Biomedical subjects
D Seligson
Publications and source records attributed to D Seligson.
Perspective on ski fractures of the leg and ankle.
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Closed medullary biopsy for disseminated malignancy.
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Measurement of fracture gap motion in external fixation.
A testing machine to study fracture gap motion ex vivo was devised. The apparatus permits direct measurement of bending and shear at a fracture site under different loading conditions. Using this device the single and double frame Hoffmann external fixateurs were compared to a Küntscher medullary nail. Shear displacements of (0.4-1.7 mm) were observed for the fixateurs as opposed to 0.3 mm for the intermedullary nail. Changing from a single to a double frame halved hinge motion at the fracture site and reduced shear by 25%.
Log splitter injuries to the hand.
Use of the powered log splitter in processing wood for fuel has emerged as an important source of disabling hand injury in the Vermont area. Thirteen such injuries are reviewed and two representative cases are presented. Physicians are advised of this new mechanism of injury and the public is warned of the danger in using these machines.
Lisfranc's fracture-dislocation with intercuneiform dislocation: presentation of two cases an a plan for treatment.
The following guidelines in the initial treatment of Lisfranc's fracture-dislocation with intercuneiform disruption are supported by a review of the literature and exemplified by our case presentations. The goal of initial treatment is anatomical reduction which is accomplished in the following sequence. 1) The foot must be brought to length by longitudinal traction. 2) The position of the second cuneiform as the keystone of the transverse arch of the foot must be established. 3) The second metatarsal is then restored as the tendon of the Lisfranc's joint within the mortise of cuneiforms. 4) Fixation of the fifth metatarsal is performed if it is unstable.
Caring for the patient in a halo apparatus.
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The patellofemoral joint: 30 degrees, 60 degrees, and 90 degrees views.
In 70 patients evaluated for abnormality of the patellofemoral (PF) joint, axial radiographs at 30 degrees, 60 degrees (Ficat views) were obtained, with positive studies in 19. The examination technique and the interpretation of the Ficat views are discussed. In selected patients, the examination can yield valuable information not obtainable by other methods about the PF articulation, allowing differentiation of numerous patellar abnormalities from a torn meniscus. Its value in arthrography is also discussed, as well as its usefulness in evaluating chondromalacia and recurrent patellar subluxation.
Early and late repair of lateral ligament of the ankle.
Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15- to 30-year-old adults, it became apparent that the stability of the ankle depends primarily upon the integrity of the anterior talofibular ligament. When the "fore n' aft" stress measurement exceeds 4 mm, a positive anterior drawer test is elicited, and the ankle ligament needs surgical repair. Tibial talar tilt normals ranged up to 18 degrees. Repair (early and late) is accomplished by suturing what one finds (there is always some ligament present) and reinforcing the anterior talofibular ligament repair with overlap of the nearby lateral talocalcaneal ligament plus the marginal ankle retinaculum. Four weeks in a plaster of paris walking cast are followed by use of Ace bandages of 2 weeks. Light activity is begun 6 weeks after repair, and activity of choice is begun 8 weeks after repair. Repeat stress testing is performed at 3 months postsurgery, and a questionnaire is completed at the same time. On a point system (1 to 10) reviewing pain, stability, and swelling, the results in 50 cases rate from 8 to 10, with a lower rating improving with more time. Surgical time is approximately 30 minutes. There seems to be no need for more radical surgery utilizing other muscles. The senior author has employed this surgery for the past 19 years with approximately 165 cases. Only 50 patients with proper 3-month postoperative stress testing and questionnaire follow-up, who were operated upon 1 or more years ago, area recorded here.
Management of acute unstable thoracolumbar (T-11-L-1) fractures with and without neurological deficit.
A one-stage anterilateral decompression of the thoracolumbar spine with Harrington rod alignment and posterior fusion has proven to be an excellent approach to the management of unstable fractures between T-11 and L-1. Twenty-six cases are reported in which this tactic was used to decompress neural structures and stabilize the spine. Preoperative computed tomographic scanning and somatosensory evoked responses (SSERs) are useful adjuncts in the patient's assessment. Intraoperative SSER studies have allowed monitoring to prevent an increase in the patient's neural deficit during operation. Intraoperative myelography is used to provide objective confirmation of the adequacy of the decompression of the spinal subarachnoid space. Satisfactory stability was achieved in all 26 cases reported in this series. Eight of 11 patients with partial neurological deficits returned to essentially normal function within 6 months. None of the patients who were neurologically intact (6 cases) or who had incomplete lesions (11 cases) was made worse by the operation. None of the 9 paraplegic patients regained spinal cord function, although a dramatic improvement in the function of the L-2 and L-3 roots occurred in 1 case. This approach to the management of unstable thoracolumbar fractures is useful, carries with it a low complication rate, and should be a standard part of the neurosurgical and orthopedic armamentarium.
Nine cases of bilateral femoral shaft fractures: a composite view.
Nine cases of bilateral femoral shaft fractures were seen in a series of 126 patients treated from 1973--1977. Patients were multitrauma cases from automobile accidents. Treatment by traction followed by cast-bracing resulted in a high percentage of unsatisfactory results, lengthy recoveries, and the necessity of secondary surgical procedures to improve the results.
Recurrent themes in ambulance critique review sessions over eight years.
For 8 years biweekly ambulance critique review sessions have evaluated performance and discussed management of cases brought to our hospital by ambulance. Over 500 cases reviewed have centered primarily on evaluation and care at the scene and its possible relation to outcome. Problems which have recurred on the scene include whether the patient would have benefited from less time in stabilization and immobilization; manipulation of deformed fractures for splinting; use of tourniquets; techniques of airway maintenance; and management of infrequently seen problems such as hypothermia and drowning. Interaction problems with physicians on the scene and in the Emergency Room (ER) come from questioning physician authority even without specific knowledge of the appropriate techniques of emergency care. A related problem is lack of ER staff familiarity with Emergency Medical Technician (EMT) procedures and ambulance equipment. The value of critique review sessions has been seen in improved rapport and interaction among ER staff and ambulance personnel. Improved outcome needs to be assessed in a carefully controlled study. The enthusiasm and attendance of ER staff and ambulance personnel has grown and endured over 8 years. The review sessions have spread to other area hospitals with some success.
Precision in the diagnosis of meniscal lesions: a comparison of clinical evaluation, arthrography, and arthroscopy.
We assessed the accuracy of clinical evaluation, arthrography, and arthroscopy in the diagnosis of meniscal lesions in fifty knees in which arthrotomy was performed for disabling symptoms after evaluation by these three methods. At surgery, forty-seven menisci were removed, of which forty-four were abnormal and three were normal. In three patients with normal menisci, loose bodies were found in two and the exploration was negative in one. In the forty-four knees with a meniscal lesion, a correct diagnosis was made clinically forty time, arthrographically thirty-nine times, and arthroscopically thirty-two times. Most errors occurred in the knees with posterior horn lesions of the medial meniscus. Clinical diagnosis was least accurate for lesions of the lateral meniscus (four missed) and arthroscopy was least accurate for lesions of the posterior horn of the medial meniscus (ten missed). Arthrography appeared to provide collateral evidence of lesions not seen directly. Based on this study it was concluded that even with negative findings by arthroscopy and arthrography it still may be necessary occasionally to remove a meniscus on the basis of the clinical evaluation.
Measurement of serum thyroxine-binding capacity.
A new method for free thyroxine-binding sites on thyroxine-binding globulin has been described. This method for thyroxine-binding capacity has the virtues of reasonable specificity and convenience for routine use. When used with serum thyroxine levels it should be valuable in the calculation of free thyroxine and total thyroxine-binding globulin. A more directly estimated TBC as reported here should have more value than the various and more empirical T3 uptake methods.
An evaluation of blood smears made by a new method using a spinner and diluted blood.
Blood smears were prepared with the use of a spinner, which rotated with a fixed velocity for a fixed time. All blood samples used for spun smears were diluted with a fixed ratio of buffered isotonic saline solution. Distribution of cells in these smears was found to be random. The average number of cells per unit area was substantially uniform from place to place on the same slide and on multiple slides made with the smae sample. The distribution of leukocytes by type was also iniform. For different blood samples, the average number of cells per unit area in the smears correlated well with the measured cell concentrations per unit volume in the samples for leukocytes, erythrocytes and platelets. Leukocyte differential counts on replicate spun smears using the same bloods also agreed to within the sampling error. They similarly agreed with differential counts on pulled smears made from undiluted samples of the same bloods. With few exceptions, erythrocytic morphology on the spun smears was comparable to that on the good areas of pulled smears made with undiluted samples of the same bloods. Nearly all the spun smears were suitable for both viual and fully automated hematologic examination for leukocytes, erythrocytes, and platelets. This was true over nearly the whole area of each spun slide. In these ways this spinner method makes smears whose consistently high quality is little affected by either the properties of the blood sample or the skill of maker.
Use of the Wagner apparatus in complicated fractures of the distal femur.
Five case histories are presented involving management of complicated fractures of the distal femur with the Wagner apparatus used for external fixation. The advantages of this method are that it involves less metal and less extensive surgical exposure than internal fixation devices. There is ample wound access, more rigid fixation, earlier ambulation, and increased patient comfort. Use of the device as an available alternative, especially in cases complicated by vascular or neurologic injury, soft-tissue, or bilateral injury, is advocated, based on this preliminary experience.
The normal axial relationship of the wrist.
The normal axial relationship of 360 wrists was measured. The results differ from those previously published in the radiological literature. The difference may be explained by the small series' size or inadequate technical criteria used in previous studies.
Direct determination of total serum cholesterol by use of double-wavelength spectrophotometry.
We describe a simple, accurate method for direct determination of total cholesterol in serum. Systematic investigation of a previously described modified Liebermann-Burchard reagent has indicated the necessity of accounting for both bilirubin interference and decreased specificity owing to exothermia. Double-wavelength spectrophotometry was used to optically null out bilirubin as an interfering factor, whereas adding serum to the cold reagent increases its specificity for the cholesterol color reaction. Comparison of 106 cholesterol values with those obtained by the procedure of Abell et al. [J. Biol. Chem. 195, 357 (1952)] yielded a correlation coefficient greater than 0.99; our inter-run coefficient of variation of polled laboratory serum was 1.7%.