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Biomedical subjects

D Ring

Publications and source records attributed to D Ring.

At least 37 records · Page 2Linked to original sources
PubMed1998

Operative treatment of post-traumatic proximal radioulnar synostosis.

The results of operative resection of a post-traumatic proximal radioulnar synostosis performed by one surgeon in eighteen limbs of seventeen consecutive patients during an eight-year period were reviewed retrospectively. The resection was performed an average of nineteen months after the injury; eight limbs had the resection less than twelve months after the injury. A free fat graft was used in the first eight patients. No adjuvant non-steroidal anti-inflammatory medication or low-dose radiation was used postoperatively as prophylaxis against heterotopic ossification. We classified the proximal radioulnar synostoses into three subgroups: A indicated a synostosis at or distal to the bicipital tuberosity (four limbs), B indicated a synostosis involving the radial head and the proximal radioulnar joint (seven limbs), and C indicated a synostosis that was contiguous with bone extending across the elbow to the distal aspect of the humerus (seven limbs). The patients were followed for an average of thirty-four months (range, twenty-four to sixty months). The synostosis recurred in one patient, the only patient in the series who had sustained a closed head injury at the time of the initial injury. Additional complications included a fracture of the ulna, a broken pin on a hinged elbow distractor, and dislodgment of a free nonvascularized fat graft in one patient each. The seventeen limbs that did not have a recurrence regained an average of 139 degrees of rotation of the forearm. With the number of patients available, we could not detect a significant relationship between subsequent rotation of the forearm and the size of the synostosis, the use of interpositional fat, or the concomitant use of a hinged elbow distractor. The eight limbs that had resection of the synostosis less than twelve months after the injury regained an average of 144 degrees of rotation compared with 134 degrees in the nine limbs that had resection at least twelve months after the injury. This difference could not be shown to be significant. In this series, operative resection of a post-traumatic proximal radioulnar synostosis led to good results despite the lack of adjuvant radiation therapy or anti-inflammatory medication.

Adult↗
PubMed1998

Monteggia fractures in adults.

The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. There were twenty-five women and twenty-three men, and the average age was fifty-two years (range, eighteen to eighty-eight years). According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. Twenty-six patients (68 percent) who had a Bado type-II fracture had an associated fracture of the radial head; ten of these patients also had a fracture of the coronoid process as a single large fragment. The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). An ulnar diaphyseal fracture was fixed with an intramedullary Steinmann pin in one patient. The remaining patients had fixation with a plate and screws. The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. Nine patients, all of whom had a Bado type-II fracture, needed a reoperation within three months after the initial operation; five had revision of a loose ulnar fixation device, three had resection of the radial head, and one had removal of a wire that had migrated from the radial head into the elbow articulation. Other important complications included proximal radioulnar synostosis in three patients, ulnar malunion in three, posterolateral rotatory instability of the ulnohumeral joint in one, and instability of the distal radioulnar joint in one. At the most recent follow-up examination, which was performed after all of the reoperations and reconstructive procedures had been done, the average score according to the system of Broberg and Morrey was 86 points (range, 15 to 100 points). The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. Six of the eight patients who had an unsatisfactory (fair or poor) result had had a Bado type-II fracture with a concomitant fracture of the radial head. These unsatisfactory results were related to a malunited fracture of the coronoid process in two patients, a proximal radioulnar synostosis in one, a malunited fracture of the coronoid process and a proximal radioulnar synostosis in one, a malunion of the ulna in one, and painfully restricted rotation of the forearm after operative fixation of a comminuted fracture of the radial head in one. The other two unsatisfactory results were in a patient who had had a Bado type-I fracture and in one who had had a Bado type-IV fracture. The results of the present series are much better than those reported in most earlier studies, suggesting that stable anatomical fixation of the ulnar fracture (including associated fracture fragments of the coronoid process) with a plate and screws inserted with use of current techniques of fixation leads to a satisfactory result in most adults who have a Monteggia fracture. The posterior (Bado type-II) fracture is the most common type of Monteggia fracture in adults. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries.

Female↗
PubMed1997

Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the factors influencing symptom relief after uninstrumented posterolateral spinal fusion with or without decompression in adult patients with chronic back pain and previously asymptomatic low-grade isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: The role of previously asymptomatic low-grade isthmic spondylolisthesis in chronic adult low back pain is unclear. Operative intervention in this setting is controversial. METHODS: Twenty-four consecutive adult patients with chronic low back pain and low-grade isthmic spondylolisthesis first detected during routine work-up of new onset low back pain underwent spinal fusion with or without decompression. The influence of active worker's compensation or litigation claims, radicular pain, concomitant laminectomy, age, gender, fusion to L4, intervertebral disc bulge, and pseudarthrosis were investigated. RESULTS: All 13 patients involved in worker's compensation claims or pending litigation had fair or poor results. Nine of 11 patients without such issues had good or excellent results. Although the strong association of worker's compensation with poor results made it difficult to assess the importance of other risk factors, the data suggest that good results may be more likely in patients with radiculopathy who undergo laminectomy. CONCLUSIONS: This investigation, although limited by a number of factors including small sample size and retrospective, unblinded review, suggests that active worker's compensation and litigation issues are associated strongly with poor results of operative management for chronic low back pain in adult patients with low-grade spondylolisthesis.

Adult↗
PubMed1997

An association between the flat back and postpolio syndromes: a report of three cases.

The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spinal fusion for degenerative disease as adults were reviewed. The flat back syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral fracture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial operative restoration of, lumbar lordosis. Considering the essential role that the trunk extensor musculature plays in maintaining upright posture, it may be that a new onset of weakness (postpolio syndrome) in this musculature represents a major contributing factor to the flat back syndrome in these patients. Spine surgeons considering operative procedures in patients with a remote history of paralytic poliomyelitis should be aware of the possible increased risk of the flat back syndrome in this population of patients.

Back Pain↗
PubMed1997

Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures.

A new plate designed specifically to address complex wrist pathology was used for the internal fixation of 22 complex fractures of the distal radius in 22 patients in a prospective multicenter trial. The majority of fractures were group C2- and C3-type fractures according to the Comprehensive Classification of Fractures. No plate failures, loss of reduction, nonunions, or infections occurred. Within the average follow-up time of 14 months, the functional results (including an average motion of 76% and an average grip strength of 56% of the contralateral side) were comparable to those reported for similar fractures in previous investigations. Five patients had irritation of the tendons in the second dorsal compartment. This trial serves both as a verification of the safety and efficacy of this distal radius plate as well as a demonstration of its utility in the treatment of complex fractures of the distal radius.

Adult↗
PubMed1997

Recalcitrant nonunion.

One surgeon treated 13 patients with 14 long home fractures that remained ununited for 10 or more years (average, 16 years) and after an average of three prior surgeries. The clavicle was involved in two cases, the humerus in five (one proximal, three diaphyseal, and one distal intraarticular), the femoral diaphysis in three, and the tibial diaphysis in four. The patients were observed for an average of 54 months. All of the fractures healed, and every patient in the series regained functional use of the involved limb without reports of pain, instability, or persistent swelling related to the site of nonunion. Three patients had persistent leg length discrepancies, and five had substantial residual stiffness of one or both adjacent joints. This experience has shown that despite the longevity of the nonunions, healing can be achieved using the basic concepts of the creation of a stable skeletal fixation in the presence of a well vascularized environments with the addition of autogenous bone graft. By the same token, the duration of the nonunion will lead to soft tissue maladaptation and contracture that at times compromise successful restoration of limb length or adjacent articular mobility.

Adult↗
PubMed1997

Transolecranon fracture-dislocation of the elbow.

OBJECTIVE: To characterize the prevalence, morphology, and prognosis of anterior (transolecranon) fracture-dislocations of the elbow. DESIGN: Retrospective case series. SETTING: A consecutive series of thirteen patients from a single level-one trauma center, plus four patients from the practices of two of the senior authors. PATIENTS: Three of seventeen patients had simple, oblique fractures of the olecranon, and fourteen had complex, comminuted fractures of the proximal ulna, including fragmentation of the olecranon in seven patients, large coronoid fragments in eight patients, and segmental fractures of the ulna in six patients. Fourteen patients were male and three were female, with an average age of thirty-eight years (range, 18 to 78 years). INTERVENTION: All fractures were treated by open reduction and internal fixation. Two one-third tubular plates had to be revised to 3.5-millimeter dynamic compression plates within six weeks of the initial operation. MAIN OUTCOME MEASURE: Elbow performance rating of Broberg and Morrey. RESULTS: At an average follow-up of twenty-five months, overall outcome was rated as excellent in seven patients, good in eight, and fair in two. Mild posttraumatic arthritis was noted in only two patients. Large coronoid fragments and extensive comminution of the trochlear notch did not preclude a good result provided that stable, anatomic fixation was achieved. CONCLUSIONS: Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparent radiocapitellar dislocation. Stable restoration of the appropriate contour and dimensions of the trochlear notch of the ulna will lead to a good result in most cases.

Adolescent↗
PubMed1997

Complex nonunion of fractures of the femoral shaft treated by wave-plate osteosynthesis.

We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation. Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.

Adolescent↗
PubMed1997

Spinal canal compromise in Proteus syndrome: case report and review of the literature.

A 24-year-old Vietnamese man with Proteus syndrome presented to the emergency department with progressive paraplegia and underwent urgent operative decompression of an angiolipomatous mass compressing the spinal cord. The associated spinal deformity and difficulty in imaging the mass, together with the paucity of discussion regarding the spinal cord sequelae of this rare syndrome in the literature, made this an extremely challenging case. Spinal cord compromise in patients with Proteus syndrome can result from either infiltration of the spinal canal by an angiolipomatous mass or canal narrowing as a result of vertebral hypertrophy. Regardless of the cause, the prognosis for neural recovery remains poor.

Adult↗
PubMed1997

Salvage anterior C1-C2 screw fixation and arthrodesis through the lateral approach in a patient with a symptomatic pseudoarthrosis.

On occasions when the posterior approach to the upper cervical spine is not feasible, the options provided by a lateral exposure can be invaluable. A case of a nonunited posterior fusion between C1 and C2, with a free-floating posterior C1 arch due to nonhealing of a previous intraoperative C1 ring fracture, is presented to illustrate this point. This 28-year-old man underwent screw fixation between the first and second cervical vertebrae, supplemented with autogenous iliac crest cancellous bone graft, via the lateral approach of Whitesides. The patient's symptoms subsequently resolved, and radiographic evaluation 3 months after the procedure revealed a solid fusion.

Adult↗
PubMed1996

Treatment of deformity of the lower limb in adults who have osteogenesis imperfecta.

The Ilizarov method of lengthening was used to correct deformities of the lower extremity in six patients who had type-1 osteogenesis imperfecta, as categorized by Silence et al. The average age was thirty-one years (range, fourteen to fifty-one years). The deformities included shortening of four tibiae and three femora as well as an angular malalignment (average, 28 degrees; range, 20 to 40 degrees) of all four tibiae and one femur. One patient also had a non-union of the right femur. The average angular correction was 23 degrees (range, 20 to 30 degrees). The seven limb segments gained an average of 6.6 centimeters (range, two to eleven centimeters) in length. All limb-length discrepancies were corrected to within two centimeters of the length of the contralateral limb. At an average of three years and four months (range, one year and seven months to six years), the roentgenographic appearance of the fully matured bone was comparable with that of the original bone. There was no fractures or increases in the angulation of the segment of new bone. Two patients had pain when walking; it was related to a chronic pin-track infection in one and to osteoarthrosis of the ankle in the other. The functional status of four patients was improved and that of the other two patients was unchanged. All six patients were pleased with the outcome of the procedure. There was eighteen complications: stiffness of the knee in two patients; a peroneal nerve palsy in two; a superficial pin-track infection in three; and a deep pin-track infection, greater-than-normal loss of blood intraoperatively, loosening of two pins, worsening of the instability of the knee, and an infection in the knee in one patient each. In another patient, a Rush rod that had been placed before correction of the deformity migrated proximally and had to be removed after completion of the correction. There were five fractures.

Adolescent↗
PubMed1996

A comparison of early and late reconstruction of malunited fractures of the distal end of the radius.

We retrospectively evaluated the results for ten patients in whom a malaligned fracture of the distal end of the radius had been treated with early reconstruction (an average of eight weeks [range, six to fourteen weeks] after the injury) consisting of an osteotomy through the site of the fracture, autogenous cancellous iliac-crest bone-grafting, and internal fixation. The results for these patients were compared with those for ten patients in whom functional limitation after complete healing of a fracture of the distal end of the radius in a malreduced position had been treated with late reconstruction (an average of forty weeks [range, thirty to forty-eight weeks] after the injury) consisting of an osteotomy, corticocancellous bone-grafting, and internal fixation. The average duration of follow-up was forty-eight months (range, twenty to 120 months) after the early reconstructions and thirty-four months (range, twenty-four to forty-eight months) after the late reconstructions. After the early reconstructions, flexion of the wrist averaged 45 degrees; extension of the wrist, 52 degrees; pronation of the forearm, 79 degrees; and supination of the forearm,77 degrees, compared with 42, 45, 77, and 68 degrees, respectively, after the late reconstructions. Grip strength averaged forty-two kilograms after the early reconstructions, compared with twenty-five kilograms after the late ones. One patient from each cohort had mild pain in the radiocarpal joint. According to the scale of Fernandez, there were seven excellent and three good results after the early reconstructions, and one excellent, seven good, and two fair results after the late reconstructions. Complications included a rupture of the extensor pollicis longus tendon twelve weeks after one of the early reconstructions, persistent pain at the donor site of the iliac-crest bone graft after a late reconstruction, and a delayed union that necessitated a second procedure after another late reconstruction. We believe that the results of early and late reconstruction of malunited fractures of the distal end of the radius are comparable. For patients who have radiographic characteristics that are predictive of persistent functional limitation, early reconstruction is technically easier and reduces the over-all period of disability.

Adult↗
PubMed1996

Operative treatment of volar intra-articular fractures of the distal end of the radius.

We retrospectively reviewed the results of operative treatment of forty-nine volar marginal intra-articular fractures of the distal end of the radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragment, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty-four B3.3 fractures (characterized by comminution of the volar fragment). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the over-all outcome. After an average of fifty-one months (range, twenty-four to 117 months), there were thirty-one excellent, ten good, and eight fair results according to the system described by Gartland and Werley, and thirty-two excellent, nine good, five fair, and three poor results according to the modified system of Green and O'Brien. Two factors were found to have a significant association with a fair or poor outcome: evidence of osteoarthrosis on the most recent follow-up radiographs and reversal of the normal volar tilt of the distal end of the radius. The age of the patient, the interval from the injury to the operation, a concomitant injury of the ipsilateral upper extremity, an associated fracture of the ulnar styloid process, the radio-ulnar index, ulnar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly associated with the outcome.

Adolescent↗
PubMed1996

Pyogenic infectious spondylitis in children. The evolution to current thought.

The historic evolution of pyogenic infectious spondylitis from its initial descriptions to its current characterization illustrates the degree to which our means of perception and evaluation influence our understanding of an illness. As new concepts resulting from medical innovations challenge traditional beliefs regarding the etiology and optimum treatment of pyogenic infectious spondylitis in children (commonly termed discitis), controversies have arisen. This review attempts to clarify these issues by reconstructing their historic basis and delineating the limitations of our current knowledge. In our opinion, this exercise demonstrates the similarities between pyogenic infectious spondylitis in children and adults and provides support for the management of this illness at all ages with parenteral antibiotics, cast or brace immobilization when needed for symptomatic relief, and, rarely, operative débridement.

Adult↗