Biomedical subjects

H D Moehring

Publications and source records attributed to H D Moehring.

11 recordsLinked to original sources

PubMed1996

Removal of intramedullary nails from the femur: a review of 45 cases.

The excellent biocompatibility of titanium and its alloys may result in osseointegration. In order to determine if this presents an obstacle to removal of intramedullary nails, we retrospectively reviewed a series of 45 cases of isolated removal of a femoral nail. Indications for removal were persistent pain and discomfort, request of an asymptomatic patient, or skeletal immaturity. Twenty-three nails were titanium, and 22 were stainless steel. Although removal of the titanium nails had a significantly longer operative time (110 vs. 84 min), analysis of variance indicated that this was due to a greater number of crosslocking screws in the titanium nails (2.2 vs. 0.6) and a tendency to set the titanium nails deeper in the femur. The use of the titanium material per se did not pose a risk factor for difficulty in late removal of an intramedullary nail.

Adult↗

PubMed1995

Traumatic hip dislocation: early MRI findings.

PURPOSE: Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries that may have therapeutic or prognostic significance and be better delineated by MRI than by conventional radiography. PATIENTS AND METHODS: Prospective MRI of both hips was formed on 18 patients (14 male, 4 female; age range 14-54 years; average age 30.5 years) within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the time of injury and the imaging studies ranged from 2 to 35 days (average 13.2 days). Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2* (MPGR) sequences. Images were retrospectively evaluated by consensus of three radiologists for possible abnormalities of the bone and cartilage, joint space, and soft tissues. Because all patients were treated with closed reduction, surgical correlation was not obtained. RESULTS: All patients had a joint effusion or hemarthrosis. Of the 14 patients with posterior dislocation, isolated femoral head contusions (trabecular microfractures) were identified in 6 patients. Four patients had small femoral head fractures, and one had an osteochondral defect. Acetabular lip fractures were seen in six patients, and one patient had a labral tear. Four patients had intra-articular loose bodies and one had ligamentum teres entrapment. Twelve patients had iliofemoral ligament injury. All patients had muscle injury involving the gluteal region and medical fascial compartment, and 13 patients had anterior fascial compartment muscle injury. Seven patients with posterior dislocation had posterior fascial compartment injury. Of the four patients with anterior dislocation, two had bony contusion, two had cortical infraction, one had a labral tear, and all four had an iliofemoral ligament injury. All four patients in this group had muscle injury of the gluteal region and of the anterior and medial fascial compartments. CONCLUSIONS: MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation.

Acetabulum↗

PubMed1995

Open tibia fractures in the splenectomized trauma patient: results of treatment with locking, intramedullary fixation.

OBJECTIVE: To confirm our clinical impression that patients with traumatic splenectomy had more complications in the treatment of open tibia fractures, we retrospectively reviewed the records of patients with open tibia fractures treated between 1989 and 1992. MATERIALS AND METHODS: Eight patients with open tibia fractures and traumatic splenectomies were compared to 43 patients with open tibia fractures and intact spleens. The latter group typically underwent either exploratory laparotomy or peritoneal lavage. The two groups were similar with respect to age, mechanism of injury, fracture wound classification, and injury severity score (22.4 in the splenectomized patients, 18.6 in the control). All tibia fractures were treated with a nonreamed, cross-locked, titanium intramedullary nail, and all patients were treated according to the same protocol of antibiotic therapy. Patients were followed for two years or until roentgenographic and clinical union. RESULTS: The splenectomized patients had a significantly higher incidence of chronic osteomyelitis (25% vs. 4.6%), and the need for additional tibial surgeries to achieve union (75% vs. 16%). Time to union averaged 11.3 months in the splenectomized group and 7.6 months in the patients with intact spleens. CONCLUSIONS: The increased risk for chronic osteomyelitis and other complications of tibial fracture in the splenectomized patients should be taken as an argument favoring splenic, repair, when possible, rather than splenectomy in victims of blunt multiple trauma.

Adolescent↗

PubMed1995

Compartment pressure monitoring during intramedullary fixation of tibial fractures.

Twenty-six legs in 25 patients were monitored prospectively for compartment pressures during intramedullary nailing of open and closed tibial shaft fractures. Twenty-three patients were treated within 24 hours of admission. Twenty-three unreamed and three reamed intramedullary rods were utilized. Compartment pressures were measured initially, following fracture reduction, and during reaming. Pressures were also measured at the completion of nailing with the ankle dorsiflexed and at rest (plantar flexed) to determine positional effects on compartment pressures. Nine fractures (35%) were found to have persistently elevated pressures (> 40 mm Hg) and underwent immediate four-compartment fasciotomy. The remaining group of 17 fractures (65%) was monitored throughout the intraoperative period. No patient monitored intraoperatively developed postoperative compartment syndrome.

Adolescent↗

PubMed1994

Ankle dislocation.

From 1980 to 1991, 14 patients with pure ankle dislocation unassociated with fracture were identified. All patients were young adults (18-41 years of age) with a male preponderance (11 of 14). The cause of injury in nine of the 14 cases was a motor vehicle accident and in the remainder, sporting events or fall from a height. Thirteen of the 14 injuries were open, and 12 patients underwent lateral ligamentous repair. Twelve of the 14 patients were available for follow-up, which ranged from 15 to 122 months. Two patients had poor results; the remainder (10 of 12) had good and excellent results. Interestingly, no patient had signs or symptoms of instability. One patient required immediate below-the-knee amputation for open dislocation associated with avulsion of soft tissue and neurovascular structures.

Adolescent↗

PubMed1994

The use of cannulated screws in musculoskeletal trauma. A review of surgical techniques.

The use of minimally invasive techniques for the treatment of articular and periarticular fractures is becoming more popular, especially when formal open reduction and internal fixation is contraindicated because of associated soft-tissue compromise and swelling. Cannulated screws are frequently effective in these situations and can be inserted by way of limited open or percutaneous techniques in many cases. Accurate fracture reduction can be attained through insertion of cannulated screws over a guide pin, resulting in provisional stability of the fracture. In most instances, such methods of fracture reduction are adjunctive and require the addition of external fixation, limited internal fixation, and cast bracing or orthotic considerations. Applications of cannulated screw fixation in specific trauma injuries are discussed as are indications, contraindications, advantages, and disadvantages of such methods.

Adult↗

PubMed1988

Flexible intramedullary fixation of femoral fractures.

Fifty femoral fractures in 47 patients were treated by the insertion of flexible intramedullary Ender rods and observed until fracture healing was complete. Both condylocephalic and trochanteric approaches were used with a preference for the latter when biomechanically feasible. The fractures ranged from the intertrochanteric-subtrochanteric junction to the supracondylar area of the femur. This technique can be used to treat fractures unsuited for conventional rods. The system is relatively uncomplicated, the technique atraumatic. Healing is generally rapid. There were no non-unions, infections, surgical deaths, or significant residual deformities.

Adolescent↗

PubMed1988

Postoperative clostridial infection. A case report.

The classic fulminating, rapidly progressive, and potentially lethal clostridial myonecrosis (CM), also known as gas gangrene, is a familiar entity. Nevertheless, individual experience with this dreaded disease is extremely rare or nonexistent. Clostridial cellulitis does not involve muscle necrosis and is associated with a lower mortality rate. Although still potentially limb threatening, clostridial cellulitis is a source of considerable morbidity. In a 13-year-old boy the symptoms did not appear until two weeks postoperatively. Definitive treatment was not instituted until five days later.

Adolescent↗

PubMed1986

Irreducible supracondylar fracture of the humerus complicated by anterior interosseous nerve palsy.

Supracondylar fractures of the humerus are common injuries in childhood and constitute greater than 50% of fractures involving the elbow joint. Neurovascular compromise is not infrequent and has been variously reported as occurring in 5%-17% of displaced fractures. A seven-year-old girl with isolated involvement of the anterior interosseous branch of the median nerve, an uncommon complication, is reported, along with a review of the literature.

Child↗

PubMed1985

Brucella sacroiliitis. A case report.

Brucellosis is an uncommon infectious disease in the United States though it remains endemic in many parts of the world. Signs and symptoms of the disease are highly variable, with musculoskeletal complaints occurring frequently. The combination of an uncommon infection presenting with protean manifestations often results in missed or delayed diagnosis in the Western world.

Adolescent↗

PubMedDate not supplied

Nonsecretory myeloma. A case report.

While the entity of nonsecretory myeloma is rare, its diagnosis may be delayed or remain undetected if too much reliance is placed on the presence of a serum or urinary M component, which traditionally has been considered an important, if not essential, feature of plasma cell myelomatosis. Nonsecretory myeloma is characterized radiographically by the presence of classic osteolytic lesions. Laboratory studies reveal anemia, hypogammaglobulinemia, and/or the failure to demonstrate a monoclonal immunoglobulin or Bence Jones protein on repeated electrophoretic analysis. Bone marrow aspirates reveal the presence of cytologically documented myeloma cells.

Aged↗