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Biomedical subjects

D Segal

Publications and source records attributed to D Segal.

170 records · Page 10Linked to original sources
PubMedDate not supplied

Congenital absence of lumbar facets as a cause of lower-back pain.

Unilateral arch hypertrophy secondary to congenital absence of lumbar articular facets is a rare condition of still undetermined etiology. Most symptomatic cases had a history of mild trauma. Radiologic criteria using plain films and CAT scan are available to make the diagnosis of unilateral arch hypertrophy and the specific defects that cause this condition. Awareness of these signs by the orthopedic community may prove helpful in recognizing this anomaly as a cause of lower-back pain in the future. It would seem logical to conclude that the source of pain in patients with this congenital anomalies may be due to microfracture of the hypertrophic side caused by the concentration of stresses. Treatment of this condition varies, and too few cases are reported to draw any conclusions. A conservative approach of bedrest and immobilization should be attempted first. However, if this regime proves unsuccessful after a long well-documented trial, fusion seems to offer a good prognosis in the cases thus far treated by this method.

Adult↗
PubMedDate not supplied

Bilateral distal radius and ulnar fractures in adolescent weight lifters.

Two cases of bilateral radius and ulnar fractures in adolescent weight lifters are described. The fractures healed without complications. However, the authors stress that these injuries can be prevented if coaches, trainers, and sports medicine physicians are aware of their occurrence and undertake necessary preventative measures. Adequate supervision with spotters at the end of each bar, appropriate foot wear, and, above all, the maximum level of concentration are key factors in preventing these injuries.

Adolescent↗
PubMedDate not supplied

Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay.

OBJECTIVE: An evaluation of the impact of a social work preadmission program on length of stay (LOS) of orthopedic patients undergoing elective total hip or total knee replacement surgeries (under diagnosis-related groups [DRGs]) at the Hadassah Ein-Kerem Hospital in Jerusalem is Israel. INTERVENTION: The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning, coordination of nursing and physiotherapy evaluations, ensuring completion of all medical tests prior to admission, and additional psychosocial follow-up during hospitalization to carry out the original discharge plan or prepare alternatives. PATIENTS: The intervention patients were divided into two groups in order to see changes over time: May through December 1994 (n = 48), and January through December 1995 (n = 81). The comparison groups included patients operated on at the same hospital during 1993 (n = 51) and during January through April 1994 (n = 21) and at the Hadassah Mount Scopus Hospital during the same time periods. Patients in the comparison groups received usual social work intervention, as necessary, only after hospitalization. RESULTS: Mean LOS was reduced significantly in the intervention patient groups, as compared to the preintervention patient groups in the same hospital, from 14.2 days (standard deviation [SD], 4.7) in 1993 and 14.7 (SD, 5.1) in January through April 1994 to 10.9 (SD, 3.0) in May through December 1994 and to 9.1 (SD, 2.8) in 1995 (P < .01). Length of stay also was reduced in the comparison hospital, but by 1995 was longer than in the intervention patients. No differences in LOS by gender, age, or marital status were found. Length of stay was significantly longer for those undergoing total hip replacement as compared to those undergoing total knee replacement in all the groups. CONCLUSIONS: Preadmission screening and case management by a social worker can contribute to the efforts to decrease LOS of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.

Aged↗
PubMedDate not supplied

One-stage treatment of gunshot wounds.

Delayed primary closure has been advocated for the treatment of gunshot wounds owing to the fact that they are highly contaminated. The authors believe that with meticulous debridement, contaminants are removed; thus, early wound coverage with meshed split-thickness skin graft allows for drainage along with faster healing of all tissues. Split-thickness skin excision was found to be a useful procedure in the immediate management of gunshot injuries.

Adult↗
PubMedDate not supplied

C7--T1 bilateral facet dislocation: a rare lesion presenting with the syndrome of acute anterior spinal cord injury.

Dislocation of the cervicothoracic junction, between the C7 and T1 vertebrae, occurred in a 46-year-old inebriated man. The C7--T1 junction is difficult to visualize on roentgenographs even when the upper extremities are pulled down. This injury is uncommon and often undiagnosed immediately after injury (Fig. 7). The reason the dislocation was not reduced prior to anesthesia is attributable to poor roentgenographic visualization and insufficient traction. The latter resulted from the patient's rapid motor recovery, which discouraged the use of more than 10 lb of skeletal traction. Surgical stabilization was effective and permitted the patient to ambulate immediately.

Cervical Vertebrae↗
PubMedDate not supplied

Technical complications of the tibiofibular syndesmotic screw.

Three patients with ankle fractures are presented to demonstrate poor results due to improper application of a syndesmotic screw. In these cases failure of surgical treatment caused accelerated disruption of the ankle mortise with cartilage wear, or instability and joint distraction. Simple internal fixation with a single screw requires strict awareness of the potential harm that can be inflicted on the joint. The syndesmotic screw has to be inserted with a proper understanding of the biomechanics of ankle joint structures.

Adult↗
PubMedDate not supplied

Fatigue fractures of tibial and femoral shaft in soldiers.

In 136 fatigue fractures in military recruits, 58 were in the femoral shaft and 43 were in the tibia. Fatigue fractures in the long bones of the lower limb can be classified on the extend of the periosteal reaction. Most were grade 1, showing periosteal reaction only on one or two cortices as seen on the anteroposterior and lateral projections of the roentgenograms. Physical activity was discontinued immediately when fatigue fracture of the femur or tibia was suspected on clinical grounds alone. Early clinical diagnosis the long bone fatigue fractures in all patients except one. The injured soldiers were ambulatory without plaster cast immobilization or crutches. The suggested classification was used to select patients with Grade 1 fatigue fracture for early resumption of active military training.

Adolescent↗