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Biomedical subjects

J B Jupiter

Publications and source records attributed to J B Jupiter.

At least 55 records · Page 3Linked to original sources
PubMed1998

Operative management of diaphyseal fractures of the humerus. Plate versus nail.

Although nonoperative treatment is indicated and successful for the majority of diaphyseal humeral fractures, operative intervention is indicated in several situations. Either intramedullary nail or plate fixation commonly is used for the operative management of this problem. Familiarity with the surgical techniques and application of both types (and subtypes) of implants is necessary to allow optimal treatment for the widest range of fracture patterns. In most indications for operative management, internal fixation with plates is preferred. Stable fixation, sparing adjacent joints from iatrogenic injuries, and direct visualization and protection of the radial nerve are of critical importance in maximizing postoperative function and in most cases outweight the potential advantages of a loadsharing implant inserted through a more limited incision.

Biomechanical Phenomena↗
PubMed1998

LC-DC plating with bone graft in posttraumatic nonunions in the middle third of the clavicle.

Nonunions and malunions of the clavicle are uncommon but can be disabling, causing pain, limitation of shoulder motion or local brachial plexus compression. Reconstructive procedures are focused on gaining union and restoring functional clavicular anatomy. We would like to present a surgical procedure in which an autologous iliac crest graft and a 3.5 mm low contact-dynamic compression plate (LC-DCP) are used to regain clavicular stability and union. Surgery was performed in all eight patients for symptomatic nonunion. Eight patients treated by this method between 1991-1996 showed clinical and radiological union after an average follow-up time of eight months. All patients were highly satisfied with the surgical result. The advantages of the LC-DCP in the internal fixation of clavicular nonunions with its demanding anatomical and biomechanical characteristics are presented.

Adult↗
PubMed1998

The management of acute fractures involving the distal radio-ulnar joint and distal ulna.

The acute management of fractures involving the distal radio-ulnar joint and distal ulna is controversial. The primary goal is recognition and differentiation between stable and unstable fracture patterns. Although an operative approach is adopted in the treatment of these injuries, the optimal management protocol awaits good prospective randomized studies.

Humans↗
PubMed1997

Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures.

A new plate designed specifically to address complex wrist pathology was used for the internal fixation of 22 complex fractures of the distal radius in 22 patients in a prospective multicenter trial. The majority of fractures were group C2- and C3-type fractures according to the Comprehensive Classification of Fractures. No plate failures, loss of reduction, nonunions, or infections occurred. Within the average follow-up time of 14 months, the functional results (including an average motion of 76% and an average grip strength of 56% of the contralateral side) were comparable to those reported for similar fractures in previous investigations. Five patients had irritation of the tendons in the second dorsal compartment. This trial serves both as a verification of the safety and efficacy of this distal radius plate as well as a demonstration of its utility in the treatment of complex fractures of the distal radius.

Adult↗
PubMed1997

Comparative classification for fractures of the distal end of the radius.

As suggested by Muller, a useful classification system for distal radius fractures must consider the severity of the bone lesion and serve as a basis for treatment and for evaluation of outcome. Although these fractures have long been considered to be Colles or Smith's fractures, they have been subjected to extensive scrutiny in order to define fracture morphology and treatment considerations. This review highlights a number of contemporary classification systems for distal radius fractures, including the systems of Older et al., the Comprehensive Classification of fractures, the Melone intra-articular classification system, and that of Fernandez.

Colles' Fracture↗
PubMed1997

Recalcitrant nonunion.

One surgeon treated 13 patients with 14 long home fractures that remained ununited for 10 or more years (average, 16 years) and after an average of three prior surgeries. The clavicle was involved in two cases, the humerus in five (one proximal, three diaphyseal, and one distal intraarticular), the femoral diaphysis in three, and the tibial diaphysis in four. The patients were observed for an average of 54 months. All of the fractures healed, and every patient in the series regained functional use of the involved limb without reports of pain, instability, or persistent swelling related to the site of nonunion. Three patients had persistent leg length discrepancies, and five had substantial residual stiffness of one or both adjacent joints. This experience has shown that despite the longevity of the nonunions, healing can be achieved using the basic concepts of the creation of a stable skeletal fixation in the presence of a well vascularized environments with the addition of autogenous bone graft. By the same token, the duration of the nonunion will lead to soft tissue maladaptation and contracture that at times compromise successful restoration of limb length or adjacent articular mobility.

Adult↗
PubMed1997

The management of femoral diaphyseal nonunions.

OBJECTIVE: To assess the efficacy of treatment and develop an algorithm for management of nonunions of the femoral diaphysis. STUDY DESIGN: Retrospective. SETTING: University hospital. METHODS: Forty-four patients treated at one institution for nonunion of the femoral diaphysis were studied. Thirteen of these patients had a history of infection. After debridement (where appropriate) and repair of the femoral nonunion, follow-up averaged twenty-eight months (range, 24 to 108 months). All patients were examined at final follow-up. RESULTS: Thirty-three patients achieved union after one procedure, and eight patients achieved union after additional procedures. One patient underwent above-knee amputation, and two patients remained ununited at the time of their final follow-up. Time to union averaged 11.8 months. Seventeen patients healed with more than two centimeters of shortening, and ten patients lost more than 30 degrees of knee flexion. CONCLUSION: Established femoral diaphyseal nonunions can be treated effectively, even in the presence of chronic sepsis. Selective use of a vascularized fibula transfer has proven beneficial in addressing intercalary defects. Plate fixation, with or without a vascularized fibula transfer, has been the predominant mode of skeletal stabilization in more complex reconstructions.

Adolescent↗
PubMed1997

Transolecranon fracture-dislocation of the elbow.

OBJECTIVE: To characterize the prevalence, morphology, and prognosis of anterior (transolecranon) fracture-dislocations of the elbow. DESIGN: Retrospective case series. SETTING: A consecutive series of thirteen patients from a single level-one trauma center, plus four patients from the practices of two of the senior authors. PATIENTS: Three of seventeen patients had simple, oblique fractures of the olecranon, and fourteen had complex, comminuted fractures of the proximal ulna, including fragmentation of the olecranon in seven patients, large coronoid fragments in eight patients, and segmental fractures of the ulna in six patients. Fourteen patients were male and three were female, with an average age of thirty-eight years (range, 18 to 78 years). INTERVENTION: All fractures were treated by open reduction and internal fixation. Two one-third tubular plates had to be revised to 3.5-millimeter dynamic compression plates within six weeks of the initial operation. MAIN OUTCOME MEASURE: Elbow performance rating of Broberg and Morrey. RESULTS: At an average follow-up of twenty-five months, overall outcome was rated as excellent in seven patients, good in eight, and fair in two. Mild posttraumatic arthritis was noted in only two patients. Large coronoid fragments and extensive comminution of the trochlear notch did not preclude a good result provided that stable, anatomic fixation was achieved. CONCLUSIONS: Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparent radiocapitellar dislocation. Stable restoration of the appropriate contour and dimensions of the trochlear notch of the ulna will lead to a good result in most cases.

Adolescent↗
PubMed1997

Complex nonunion of fractures of the femoral shaft treated by wave-plate osteosynthesis.

We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation. Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.

Adolescent↗
PubMed1997

Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft.

Nine patients who had a complex, combined skeletal and soft-tissue defect involving the radius were managed with operative reconstruction with use of a vascularized osteoseptocutaneous fibular autogenous graft. All of the patients were male, and the average age was thirty-two years (range, twenty-one to forty-two years). Three patients sustained the injury as the result of a gunshot wound and two each, as the result of a motor-vehicle accident, a fall from a height, or a machinery-related accident. Five patients had a concomitant fracture of the ulna. The average length of the radial defect was seven centimeters. Six patients had a deep osseous infection. The average length of the fibular autogenous graft was 7.9 centimeters, and the average size of the associated fasciocutaneous component was 11.8 by 5.9 centimeters. Two patients had a concomitant arthrodesis of the wrist. A split-thickness skin graft was used to close the donor site in six patients. Two patients had postoperative vascular complications that necessitated revision with an autogenous vein graft. One patient had a second operation six months postoperatively to correct an angular deformity that had developed secondary to a non-union at the graft-host bone junction. After an average duration of follow-up of twenty-four months, all but one of the patients had radiographic evidence of osseous union at both the proximal and the distal graft-host bone junction. No patient had evidence of resorption of the graft or symptoms referable to the donor leg at the time of the most recent examination. Six patients had returned to their preinjury occupation.

Adult↗
PubMed1997

Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius.

Twenty-five patients who had had an opening-wedge osteotomy for the treatment of a malunited, volarly displaced fracture of the distal end of the radius were studied retrospectively. The indications for the operation were pain and functional limitations rather than the degree of anatomical deformity. Fifteen patients were men and ten were women; their average age was forty-six years (range, twenty-one to eighty-four years). Preoperative radiographs revealed an average ulnar inclination of 14 degrees, an average ulnar variance of five millimeters, and an average volar inclination of 24 degrees. Extension of the wrist averaged 25 degrees; flexion of the wrist, 53 degrees; supination of the forearm, 41 degrees; and pronation of the forearm, 64 degrees. The average grip strength was a force of seventeen kilograms compared with a force of forty kilograms in the contralateral hand. At an average of sixty-one months (range, eighteen to 114 months) after the osteotomy, supination of the forearm had improved to an average of 69 degrees and pronation had improved to an average of 75 degrees (p < 0.05 for both). Extension of the wrist had improved to an average of 55 degrees, and grip strength had improved to a force of thirty kilograms (p < 0.05 for both). Volar inclination averaged 5 degrees; ulnar variance, zero millimeters; and ulnar inclination, 22 degrees. A reoperation was performed in eleven patients. Seven patients had removal of the hardware only, two had a procedure involving the distal radioulnar joint, one had a procedure because the site of the osteotomy had not healed, and one had a median-nerve release. The functional result was rated as very good in ten patients, good in eight, fair in three, and poor in four.

Adult↗
PubMed1996

Contoured LCDC plating of the proximal ulna.

Comminuted fractures of the proximal ulna, particularly in combination with dislocation of the radial head, represent complex injuries which threaten both elbow and forearm motion. Thirty-seven complex proximal ulna fractures were treated with a dorsally applied, limited-contact titanium plate, contoured to fit the anatomy of the olecranon and proximal ulna. Twenty-four patients had Monteggia fracture/dislocations, and 13 had isolated but complex fractures of the proximal ulna. After an average follow up of 24 months, good or excellent functional results were achieved in 27 patients.

Adolescent↗
PubMed1996

Blade plate reconstruction of metaphyseal nonunion of the tibia.

Sixteen patients with nonunion of the metaphyseal region of the proximal or distal tibia after fracture or reconstructive procedures were surgically treated using a fixed angle blade plate and autogenous bone grafting. Eight of these nonunions were complicated by prior sepsis. The average time of followup assessment was 23 months. Fourteen of these 16 nonunions went on to uncomplicated union after the index procedure. Failure of the tibial fracture to unite in 2 patients required further surgical intervention with a ring external fixator. The authors recommend blade plate reconstruction for metaphyseal nonunion of the proximal and distal tibia, especially when complicated by angular deformity, small osteopenic metaphyseal fragments, and stiff adjacent joints.

Adult↗
PubMed1996

Management of humeral nonunion after the failure of locking intramedullary nails.

We reviewed 21 cases of humeral nonunion following the failure of "locking" humeral nails. The nails had been inserted as the primary operative procedure following humeral fracture in fifteen cases or after the failure of closed treatment in six cases. Reconstruction after the failure of these implants was complicated by poor bone stock and difficulty in achieving union. Although technically difficult, open reduction and internal fixation with plating and bone grafting (successful in nine of nine cases) was more consistent than exchange nailing (successful in four of 10 cases) in achieving union (p = 0.01). Two patients refused further surgical intervention. The degree of bone loss associated with a loose nail, the lack of success of exchange nailing, and the insertion site morbidity associated with humeral nail removal differentiate these nonunions from similar lower extremity problems. The degree of bone loss following failed locking nailing of the humerus is a major concern, and exchange nailing alone may not be an acceptable option to deal with this problem.

Adolescent↗