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Biomedical subjects

E K Alpar

Publications and source records attributed to E K Alpar.

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

A high risk group for thoracolumbar fractures.

Unconscious patients with multiple injuries present a major diagnostic and therapeutic problem. The incidence of neurological deficit increases if diagnosis of a spinal injury is delayed or missed. Thoracolumbar fractures are commonly the result of high energy injuries and in an unconscious patient the risk of missing such fractures is increased considerably. There is little consensus on which blunt trauma patients warrant thoracolumbar spine films when no pain, tenderness, neurological deficit or cervical spine injuries are identified. We present a retrospective analysis of all patients who were admitted to the Major Injuries Unit at the Birmingham General Hospital and underwent radiological survey of the thoracolumbar spine. Of the 110 patients, all spinal fractures were detected in 94 patients with a Glasgow Coma Scale (GCS) > or = 11. Of the 16 with a GCS < or = 10, 9 patients had sustained injuries of their thoracolumbar spine 4 of which were not detected initially due to a decreased level of consciousness. The common features amongst the 4 patients with missed injuries were: (1) High velocity injury. (2) Decreased level of consciousness on admission. (3) Associated head injury. (4) Pelvis/lower extremity injury. We describe the four cases and identify a group of high risk patients for thoracolumbar fractures. Radiological examination of the thoracolumbar spine is essential in this group.

Accidents, Traffic↗
PubMed1997

Trauma management.

Explore the source record for details and available documents.

Critical Care↗
PubMed1994

The epidemiology of fractured femurs and the effect of these factors on outcome.

We have analysed 250 cases of fractured shaft of the femur with the objective of highlighting any preventative measures and anticipating morbidity associated with cause and type of injury. The younger patients typically injure themselves as pedestrians, motorcyclists and bicyclists in Summer. The older patients tend to have falls in late Summer and Winter. The outcome varies depending on the cause, type and age of the injured person. The greatest morbidity was found in high-velocity accidents involving motorcyclists, pedestrians and car accidents. Knee flexion is a particular problem with these injuries and we are currently using continuous passive motion in conjunction with a continuous opiate infusion where this is likely to be a problem. The results also suggest that the mechanism of injury and its possible prevention, particularly in motorcycle design, could be as important as the type of treatment. Elderly females following falls also form a distinct group, suggesting that osteoporosis is a major factor with the best outcome associated with treatment by internal fixation. We feel that age alone should not be a reason for exclusion from intramedullary fixation and this merits further study.

Accidental Falls↗
PubMed1994

Injuries associated with a fractured shaft of the femur.

A knowledge of injury patterns, both from the mechanism of injury and from their associations, allows specific injuries to be suspected and actively excluded. We have reviewed fractures of the femoral shaft to highlight the patterns of their associated high morbidity and mortality. Our survey shows that accidents involving motorcyclists, pedestrians and motor cars have the highest incidence of associated injury. Common associations include chest, head, pelvis and ipsilateral leg injuries in pedestrians, and pelvic and ipsilateral leg injuries in motorcyclists. Rarer associations with femoral shaft fractures include ipsilateral tibia and talus/navicular fractures in motorcyclists, knee injuries and contralateral acetabular fractures in pedestrians and contralateral necks of femur in motor car passengers.

Accidental Falls↗
PubMed1991

Meniscus repair.

A prospective study of repair of longitudinal, peripheral, and posterior horn meniscus tears was carried out in 50 patients. The mean length of follow-up was 5 year. Forty-eight of the patients were symptom-free and post-repair arthroscopic examination confirmed that the repaired menisci have healed satisfactorily. The rationale and technique for surgical repair of the meniscus of the knee are presented.

Adult↗
PubMed1987

Early prediction of outcome following head injury in children.

A retrospective survey of 166 children aged 15 years or less was made in an attempt to identify which clinical features presenting in the first 24 hours after a head injury might be helpful in predicting the eventual outcome as defined by the Glasgow Outcome Scale. In 88% of the children, the trend of Glasgow Coma Scale score over the first 24 hours was useful. This included children admitted with a score of 3 or 4 and those with a score of 5 or more who did not deteriorate within 24 hours of injury. In this group only 2% of the predictions would have been inaccurate and in only 0.7% would the outcome have been worse than the prediction. The presence of both abnormal plantar and pupillary light reflexes predicted death or significant disability in 99% of cases.

Adolescent↗
PubMed1987

Outcome of supracondylar fractures of the humerus in children.

Seventy patients who had sustained supracondylar fractures of the humerus as children were examined. Loss of carrying angle of the elbow occurred if the fracture was immobilized in a varus position during healing. Varus malalignment could have been obviated if comparative radiographs of the other elbow had been taken and the Baumann angles compared. Rotation and posterior displacement at the fracture had little bearing on the outcome. Immobilization of the fracture in a collar and cuff sling was as effective as more elaborate methods.

Adolescent↗
PubMed1986

Intraspinal spur and scoliosis.

An unusual case of scoliosis, associated with an osteocartilaginous spur producing narrowing of the spinal canal, is reported. Routine physical examination and radiography revealed no abnormality apart form an absent left-ankle reflex. The defect was discovered at autopsy following death during operation. In order to discover this rare associated defect in scoliotic patients, myelography is recommended whenever a minor neurological defect is present.

Adolescent↗
PubMed1985

Late stability of the cervical spine.

Radiological criteria, laid down to detect instability of the cervical spine after cadaveric biomechanical studies, were applied to 52 cases of cervical spine injury. Only one case of instability was detected, and late neurological signs resolved after posterior cervical fusion. Three other cases which fulfilled the radiological criteria of instability clinically were symptom free. It is concluded that these criteria alone cannot establish the indications for surgical intervention.

Adolescent↗
PubMed1981

Midshaft fractures of forearm bones in children.

Eighty midshaft fractures of the forearm bones in children are reviewed. These fractures occur predominantly in boys and are more frequent in the left forearm. The fractures can occur at any age, but the majority are seen between 6 and 8 years of age. They are divided into two groups: greenstick (Type 1) and displaced fractures (Type 2). Greenstick fractures (Type 1, 82.5 per cent) need only correction of the deformity without breaking the intact cortex, followed by supervized splintage for 6 weeks. Type 2(a) (3.8 per cent) fractures, where only one bone is displaced, were treated conservatively, but the displaced bone tends to heal with lateral angulation causing limited rotation unless adequately aligned surgically. Type 2(b) (13.7 per cent) fractures, where both bones are displaced, occur in young teenagers. The majority of these should be treated by internal fixation if adequate alignment cannot be achieved or maintained by conservative means.

Adolescent↗
PubMed1978

Long-term results of ulnar to median nerve pedicle grafts.

Nerve pedicle grafts in the upper limb were performed on nine patients with Volkmann's Ischaemia. Long-term follow-up of three cases has shown that the results of this operation are successful. Sensory and motor recovery of the median nerve occurs and consequently useful hand function is regained. Since Volkmann's Ischaemic contracture is not rare in developing countries, this operation should be the treatment of choice when the median and ulnar nerves have been damaged beyond hope of recovery.

Adult↗