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Biomedical subjects

J B Jupiter

Publications and source records attributed to J B Jupiter.

At least 73 records · Page 4Linked to original sources
PubMed1996

Coronal shear fractures of the distal end of the humerus.

We identified a shear fracture of the distal articular surface of the humerus, with anterior and proximal displacement of the capitellum and a portion of the trochlea, in six patients (five female and one male). The average age of the patients was thirty-eight years (range, ten to sixty-three years). Each fracture was the result of a fall from a standing height. A characteristic radiographic abnormality, which we have termed the double-arc sign, was seen on the lateral radiograph of each patient and represented the subchondral bone of the displaced capitellum and the lateral trochlear ridge. All patients were managed with open reduction, internal fixation, and early motion of the elbow. The average duration of follow-up was twenty-two months (range, eighteen to twenty-six months). The fracture united in all patients at an average of six weeks (range, four to nine weeks), without radiographic evidence of osteonecrosis of the fracture fragment. Flexion of the elbow averaged 141 degrees (range, 130 to 150 degrees), with an average flexion contracture of 15 degrees (range, 0 to 40 degrees). Pronation of the forearm averaged 83 degrees, and supination averaged 84 degrees. All patients had a good or excellent functional result, according to the elbow-rating scale of Broberg and Morrey.

Activities of Daily Living↗
PubMed1996

Treatment of deformity of the lower limb in adults who have osteogenesis imperfecta.

The Ilizarov method of lengthening was used to correct deformities of the lower extremity in six patients who had type-1 osteogenesis imperfecta, as categorized by Silence et al. The average age was thirty-one years (range, fourteen to fifty-one years). The deformities included shortening of four tibiae and three femora as well as an angular malalignment (average, 28 degrees; range, 20 to 40 degrees) of all four tibiae and one femur. One patient also had a non-union of the right femur. The average angular correction was 23 degrees (range, 20 to 30 degrees). The seven limb segments gained an average of 6.6 centimeters (range, two to eleven centimeters) in length. All limb-length discrepancies were corrected to within two centimeters of the length of the contralateral limb. At an average of three years and four months (range, one year and seven months to six years), the roentgenographic appearance of the fully matured bone was comparable with that of the original bone. There was no fractures or increases in the angulation of the segment of new bone. Two patients had pain when walking; it was related to a chronic pin-track infection in one and to osteoarthrosis of the ankle in the other. The functional status of four patients was improved and that of the other two patients was unchanged. All six patients were pleased with the outcome of the procedure. There was eighteen complications: stiffness of the knee in two patients; a peroneal nerve palsy in two; a superficial pin-track infection in three; and a deep pin-track infection, greater-than-normal loss of blood intraoperatively, loosening of two pins, worsening of the instability of the knee, and an infection in the knee in one patient each. In another patient, a Rush rod that had been placed before correction of the deformity migrated proximally and had to be removed after completion of the correction. There were five fractures.

Adolescent↗
PubMed1996

A comparison of early and late reconstruction of malunited fractures of the distal end of the radius.

We retrospectively evaluated the results for ten patients in whom a malaligned fracture of the distal end of the radius had been treated with early reconstruction (an average of eight weeks [range, six to fourteen weeks] after the injury) consisting of an osteotomy through the site of the fracture, autogenous cancellous iliac-crest bone-grafting, and internal fixation. The results for these patients were compared with those for ten patients in whom functional limitation after complete healing of a fracture of the distal end of the radius in a malreduced position had been treated with late reconstruction (an average of forty weeks [range, thirty to forty-eight weeks] after the injury) consisting of an osteotomy, corticocancellous bone-grafting, and internal fixation. The average duration of follow-up was forty-eight months (range, twenty to 120 months) after the early reconstructions and thirty-four months (range, twenty-four to forty-eight months) after the late reconstructions. After the early reconstructions, flexion of the wrist averaged 45 degrees; extension of the wrist, 52 degrees; pronation of the forearm, 79 degrees; and supination of the forearm,77 degrees, compared with 42, 45, 77, and 68 degrees, respectively, after the late reconstructions. Grip strength averaged forty-two kilograms after the early reconstructions, compared with twenty-five kilograms after the late ones. One patient from each cohort had mild pain in the radiocarpal joint. According to the scale of Fernandez, there were seven excellent and three good results after the early reconstructions, and one excellent, seven good, and two fair results after the late reconstructions. Complications included a rupture of the extensor pollicis longus tendon twelve weeks after one of the early reconstructions, persistent pain at the donor site of the iliac-crest bone graft after a late reconstruction, and a delayed union that necessitated a second procedure after another late reconstruction. We believe that the results of early and late reconstruction of malunited fractures of the distal end of the radius are comparable. For patients who have radiographic characteristics that are predictive of persistent functional limitation, early reconstruction is technically easier and reduces the over-all period of disability.

Adult↗
PubMed1996

Operative treatment of volar intra-articular fractures of the distal end of the radius.

We retrospectively reviewed the results of operative treatment of forty-nine volar marginal intra-articular fractures of the distal end of the radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragment, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty-four B3.3 fractures (characterized by comminution of the volar fragment). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the over-all outcome. After an average of fifty-one months (range, twenty-four to 117 months), there were thirty-one excellent, ten good, and eight fair results according to the system described by Gartland and Werley, and thirty-two excellent, nine good, five fair, and three poor results according to the modified system of Green and O'Brien. Two factors were found to have a significant association with a fair or poor outcome: evidence of osteoarthrosis on the most recent follow-up radiographs and reversal of the normal volar tilt of the distal end of the radius. The age of the patient, the interval from the injury to the operation, a concomitant injury of the ipsilateral upper extremity, an associated fracture of the ulnar styloid process, the radio-ulnar index, ulnar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly associated with the outcome.

Adolescent↗
PubMed1995

Skeletal repair by in situ formation of the mineral phase of bone.

A process has been developed for the in situ formation of the mineral phase of bone. Inorganic calcium and phosphate sources are combined to form a paste that is surgically implanted by injection. Under physiological conditions, the material hardens in minutes concurrent with the formation of dahllite. After 12 hours, dahllite formation was nearly complete, and an ultimate compressive strength of 55 megapascals was achieved. The composition and crystal morphology of the dahllite formed are similar to those of bone. Animal studies provide evidence that the material is remodeled in vivo. A novel approach to skeletal repair is being tested in human trials for various applications; in one of the trials the new biomaterial is being percutaneously placed into acute fractures. After hardening, it serves as internal fixation to maintain proper alignment while healing occurs.

Animals↗
PubMed1995

The application of the limited contact dynamic compression plate in the upper extremity: an analysis of 114 consecutive cases.

We sought to assess the clinical effectiveness of a new plate design which offers improved biological and biomechanical features, the limited contact dynamic compression (LCDC) plate. We analysed 114 LCDC plates applied consecutively for upper extremity fractures or reconstruction in 94 patients. Three patients were lost to follow-up, leaving 111 plates in 91 patients followed to definitive fracture/osteotomy outcome. Thirty-seven plates were applied for reconstruction in 35 patients, including 11 where standard implants had failed. Fifty-six patients had 74 plates applied for acute fractures including 12 open fractures, 23 multiply injured patients, 26 patients with concomitant fractures and seven associated neurovascular injuries. All patients were followed to definitive outcome. Union was achieved at an average of 10.7 weeks in 105 platings, while three delayed unions eventually united without further intervention, an overall union rate of 108/111, or 97.3 per cent. There were no mechanical failures of the plates or screws. In this large series a union rate of 97.3 per cent with no implant failures confirms its clinical application for traumatic and reconstructive problems in this area. Improved contouring, easier screw placement, decreased interference with cortical bone blood flow and excellent union rates are definite short-term advantages. Theoretical long-term benefits of decreased stress-shielding and lower refracture rates will require longer follow up.

Adolescent↗
PubMed1995

The complications and difficulties of management of nonunion in the severely obese.

Operative fixation of 22 nonunited fractures was undertaken in 21 obese patients. Eleven patients were women and 10 were men, with an average age of 46.3 years (range 25-74). The average body mass index in this group of patients was 37.9 kg/m2 (range 33.2-57.1). Two patients were classified as morbidly obese and 19 as severely obese. The management of these patients proved to be fraught with difficulties related to their obesity. There were a number of occurrences believed to be related to poorly protective positioning and prolonged ischemic pressure under the patient's body weight during the administration of anesthetic, including a peroneal compartment syndrome, a gluteal compartment syndrome with sciatic nerve palsy, bilateral brachial plexus stretch injuries, an anterior interosseous nerve palsy, and the postoperative development of a patch of scalp alopecia. There were two wound separations and no episodes of thromboembolic disease. Sixteen nonunited fractures healed after the index procedure at an average time to healing of 5.6 months (range 2-14). Five nonunited fractures required a second procedure to gain union [average total time to healing 17 months (range 10-31)]. A single fracture remains ununited. Awareness of the unique technical demands and operative and anesthetic risks encountered when undertaking an operative procedure in a severely obese patient is imperative for the safe and successful treatment of orthopaedic surgical problems in these patients.

Adult↗
PubMed1995

Delayed onset of forearm compartment syndrome: a complication of distal radius fracture in young adults.

The signs and symptoms of elevated intracompartmental pressure in the volar forearm compartment developed on a delayed basis (range 18-54 h) in the absence of constricting casts or dressings in eight limbs after high-energy intraarticular fractures of the distal end of the radius. Intracompartment pressures averaged 80 mm Hg in the six limbs tested. Despite urgent decompression and fracture fixation with delayed wound closure, final functional outcomes were compromised in seven cases, reflecting the severity of the articular injuries, and poor in one case, in which a wrist fusion was later required. If potentially serious complications are to be prevented, careful observation of these patients, often for periods of 48 h, is important. Selective recording of forearm intracompartmental pressures may be advised in at-risk patients.

Adult↗
PubMed1995

The infected nonunion of the tibia.

Ununited fracture of the tibia complicated by infection is not only a complex surgical problem but also a chronic and at times debilitating condition. The principle methods used to diagnose and stage posttraumatic tibial osteomyelitis are described. Infected nonunions of the tibia are characterized by the extent of bony loss and the presence of a functional ipsilateral fibula. Using this tibial staging criteria, a series of 37 infected nonunions of the tibia are reviewed. Twenty patients were male and 16 were female, with an average age of 33 years. The distal third of the tibia was involved in 19 patients, the middle third in 11, and proximal third in 7. Twenty three of the tibia were infected with > 1 organism. Thirty were Type 3 (tibial defect of 6 cm or less with a long and usable fibula), 4 Type 4 (tibial defect > 6 cm without usable fibula), and 3 Type 5 (tibial defect > 6 cm without usable fibula). The patients were evaluated at an average of 61 months after treatment. Union and eradication of infection were achieved in 35 of 37 patients. The results of the Health Impact Analysis suggest that the infected nonunion of the tibia represented a chronic and debilitating disorder with a lasting impact.

Adolescent↗
PubMed1995

Complex fracture patterns of the upper extremity.

Combined skeletal injuries to the upper limb present complex management problems because they may result in dysfunction of the terminal unit of the upper limb-the hand. This article explores complex patterns of skeletal and soft tissue injuries, including complex soft tissue trauma with closed and open fractures; the floating shoulder, elbow, and forearm; and the role of skeletal fixation in conjunction with the complex fracture patterns. As the functional capacity of the upper limb reflects an integration of all its component parts, a combined approach to skeletal and soft tissue trauma is of fundamental importance in upper limb trauma.

Arm Injuries↗
PubMed1995

Acute exercise-induced bilateral anterolateral leg compartment syndrome in a healthy young man.

While compartment syndrome after traumatic injury is a well-recognized entity, atraumatic or exercise-induced acute compartment syndrome is not as widely reported. This syndrome, usually unilateral, was first described as "march gangrene" in 1943, and can result in the loss of life or limb. Bilateral cases are usually associated with an underlying medical condition. We wish to report a case of acute, bilateral, exercise-induced anterolateral leg compartment syndrome in a healthy young man. Early recognition and prompt treatment by decompressive fasciotomy is of vital importance if limb function is to be preserved and complications are to be avoided.

Adult↗
PubMed1994

Low-contact dynamic compression plating of the clavicle.

Internal fixation of the clavicle is rarely necessary. When it is warranted, the clavicle's complex three-dimensional morphology and functional anatomy, proximity to vital structures, and the multidirectional biomechanical forces acting upon it place considerable demands on any implant used for skeletal fixation. We treated nine clavicles with the recently-introduced 3.5 mm low contact-dynamic compression plate (LC-DCP). Surgery was performed for symptomatic non-union in six patients, shoulder dysfunction following a malunited fracture in one, for an open fracture in one, and for an acute fracture associated with brachial plexus injury in one. After an average follow-up period of 17 months union was secured in each case. The advantages afforded by the 3.5 mm LC-DCP in internal fixation of the clavicle with its uniquely demanding anatomical and biomechanical characteristics are discussed.

Adolescent↗
PubMed1994

Blade plate fixation of proximal humeral non-unions.

Non-union of fracture of the proximal humerus is unusual and can be difficult to treat. It is found more often than not in the elderly patient with weak bone, resorption at the fracture site, contracture of the glenohumeral joint and associated medical conditions. A blade plate, designed specifically for the treatment of these non-unions, was used in nine patients--seven females and two males (mean age 66 years)--who had painful non-union with a mean duration of 22.5 months. Autologous bone grafting was used in all cases. Eight non-unions followed displaced two-part proximal humeral fractures: five had been initially treated conservatively and four with medullary nails. Five patients had associated medical illness. After a mean of 6.5 months (range 4-28 months), union had been achieved in all but one patient. Functional evaluation revealed good results in five patients, fair results in three and one poor result. Use of the blade plate offered a successful method of stable internal fixation in these complex cases.

Aged↗
PubMed1994

A microsurgical suction mat.

We describe a suction mat used to maintain a bloodless field during microsurgery. The mat is inexpensive, can be quickly fashioned from readily available operating room items, and functions with exceptional reliability.

Humans↗
PubMed1994

The floating radius in bipolar fracture-dislocation of the forearm.

Ten cases of bipolar forearm fracture-dislocation are presented. Recognition of the full extent of the skeletal, articular, and soft-tissue injuries is essential. Treatment consists of an anatomical reduction and proximal and distal stabilization of the skeleton to achieve control as well as maintain the position of the floating radius segment. The forearm bones can then be maintained in an optimal position to avoid interosseous soft-tissue contracture that will compromise the supination-pronation function of the forearm.

Adult↗