Biomedical subjects
Publications and source records attributed to E E Berg.
A case is presented in which an ossicle was evaluated acutely. Arthroscopy disclosed a tibial osteochondral fracture avulsed by the posterior attachment of the medial meniscus. Treatment was conservative with a good clinical result.
To evaluate the ability to perform a widening arthroscopic intercondylar notchplasty as part of an anterior cruciate ligament reconstruction, 20 patients had notch-width index measurements compared with either preoperative or normal-side values. The notch-width index increased an average of 0.062, correlating with absolute notch widening of 4-6 mm. This study provides in vivo evidence that notchplasty widening can be reproducibly performed arthroscopically. The optimal notch width for reconstructive anterior cruciate ligament surgery has yet to be determined.
Austin T. Moore designed a little-known prototype press-fit distal femoral resurfacing knee prosthesis. The implant's history and its long-term follow-up result in one existing patient are reported in the 51st anniversary year of Dr. Moore's first prosthetic procedure.
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Four adults who had symptomatic instability of the ankle had an associated os subfibulare. Operative exploration revealed the ossicle to represent a non-union of an avulsion fracture of the anterior talofibular ligament. These findings suggest that an os subfibulare represents an avulsion fracture that may or may not be associated with laxity of the anterior talofibular ligament, rather than being a normal variant.
A retrospective review was undertaken of 127 lower extremity fasciotomies performed for compartment syndrome after acute ischemia and revascularization in 73 patients with vascular trauma and 49 patients with arterial occlusive disease. One hundred twelve (88%) fasciotomies were performed early (at the time revascularization); 15 (12%) were delayed because of late compartment syndrome diagnosis. Ninety-four (77%) patients had more than one accepted indication for fasciotomy. Double-incision fasciotomy was used in 98 (77%) extremities, single-incision fasciotomy was used in 19 (15%), and fasciotomy-fibulectomy was used in 10 (8%). Fasciotomies were closed in 88 (69%) patients an average of 14 days after surgery. Seven patients needed multiple skin grafting procedures or myocutaneous flaps to close the wound; none compromised limb salvage. Five other patients had minor wound infections that resolved. Functional status returned to preoperative levels by the time of discharge from the hospital in 59 (48%) patients. Thirty-one (24%) patients had residual lower extremity disability related to delayed union of the fracture (five), chronic neuropathy (20), leg swelling (one), or ischemic nonhealing fasciotomy wounds (three); two patients had unrelated disabilities. Fourteen (11%) amputations were required for refractory limb ischemia; two (1.6%) were required for wet gangrene of the foot, which infected the fasciotomy site; the others had open noninfected incisions. Eighteen (15%) patients died of cardiopulmonary failure or multisystem failure or both, without fasciotomy-related problems. Open fasciotomy for compartment syndrome after acute lower extremity ischemia and revascularization was associated with an increased risk of minor wound morbidity. However, limb loss and death resulted from persistent ischemia and underlying systemic disease processes or injuries, but not from open fasciotomy wound complications.
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A patient with an ulnopalmar fifth carpometacarpal joint dislocation was successfully treated by nonoperative means. Dissection of five fresh cadaveric specimens revealed that the intermetacarpal ligament is the primary restraint to this unusual type of dislocation.
The hypothesis that the treatment of adduction of the fore part of the foot in the child is altered by an associated deformity of the middle or the hind part, or both, was tested in a prospective study of eighty-four patients (124 feet). Radiographic classification delineated four configurations of adduction of the foot, based on varying relationships of the fore, middle, and hind parts of the foot. Twenty-two (43 per cent) of the feet with adduction of the fore part alone (simple metatarsus adductus) required no treatment, as compared with eighteen feet (24 per cent) with the other types of adduction (p less than 0.03). The patients with a complex skew-foot deformity required twice as long a period of cast treatment as those with simple metatarsus adductus (p = 0.0001). On evaluation at a minimum follow-up of two years, only one of the 124 feet had residual adduction of the fore part of the foot, as determined radiographically. It was also found that the use of the Denis-Browne bar was accompanied by an increased incidence of flat-foot deformity at follow-up.
Our basic science knowledge predicates all enlightened discussions of anterior cruciate ligament morbidity and the principles of its reconstruction. To provide a framework for this symposium, the salient anatomy, embryology, and biomechanical functions of this complex structure are presented.
A retrospective review of acromioplasty and distal clavicle resections disclosed 40 cases in which postoperative ectopic bone formation caused recurrent shoulder impingement or acromioclavicular joint pain. Symptomatic lesions either encroached on the supraspinatus outlet or were located in the acromioclavicular interval and were large in size. The incidence of symptomatic heterotopic ossification occurring after acromioplasty or distal clavicle excision was 3.2% and was disproportionately seen in patients with chronic pulmonary diseases (p < 0.05). Heterotopic bone formation could not be correlated with the method of bone resection and occurred after both open and arthroscopic procedures. No evidence of bone remnants or calcific deposits was seen in 17 patients in whom postoperative radiographs were taken within 8 weeks of the operation. It thus appeared that the heterotopic bone formed de novo after the procedure. Twenty patients had repeat shoulder surgery to ameliorate symptoms; four of these had a second recurrence of postoperative heterotopic bone formation. Three of the four required a third procedure and had effective prophylaxis against heterotopic ossification. It is suggested that patients at risk (e.g., with a profile of hypertrophic pulmonary osteoarthropathy or active spondylitic arthropathy) be treated with prophylaxis for heterotopic ossification after acromioplasty and distal clavicle resections.
A method of acromioclavicular joint repair after disclocation is described. This method entails extraarticular acromioclavicular fixation, coracoclavicular ligament repair, and a corticotomy of the clavicle. At a minimum 2-year follow-up period, in four patients the coracoclavicular interval was improved an average of 12.5 mm and was restored to within 2 mm of the normal side on stress radiographs.
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The anterior, posterior, and transverse bundles of the medial collateral ligaments of fresh cadaveric elbows were painted with a special radiopaque tantalum cyanoacrylic preparation. The extent of each ligament and their origins and insertions were examined with radiography. This study provided radiographic correlation for these important soft tissue structures and an anatomic understanding of elbow fractures with ligament avulsion.
OBJECTIVE: To evaluate the clinical results of comminuted patella fracture fixation after an extensile surgical approach by using a tibial tuberosity osteotomy. DESIGN: Prospective, clinical. PATIENTS: Six knees with displaced comminuted patella fractures had stable internal fixation after an osteotomy of the tibial tubercle. All had immediate postoperative continuous knee motion and were followed for an average of thirty-one months (minimum of eighteen months). OUTCOME MEASURES: Time to clinical and radiographic union, Hospital for Special Surgery (HSS) Knee Scores and comparisons with literature cohort studies. RESULTS: Clinical union of the osteotomy occurred at an average of eight weeks (range 6 to 12 weeks) and of the patella fractures at an average of eleven weeks (range 8 to 21 weeks). There was no radiographic evidence of osteotomy displacement, fracture implant loosening, migration, or failure. All patients had clinical residua, which included loss of motion, thigh muscle atrophy, and barometric complaints. HSS Knee Scores averaged 75 points with four good, one fair, and one poor result. These results were comparable to those of previously published reports of ablative surgery for this type of fracture. CONCLUSION: Comminuted patella fractures are severe injuries that usually result in some lingering morbidity. Internal fixation preserves bone stock, which facilitates future reconstructive procedures. The described tibial tuberosity osteotomy, patella eversion technique of fracture exposure improved visualization and reduction of the articular surface. The osteotomy healed in all cases and did not adversely affect the clinical results.
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