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Biomedical subjects

G G Steinberg

Publications and source records attributed to G G Steinberg.

13 recordsLinked to original sources
PubMed1996

A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty.

Cross-sectional studies have demonstrated significant decreases in bone mass in femoral cortical bone adjacent to prostheses. Thirty-six patients who had undergone 31 cemented and 9 uncemented primary total hip arthroplasties (THA) were prospectively studied to define further the natural history of this femoral cortical bone loss. Dual-energy X-ray absorptiometry (DXA) was employed to quantify bone mineral density (BMD) changes in four subregions around the femoral prostheses. Femoral BMD loss (average 12.3%) was observed in the three proximal subregions 2 months postoperatively. This loss increased to 21.2% by 6 months postoperatively, and by 2 years postoperatively it averaged 25.5% in the same three subregions. There were no significant BMD changes in the subregion distal to the prosthesis tip or in the contralateral hip. Subgroups were compared based on prosthesis size and cement use. Statistically significant differences in BMD loss were observed between the large cemented cobalt chrome prosthesis group (n = 8) and the large uncemented titanium prosthesis group (n = 8). These differences were only present in the most proximal medial subregion where the large cemented groups had twice the bone loss in this area as compared with the large uncemented group. The data indicate that bone loss occurs adjacent to femoral prosthesis within 2 months of surgery and that DXA is a useful technique to quantify prospectively femoral cortical bone loss following THA.

Adult↗
PubMed1996

Intermediate-term experience of Pipkin fracture-dislocations of the hip.

The purpose of this study was to review our intermediate-term experience with posterior fracture-dislocations of the hip. We evaluated the accuracy of the Pipkin and Brumback classification schemes as predictors of outcome, assessed the importance of certain treatment variables, and determined the complication rates of this injury in a group of 33 patients followed for an average of 49 months. The overall results were 67% good, 18% fair, and 15% poor, with no excellent results. The Pipkin classification scheme was a useful predictor of outcome because patients with less severe Pipkin 1 or 2 injuries had statistically significant better outcomes than did those who sustained Pipkin 3 or 4 injuries (p < 0.02). Due to a large number of subgroups, we could not demonstrate the usefulness of the Brumback classification system as a predictor of outcome. There were no statistically significant differences in outcome or complication rates when comparing time with hip reduction, definitive operative intervention, or anatomic operative approach to injury. Our study represents the second largest report on posterior dislocation of the hip associated with femoral head fracture. Although outcome of the patients in our series is not outstanding, the 67% good results represent a significant improvement over all previous reports with large numbers of patients. We demonstrate significant improvement in prognosis when treatment goals for these injuries include anatomic reduction, restoration of hip joint stability, and removal of all interposed bone fragments.

Adolescent↗
PubMed1995

Reversible osteolysis.

This is a case report of a 44-year-old patient in whom osteolytic changes that developed around the distal end of the femoral prosthesis appeared to reverse with the use of antiinflammatory medication and pulsed electromagnetic field stimulation. Most reported cases of osteolysis have been described as showing progressive change at a variable rate. There has not been any previously documented case in which there has been reversal of osteolytic change.

Adult↗
PubMed1993

Heterotopic ossification after femoral intramedullary rodding.

Heterotopic ossification (HO) after femoral intramedullary rodding is a significant complication of the procedure. One hundred eighteen cases of femoral roddings performed on 113 patients were available for review. The data were computerized and evaluated using univariate analysis and multivariate regression analysis. A statistically significant increase of HO was found with male gender, increased delay to surgery, and in patients requiring prolonged intubation because of their multiple injuries. HO was classified using a modified version of the method of Brumback et al. (grades 0-IV). A strong correlation of HO with brain injury documented by computed tomography scan was also found to be statistically significant for the more severe grades of HO. This group of patients had not previously been identified as being at high risk for HO.

Adolescent↗
PubMed1991

Quantifying bone loss from the proximal femur after total hip arthroplasty.

To define the natural history of bone loss around a femoral prosthesis, the bone mineral content and bone mineral density were measured for each femur in 28 patients with unilateral total hip arthroplasty, 18 age-matched controls, and seven patients with unilateral osteoarthritis. The areas measured were inside the lesser trochanter and 4.8 cm distal to it. The contralateral hip served as the control. Three years after arthroplasty there was 40% loss in average bone mineral content inside the lesser trochanter, and 28% loss in average bone mineral content 4.8 cm distally in the medial cortex. At seven to 14 years after operation, patients had lost 40% of bone proximally and 49% distally. The data suggest that this may progress in a proximal-to-distal fashion, and could account for a 50% decrease in bone mass seven to 14 years after surgery.

Absorptiometry, Photon↗
PubMed1988

The intertrochanteric hip fracture. A retrospective analysis.

One hundred intertrochanteric hip fractures were analyzed utilizing a computer-assisted digitization system to study the factors affecting postoperative stability. Fractures were evaluated by measuring shortening and angulation, collapse of telescoping device when utilized, and migration of the fixation device within the femoral head. Fractures were classified preoperatively according to their stability and postoperatively according to the type of operative reduction performed. The failure rate and postoperative stability were then compared according to the type of fracture, type of operative reduction, and internal fixation device utilized. Results indicate that the preoperative fracture classification is a strong and significant determinant of postoperative stability. Conversely, the type of operative reduction was not as significant a determinant of postoperative stability. In particular, medial displacement osteotomy had no advantage over anatomic reduction in the unstable fracture. The use of a fixed angle nail plate was associated with an increased failure rate.

Adolescent↗
PubMedDate not supplied

Humeral bone density losses after shoulder surgery and immobilization.

This study evaluates disuse osteoporosis of the proximal humerus after shoulder surgery and immobilization. This was accomplished by quantifying bone mineral density changes in 22 patients' proximal humeri after 6 weeks of immobilization for soft-tissue shoulder surgery. The bone mineral density of the humeral head, neck, and proximal diaphyseal subregions was determined 1 to 2 weeks before surgery and at 3, 6, and 12 weeks after surgery with dual-energy x-ray absorptiometry. By the sixth postoperative week statistically significant bone mineral density decreases of 6% to 14% were observed in the humeral neck and head subregions, respectively. The changes in these three regions diminished slightly after 6 weeks of remobilization, but the differences were still statistically significant. No significant bone mineral density changes occurred in any subregion or during any time interval in the nonoperated humerus. Our study represents the first report with dual-energy x-ray absorptiometry to quantify bone loss of the proximal humerus of patients after shoulder immobilization. Further long-term study is warranted to determine the clinical significance of this bone loss and to determine whether these losses are partially or fully recoverable.

Absorptiometry, Photon↗
PubMedDate not supplied

Ewing's sarcoma arising in a unicameral bone cyst.

An 8-year-old boy sustained a fracture of the distal fibula. The fracture resulted from Ewing's sarcoma infiltrating a unicameral bone cyst. Ewing's sarcoma has not previously been described in association with a unicameral bone cyst.

Bone Cysts↗
PubMedDate not supplied

Bipartite trapezium with adduction contracture of the thumb: a case report.

This is a case report on bipartite trapezium in a 12-year-old girl that presented as a painless protrusion at the base of the first metacarpal bone associated with an adduction contracture of the thumb. This seems to be the first such case to have been reported in an adolescent. The condition bears no resemblance to the numerous descriptions in the literature on accessory bones about the trapezium.

Child↗