Biomedical subjects
Publications and source records attributed to J C DeLee.
Both patients and doctors have come to expect a high rate of success from arthroscopic partial meniscectomy. Failure of this procedure may result from a number of causes, most of which can be detected preoperatively. This article elucidates these potential pitfalls so that the patient can be offered better preoperative counseling.
There has been a great deal of concern within the orthopedic community regarding the lack of objective data available on the multitude of knee braces flooding the marketplace. This article hopes to fill that void by presenting an overview of the history and classification of knee braces.
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We retrospectively reviewed the cases of fourteen patients who had reflex sympathetic dystrophy of the knee. All fourteen were hospitalized, and epidural block anesthesia was instituted with an indwelling catheter for an average of four days, during which continuous passive motion, manipulation (as necessary), stimulation of muscles, and alternating hot and cold soaks were used. The average length of follow-up was thirty-two months. Eleven patients had complete resolution of the symptoms, two had sufficient intermittent aching with changes in the weather to need medication, and one had no relief. The diagnosis was confirmed if the symptoms were relieved by a lumbar sympathetic block. Pain that was out of proportion to the severity of the injury was the most consistent finding, being present in all fourteen patients. However, variation in clinical severity is characteristic of the syndrome. Eleven of the fourteen patients had had a previous patellar operation. After the onset of the symptoms, nine patients had two or more arthroscopic examinations, without notable findings. All fourteen patients had had extensive physical therapy and medical treatment before the epidural block was performed.
Fractures of the proximal part of the fifth metatarsal can be separated into two types: those involving the tuberosity, and those involving the proximal part of the diaphysis distal to the tuberosity. Recently it has been recognized that the latter group, Jones' fractures, may be difficult to treat. Although reports in the literature have indicated the potential difficulties in the treatment of Jones' fractures, prevailing guidelines for their management are ambiguous. Apparently the varied clinical and roentgenographic manifestations of these fractures have not been correlated with their response to treatment. In this paper we describe a classification of these fractures and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions. The treatment of choice for acute fractures is immobilization of the limb in a toe to knee cast with nonweight-bearing. Fractures with delayed union may eventually heal if they are treated conservatively, but an active athlete with delayed union or an established nonunion will benefit from operative intervention. The procedures of choice are medullary curettage and bone grafting, and closed axial intramedullary screw fixation using a 4.0-mm ASIF malleolar screw.
Between 1979 and 1982, thirty-eight patients with chronic non-hematogenous osteomyelitis were treated by local débridements of the wound, prolonged parenteral administration of antibiotics, and an average of forty-eight once-a-day treatments with hyperbaric oxygen. Of these thirty-eight patients, thirty-four remained free of clinical signs of osteomyelitis for an average of thirty-four months (range, twenty-four to fifty-nine months) after this regimen of treatment. Only four of the thirty-eight patients had been free of clinical signs of osteomyelitis for as long as three months during the two years preceding this treatment. Three of the four failures of treatment were evident within one month after treatment. This method of treatment appears to prolong the infection-free interval of patients with chronic non-hematogenous osteomyelitis.
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Nine children who were less than fourteen years old and had open physes and ligament injuries of the knee were studied. Despite an initial thorough physical and roentgenographic evaluation, the full extent of the lesion was determined only at operation in seven of the nine patients. The intercondylar eminence of the tibia was avulsed in five patients, four of whom had associated collateral ligament injuries and a positive anterior drawer sign. Despite surgical repair, all nine patients demonstrated some degree of postoperative ligament instability. This was increased in those patients in whom menisectomy had been performed concomitantly with ligament repair. Although none of the children were symptomatic at the time of writing, development of degenerative arthritis in the future must be considered. Ligament injury must be considered in the differential diagnosis of the child suffering from knee trauma. The association of avulsion of the tibial spine and collateral ligament injury is emphasized.
Adult, male white New Zealand rabbits were used to compare two new synthetic suture materials, polyglycolic acid (Dexon) and polypropylene (Prolene), with wire, plain catgut, and silk. The purpose of the study was simply to determine the reaction of nerve tissue to each of the five different materials. No attempt was made to measure functional results. The nerves were examined grossly and microscopically in an effort to evaluate which suture incited the least host reaction. Although no difference was noted in the initial cellular response, Prolene was shown to incite the least fibrolastic response. Silk evoked the most marked fibroblastic response.
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This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diagnosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed calculation of the time of exposure to injury per athlete in the sample. There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an incidence of injury of 0.506 injury per athlete per year. Severe injuries--those requiring hospitalization--were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.
In 15 patients traction followed by cast brace was an acceptable method of treatment for ipsilateral fractures of the tibia and femur. Prolonged healing times and limited range of motion of the knee were not significant problems. This method of treatment is especially indicated in patients with severe open injuries or comminution of femoral shaft fractures which do not safely lend themselves to rigid internal fixation. The hospitalization time, 5 weeks, is considerably less than for spica cast treatment of femoral shaft fractures and is comparable to that reported for open reduction and rigid fixation of femoral shaft fractures.