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Biomedical subjects

D Seligson

Publications and source records attributed to D Seligson.

At least 19 recordsLinked to original sources
PubMed2001

Description of a rare type of posterior pelvis traumatic involvement: the green-stick fracture of the sarcum.

Fractures of the pelvic ring in children behave differently than in adults. In children, bone elastic properties allow for plastic deformation instead of complete breaks. To the best of our knowledge no reports of this bony behavior have been described in the sacrum, and this could explain the presence of single displaced anterior breaks without evident posterior pelvic disruption. The objective of this paper is to document a rare type of posterior pelvis trauma: the green-stick fracture of the sacrum.

Adolescent↗
PubMed2001

Technique for removal of broken interlocking screws.

Breakage of an interlocking screw is a known complication in tibial fractures treated by intramedullary nailing. This happens most often in delayed union or nonunion because of the lack of progressive load transference from the nail to the healing bone. To treat this problem, the nail and screws need to be removed. This article describes a simple technique for the removal of broken interlocking screws.

Bone Screws↗
PubMed2001

Pullout strengths of self-reinforced poly-L-lactide (SR-PLLA) rods versus Kirschner wires in bovine femur.

OBJECTIVE: To determine the relative amount of fixation of self-reinforced poly-L-lactide (SR-PLLA) rods and Kirschner wires in bovine cancellous bone by comparing their pullout strength DESIGN: An in vitro laboratory study was performed using bovine femurs. Ten two-millimeter-diameter pins of each type were inserted into cancellous bone and then pulled out, using a material testing machine. The maximum force (pullout strength) was selected over other measurements to compare the amount of fixation of the two types of pins. All of the pins were retrieved for microscopic analysis. A paired t test was performed to analyze the differences between the pullout strength of the two types of pins. SETTING: Orthopaedic Bioengineering Laboratory, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A. SPECIMENS: Two young fresh bovine distal femurs, ten two-millimeter-diameter Kirschner wires, ten two-millimeter-diameter bioabsorbable SR-PLLA rods MAIN OUTCOME MEASUREMENTS: Pullout strength in Newtons, and microscopic pin surface aspect after insertion. RESULTS: Significant differences were noted between the maximum force required to remove the two types of pins (p < 0.01) The K-wire mean pullout force was 37.7 N (SD 13.6), and the SR-PLLA rod mean pullout force was 53.6 N (SD 19.3). Microscopic analysis indicated surface modification only on the SR PLLA rods. DISCUSSION: SR-PLLA composites have shown comparable clinical results to their metallic counterparts. In this study, the pullout strength of SR-PLLA rods was compared with that of conventional K-wires. A significant difference (p < 0.01) favoring bioabsorbable pullout strength was noted. The bioabsorbable pin surface modification during insertion is an interesting finding that warrants further investigation as a potential source of improved fixation. CONCLUSION: SR-PLLA rods retain their hold in bovine cancellous bone better than K-wires. This finding offers to the orthopaedic surgeon more information about new pin fixation methods.

Animals↗
PubMed2001

Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears.

Our study assessed the accuracy of shoulder ultrasonography in detecting complete and partial rotator cuff tears. We performed a prospective study in 24 patients scheduled for shoulder arthroscopy for impingement, partial-thickness or full-thickness (complete) rotator cuff tears, adhesive capsulitis, or arthritis. Before surgery, all patients underwent diagnostic shoulder ultrasonography followed by a shoulder arthroscopy with examination of the rotator cuff. The arthroscopic findings of rotator cuff integrity were compared with the diagnoses made from ultrasonography. The ultrasonographer was not blinded to the history and examination findings, and the surgeon was not blinded to the results of the ultrasonography. Ultrasound had sensitivity and specificity rates of 80% and 100%, respectively (positive and negative predictive rates of 100% and 88%), in the diagnosis of full-thickness rotator cuff tears and sensitivity and specificity rates of 71% and 100%, respectively (positive and negative predictive values of 100% and 88%), for partial-thickness tears. Although the potential for bias exists in this study, the results suggest that diagnostic ultrasound is effective in the diagnosis of rotator cuff tears.

Adult↗
PubMed2001

Plating of femoral shaft fractures. A review of 15 cases.

The objective of this study was to define the role, indications and outcome of plating in femur shaft fractures. All femoral shaft fractures admitted and treated by the authors during a 2-year period were analysed. The authors personally treated a total of 135 femur fractures. Of these 135 fractures, 15 (11%) were treated with primary plating. The femoral fractures were classified as grade I (n = 4), grade III (n = 3), grade IV (n = 4), grade V (n = 3), and grade VII (n = 1) (OTA classification). Three patients sustained open fractures (one grade I and two grade II, Gustilo and Anderson classification). Pelvic (6) or ipsilateral lower extremity injuries (4) occurred in 10 of the 15 patients. A total of 23 body areas were injured, most commonly the chest (n = 10), abdomen (n = 5), head (n = 6) and blood vessels (n = 3). There were no infections reported. Two implant failures were noted. Femur plating is a useful technique in polytrauma patients for specific indications where intramedullary nailing (IMN) may be contra-indicated or technically not feasible. Although the postoperative morbidity (ARDS, death) in our study seems to be lower after plating than after intramedullary nailing, the rate of complications of fracture healing (30%) is significantly greater with femur plating than with intramedullary nailing (12%).

Adolescent↗
PubMed2001

Knee fusion--a new technique using an old Belgian surgical approach and a new intramedullary nail.

Knee arthrodesis is a useful procedure in difficult cases such as failed total knee arthroplasty, severe articular trauma, bone tumors, and infected knee joints. The most common techniques for knee fusion include external fixation and intramedullary nailing. Küntscher's nail is driven antegrade from the intertrochanteric region into the knee. We describe a new technique for knee arthrodesis using a new intramedullary nail and an old Belgian surgical approach to the knee joint published by Lambotte in 1913. This approach provides excellent exposure for the implantation of the nail by osteotomizing the patella vertically. The nail is implanted using HeyGroves method, whereby the nail is inserted retrograde into the femur and pulled distally anterograde into the tibia. We now use this technique as our standard procedure for knee fusion.

Arthrodesis↗
PubMed2000

Medulloscopy of the tibia: initial report of a new technique.

This study shows the ability of 3 standard endoscopic instruments to access the length of the intramedullary canal through a technique that we have termed "medulloscopy." Cadaveric studies were performed to determine the dimensions of the proximal tibia and the relative abilities of a knee arthroscope, a hip arthroscope, and a flexible rhinolaryngoscope to visualize the length of the intramedullary canal of the tibia. The 3 endoscopes were able to access the length of the intramedullary canal in the following proportions: 19.1% +/- 1.0% for the knee arthroscope, 29.1% +/- 3.8% for the hip arthroscope, and 84.1% +/- 1.8% for the flexible scope (P <.05). The proximal aspect of the intramedullary canal of the tibia can be visualized with standard knee and hip arthroscopic equipment. A flexible rhinolaryngoscope was required to access the distal tibia. Further studies are needed to determine the specific indications for intramedullary arthroscopy.

Aged↗
PubMed2000

Poller screws.

Explore the source record for details and available documents.

Bone Screws↗
PubMed2000

Treatment of closed tibia shaft fractures: a survey from the 1997 Orthopaedic Trauma Association and Osteosynthesis International--Gerhard Küntscher Kreis meeting.

OBJECTIVE: To identify any consensus of opinion regarding treatment and outcome of a closed mid-shaft tibia fracture among orthopedic surgeons. DESIGN: Survey. SETTING: 1997 combined meeting of the Orthopaedic Trauma Association and Osteosynthesis International-Gerhard Küntscher Kreis. MAIN OUTCOME MEASUREMENT: Percentage of responses to key questions. Proportion test (nonparametric) for statistical significance. RESULTS: There is no consensus of opinion regarding treatment for this fracture type. Wide variation exists between and within the different subgroups of orthopaedic surgeons surveyed. CONCLUSIONS: This brings into focus the spectrum of acceptable care for the management of fractures. More studies must be conducted to identify optimal treatment for closed mid-shaft tibia fractures.

Adult↗
PubMed1999

Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft.

Osteomyelitis of the diaphysis of the tibia in adults is an uncommon but disabling condition. It occurs principally in patients with complex fractures of the tibial shaft in which devitalized bone becomes infected either with a single strain of a virulent organism or with multiple organisms. The outcome of treatment depends on the assessment and management of three interrelated factors, which are the vitality and stability of the bone, the virulence and antibiotic susceptibility of the infecting organism, and the condition of the soft tissues. The impact of the infection on the patient's vitality is of great importance. Successful management depends on control of inflammation, excision of dead bone, and stabilization of the skeleton. Interlocking nailing and local antibiotic treatment are particularly successful strategies. In the future, modification of the inflammatory response with local tissue mediators may become an important adjunctive therapy.

Adult↗
PubMed1999

Should distal interlocking of tibial nails be performed from a medial or a lateral direction? anatomical and biomechanical considerations.

OBJECTIVE: To compare the relative risks of neurovascular injury from perforation during distal interlocking and the biomechanical stability of two approaches to distal interlocking of tibial nails. DESIGN: In vitro anatomical and biomechanical study. SETTING: All mechanical testing was performed in a servohydraulic test frame with a customized motion transducer. INTERVENTION: Tibial nails were interlocked distally with a medial-to-lateral (ML) or a lateral-to-medial (LM) approach. MAIN OUTCOME MEASURE: The distances from the nearest end of each distal locking screw to four neurovascular structures were measured manually with calipers, and two-dimensional motion under simulated stance load across the fracture site was recorded. RESULTS: There were greater distances from the posterior tibial neurovascular bundle and the superficial peroneal nerve with distal targeting from the LM direction compared with targeting from the ML direction. Biomechanically, the ML nail configuration demonstrated slightly greater resistance to bending than the LM configuration. CONCLUSIONS: Distal tibial interlocking from the LM direction appears to be safer than interlocking from the ML direction with regard to relative distances from the neurovascular structures. This small anatomical advantage must be considered in light of slightly greater resistance to bending of the ML interlocking configuration compared with the LM interlocking configuration.

Biomechanical Phenomena↗
PubMed1999

Use of a tobramycin-impregnated polymethylmethacrylate pin sleeve for the prevention of pin-tract infection in goats.

OBJECTIVE: To test the hypothesis that antibiotic-laden polymethylmethacrylate (PMMA) pin sleeves prevent infection around skeletal external fixation pins. DESIGN: An experimental study using an animal model was conducted. ANIMALS: In each of five goats, three four-millimeter half-pins were placed in the left and right iliac crests, for a total of thirty half-pins. The pins were infected with one milliliter of broth containing 7.6 x 10(5) colony-forming units per milliliter of Staphylococcus aureus (ATCC 25923). INTERVENTION: The pins in the right iliac crest were treated with the tobramycin-impregnated pin sleeves, and the pins in the left iliac crest (control) were left untreated. RESULTS: The results showed clinical evidence of infection (i.e., looseness and gross pus) and heavy bacterial growth (average 6.8 x 10(10) colony-forming units per milliliter) for the untreated pins, but no clinical evidence of infection and no bacterial growth at forty-eight hours for the treated pins. CONCLUSION: The present results indicate that the use of the antibiotic-impregnated PMMA pin sleeve can prevent the development of pin-tract infection and appears to prevent colonization of the external fixation pins.

Animals↗
PubMed1999

Bone grafting from the proximal tibia.

OBJECTIVE: A retrospective study was undertaken to analyze the results of proximal tibial bone grafts with immediate postoperative weight bearing. METHODS: Over a 2-year period, 54 patients underwent bone grafting harvested from the proximal tibia. Postoperatively patients were allowed to bear weight as tolerated on the donor site. Mean follow-up was 26.4 weeks, with a range of 6 to 80 weeks. Indications for bone grafting were fresh fractures with primary grafting and nonunions. RESULTS: The overall complication rate was 1.9%, with one patient suffering a local hematoma. No major complications such as fracture, sensory deficit, or wound infection were observed. Immediate postoperative weight bearing did not have any deleterious effects. Higher complication rates for iliac graft sites have been reported. The amount of bone that can be harvested is usually more than adequate. CONCLUSION: Complication rates are low without significant patient morbidity. Most importantly, the patients may start weight bearing immediately after surgery.

Adult↗
PubMed1999

Absorbable fasteners for the fixation of ankle fractures.

Bioabsorbable materials have been used for the treatment of fractures for more than a century. We reviewed the results of a combined series of 30 ankle fractures from Bad Hersfeld, Germany, and Louisville, Kentucky, using initially polyglycolide and more recently poly-L-lactide screws and rods. The results were comparable to treatment with metal screws. The advantage of bioabsorbable implants is they do not need operations to take them out. There was a low incidence of reaction around the screw heads, which was reduced further with the use of the newer self-reinforced poly-L-lactate screws. The technique for use of plastics is different than the methods for placement of metal screws. Bioabsorbables will have an increasing role in fracture fixation in the future.

Absorbable Implants↗
PubMed1998

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery.

Adult↗