plating and use of tension band wires are also effective strategies for osteoporotic fractures. Finally, to reduce the morbidity of bone graft harvest and to ensure adequate volumes of graft, the use of bone graft substitutes is particularly applicable in elderly patients. All patients with evidence of osteoporosis should be started on a medical regimen to combat further bone loss that includes calcium supplementation with a prescription for antiresorptive agents, including bisphosphonates, calcitonin, or hormone replacement therapy.

Bone Transplantation↗
PubMedDate not supplied

Internal fracture fixation in patients with osteoporosis.

Because of the decreased holding power of plate-and-screw fixation in osteoporotic bone fractures, internal fixation can have a high failure rate, ranging from 10% to 25%. Screws placed into cortical bone have better resistance to pullout than do those placed into adjacent trabecular bone. Plates should not be used to bridge unstable regions of bony comminution in osteoporotic patients. Fixation stability is optimized by securing stable bone contact across the fracture site and by placing screws both as close to and as far from the fracture as possible. Intentional shortening can improve stability and load sharing of the fracture construct. Structural bone graft or other types of fillers can be used to fill voids when comminution prevents stable contact. Load-sharing fixation devices such as the sliding hip screw, intramedullary nail, antiglide plate, and tension band constructs are better alternatives for osteoporotic metaphyseal locations. Proper planning is essential for improved fracture fixation in this high-risk patient group.

Fracture Fixation, Internal↗