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Biomedical subjects

J B Jupiter

Publications and source records attributed to J B Jupiter.

At least 145 records · Page 8Linked to original sources
PubMed1985

Silicone synovitis of the wrist.

Foreign body giant cell synovitis and focal bony destruction requiring secondary surgery developed in nine patients after carpal and radiocarpal arthroplasty with silicone rubber implants. Synovitis followed silicone rubber replacement of the lunate in four patients, the carpal scaphoid in two patients, and the trapezium in one patient, trapezial resurfacing hemiarthroplasty in one patient, and total wrist arthroplasty in one patient. All the removed implants were deformed. Some had changed in color from clear white at the time of insertion to yellow-white or deep yellow upon removal. Scanning electron microscopy of a silicone rubber implant of the lunate removed from one patient revealed extensive fibrillation in the capitate fossa. Light microscopy of the synovium revealed hyperplasia and hundreds of fragments of silicone particulate debris throughout the tissue adjacent to the implant. The silicone debris was surrounded by multinuclear foreign body giant cells in the eight patients from whom the synovium was studied. All patients required revision surgery. We believe that in the patients studied, synovitis represented a biologic reaction to the silicone fragments found scattered throughout the synovium for the following reasons: The synovitis found was not present before surgery (except in the patient with rheumatoid arthritis); the synovitis found was not associated with the condition for which replacement arthroplasty was performed (except in the patient with rheumatoid arthritis); synovitis subsided after implants were removed; and synovitis was noted histologically in areas of silicone debris and appeared directly related to silicone seeding. Fibrillation, fragmentation, and local seeding of silicone after carpal or radiocarpal arthroplasty appear related to gradual deformation of the implant, which was the result of repeated compressive loading and shearing. Clinically significant complications of rubber carpal or radiocarpal arthroplasty with silicone rubber implants may develop from silicone synovitis.

Adolescent↗
PubMed1985

Intercondylar fractures of the humerus. An operative approach.

In this paper we review a series of thirty-four intercondylar fractures of the distal end of the humerus that were treated by open reduction over a ten-year period. The fracture patterns were classified according to the system of Müller et al. and a strict rating scale incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow-up of 5.8 years, thirteen results were rated as excellent; fourteen, as good; four, as fair; and three, as poor. Complications included postoperative neuritis in five patients; three non-unions; and refracture, heterotopic bone, and deep sepsis in one patient each.

Adolescent↗
PubMed1984

Vascular injuries and closed extremity fractures in children.

The association of a major vascular injury with a closed extremity fracture in the pediatric patient is uncommon. The present study of seven such patients includes five fractures treated by open reduction and internal fixation (ORIF) prior to vascular reconstruction. Two were treated in skeletal traction without vascular reconstruction. Most vascular injuries were not diagnosed initially, consequently delaying repair. Early follow-up examination revealed the following complications: wound infections, below-knee amputation, deep vein thrombosis (DVT), and motor and sensory deficits. All of the fractures healed. Late follow-up examinations revealed two cases of overgrowth and one of limb undergrowth. Minor motor and sensory deficits were present, but overall function was good. Arteriography should be performed prior to surgical repair. Because of problems with growth disturbance that require long-term follow-up evaluation, all major vascular injuries should be repaired despite adequate collateral circulation to keep the limb viable. Prompt, accurate diagnosis followed by surgical repair will improve the long-term results.

Accidents, Traffic↗
PubMed1982

The association of septic thrombophlebitis with subperiosteal abscesses in children.

An association of septic thrombophlebitis with acute osteomyelitis in four children is described. Each patient presented with physical findings consistent with thrombophlebitis. Venography, done in two, demonstrated significant acute thrombophlebitis, and another had an infected venous cutdown. A subperiosteal abscess was the predominant bony involvement found in all three patients who underwent surgical drainage. The initial radiographs were normal in each case. Bone scans showed diffuse increase in activity in the extremity, consistent with hyperemia, but no focal areas of increased uptake to suggest osteomyelitis. Computerized tomography, done in two patients, failed to reveal any bony abnormality, although subperiosteal abscesses were drained within 48 hours of each study. The existence of reverse collateral venous flow through the bone, associated with a rise in intramedullary pressure, may be responsible for these findings.

Abscess↗
PubMed1982

Vascularized autogenous whole joint transfer in the hand--a clinical study.

Nine vascularized autogenous whole joint transfers were employed in the reconstruction of traumatized joints of six male patients ages 6 to 38 years. The proximal interphalangeal joint was involved in four patients, the thumb metacarpophalangeal (MP) joint in two, and the small finger MP joint in one. In five patients, the donor joint came from the foot, and in one patient an MP joint was transferred from a digit that had sustained a more distal amputation. The mean follow-up was 24 months (range 13 to 38). Bony union as well as full radiographic preservation of the articular space has occurred in each case. Four joints were transferred with an open epiphysis and three demonstrated longitudinal growth and an intact epiphyseal plate. The mean range of active motion was 22 degrees/55 degrees. We believe the early results demonstrate the feasibility of this method of joint reconstruction in the young patient.

Adolescent↗
PubMed1982

The effect of hypothermia and tissue perfusion on extended myocutaneous flap viability.

The salutary effect of hypothermia and tissue perfusion on extending the ischemic tolerance of the canine latissimus dorsi myocutaneous flap was demonstrated in this experimental study. A total of 175 flaps from 89 adult mongrel dogs were elevated with one-half the flaps perfused with iced Collins renal preservation solution. With the exception of control flaps kept at ambient temperature, the remaining flaps were stored at 4 degrees C for periods ranging from 24 to 192 hours followed by transplantation into the groins of recipient dogs, with anastomosis of the thoracodorsal artery and vein in an end-to-side manner to the femoral artery and vein, respectively. The study was divided into two distinct sections. The acute phase involved the transplantation of 77 flaps into random recipient dogs, and following a 3-hour period of systemic perfusion, the flaps were removed, weighed, and sectioned for later histologic study. Progressive increase in flap weight was observed up to 96 hours of hypothermia with a sharp decline in weight at 120 hours of hypothermia. The increase in flap weight in the nonperfused flaps was significantly greater than the previously perfused flaps. Histologically, at 120 hours of hypothermia, loss of vascular integrity was noted, suggestive of a no-reflow phenomenon. In the second, or extended-flap, study, 98 flaps were transplanted into the groins of the original donor animal and allowed to remain in situ for a 2-week period. The flaps were then carefully observed for viability, removed, and sectioned for histologic study. Hypothermic support of up to 96 hours extended viability in both perfused and nonperfused flaps, although beyond this hypothermic period viability was seen only in previously perfused flaps. The clinical implications of this study include hypothermic perfusion of a major-extremity amputation prior to replantation or the temporary storage of a free myocutaneous flap.

Animals↗
PubMed1982

Salvage replantation of lower limb amputations.

Three cases are reported in which the microsurgical salvage of parts of traumatic lower extremity amputations associated with degloved proximal skin loss provided sturdy, sensate skin and soft-tissue coverage and thereby preserved functional below-knee amputation levels. In two instances, a free innervated filletted flap was constructed from the foot of the amputated limb, and in the third case, the amputated lower leg was shortened, successfully replanted, and followed later by elective amputation of a foot at the Syme level. At a mean follow-up of 2 years, all three patients are ambulating well in below-knee prostheses.

Adult↗
PubMed1981

Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer.

This paper reports on nine instances of combined second and third toe-to-hand transfers in eight patients for severe transmetacarpal mutilating hand injuries. In four cases, the transfer included an innervated flap from the fibular side of the great toe to provide sensibility to a previously constructed osteoplastic thumb. Prehensile function was significantly improved by providing chuck or tripod pinch as well as improved pulp-to-pulp and lateral pinch. At a mean follow-up of 20.3 months, there was only one failure.

Adult↗
PubMed1981

Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).

Adult↗
PubMedDate not supplied

Ununited humeral diaphyses.

A nonunion of a diaphyseal fracture of the humerus can present a major functional problem even in the elderly population. Advances in operative exposures combined with newer techniques of achieving stable internal fixation even in the presence of pathologic bone have enabled the surgeon to successfully treat even the most complex nonunions.

Fracture Fixation, Internal↗
PubMedDate not supplied

Clavicle malunion.

The clavicle fracture that has united with deformity or shortening may have an adverse effect on normal shoulder girdle function. We report on 4 patients in whom a malunited fracture of the clavicle was believed to be a contributing factor to shoulder girdle dysfunction. In each patient, the functional status of the involved limb was improved after corrective osteotomy at the site of deformity, realignment, and plate fixation.

Adult↗
PubMedDate not supplied

The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus.

Stable internal fixation is essential to obtain healing of an ununited fracture of the proximal humerus. Standard plate and screw fixation may be inadequate to secure a small, osteopenic proximal fragment. We used blade plates and autogenous cancellous bone graft to repair ununited fractures of the proximal humerus in 25 patients (19 women and 6 men) with a mean age of 61 years. Healing was documented in 23 of 25 patients (92%). Objective and subjective instruments documented substantial functional improvement in patients with healed fractures. The results were classified as good or excellent in 20 of 25 patients, and few complications were encountered. Blade plate fixation facilitates successful treatment of ununited fractures of the proximal humerus.

Adult↗
PubMedDate not supplied

Salter-Harris type III and IV epiphyseal fractures in the hand treated with tension-band wiring.

We present tension-band wiring in the treatment of Salter-Harris types III and IV avulsion fractures in the hand. By placing a small-gauge wire through the insertion of the ligament into the fracture fragment, accurate reduction and stability, allowing early mobilization, are achieved, avoiding many of the pitfalls and complications of other methods of internal fixation. The technique is simple and adheres to important physiological and biomechanical principles.

Adolescent↗
PubMedDate not supplied

Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report.

OBJECTIVE: The purpose of the study was to evaluate the feasibility of Norian SRS bone cement injected percutaneously into a distal radius following reduction in both preventing loss of reduction as well as safety. DESIGN: The study was a prospective clinical study with an established protocol. SETTING: The study was conducted at the Massachusetts General Hospital following approval of the institutions Investigational Review Board. All patients were required to read and approve an informed consent document. PATIENTS: While twenty patients' radiographs fulfilled the requirement of a dorsally displaced extraarticular fracture to have occurred within 72 hours of presentation, only five consented to participate fully and one voluntarily withdrew after a six-month follow-up. INTERVENTION: All fractures were reduced under regional or general anesthesia, and the Norian SRS was introduced via a catheter system into the metaphyseal defect of the fracture. A short arm cast was applied and remained in place for six weeks. MAIN OUTCOME MEASUREMENTS: Radiographic parameters of fracture reduction were measured prospectively by an independent radiologist throughout the 12 months of the study. Clinical parameters of hand and wrist function were measured prospectively by an independent occupational therapist. RESULTS: At 12-month follow-up, radial length was a mean 9.9 mm with an average loss of < 1 mm; radial angle maintained at a mean 25.4 degrees; volar angle was within normal range (0-21 degrees) in 4; and 1 patient had a dorsal angle of 7 degrees. Wrist motion improved 50 percent between 6 weeks and 3 months and improved further by 12 months when grip strength reached a mean of 88 percent of the contralateral side. Dorsal and volar extrusion of injected Norian SRS in 4 patients resorbed over time. There were no clinically significant adverse effects or complications. CONCLUSIONS: Norian SRS proved to be clinically safe and effective as a cancellous bone cement to maintain fracture reduction of unstable extraarticular distal radius fractures.

Bone Cements↗
PubMedDate not supplied

The management of patients with back pain and idiopathic vertebral sclerosis.

Twenty-two patients with severe back pain associated with radiologic evidence of vertebral sclerosis are reported. There were 19 women and 3 men; the average age was 42 years. Duration of pain averaged 4.3 years. The characteristic radiologic findings were diffuse sclerosis of the anterior inferior portion of the vertebral body and narrowing of the adjacent disc space. There was no extension of the sclerosis beyond the vertebral body, no paravertebral mass, and no loss of vertebral height. These radiologic characteristics, in conjunction with other clinical findings, should permit a diagnosis without the need for biopsy.

Adult↗
PubMedDate not supplied

Lower limb replantation. A report of nine cases.

An analysis of nine replantations of completely amputated lower limbs is presented in this paper. Four cases were successful, including two at the level of the distal third of the tibia, one through the midfoot, and one at the proximal third of the tibia. The latter case involved the replantation of the shortened limb followed by a Syme's amputation of the foot to preserve a functional below-knee amputation level. In each successful case protective sensibility, bony union, and a stable stance and functional gait has been achieved, thereby eliminating a prosthetic requirement.

Accidents, Occupational↗